Medical Coding and Billing Articles
by Find-A-Code and friends
recent articles
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April 2nd, 2020
More Telehealth Changes Announced by CMS
| Published April 2nd, 2020
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
March 31st, 2020
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
| Published March 31st, 2020
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 ...
March 31st, 2020
COVID-19 Chiropractic Resources
| Published March 31st, 2020
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.
March 30th, 2020
Spotlight: UCR Fees are Available on DRGs- Check it Out!
| Published March 30th, 2020
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 ...
March 30th, 2020
Providing Telehealth Services During COVID-19 Crisis
| Published March 30th, 2020
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.
April 1st, 2020
Interprofessional Consult Services
| Published March 27th, 2020 - Last Review/Update April 1st, 2020
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, ...
March 26th, 2020
2020 Medicare Part D Coverage Gap (AKA donut hole)
| Published March 26th, 2020
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 ...
March 26th, 2020
Medicare Part D Coverage Gap (Donut Hole) Closes in 2020
| Published March 26th, 2020
Overview of the Part D coverage gap, how it got closed, what the picture looks like for 2020, and long-term outlook.
March 26th, 2020
New Biofeedback Codes to replace 90911 Eff 2020-01-01
| Published March 26th, 2020
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), ...
March 26th, 2020
LATEST COVID-19 INFORMATION FOR BILLING NON-FACE-TO-FACE SERVICES
| Published March 26th, 2020
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 ...
March 25th, 2020
COVID-19: Cybercrime, Telehealth, and Coding
| Published March 25th, 2020
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 ...
March 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
| Published March 24th, 2020
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: ...
March 23rd, 2020
2021 Brings Another Risk Adjustment Calculation Change
| Published March 23rd, 2020
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...
March 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
| Published March 21st, 2020
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 ...
March 23rd, 2020
Implementing Telehealth Visits
| Published March 20th, 2020 - Last Review/Update March 23rd, 2020
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 ...
March 17th, 2020
Additional Coronavirus Testing Code Announced
| Published March 17th, 2020
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.
March 16th, 2020
CPT Coding Guidance on New Code for COVID-19
| Published March 16th, 2020
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 ...
March 5th, 2020
Who Qualifies for Chronic Care Management Services
| Published March 5th, 2020
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 ...
March 5th, 2020
The difference between Jones and Proximal Diaphyseal Fractures of the Fifth Metatarsal (2018-10-23)
| Published March 5th, 2020
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 ...
March 2nd, 2020
Coronavirus - What in the World is it and How is it Coded? 2020-02-20
| Published March 2nd, 2020
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 ...
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