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Recent articles:Click on the title to see the article summary and a link to the full article. November 8th, 2018 Diagnosis Coding for Cardiology| Published November 8th, 2018
Diseases of the Circulatory system are found in Chapter 9 and reported with I00 through I99 according to the following sections:
Acute rheumatic fever (I00-I02)Chronic rheumatic heart diseases (I05-I09)Hypertensive diseases (I10-I16)Ischemic heart diseases (I20-I25)Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)Other forms of heart disease (I30-I52)Cerebrovascular diseases (I60-I69)Diseases of arteries, ... Tags: Specl: Cardiology|Vascular Topic: ICD10CM Coding November 8th, 2018 Muscle Testing and Range of Motion Information| Published November 8th, 2018 Be sure to understand the unique code requirements for Muscle and Range of Motion Testing. Tags: Specl: Chiropractic Specl: Physical Medicine|Physical Therapy Topic: CPT Coding Topic: Modifier Coding Topic: Procedure Coding November 7th, 2018 Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?| Published November 7th, 2018 The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ... Tags: Topic: E+M Documentation and Coding Topic: Fees Topic: HCPCS Coding Topic: Medicare Topic: Quality Payment Program Topic: Reimbursement Topic: TeleMedicine November 7th, 2018 Medi-Cal Coverage Criteria for Hospital Beds and Accessories| Published November 7th, 2018 Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required. Tags: Loc: California Payer: AMC|Medicaid Topic: DME Topic: Documentation Topic: HCPCS Coding Topic: Supply Coding November 1st, 2018 CMS: Medicare Diabetes Prevention Program Expanded Model| Published November 1st, 2018 CMS announces the Medicare Diabetes prevention program is now a new covered service. Per a recent MLN news release. Medicare Beneficiaries will be notified in 2019 in a Medicare handout. Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately... Tags: Payer: CMS|Medicare Topic: Preventive Medicine October 31st, 2018 How to Use Modifier Indicators with NCCI Edits (2018-10-31)| Published October 31st, 2018 To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator. Medicare may have restrictions on the use of a modifier used to bypass an edit. This important part of coding can alert a payer or ... Tags: Topic: Coding October 31st, 2018 Anesthesia and Pain Management| Published October 31st, 2018 - Last Review/Update November 1st, 2018
Anesthesia and Pain management is under close watch from the OIG according to a report from Anesthesia Business consultants, they stated, "The Health and Human Services Office of Inspector General (HHS OIG) reports in its most recent Semi-annual Report to Congress that in FY 2017 it brought criminal actions against 881 individuals or organizations ... Tags: Specl: Anesthesia|Pain Management October 30th, 2018 Documentation Requirements for Allergy Testing 10/29/2018| Published October 30th, 2018
Per CMS, First Coast Service Options LCD 33261:
Medical record documentation (e.g., history & physical, office/progress notes, procedure report, test results) must include the following information, and be available upon request:
A complete medical and immunologic history and appropriate physical exam obtained by face-to-face contact with the patient.
The medical necessity for performing ... Tags: Specl: Allergy|Immunology Topic: CPT Coding Topic: ICD9 Coding October 30th, 2018 Common Allergy CPT Codes and MUEs| Published October 30th, 2018 Below is a list of common CPT codes for Allergy and Immunology. Each code is listed with the following information:
Medicare Unlikely Edits (MUEs) for both a Non-Facility (NF) and Facility (F) setting.
Professional/Technical Component (PC/TC) Indicator.
Key Indicator or Procedure Code Status Indicator, which is a Medicare assigned "Indicator" to each code in ... Tags: Specl: Allergy|Immunology Topic: CPT Coding October 29th, 2018 Allergy Testing 10/29/2018| Published October 29th, 2018 Allergy testing may be performed due to exaggerated sensitivity or hypersensitivity. Using findings based on the patient’s complaint and face-to-face exam. Testing may be required to identify and determine a patient's immunologic sensitivity or reaction to certain allergens using certain CPT codes.
According to CMS, LCD 33261, allergy testing can be ... Tags: Specl: Allergy|Immunology Topic: CPT Coding October 19th, 2018 We've Always Done It This Way and Other Challenges in Education| Published October 19th, 2018 - Last Review/Update November 1st, 2018 As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into... Tags: Topic: Auditing Topic: Documentation Topic: Practice Management October 17th, 2018 Wolters Kluwer Drug Pricing| Published October 17th, 2018 Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average... Tags: October 16th, 2018 Pelvic Floor Dysfunction Treatment Coverage| Published October 16th, 2018 Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings.
Coverage by payers ... Tags: Specl: Physical Medicine|Physical Therapy Topic: CPT Coding Topic: HCPCS Coding Topic: ICD10CM Coding Topic: Procedure Coding Topic: Supply Coding October 16th, 2018 Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?| Published October 16th, 2018
Question:
We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ... Tags: Specl: Chiropractic Specl: Physical Medicine|Physical Therapy Topic: ICD10CM Coding October 16th, 2018 Q/A: What Codes do I use for CLIA-Waived Tests?| Published October 16th, 2018
Question:
I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ... Tags: Specl: All Specialties Specl: Chiropractic Topic: CPT Coding October 11th, 2018 Type of Bill Codes| Published October 11th, 2018
Type of bill codes identifies the type of bill being submitted to a payer. Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1.
First Digit = Leading zero. Ignored by CMSSecond ... Tags: Payer: CMS|Medicare Topic: Billing October 5th, 2018 Prolonged Services Its Not Just About Time| Published October 5th, 2018 - Last Review/Update October 17th, 2018
Time, as it applies to E/M codes, has often been viewed as an "if/then" proposition. "If" the documentation shows that a majority of the encounter was based on counseling and/or coordination of care, "then" we choose the highest level of service based on the total time of the encounter.
However, a ... Tags: Topic: Auditing Topic: CPT Coding Topic: E+M Documentation and Coding October 2nd, 2018 Use My Code Set to Save Priced Procedures| Published October 2nd, 2018 Use My Code Set to save priced procedures to refer to commonly used procedures. Once your CCI edits are done and you have your list of Codes, add notes to My Codes. Add all important information to the Code, for viewing again instead of re-working your most commonly used procedures.... Tags: Topic: Modifier Coding October 2nd, 2018 Tools and Resources for Life Care Planners| Published October 2nd, 2018 Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on... Tags: Topic: CPT Coding October 1st, 2018 HCC - Acceptable Provider Interpretation for Diagnostic Testing| Published October 1st, 2018
The following table is taken from the Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance dated 2017-09-27 (see References). It is a listing of acceptable provider interpretation of diagnostic testing.
Acceptable Examples include:
Cardiology and Vascular Surgeons
Echocardiogram (including Doppler, Duplex, Color flow of the heart vessels)
EKG (electrocardiogram) – Stress test, Cardiac ... Tags: Topic: Risk Adjustment |
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