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Viewing:  Feb 23, 2018

Medical Coding and Billing Articles

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No HCPCS Code Available? Now What?

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HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes. There are several types of HCPCS level II codes such as: Permanent National Codes Dental Codes Miscellaneous Codes Temporary National ...

Tags:  Specl: All Specialties    Topic: HCPCS Coding   

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New Modifiers Released in 2018

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There were 13 new modifiers released in 2018, be sure you are using them if appropriate.     FY X-ray taken using computed radiography technology/cassette-based imaging    JG Drug or biological acquired with 340b drug pricing program discount    QQ Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was ...

Tags:  Topic: CPT Coding    Topic: Modifier Coding   

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Payment Rates Increase for Behavioral Health Office Services

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Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...

Tags:  Specl: Behavioral Health|Psychiatry|Psychology    Topic: CPT Coding    Topic: Fees    Topic: HCPCS Coding    Topic: Modifier Coding   

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Medicare Using Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting January 2018

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On June 17, 2016, CMS announced the release of its final rule implementing section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA). This final rule requires reporting entities to report private payor rates paid to laboratories for lab tests, which will be used to calculate Medicare payment ...

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HIPAA Breach Settlements and Ransomware Attacks - Is Your Practice Secure?

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Two recent reports should make providers stop, take notice and make sure their practice's policies and procedures are up-to-date. The first one involves a HIPAA Breach settlement of a company with facilities in several states. The OCR memo stated "In addition to a $3.5 million monetary settlement, a corrective action plan ...

Tags:  Specl: All Specialties    Topic: HIPAA   

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Scoring & Reporting Your Audit Findings

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This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week.

Tags:  Specl: All Specialties    Topic: Auditing    Topic: Compliance    Topic: E+M Documentation and Coding   

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Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes

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According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...

Tags:  Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding   

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Pre-Existing or Gestational?

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It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)? Trimester: When did the pregnancy-related condition develop? Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia) Code examples: O99.011 Anemia ...

Tags:  Specl: Obstetrics|Gynecology    Topic: Documentation    Topic: ICD10CM Coding   

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Patients Undergoing a Bone Marrow Transplant (BMT)

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Accoring to Wisconsin Physicians Service Insurance Corporation L34699, when using J2820 for patients undergoing a bone marrow transplant (BMT), 2 diagnosis codes are required:1) Z76.82 Awaiting organ transplant status2) Pick a code from one of these categories: C81- Hodgkin Lymphoma C82- Follicular Lymphoma Non-follicular Lymphoma C83.1- Mantle cell lymphoma C83.3- Diffuse large B-cell lymphoma C83.7- Burkitt lymphoma C83.8- Other (Intravascular large B-cell lymphoma, Primary effusion B-cell lymphoma, or Lymphoid granulomatosis) Mature T/NK-cell lymphomas C84.4- Peripheral T-cell ...

Tags:  Topic: HCPCS Coding    Topic: ICD10CM Coding   

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Diagnosis Codes Used With : Vertebroplasty, Vertebral Augmentation and Computed Tomography

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Per CGS Administrators LCD L34048 the following codes are the ICD-10-CM Cdes that support Medical Necessity: (Be sure to verify with your local payer) Stand Alone ICD-10 codes M80.08XA M80.88XA M80.88XG Primary Diagnosis Codes M48.51XA M48.52XA M48.53XA M48.54XA M48.55XA M48.56XA M48.57XA M48.58XA M84.68XA Secondary Diagnosis Codes One of the following diagnosis codes must be reported with one of the codes above in group 2.Combination coding of the primary diagnosis(group 2) of pathologic fracture ...

Tags:  Specl: Orthopedics    Specl: Radiology    Topic: ICD10CM Coding   

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How to Code Screening and Diagnostic Colonoscopy

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The following information is from BC Advantage. Colonoscopy is a common procedure performed byGastroenterologists. CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis" ...

Tags:  Topic: Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding    Topic: Modifier Coding   

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Q and A: Coding Mixed Cardiogenic and Septic Shock

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Q: If the attending documented, "likely mixed cardiogenic and septic shock," can I assign codes R57.0 and R65.21? A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember,...

Tags:  Topic: Coding    Topic: ICD10CM Coding   

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Important CDI and Coding Updates

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COPD and Pneumonia The requirement for code J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) to be coded first when a patient has pneumonia and COPD has been eliminated as of October 1. The 2018 version of ICD-10-CM replaced the "use additional code" with "code also." According...

Tags:  Topic: Coding    Topic: ICD10CM Coding   

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Using a 2015 Certified EHR in MIPS Year 2

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The following information is from BC Advantage. As of Dec 31, 2017, Acumen EHR v8.0 achieved Office of the National Coordinator for Health Information Technology (ONC-Health IT) 2015 edition certification! What's a 2015 CEHRT?A CEHRT (Certified EHR Technology) is defined by CMS specifically for their incentive payment programs such as...

Tags:  Topic: Meaningful Use    Topic: Practice Management    Topic: Quality Payment Program   

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Are Your Computers Vulnerable to Cyber Attacks?

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Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings. On ...

Tags:  Specl: All Specialties    Topic: HIPAA   

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CMS Changes Definitions for Therapeutic Shoe Inserts

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CMS recently revised their definitions for custom fabricated and therapeutic inserts in order to meet current technology standards. Healthcare providers need to be sure to review the revisions in order to appropriately bill Medicare for inserts. For example, for custom fabricated, molded-to-patient, they have added the following: iii. For inserts used with ...

Tags:  Specl: Podiatry    Topic: DME   

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MAC Operations Continue During Shutdown

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CMS announced today, during the time that the partial government shutdown is in effect, Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payment. ...

Tags:  Payer: CMS|Medicare   

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OIG Reviews Medicare Advantage Claims

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On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that: "Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ...

Tags:  Specl: All Specialties    Topic: Compliance    Topic: Medicare   

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Don’t Be Hesitant About Collecting Co-Pays

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If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...

Tags:  Loc: All Locations    Specl: All Specialties    Topic: Billing    Topic: Fees    Topic: Insurance    Topic: Practice Management    Topic: Reimbursement   

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Two of the Largest Public-Private Health-Care Forms a New Partnership.

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CMS announced today, “VA, Health and Human Services Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts”.   This new alliance will allow the VA access to CMS’ program integrity protocols which will enable them to close existing gaps in their claims payment process. CMS stated in the announcement today, “CMS ...

Tags:  Topic: Technology   

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