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Medical Coding and Billing Articles

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Pain Codes in ICD-10-CM

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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   

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Spotlight: ICD-10-CM Validator

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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...

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Spotlight: Medicaid Information

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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   

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Spotlight: CPT to Revenue Codes Crosswalks

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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   

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Q/A: How do we Know Which Codes a Payer Will Allow?

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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   

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The Impact of Medical Necessity on High Level E/M Services

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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   

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CPT Announces 2021 E/M Changes

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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   

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Coverage for Hearing Aids and Auditory Implants

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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   

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Let's Talk High Risk E/M Services

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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   

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Type of Bill Code Structure (2018-08-30)

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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   

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How to Report Imaging (X-Rays) of the Thumb

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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   

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Revised ABN Requirements Still Fuzzy

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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   

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Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

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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   

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Spotlight: Services Excluded from Global Surgery Payment

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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   

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Voluntary Repayments

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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   

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Podiatrist Billing for Physical Therapy

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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   

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OIG Announces - New Review For Medicare Part B Payments for Podiatry and Ancillary Services

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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   

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Date of Service Reporting for Radiology Services

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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   

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Q/A: Can you Help me Understand the New Medicare Insurance Cards?

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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   

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Billing Guidelines for Repositioning

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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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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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