Medical Coding and Billing Articles

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Understanding the Basics of Reporting Mammography Services

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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.

tags  Specl: Oncology|Hematology    Specl: Radiology    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Medicare    Topic: Modifier Coding    Topic: Preventive Medicine    Topic: Procedure Coding   

The Conundrum Presented by Outpatient Surgeries

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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...

tags  Topic: Admin    Topic: Billing    Topic: Coding    Topic: Hospital    Topic: Inpatient Coding    Topic: Medicare    Topic: Practice Management    Topic: Reimbursement   

HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights

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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

tags  Specl: Behavioral Health|Psychiatry|Psychology    Specl: Primary Care|Family Care    Topic: Admin    Topic: Billing    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Insurance    Topic: Medicare    Topic: Reimbursement    Topic: Training   

Recent AMA Study Finds Half of Black Women Have High Blood Pressure

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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...

tags  Topic: ICD10CM Coding    Topic: Medicare    Topic: Preventive Medicine   

Making the Case for Clean Claims

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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...

tags  Topic: Admin    Topic: Appeals    Topic: Billing    Topic: Claims Processing    Topic: Denial Management    Topic: Medicare    Topic: Practice Management    Topic: Reimbursement   

Moving to Medical Decision-Making as the Key Component

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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...

tags  Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Social Determinants of Health (SDOH)   

Minor Procedures Get a Major Sting in the 2021 CERT Report

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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.

tags  Topic: Documentation    Topic: E+M Documentation and Coding    Topic: EHR    Topic: Medicare    Topic: Practice Management   

Continuous Glucose Monitors (CGMs) -- New Codes

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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 ...

tags  Topic: DME    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Supply Coding   

What Do You Know About the NEW ICD-10 COVID-19 Codes?

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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.

tags  Topic: ICD10CM Coding   

How to Reduce the Risk of Copy and Paste

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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...

tags  Topic: Admin    Topic: Coding    Topic: CPT Coding    Topic: Diagnosis Coding    Topic: Documentation    Topic: EHR    Topic: Fraud    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Medicare    Topic: Practice Management    Topic: Procedure Coding   

Opportunities to Identify Risk Adjustable Chronic Conditions Expands in 2022

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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?

tags  Topic: Coding    Topic: CPT Coding    Topic: DME    Topic: HCPCS Coding    Topic: Medicare    Topic: Procedure Coding    Topic: Social Determinants of Health (SDOH)   

Preventive Services

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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...

tags  Topic: Auditing    Topic: CDT (Dental) Codes    Topic: Compliance    Topic: CPT Coding    Topic: Documentation    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Preventive Medicine   

Pulmonary Hypertension Classification Review

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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.

tags  Topic: ICD10CM Coding   

The Impact of Coding on Maternal Outcomes

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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...

tags  Specl: Obstetrics|Gynecology    Topic: HCPCS Coding    Topic: ICD10CM Coding   

CMS Creates New Code for Over-the-Counter COVID-19 Test

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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.”

tags  Topic: Billing    Topic: Codapedia    Topic: Code Updates    Topic: Coding    Topic: COVID-19    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Medicare    Topic: Supply Coding   

Substance Use Disorder Treatment Incentive Program Receives Go Ahead From the OIG

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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.

tags  Topic: Code Updates    Topic: Compliance    Topic: CPT Coding    Topic: Fraud    Topic: HCPCS Coding    Topic: HIPAA    Topic: ICD10CM Coding    Topic: Medicare    Topic: Modifier Coding    Topic: OIG    Topic: Substance Use Disorder   

2022-03-03-MLNC - 2022 Payment, Quality, & Policy Changes

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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...

tags  Topic: CPT Coding    Topic: HCPCS Coding    Topic: Hospice    Topic: Hospital    Topic: ICD10CM Coding    Topic: Inpatient Coding    Topic: Medicare    Topic: NDC - National Drug codes    Topic: Payment Models    Topic: Practice Management    Topic: Preventive Medicine   

Infuse Yourself with Knowledge on Reporting Therapeutic, Prophylactic, and Diagnostic Injection Services

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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.

tags  Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: Modifier Coding    Topic: Practice Management    Topic: Procedure Coding    Topic: Reimbursement   

Medicare FFS Beneficiaries Average 2 or More Chronic Conditions

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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?

tags  Topic: ICD10CM Coding    Topic: Risk Adjustment   

Telehealth: The Current PHE Status and What to Expect

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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...

tags  Topic: COVID-19    Topic: Medicare    Topic: TeleMedicine   

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