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Viewing:  Apr 27, 2018

Medical Coding and Billing Articles

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Documenting DMEs

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As per MLN MM8304,  This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g). Due to concerns ...

Tags:  Specl: All Specialties    Topic: DME    Topic: HCPCS Coding    Topic: Medicare   

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The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims?

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As the Medicare program has grown, the Centers for Medicare and Medicaid Services (CMS) has employed a variety of different claims audit mechanisms to better ensure that the Medicare Trust Fund is protected from waste, fraud and abuse....

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

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Proper Record Keeping and Documentation

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Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...

Tags:  Specl: Dental    Topic: Billing    Topic: Documentation    Topic: Practice Management   

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Coverage Criteria for Nonwearable Automatic Defibrillators

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According to Noridian and CGS Administrators LCD L33690, a nonwearable automatic defibrillator (E0617) is covered for beneficiaries in two circumstances. They meet either (1) both criteria A and B or (2) criteria C, described below: The beneficiary has one of the following conditions (1-8):A documented episode of cardiac arrest due to ventricular fibrillation, not due to a ...

Tags:  Topic: DME    Topic: HCPCS Coding    Topic: LCDs and NCDs   

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Indications for Serotypes A and B Botulinum Toxins

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According to Novitas LCD L27476, the following indications apply: 1. Blepharospasm and strabismus2. Spastic dystonia or focal dystonias to relieve pain, to assist posturing and walking, to increase range of motion, to assist in the outcome of physical therapy, and/or to reduce spasm thus allowing adequate perineal hygiene.3. Spasmodic dysphonia4. Achalasia and cardiospasm when ...

Tags:  Topic: HCPCS Coding    Topic: Medicare    Topic: Pharmaceutical   

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Billing Nutrition Counseling in a Chiropractic Setting

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Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ...

Tags:  Specl: Chiropractic    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD9 Coding    Topic: Modifier Coding    Topic: Procedure Coding   

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Dentists Submitting Claims to Medicare

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When a Dental provider is treating a Medicare Beneficiary, it is important to get a copy of the Medicare card to verify the patient's medical benefits, provider eligibility and claims address/submission prior to submitting a claim. CMS is in the process of changing Medicare Policy Numbers, so you may see ...

Tags:  Specl: Dental    Topic: Billing    Topic: Practice Management   

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Use it or Lose it - How We Can Help!

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If you don’t use the correct information or document the proper information and submit a medical claim you will lose!  You will lose reimbursement, could be excluded from participating in Federal Health Care programs, you could possibly lose your license and family time. The government has every tool they need, you ...

Tags:  Topic: Practice Management   

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Billing Nutrition Counseling

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Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management ...

Tags:  Specl: All Specialties    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD9 Coding    Topic: Modifier Coding    Topic: Procedure Coding   

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Using Pulmonary Stress Tests

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As per Palmetto GBA LCD L33444, exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions. The pulmonary stress test will be considered medically necessary for these conditions:INDICATIONS:Evaluation of exercise tolerance• Determination of functional impairment or capacity • ...

Tags:  Topic: CPT Coding   

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Coverage Criteria for Peripheral Venous Examinations

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According to National Government Services LCD L33627, indications for venous examinations are separated into three major categories: deep vein thrombosis (DVT), chronic venous insufficiency, and vein mapping. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedure(s). Since the signs and symptoms of ...

Tags:  Topic: CPT Coding    Topic: HCPCS Coding   

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CMS Compliance Guidelines Focused Trainings

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Since the publication of the Compliance Program Guidelines in 2012, the Medicare Part C & D Oversight and Enforcement Group, Division of Compliance Enforcement, has presented a series of focused trainings for the industry on the application of the seven elements of an effective compliance program. These trainings are designed ...

Tags:  Payer: CMS|Medicare    Topic: Compliance   

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What Do Patients Expect in 2018?

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Evolutions in technology continue to merge with a trend toward consumerism in healthcare. As a result, patients are expecting a different kind of experience in managing their healthcare....

Tags:  Topic: Billing    Topic: Practice Management    Topic: Technology   

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Medicare Telemedicine Changes for 2018

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Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.  Originating Site Fee Each ...

Tags:  Loc: All Locations    Payer: All Payers    Payer: CMS|Medicare    Specl: All Specialties    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding    Topic: TeleMedicine   

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Maximizing Resources for ICD-10 Coding Audits

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From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind....

Tags:  Topic: Auditing    Topic: ICD10CM Coding    Topic: ICD10PCS Coding   

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Avoiding D9 Denials

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The following is according to WPS. Please make sure what is bold below is entered verbatim on the second line of the "Remarks" section. This should be the only thing on the second line of remarks: Patient control nbr - If you are changing or adding a patient control number Admission hour - If you are changing or adding the admission ...

Tags:  Topic: Billing    Topic: Claims Processing    Topic: Denial Management    Topic: UB04 Form and Coding   

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Documentation for Evaluation and Management (E/M) Services

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According to WPS, when billing or coding for E/M services you should follow a few guidelines. Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation. Critical Care Visits  Clear indication of patient ...

Tags:  Topic: CPT Coding    Topic: Documentation    Topic: E+M Documentation and Coding   

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Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together

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I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again?

Tags:  Specl: Cardiology|Vascular    Specl: Gastroenterology    Specl: General Surgery    Topic: CPT Coding    Topic: Modifier Coding   

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Medicare Beneficiary Identifier (MBI) Beginning April 1, 2018 (This is Not a Joke)

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The law requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new unique Medicare number will replace the current Health Insurance Claim Number (HICN) on the new Medicare cards. The new cards will be mailed in...

Tags:  Payer: CMS|Medicare   

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Q/A: Billing for GI Anesthesia

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Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary.

Tags:  Payer: CMS|Medicare    Specl: Gastroenterology    Topic: CPT Coding    Topic: Modifier Coding   

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Past Articles

Many of the following articles have been tagged with the tags shown above. These are displayed here again for historical purposes.

The following articles are published here and elsewhere on the Internet. If you would like to publish one of these articles on your website, please contact us and let us know which article you would like to publish and where you will be publishing it.

Articles: ICD-10

Articles: Medical Coding

Articles: Medical Billing

Articles: Medical Billing and Coding (General)


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