Medical Coding and Billing Articles

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How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —

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Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.

tags  Topic: Claims Processing    Topic: LCDs and NCDs    Topic: Practice Management    Topic: Training   

Cross-A-Code Instructions in Find-A-Code

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Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.

tags  Topic: Claims Processing    Topic: Coding    Topic: Documentation    Topic: Medicare    Topic: Practice Management    Topic: Reimbursement   

COVID Vaccine Codes Announced

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On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.

tags  Topic: Code Updates    Topic: COVID-19    Topic: CPT Coding   

Locating Periodontal Disease in ICD-10-CM

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When coding a diagnosis for periodontal disease, keep in mind there are more options than just chronic or acute. To get started, look at chapter 11, Diseases of the digestive system (K00-K95). Looking at this section a little further, you can see this is where the oral cavity is coded ...

tags  Specl: Dental    Topic: Coding    Topic: ICD10CM Coding   

Staging and Grading Periodontitis

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We now understand periodontitis may present itself as a manifestation of systemic diseases in fact; according to DeltaDental, research shows that more than 90 percent of all systemic diseases have oral manifestations, including swollen gums, mouth ulcers, dry mouth, and excessive gum problems. Some of these diseases include: Diabetes Leukemia Oral cancer Pancreatic cancer Heart ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery    Topic: Assessment Tools    Topic: CDT (Dental) Codes   

Incident To

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Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ...

tags  Specl: Cardiology|Vascular    Specl: Endocrinology    Specl: Gastroenterology    Specl: General Surgery    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Oncology|Hematology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pain Management    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Rheumatology    Specl: Urology|Nephrology   

OIG – Fraud and Abuse Study with COVID-19 Testing

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According to the Office of Inspector General (OIG), “The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented demand for diagnostic laboratory testing to determine whether an individual has the virus. Beyond the COVID-19 tests, laboratories can also perform add-on tests, for example, to confirm or rule out diagnoses ...

tags  Specl: Laboratory|Pathology    Topic: COVID-19    Topic: OIG   

CMS Expands Telehealth Again

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On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.

tags  Payer: AMC|Medicaid    Payer: CMS|Medicare    Topic: Code Updates    Topic: COVID-19    Topic: TeleMedicine   

What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?

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When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ...

tags  Loc: All Locations    Specl: All Specialties    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Guidelines and Manuals   

Medicare Improper Payment Report for Chiropractic (2019)

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CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report by specialty, chiropractic has the highest Part B improper payment ...

tags  Topic: Compliance    Topic: Documentation    Topic: Medicare   

Medicare Improper Payment Report for Behavioral Health Services (2019)

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CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report, behavioral health services have some of the highest Part ...

tags  Specl: Behavioral Health|Psychiatry|Psychology    Topic: Compliance    Topic: Documentation   

Medicare Improper Payment Report (2019)

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The Medicare Improper Payment Report for 2019 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July ...

tags  Topic: Compliance    Topic: Documentation    Topic: ICD9v3 Coding   

Significant COVID-19 Code Changes as of October 6

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Significant COVID-19 Code Changes as of October 6

tags  Topic: Code Updates    Topic: COVID-19    Topic: CPT Coding    Topic: Modifier Coding   

Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) Program

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To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.

tags  Payer: AMC|Medicaid    Payer: CMS|Medicare    Specl: Behavioral Health|Psychiatry|Psychology    Specl: Chiropractic    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Ophthalmology    Specl: Optometry    Specl: Pain Management    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Topic: Compliance   

An Infectious Disease Control Plan is Essential

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Every business encounters infections. The COVID-10 pandemic has only highlighted this fact, but considering that infectious diseases, such as the seasonal flu, are an ongoing problem, all organizations need to implement an Infectious Disease Control Plan as part of an active compliance plan because it’s required by law. Your organization must take steps to mitigate this risk to both patients and employee

tags  Topic: Compliance    Topic: OSHA   

New Codes for Cytokine Release Syndrome (CRS)

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New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.

tags  Specl: Allergy|Immunology    Specl: Anesthesia|Pain Management    Specl: Cardiology|Vascular    Specl: Endocrinology    Specl: Home Health|Hospice    Specl: Neurology|Neurosurgery    Specl: Oncology|Hematology    Specl: Pain Management    Specl: Rheumatology    Topic: Code Updates    Topic: Diagnosis Coding    Topic: ICD10CM Coding   

ICD-10-CM 2021 Coding Updates for Chiropractic

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October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. This year there are some interesting changes such as a new headache type, new codes related to TMJ, several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard), and some other changes.

tags  Specl: Chiropractic    Topic: Code Updates    Topic: ICD10CM Coding   

Locating a Diagnosis Code in ICD-10-CM for Dental Offices

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Diagnosis codes used to report with procedures are called ICD-10-CM - International Statistical Classification of Diseases. These codes are published annually in October. To find a diagnosis code in ICD-10-CM, it is important to understand how the chapters and sections are set up. Each chapter is broken down into sections and ...

tags  Specl: Dental    Topic: ICD10CM Coding   

My Location and CBSA is Missing!

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We often get questions on missing Core Based Statistical Areas, known as CBSAs. CBSAs are used for pricing and other factors according to the geographical location. If you do not see your CBSA, it is important to note they are not missing - it may not have an assignment, according to ...

tags  Topic: Fees    Topic: Practice Management   

More COVID-19 Codes Added as of September 8, 2020

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The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.

tags  Topic: Code Updates    Topic: COVID-19    Topic: CPT Coding    Topic: Procedure Coding   

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