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Viewing:  Jan 16, 2019

Medical Coding and Billing Articles

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AMA Issues new CMT Information

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As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ...

Tags:  Specl: Chiropractic    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Modifier Coding    Topic: Procedure Coding   

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Scanning the Unscannable: Improving Patient Flow in MRI

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Stay Ahead of your CEUs in 2019Get the latest webinars and earn over 24 CEUs each year included with your BC Advantage Magazine subscription. Latest Webinar: Scanning the Unscannable: Improving Patient Flow in MRI Presenter: Wendy Stirnkorb, President & CEO Stirnkorb Consulting, LLC Time: 46 Minutes Cost: $0.00 to all BC Advantage Magazine Subscribers CEUs: 1.0 On-demand: Watch 24/7 from work or ...

Tags:  Specl: Radiology    Topic: CEUs   

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How to Report Co-Surgeons Using Modifier 62

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Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session. An easy way to explain this is to visualize a patient requiring cervical fusion where ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Auditing    Topic: Coding    Topic: Documentation    Topic: ICD9v3 Coding    Topic: Medicare    Topic: Modifier Coding    Topic: Procedure Coding   

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Are You Protecting Your Dental Practice From Fraud?

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With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ...

Tags:  Payer: All Payers    Specl: All Specialties    Topic: Auditing    Topic: CDT (Dental) Codes    Topic: Claims Processing    Topic: Denial Management    Topic: Fraud    Topic: Insurance    Topic: Payer Guidelines    Topic: Practice Management    Topic: Procedure Coding    Topic: Training   

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Nine New Codes for Fine Needle Aspirations (FNA)

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If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ...

Tags:  Loc: All Locations    Payer: All Payers    Specl: Allergy|Immunology    Specl: Cardiology|Vascular    Specl: Dermatology|Plastic Surgery    Specl: Emergency Medicine    Specl: Endocrinology    Specl: ENT|Otolaryngology    Specl: Gastroenterology    Specl: General Surgery    Specl: Internal Medicine    Specl: Interventional Radiology    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Oncology|Hematology    Specl: Ophthalmology    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pediatrics    Specl: Podiatry    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Radiology    Specl: Rheumatology    Specl: Urology|Nephrology    Topic: Auditing    Topic: Billing    Topic: CPT Coding    Topic: Modifier Coding   

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Dry Needling

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The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ...

Tags:  Specl: All Specialties    Specl: Chiropractic    Topic: Codapedia    Topic: CPT Coding    Topic: Modifier Coding    Topic: Procedure Coding   

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CMS Finalizes Major Changes to ACO Program

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Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register ...

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Health Care Reform    Topic: Medicare   

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Are You Ready For the 2019 New Codes

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Many articles have been published regarding the 2019 proposed Evaluation and Management coding changes but hopefully, you have taken the time to review those in detail and be ready for them. If not, here is a link to a Find-A-Code article written by Wyn Staheli (Director of Research) entitled, “Are You Ready ...

Tags:  Topic: Coding    Topic: CPT Coding   

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2019 Coding Changes for Chiropractic

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The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...

Tags:  Specl: Chiropractic    Topic: CPT Coding    Topic: HCPCS Coding    Topic: ICD10CM Coding   

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New Genetic Test for Severe Inherited Conditions

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For 2019 a new code has been introduced (81443) which represents genetic testing for 15 genes associated with severe, inherited conditions. The results of this test may be used to identify carrier status during prenatal genetic counseling, confirm a clinical diagnosis, or identify at-risk family members for the following severe ...

Tags:  Loc: All Locations    Specl: Laboratory|Pathology    Topic: CPT Coding   

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Welcome 2019 CPT Codes!

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The AMA has released the New, Revised and Deleted CPT codes these are currently available on Find-A-Code. View the entire list of changes on the CODE tab and select CPT. Be sure to review all of the changes effective January 01, 2019.   168 New Codes 72   Deleted Code 51   Revised Codes Here are ...

Tags:  Topic: CPT Coding   

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The Diabetic Patient and Medical Manifestations

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Tags:  Topic: CDT (Dental) Codes    Topic: CPT Coding    Topic: ICD10CM Coding   

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Flexion-Distraction Billing Clarification

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Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article ...

Tags:  Specl: Chiropractic    Topic: CPT Coding    Topic: Procedure Coding   

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Quality Measures Finalized for 2019

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CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are: Physical therapists Occupational therapists Qualified speech-language pathologists Qualified audiologists Clinical psychologists Registered dietitian or nutrition professionals The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...

Tags:  Topic: Quality Payment Program   

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Medicare Advantage Providers are not Required to be Enrolled in Medicare

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There was a ruling that was requiring providers to be enrolled in Medicare in order to provide services for Part C (Medicare Advantage (MA)) and/or Part D. However, on April 2, 2018, CMS released the 2019 Final Rules for MA and Part D which changed this previous ruling. According to ...

Tags:  Payer: CMS|Medicare    Topic: Compliance    Topic: Medicare   

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Are HIPAA Changes Coming?

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On December 14, 2018, the Office for Civil Rights (OCR) issued a Request for Information (RFI). They are considering making changes to some of the HIPAA regulations. Earlier this year at the HIMSS (Healthcare Information and Management Systems Society) meeting, Roger Severino, the head of the Office for Civil Rights ...

Tags:  Topic: Compliance    Topic: HIPAA   

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Reporting Unilateral or Bilateral Codes

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Generally, Audiology tests are coded as if they were performed on both ears, if the testing was performed only on one ear, you are required to append a modifier to acknowledge there was a reduced service or a unilateral assessment, using modifier 52 - Reduced Services. (Be sure to read...

Tags:  Specl: ENT|Otolaryngology    Topic: Modifier Coding   

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Keeping Up to Date

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Keeping up to date on coding and documentation changes, is critical for medical coders, billers, auditors, and compliance personnel. Every year American Medical Association (AMA) creates, revises, and deletes CPT codes on January 1st. Same thing occurs with the ICD-10 codes in October. For CPT codes, the intention of the...

Tags:  Topic: Coding    Topic: Compliance    Topic: Documentation   

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Auditing looking between the lines

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When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not...

Tags:  Topic: Auditing    Topic: Documentation    Topic: Practice Management   

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Errors Billing Outpatient Services When Patient is also Inpatient

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The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals.  CMS suggests using the following resources to ensure compliance: Medicare Inappropriately Paid Acute-Care Hospitals for ...

Tags:  Payer: CMS|Medicare    Specl: All Specialties    Topic: Billing    Topic: Compliance    Topic: Hospital    Topic: Medicare   

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Past Articles

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Articles: ICD-10

Articles: Medical Coding

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Articles: Medical Billing and Coding (General)


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