Medical Coding and Billing Articles

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More Telehealth Changes Announced by CMS

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On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information

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

CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes

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Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly.  Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...

tags  Specl: Chiropractic    Specl: Home Health|Hospice    Specl: Pain Management    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Specl: Skilled Nursing    Topic: CPT Coding    Topic: Modifier Coding   

COVID-19 Chiropractic Resources

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COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.

tags  Specl: Chiropractic    Topic: Medicare    Topic: TeleMedicine   

Spotlight: UCR Fees are Available on DRGs- Check it Out!

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Check out the information page on any DRG! Look up DRGs by going to the list of DRG codes found under the Codes tab at the top of the page, or simply type in the desired DRG by using the search bar on the homepage. When using the search bar, be sure you have the ...

tags  Topic: Fees   

Providing Telehealth Services During COVID-19 Crisis

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The rules for providing telehealth services during this pandemic have changed and some requirements have been waived. Please keep in mind that “waiving requirements” does not mean that anything goes. Another important consideration is that Medicare and private payers may likely have different rules so you need to make sure that you know individual payer requirements during this time.

tags  Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding   

Interprofessional Consult Services

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The recent coronavirus crisis has brought non-face-to-face services to the forefront of coding and billing conversations. With the entire healthcare industry focused on caring for patients during an unprecedented and fast-moving pandemic, the goal of increasing patient access while reducing the risk of spreading infection has become paramount. In this climate, ...

tags  Topic: CPT Coding   

2020 Medicare Part D Coverage Gap (AKA donut hole)

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Not every Medicare drug plan has complete coverage for prescription drugs - most have some sort of coverage gap, known as the “Donut Hole”. The coverage gap is a temporary limit on coverage under the drug plan. This coverage gap will not affect everyone and begins after you have used ...

tags  Payer: CMS|Medicare    Topic: Pharmaceutical   

Medicare Part D Coverage Gap (Donut Hole) Closes in 2020

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Overview of the Part D coverage gap, how it got closed, what the picture looks like for 2020, and long-term outlook.

tags  Payer: CMS|Medicare    Topic: Medicare    Topic: Pharmaceutical   

New Biofeedback Codes to replace 90911 Eff 2020-01-01

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CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911. According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate. Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ...

tags  Specl: Acupuncture|Alternative    Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding   

LATEST COVID-19 INFORMATION FOR BILLING NON-FACE-TO-FACE SERVICES

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Healthcare providers and the population at large are concerned about safe access to care considering the COVID-19 pandemic. As a result, we have received many inquiries this week about how to bill for “telehealth” services. Let’s first address that true telehealth services have some pretty stringent requirements from CMS, including that ...

tags  Specl: Internal Medicine    Specl: Pediatrics    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: HCPCS Coding   

COVID-19: Cybercrime, Telehealth, and Coding

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Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...

tags  Specl: Chiropractic    Topic: Billing    Topic: Compliance    Topic: TeleMedicine   

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

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Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Auditing    Topic: Billing    Topic: Claims Processing    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Diagnosis Coding    Topic: ICD10CM Coding    Topic: Practice Management    Topic: Reimbursement    Topic: Technology   

2021 Brings Another Risk Adjustment Calculation Change

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In 2021, a big change in Risk Adjustment score calculations will take place, which will affect payments to Medicare Advantage (MA) plans for the coming year and take us closer to quality and value-based programs instead of fee-for-service (FFS) or risk-adjusted (RA). Currently, CMS pays a per-enrollee capitated...

tags  Loc: All Locations    Payer: CMS|Medicare    Specl: All Specialties    Topic: ICD10CM Coding    Topic: Risk Adjustment   

Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)

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The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Claims Processing    Topic: Code Updates    Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Modifier Coding    Topic: Payer Guidelines    Topic: Procedure Coding   

Implementing Telehealth Visits

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The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection. Step ...

tags  Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Modifier Coding   

Additional Coronavirus Testing Code Announced

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On March 13, 2020, a new CPT code was announced by the American Medical Association (AMA) who maintains the CPT code set. This early release of a CPT code is rare and is effective immediately.

tags  Topic: Code Updates    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Procedure Coding   

CPT Coding Guidance on New Code for COVID-19

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According to the AMA, "The Addition of one Category I Pathology and Laboratory code (87635) for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]) accepted at the March 2020 CPT Editorial Panel meeting. *Note that code 87635 will be a child code under parent code 87471. It is represented here ...

tags  Topic: Coding   

Who Qualifies for Chronic Care Management Services

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Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services." Examples of chronic conditions ...

tags  Specl: General Surgery    Specl: Home Health|Hospice    Specl: Skilled Nursing   

The difference between Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal (2018-10-23)

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Distinguishing the difference between Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal can be complicated, here are some examples from PubMed;  A Jones fracture currently is defined as an acute fracture of the fifth metatarsal at the junction between the proximal diaphysis and metaphysis of the fifth metatarsal without distal extension beyond the fourth to fifth intermetatarsal articulation. Tuberosity avulsion fracture (also known as pseudo-Jones fracture or dancer's fracture) A proximal diaphyseal fifth ...

tags  Specl: Podiatry   

Coronavirus - What in the World is it and How is it Coded? 2020-02-20

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On December 31, 2019, we learned of a deadly outbreak of an unknown virus, with an unknown cause. We have since learned the virus was identified in Wuhan, China as a novel coronavirus (2019-n-CoV). Until we have more information on the 2019-nCoV, persons with an underlying medical condition are considered high ...

tags  Specl: Primary Care|Family Care    Topic: Coding    Topic: ICD10CM Coding   

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