Medical Coding and Billing Articles

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​​Polysomnography Services Under OIG Scrutiny

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The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?

tags  Topic: Coding    Topic: CPT Coding    Topic: Denial Management    Topic: Documentation    Topic: Medicare    Topic: Reimbursement   

When is it Proper to Bill Nurse Visits using 99211

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When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 ‑ 99215 and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit ...

tags  Specl: Billing    Topic: CPT Coding   

Billing Dental Implants under Medical Coverage

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Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery    Topic: CPT Coding   

New Codes for COVID Booster Vaccine & Monoclonal Antibody Products

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New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.

tags  Topic: Admin    Topic: Code Updates    Topic: Coding    Topic: COVID-19    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Procedure Coding   

Understanding How Place of Service Codes Work

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The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...

tags  Specl: All Specialties    Topic: Claims Processing    Topic: Coding    Topic: CPT Coding    Topic: Modifier Coding    Topic: POS - Place of Service   

Medicare's ABN Booklet Revised

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The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.

tags  Payer: CMS|Medicare    Specl: All Specialties    Topic: ABN - Advanced Beneficiary Notice    Topic: Compliance    Topic: CPT Coding    Topic: HCPCS Coding   

Chronic Pain Coding Today & in the Future

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Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

tags  Specl: All Specialties    Topic: Diagnosis Coding    Topic: ICD-11 Coding    Topic: ICD10CM Coding   

Compliance in the Dental Office or Small Practice

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If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...

tags  Specl: All Specialties    Specl: Dental    Topic: Claims Processing    Topic: Compliance   

UCR Anesthesia Fee Calculations and Base Units - Now Available!

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As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information.   Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units). NOTE: Always ...

tags  Payer: VA - Veterans Administration    Specl: Anesthesia|Pain Management    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: Fees    Topic: Life Care Planners    Topic: UB04 Form and Coding   

Important Changes to Shared/Split Services

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Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.

tags  Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Procedure Coding   

Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021

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Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.

tags  Specl: All Specialties    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: HCPCS Coding   

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!

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If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...

tags  Specl: Orthopedics    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: Facilities    Topic: Hospital    Topic: ICD10PCS Coding    Topic: Procedure Coding   

Intersegmental Traction — What’s Happening with Roller Tables?

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Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?

tags  Specl: Chiropractic    Specl: Physical Medicine|Physical Therapy    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Procedure Coding   

Congress Has Been Busy — 11 Different Bills Pass Covering Mental Health and Substance Use

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The House of Representatives has certainly been working hard to advance behavioral health services. This article summarizes each of those bills and includes a link to contact your Senator.

tags  Specl: Behavioral Health|Psychiatry|Psychology    Specl: Emergency Medicine    Topic: Coding    Topic: Health Care Reform    Topic: Practice Management    Topic: Substance Use Disorder   

OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment

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As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.

tags  Loc: All Locations    Payer: All Payers    Specl: Risk Adjustment|HCC Coding    Topic: Diagnosis Coding    Topic: Documentation    Topic: Fraud    Topic: Guidelines ICD-10-CM    Topic: ICD10CM Coding    Topic: OIG    Topic: Risk Adjustment   

Since When did Dental Claims Require Diagnosis Codes?

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The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...

tags  Specl: Dental    Topic: ACO - Accountable Care Organization    Topic: CDT (Dental) Codes    Topic: Claims Processing    Topic: ICD10CM Coding   

Identifying Risk-Adjusted Services During the Opioid Crisis

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Between June 2019 and June 2020, the United States saw a total of 107,750 deaths from COVID-19. The spread of this virus was so extraordinary that it led President Trump to declare a public health emergency, and we watched as individual states began implementing laws and regulations to limit social interaction ...

tags  Loc: All Locations    Payer: All Payers    Specl: Behavioral Health|Psychiatry|Psychology    Specl: Pain Management    Specl: Risk Adjustment|HCC Coding    Topic: Risk Adjustment   

Comparison of Add-On Code Guidelines

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Add-on codes are codes that are not intended to be reported alone. They are reported with another primary procedure to identify that additional services have been provided in conjunction with that primary procedure. Generally, they include the words “List separately in addition to code.” Interestingly, there are some differences in the instructions/guidelines regarding the use of these codes in the CPT® codebook, the NCCI Policy Manual, and on the CMS website. This article outlines the differences between each of these.

tags  Specl: Behavioral Health|Psychiatry|Psychology    Specl: Chiropractic    Specl: Obstetrics|Gynecology    Specl: Ophthalmology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Pain Management    Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Modifier Coding    Topic: Procedure Coding   

Coding Lesions and Soft Tissue Excisions

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There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions. The code selection will be determined upon the following: Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain) Technique Topography (anatomic location) The size Tissue Level Type of closure required Layers ...

tags  Specl: Dermatology|Plastic Surgery    Specl: Primary Care|Family Care    Topic: Coding    Topic: CPT Coding    Topic: Modifier Coding   

58% of Improper Payments due to Medical Necessity for Ventilators

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Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...

tags  Specl: Home Health|Hospice    Topic: DME    Topic: HCPCS Coding    Topic: ICD9 Coding   

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