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Medical Coding and Billing Articles

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Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain

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Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.

Tags:  Specl: Acupuncture|Alternative    Specl: Chiropractic    Specl: Physical Medicine|Physical Therapy    Topic: Billing    Topic: Medicare   

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Are you Treating & Billing Medical Patients Tooth Infections

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A tooth infection, or an abscessed tooth, generally occurs as a result of tooth decay and poor oral hygiene. However, it can also develop due to previous dental work or traumatic injury.  When an infection occurs, it causes a pocket of pus to form in the mouth as a result ...

Tags:  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

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Denial Management is Key to Profitability

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Tags:  Topic: Compliance    Topic: CPT Coding    Topic: Denial Management    Topic: HCPCS Coding   

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Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?

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Question:  It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...

Tags:  Specl: Chiropractic    Specl: Physical Medicine|Physical Therapy    Topic: Coding    Topic: ICD10CM Coding    Topic: Modifier Coding   

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The Importance of Medical Necessity

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ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...

Tags:  Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: Diagnosis Coding    Topic: Documentation   

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When Can You Bill Orthosis Components Separately?

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Othoses often have extra components. When can you bill those components separately? For example, can you bill for a suspension sleeve (L2397) with a knee orthosis (e.g., L1810)?

Tags:  Topic: DME    Topic: HCPCS Coding    Topic: Supply Coding   

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Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?

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Question: Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services?  Answer: While the answer to this is yes, it is essential to understand that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual ...

Tags:  Specl: Chiropractic    Topic: Billing    Topic: Compliance   

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Will the New Low Level Laser Therapy Code Solve Your Billing Issues?

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Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...

Tags:  Specl: Chiropractic    Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD9 Coding    Topic: Procedure Coding   

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Helping Others Understand How to Apply Incident to Guidelines

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Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ...

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Auditing    Topic: Medicare   

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Rules for Rendering Unproven, Investigational or Experimental Procedures

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If you haven’t reviewed your state guidelines or taken a recent look at third-party payer policies on unproven, investigational or experimental procedures, now is the perfect time to make sure you’re up to speed with this important information.  Most providers are surprised to see commonly used devices or techniques listed ...

Tags:  Specl: Chiropractic    Topic: Compliance   

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Q/A: Do I Really Need to Have an Interpreter?

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Question: I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true? Answer:  Yes! There are both state and federal laws that need to be considered. The applicable federal laws are: Title VI of the Civil Rights Act of 1964,  Americans with Disabilities ...

Tags:  Topic: Compliance    Topic: HCPCS Coding    Topic: Procedure Coding   

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2018 Medicare Improper Payment Report Shows Slight Improvement but There's Still Work to be Done

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The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ...

Tags:  Specl: All Specialties    Topic: Compliance    Topic: Documentation   

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Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?

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Question: Can a Chiropractor refuse to file a patients Medical Insurance for an Auto Accident? Answer: There isn't a simple answer to this question. It depends on who is responsible and state laws. Who is responsible (the auto insurance or the medical insurance) can depend on state requirements as well as who is ...

Tags:  Specl: Chiropractic    Topic: Compliance    Topic: PI - Personal Injury   

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The Oral Connection

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The mouth is, was, and forever will be part of the body. The old model in traditional medicine of treating symptoms and body parts in isolation is flawed. Pioneers in functional medicine like Dr. Mark Hyman, Dr. Mike Roisen, Dr. Axe, Dr. Fuhrman, Dr. Amy Doneen, Dr. Brad Bale, and ...

Tags:  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

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Small Breaches Can Be Subject to Large Penalties

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Small Breaches Can Be Subject to Large Penalties    We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ...

Tags:  Specl: All Specialties    Topic: Compliance    Topic: HIPAA    Topic: Practice Management   

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Don't Let Your QPro Certification(s) Expire! Your Certifications Matter!

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Hello QPro Members, Just a friendly reminder!                                                                                        ...

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How to Properly Report Monitoring Patients Taking Blood-thinning Medications

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Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.

Tags:  Specl: Cardiology|Vascular    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Orthopedics    Specl: Pediatrics    Specl: Primary Care|Family Care    Specl: Skilled Nursing    Topic: Billing    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Modifier Coding   

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Extrapolation Policies Apply to RAD-V Audits

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Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Coding    Topic: Guidelines ICD-10-CM    Topic: Risk Adjustment   

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A United Approach

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A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Auditing    Topic: Billing    Topic: Claims Processing    Topic: E+M Documentation and Coding    Topic: EHR    Topic: Medicare    Topic: Procedure Coding   

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What Medical Necessity Tools Does Find-A-Code Offer?

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Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Assessment Tools    Topic: Auditing    Topic: Billing    Topic: Claims Processing    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Denial Management    Topic: Documentation    Topic: E+M Documentation and Coding    Topic: LCDs and NCDs    Topic: Payer Guidelines   

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Past Articles

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Articles: ICD-10

Articles: Medical Coding

Articles: Medical Billing

Articles: Medical Billing and Coding (General)


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