Medical Coding and Billing Articles
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recent articles
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May 17th, 2022
Understanding the Basics of Reporting Mammography Services
| Published May 17th, 2022
How familiar are you with the coding and documentation requirements for screening and diagnostic mammography? What is diagnostic digital breast tomosynthesis and can you bill for it? This article review the basics of reporting screening, diagnostic, and digital breast tomosynthesis.
May 13th, 2022
The Conundrum Presented by Outpatient Surgeries
| Published May 13th, 2022
Do you keep them under inpatient status? Or do you bring them in as outpatients and just keep them overnight? For our Medicare populations, in all of our organizations, the ability to follow the CPT code of the applicable surgical procedure is the determining factor to bill inpatient...
May 11th, 2022
HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights
| Published May 11th, 2022
New Resources to Help People Seeking Care to Understand and Access Protections Offered Under the Parity Law for Mental Health and Substance Use Disorder Benefits
May 10th, 2022
Recent AMA Study Finds Half of Black Women Have High Blood Pressure
| Published May 10th, 2022
Hypertension among Black Americans is among the highest in the world. Currently, the American Medical Association (AMA) is working to achieve optimal health for all. To do that, they need to work at the community level to bring health equity to minority communities in the U.S. A recent...
May 9th, 2022
Making the Case for Clean Claims
| Published May 9th, 2022
Medicare providers are your claims clean? Federal regulations mandate that 90 percent of “clean claims” must be paid to healthcare providers within 30 days. But what if the payor doesn’t pay within 30 days? What if your claims are unclean? The problem is – who determines what a...
May 9th, 2022
Moving to Medical Decision-Making as the Key Component
| Published May 5th, 2022 - Last Review/Update May 9th, 2022
Office billing is now based solely on either MDM or total time. Last week, I declared that it is my opinion that medical decision-making (MDM) should always be one of the components that contributes to selecting (or perhaps, demonstrating) the appropriate level of service (LOS) for the professional...
May 3rd, 2022
Minor Procedures Get a Major Sting in the 2021 CERT Report
| Published May 3rd, 2022
The 2021 Comprehensive Error Rate Testing report provides important lessons on exactly what errors are being found during chart reviews and how provider organizations can be proactive in their approach to quality documentation that not only supports the services provided to the patient but allows the providers to work in an environment of knowing what must be documented to support what they submit to the payer.
May 2nd, 2022
Continuous Glucose Monitors (CGMs) -- New Codes
| Published May 2nd, 2022
New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing.
On December 28, 2021, we published the Medicare DMEPOS final rule in the Federal Register. This addressed the ...
April 29th, 2022
What Do You Know About the NEW ICD-10 COVID-19 Codes?
| Published April 29th, 2022
Just when you think the public health emergency (PHE) is beginning to wind down, new ICD-10-CM codes for reporting certain COVID-19 information are added and implemented mid-year. This time we are looking at diagnoses related to the sequela of COVID-19 or what we often hear as long-COVID and vaccination status.
April 27th, 2022
How to Reduce the Risk of Copy and Paste
| Published April 27th, 2022
Providers should never C&P (copy and paste) material they have not read nor vetted for accuracy. A young Jeopardy! champion died from bilateral pulmonary emboli following a colectomy in January 2021. Following his surgery, it was reported that the surgeon referred to “DVT/VTE Prophylaxis/Anticoagulation” and another note read, “already ordered.” “DVT...
April 26th, 2022
Opportunities to Identify Risk Adjustable Chronic Conditions Expands in 2022
| Published April 26th, 2022
Medicare made changes to the rules governing concurrently reporting transitional care management services and chronic care management services during the same calendar month. How might this help providers identify chronic conditions that risk adjust?
April 26th, 2022
Preventive Services
| Published April 26th, 2022
In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding...
April 26th, 2022
Pulmonary Hypertension Classification Review
| Published April 26th, 2022
This article includes definitions of the five different groups of pulmonary hypertension: Pulmonary Arterial Hypertension (PAH), PH due to left heart disease, PH due to lung diseases and/or hypoxia, Chronic Thromboembolic PH (CTEPH), PH with unclear multifactorial mechanisms.
April 25th, 2022
The Impact of Coding on Maternal Outcomes
| Published April 25th, 2022
This area of coding is not so easy. While most maternal deaths are preventable, the rate has been increasing in the United States since 2000. As a matter of fact, the U.S. has twice as many maternal deaths than other high-income countries. To reverse this trend, The Joint...
April 25th, 2022
CMS Creates New Code for Over-the-Counter COVID-19 Test
| Published April 25th, 2022
COVID-19 testing coverage is expanding with a new code which became effective on April 4, 2022. From that date until the end of the COVID-19 public health emergency (PHE), Medicare is conducting a COVID-19 Test demonstration “to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements.”
April 22nd, 2022
Substance Use Disorder Treatment Incentive Program Receives Go Ahead From the OIG
| Published April 22nd, 2022
DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. CM “addresses the brain’s reward response in ways that conventional counseling and medications often cannot.” Over a course of 50 years, it has shown that this program is effective. The OIG, upon analysis, has determined that there is low risk for fraud and abuse and has offered their opinion at the request of DynamiCare Health, Inc.
April 21st, 2022
2022-03-03-MLNC - 2022 Payment, Quality, & Policy Changes
| Published April 21st, 2022
News - Ambulance Prior Authorization Model Expands April 1 - Nutrition-related Health Conditions: Recommend Medicare Preventive Services - Claims, Pricers, & Codes - HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals - Events - ICD-10 Coordination & Maintenance Committee Meeting — March...
April 19th, 2022
Infuse Yourself with Knowledge on Reporting Therapeutic, Prophylactic, and Diagnostic Injection Services
| Published April 19th, 2022
Does your documentation meet the standards for reporting therapeutic, prophylactic, and diagnostic infusions and injections? Take a minute to infuse yourself with the information needed to accurately code and sequence these services for maximum reimbursement.
April 19th, 2022
Medicare FFS Beneficiaries Average 2 or More Chronic Conditions
| Published April 19th, 2022
Medicare Advantage plans were created in an effort to improve patient health outcomes, quality of healthcare services, and reduce costs by managing chronic health conditions better than traditional Medicare plans. According to a CMS-published report from 2018, the average Medicare FFS beneficiary suffers from at least two chronic health conditions with a per capita cost of $2,067. Can you guess how many suffer from six or more chronic conditions?
April 14th, 2022
Telehealth: The Current PHE Status and What to Expect
| Published April 14th, 2022
Coming soon is the possible end of the PHE. Will it be extended? How does the Consolidated Appropriations Act of 2022 impact the PHE, and where does telehealth fit into all of this? The COVID-19 public health emergency (PHE) is slated to end this week on Thursday, April...
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