Medical Coding and Billing Articles by Month

Find-A-Code uses Usual, Customary, and Reasonable (UCR) fees as established by the Veterans Administration (VA) to help determine the amount paid for inpatient medical services based on the diagnosis and the geographic area. This article addresses information and pricing for facility fees based on Diagnosis Related Groups (DRGs). The UCR rates included in FindAcode.com come directly from the VA and are divided up into varying per diem (daily) rates as defined by the VA. Be aware that different payers may have different payment methodologies as defined by individual contracts

The Office of Inspector General (OIG) recently released a report entitled “Billing for Remote Patient Monitoring in Medicare Analyzing Medical Practices’ Billing Patterns”. Remote physiologic monitoring services (codes 99091, 99453, 99454, 99457, and 99458) were carefully reviewed because of the significant increase from 2023 to 2024 in the number of patients receiving these services (27% increase) as well as a 31% payment increase during the same time period.

RADs with bi-level capability, with or without a backup rate feature, are devices that use a noninvasive interface (mask) to deliver a higher level of airway pressure when the patient inhales compared to when they exhale. A backup rate feature enables the device to provide a prespecified respiratory rate if the patient’s spontaneous respiratory rate decreases below a set number. HMVs deliver a predetermined amount of air with each breath and typically have more monitoring, safety, alarm, and backup power features (such as batteries) than RADs.