Medical Coding and Billing Articles
by Find-A-Code and friends
recent articles
Select the title to see a summary and a link to the full article.
September 2nd, 2021
Polysomnography Services Under OIG Scrutiny
| Published September 2nd, 2021
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.”
So what are those requirements?
August 17th, 2021
When is it Proper to Bill Nurse Visits using 99211
| Published August 17th, 2021
When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 ‑ 99215 and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit ...
August 12th, 2021
Billing Dental Implants under Medical Coverage
| Published August 12th, 2021
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.
Implants could be considered ...
August 10th, 2021
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
| Published August 10th, 2021
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
August 4th, 2021
Understanding How Place of Service Codes Work
| Published August 4th, 2021
The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...
July 29th, 2021
Medicare's ABN Booklet Revised
| Published July 29th, 2021
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
July 19th, 2021
Chronic Pain Coding Today & in the Future
| Published July 19th, 2021
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
June 29th, 2021
Compliance in the Dental Office or Small Practice
| Published June 29th, 2021
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...
June 23rd, 2021
UCR Anesthesia Fee Calculations and Base Units - Now Available!
| Published June 23rd, 2021
As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information.
Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units).
NOTE: Always ...
June 22nd, 2021
Important Changes to Shared/Split Services
| Published June 16th, 2021 - Last Review/Update June 22nd, 2021
Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.
June 7th, 2021
Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021
| Published June 3rd, 2021 - Last Review/Update June 7th, 2021
Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.
May 25th, 2021
PCS Coding for Ankle Fracture - Look Deeper Into the Codes!
| Published May 25th, 2021
If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...
May 20th, 2021
Intersegmental Traction — What’s Happening with Roller Tables?
| Published May 20th, 2021
Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?
May 20th, 2021
Congress Has Been Busy — 11 Different Bills Pass Covering Mental Health and Substance Use
| Published May 19th, 2021 - Last Review/Update May 20th, 2021
The House of Representatives has certainly been working hard to advance behavioral health services. This article summarizes each of those bills and includes a link to contact your Senator.
May 18th, 2021
OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment
| Published May 18th, 2021
As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.
May 12th, 2021
Since When did Dental Claims Require Diagnosis Codes?
| Published May 12th, 2021
The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...
May 6th, 2021
Identifying Risk-Adjusted Services During the Opioid Crisis
| Published May 6th, 2021
Between June 2019 and June 2020, the United States saw a total of 107,750 deaths from COVID-19. The spread of this virus was so extraordinary that it led President Trump to declare a public health emergency, and we watched as individual states began implementing laws and regulations to limit social interaction ...
May 4th, 2021
Comparison of Add-On Code Guidelines
| Published May 4th, 2021
Add-on codes are codes that are not intended to be reported alone. They are reported with another primary procedure to identify that additional services have been provided in conjunction with that primary procedure. Generally, they include the words “List separately in addition to code.” Interestingly, there are some differences in the instructions/guidelines regarding the use of these codes in the CPT® codebook, the NCCI Policy Manual, and on the CMS website. This article outlines the differences between each of these.
April 29th, 2021
Coding Lesions and Soft Tissue Excisions
| Published April 29th, 2021
There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions.
The code selection will be determined upon the following:
Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain)
Technique
Topography (anatomic location)
The size
Tissue Level
Type of closure required
Layers ...
April 29th, 2021
58% of Improper Payments due to Medical Necessity for Ventilators
| Published April 29th, 2021
Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...
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