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Recent articles:Click on the title to see the article summary and a link to the full article. March 25th, 2019 Pain Codes in ICD-10-CM| Published March 25th, 2019
When coding with ICD-10-CM, pain codes can be found in different sections:
The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ... Tags: Specl: All Specialties Topic: Coding Topic: ICD10CM Coding March 25th, 2019 Spotlight: ICD-10-CM Validator| Published March 25th, 2019 The ICD-10-CM Validator tool allows you to check your diagnosis codes before you bill them together. The system will automatically check any Excludes and Includes notes for you. Enter one code per line into the box on the left hand side. Enter ALL the codes you will list on a... Tags: March 25th, 2019 Spotlight: Medicaid Information| Published March 25th, 2019 Find-A-Code's information is Medicare based, but did you know we also have Medicaid information? The information can be found under the Topics tab at the top of the Find-A-Code page. Hover over Topics then click States. Click the ALL STATES link at the top of the list. Here you will... Tags: Topic: Medicaid March 22nd, 2019 Spotlight: CPT to Revenue Codes Crosswalks| Published March 22nd, 2019 View CPT to Revenue Code Crosswalks with Cross-A-CodeFirst, enter your CPT code into the Comprehensive search bar. Once you click search, you should be taken to the code definition page. Scroll down to the Cross-A-Code bar and click to expand. Click the UB04 Revenue Codes bar to open the crosswalks.... Tags: Topic: Coding March 22nd, 2019 Q/A: How do we Know Which Codes a Payer Will Allow?| Published March 22nd, 2019
How do we know which codes a payer will allow?
The best way to determine the codes (CPT, ICD-10-CM and HCPCS) allowed by a payer is to review their payer policy. While it is good to know the official guidelines (e.g., ICD-10-CM Official Guidelines for Coding and Reporting, AMA Guidelines, Medicare ... Tags: Specl: All Specialties Topic: Billing Topic: Compliance March 21st, 2019 The Impact of Medical Necessity on High Level E/M Services| Published March 21st, 2019
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ... Tags: Loc: All Locations Payer: All Payers Specl: All Specialties Specl: Billing Specl: Cardiology|Vascular Topic: Auditing Topic: Billing Topic: Coding Topic: CPT Coding Topic: Documentation Topic: E+M Documentation and Coding Topic: Fraud Topic: Guidelines and Manuals Topic: Medicare Topic: Training March 21st, 2019 CPT Announces 2021 E/M Changes| Published March 21st, 2019
In 2018, Medicare announced their plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not ... Tags: Topic: CPT Coding March 20th, 2019 Coverage for Hearing Aids and Auditory Implants| Published March 20th, 2019
For hearing impairment, Medicare is firm in its stance on when it will and will not cover hearing correction. In the PUB 100-02 Medicare Benefit Policy Manual, Chapter 16, Medicare cites the Social Security Act by explaining:
"..."hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids" ... Tags: Specl: Billing Specl: Emergency Medicine Specl: ENT|Otolaryngology Specl: General Surgery Specl: Neurology|Neurosurgery Specl: Pediatrics Specl: Primary Care|Family Care March 20th, 2019 Let's Talk High Risk E/M Services| Published March 20th, 2019 - Last Review/Update March 21st, 2019
Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ... Tags: Loc: All Locations Payer: All Payers Specl: All Specialties Topic: Assessment Tools Topic: Auditing Topic: Billing Topic: Compliance Topic: CPT Coding Topic: Documentation Topic: E+M Documentation and Coding Topic: Guidelines and Manuals March 20th, 2019 Type of Bill Code Structure (2018-08-30)| Published March 20th, 2019 - Last Review/Update March 25th, 2019 The UB-04 claim form (also known as CMS 1450) is the standard facility and residential claim form used to report health claims. The Type of Bill is reported in Block No. 4 of the UB04 claim form.
Type of bill codes are four-digit codes that describe the type of bill a ... Tags: Specl: Billing Topic: Auditing Topic: Coding Topic: Facilities Topic: Hospital March 18th, 2019 How to Report Imaging (X-Rays) of the Thumb| Published March 18th, 2019 If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ... Tags: Loc: All Locations Payer: All Payers Specl: All Specialties Specl: Billing Specl: Emergency Medicine Specl: General Surgery Specl: Internal Medicine Specl: Interventional Radiology Specl: Neurology|Neurosurgery Specl: Orthopedics Specl: Pediatrics Specl: Primary Care|Family Care Specl: Radiology Topic: CPT Coding Topic: ICD10CM Coding Topic: Modifier Coding March 18th, 2019 Revised ABN Requirements Still Fuzzy| Published March 18th, 2019
Although it has been quite some time since ChiroCode published an article about the revised instructions for non-participating providers who use the ABN, there are still some outstanding questions about this change. So far, Medicare has not provided additional guidance about this question despite requests by us for clarification.
Medicare now requires non-participating providers to include the ... Tags: Topic: ABN - Advanced Beneficiary Notice Topic: Medicare March 15th, 2019 Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?| Published March 15th, 2019
I submitted a claim to the VA and it’s being denied. Why?
There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ... Tags: Payer: VA - Veterans Administration Specl: Chiropractic Topic: CPT Coding Topic: Modifier Coding Topic: Reimbursement March 11th, 2019 Spotlight: Services Excluded from Global Surgery Payment| Published March 11th, 2019 The following services are excluded from global surgery payment according to Noridian Medicare. These services may be paid for separately. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial... Tags: Topic: CPT Coding Topic: HCPCS Coding March 8th, 2019 Voluntary Repayments| Published March 8th, 2019 - Last Review/Update March 12th, 2019
Should you volunteer to repay money from Medicare or other federal healthcare programs if you believe they were the result of errors on your end? The penalties for not doing so could be severe. Under the Federal False Claims Act, if retained overpayments can be shown to be to false ... Tags: Specl: Billing March 7th, 2019 Podiatrist Billing for Physical Therapy| Published March 7th, 2019
It is not uncommon for a Podiatrist to offer Physical therapy as an ancillary service to help promote healing and convenience for their patients. If this is a part of your practice be sure you are aware of the rules and policies from your local MAC carrier and your payer policies on ... Tags: Specl: Physical Medicine|Physical Therapy Specl: Podiatry March 7th, 2019 OIG Announces - New Review For Medicare Part B Payments for Podiatry and Ancillary Services| Published March 7th, 2019
Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020. The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.
Part of the ... Tags: Specl: Podiatry Topic: Compliance Topic: OIG March 7th, 2019 Date of Service Reporting for Radiology Services| Published March 7th, 2019 Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations. Tags: Payer: CMS|Medicare Topic: Claims Processing Topic: Compliance Topic: CPT Coding Topic: Procedure Coding March 7th, 2019 Q/A: Can you Help me Understand the New Medicare Insurance Cards?| Published March 7th, 2019 As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020. Tags: Payer: CMS|Medicare Specl: All Specialties Topic: Billing Topic: Medicare March 4th, 2019 Billing Guidelines for Repositioning| Published March 4th, 2019 - Last Review/Update March 6th, 2019 Code 95992 has some very limited payer payment guidelines which need to be understood for proper reimbursement. Many payer policies consider this service bundled with Evaluation and Management Services, therefore, it would not be separately payable if there was an E/M service performed on the same date. Some providers have reported having trouble ... Tags: Topic: CPT Coding Topic: HCPCS Coding Topic: ICD10CM Coding Topic: Modifier Coding |
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