Medical Coding and Billing Articles

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AMA Announcement of Additional COVID Vaccine Codes and Guideline Changes in December

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On Friday, December 17, 2020, the AMA announced several changes in relation to the addition of new codes for the COVID-19 vaccine under development by AstraZeneca and University of Oxford. Codes 91302, 0021A, and 0022A were published on the AMA website and will be effective once they have received Emergency Use Authorization (EUA) from the FDA.

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

HIPAA Penalty Changes

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On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.

tags  Specl: All Specialties    Topic: Compliance    Topic: HIPAA   

ICD-10 Code Updates for January 1st

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Be aware that new ICD-10-CM and ICD-10-PCS codes took effect on January 1, 2021. Rarely have ICD-10-CM codes been released in January, but as you may have guessed, these changes are in relation to COVID-19. The information in this article will help your organization understand these changes.

tags  Topic: Code Updates    Topic: COVID-19    Topic: ICD10CM Coding    Topic: ICD10PCS Coding   

CMS Final Rule Changes E/M Reporting Guidelines

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Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.

tags  Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: HCPCS Coding    Topic: Modifier Coding    Topic: Procedure Coding   

Common Medical to Dental Procedures and Where to Find Them

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With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Topic: Billing    Topic: Coding    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   

CDT and CPT - The Same but Different!

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Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...

tags  Specl: Dental    Topic: CDT (Dental) Codes    Topic: CPT Coding    Topic: E+M Documentation and Coding   

IPPS and DRG's: What it Means

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Understanding hospital pricing can get complicated, so we have broken it down according to CMS and the acute Inpatient Prospective Payment System, also known as IPPS. Find-A-Code uses IPPS for inpatient pricing with our MS-DRG grouper. The following information comes from CMS.gov and answers the most common questions regarding DRGs ...

tags  Specl: Billing    Topic: Billing    Topic: Facilities    Topic: Hospital    Topic: Medicare    Topic: Payment Models    Topic: Reimbursement    Topic: UB04 Form and Coding   

Final Rule on Communications Technology and 2021 Physicians Fee Schedule

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To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...

tags  Topic: CPT Coding    Topic: Federal Register    Topic: Fees    Topic: HCPCS Coding    Topic: Medicare    Topic: TeleMedicine   

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   

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   

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