Medical Coding and Billing Articles

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Where is the CCI Edit with Modifier 25 on E/M?

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If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.  The use of Modifier 25 is one example ...

tags  Topic: Coding    Topic: Medicare    Topic: Modifier Coding    Topic: Payer Guidelines   

Packaging and Units for Billing Drugs

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To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number. Take a look at the following J1071 - Injection, testosterone cypionate, 1mg For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL (100 mg/mL = 1 mL and there are ...

tags  Topic: Auditing    Topic: Billing    Topic: Coding    Topic: HCPCS Coding    Topic: Pharmaceutical   

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?

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On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...

tags  Loc: All Locations    Payer: CMS|Medicare    Specl: All Specialties    Topic: COVID-19    Topic: CPT Coding    Topic: Modifier Coding    Topic: Risk Adjustment    Topic: TeleMedicine   

Getting Your Practice Back on Track

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As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.

tags  Specl: Chiropractic    Topic: Practice Management   

ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting

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The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).  The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.  ICD-10-CM Official Coding Guidelines - ...

tags  Specl: All Specialties    Topic: Code Updates    Topic: Documentation    Topic: ICD10CM Coding    Topic: Substance Use Disorder   

Additional Telehealth Changes Announced by CMS

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On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.

tags  Loc: All Locations    Payer: CMS|Medicare    Specl: All Specialties    Topic: Medicare    Topic: TeleMedicine   

CMS- Change in Funding for COVID-19 Economic Impact

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On Sunday night April 26, 2020, CMS announced they will no longer be "accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through HHS’ Provider Relief Fund." The COVID-19 Pandemic has ...

tags  Topic: COVID-19   

Effective Risk Adjustment Requires Accurate Calculations

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Risk adjustment is simply a way of making sure that there are sufficient funds to adequately take care of the healthcare needs of a certain population. It’s a predictive modeling methodology based on the diagnoses of the individuals in that population. As payers move to value based models, they heavily rely on risk adjustment to ensure proper funding.

tags  Topic: Risk Adjustment   

COVID-19 Clinical Trial Participation Helps Providers Earn MIPS Credit

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All healthcare providers who are currently participating in the MIPS portion of Medicare’s Quality Payment Program may want to participate in the new COVID-19 Clinical Trials improvement activity. Read more about it here.

tags  Topic: COVID-19    Topic: Quality Payment Program   

Special COVID Laboratory Specimen Coding Information

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With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.

tags  Topic: Coding    Topic: COVID-19    Topic: Documentation    Topic: HCPCS Coding   

Emergency Room and Ancillary Services

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Billing for an Emergency department is not the same as billing for a hospital or in the provider's office; there are several differences and requirements. For example. the hospital will report a stay with Diagnosis Related Groups (DRG's), which include hospital resources used during the patient's stay, while office visits ...

tags  Specl: Emergency Medicine    Topic: CPT Coding    Topic: HCPCS Coding   

Clarify the Complexity Please! NDC Codes and Drug Classification Systems

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Different Drug classification systems are used to categorize drugs to identify the medication, with each system having their own logic. There are four main drug classification systems used in the United States, not to be confused with a class of drugs or "Drug Class". A drug class is the way drugs ...

tags  Specl: All Specialties    Topic: NDC - National Drug codes    Topic: Pharmaceutical   

SOME of Us Non-Essentials May be Able to Get Back on the Road!

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The day is coming when the freeways will have 5:00 pm stop-and-go traffic again, no doubt. However, when it comes to re-opening our world, CMS has Recommendations! Changes are finally here; we are starting to see a decline in COVID-19 cases in some states and certain locations. It may be time ...

tags  Payer: CMS|Medicare    Topic: COVID-19   

Now That is Fraud! Genetic Testing "Public alert"

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Genetic testing is becoming very popular. In fact, so popular you might see it in places you would not expect such as a community event, fairs or any event happening in your community. Some labs may even offer FREE screening for genetic testing. Watch for FREE screening announcements or advertisements ...

tags  Payer: CMS|Medicare    Specl: Laboratory|Pathology    Topic: Fraud    Topic: OIG   

Dismal OIG Report on Telemedicine

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Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Compliance    Topic: Documentation    Topic: TeleMedicine   

Hypertension ICD-10-CM Coding Table, Guidelines, and Tips

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Coding hypertension properly requires knowing all the guidelines. This article summarizes how hypertension is coded using ICD-10-CM and includes tips, definitions and a very helpful coding table summarizing your options.

tags  Specl: Acupuncture|Alternative    Specl: All Specialties    Specl: Neurology|Neurosurgery    Specl: Pain Management    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Topic: ICD10CM Coding   

New CPT® Codes Approved for COVID-19 Antibody Identification

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On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.

tags  Loc: All Locations    Payer: All Payers    Specl: Billing    Specl: Cardiology|Vascular    Specl: Emergency Medicine    Specl: ENT|Otolaryngology    Specl: Gastroenterology    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Laboratory|Pathology    Specl: Oncology|Hematology    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Skilled Nursing    Topic: Billing    Topic: Code Updates    Topic: Coding    Topic: COVID-19    Topic: CPT Coding    Topic: Reimbursement   

CMS Temporarily Suspends Contract-Level RADV Audits

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The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Admin    Topic: Auditing    Topic: Compliance    Topic: Practice Management    Topic: Risk Adjustment   

Medicare Released the Amount they Will pay for COVID Testing Eff 4/14/2020

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tags  Topic: COVID-19    Topic: HCPCS Coding   

ADA is Asking for HELP with Third-Party Payers for Dentists

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With these unprecedented and extraordinary circumstances, dentists are facing new challenges with reimbursement with what is allowed and covered under their contractual obligations with their payers. The ADA recognizes the struggles dental providers are facing and is urging third-party payers to adopt new reimbursement procedures and adjust their fee schedules to help ...

tags  Specl: Dental   

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