CPT Evaluation and Management Code Changes in 2021
Virtual Conference
Get ahead of the CPT Evaluation and Management changes taking affect in 2021. Master the changes and learn how they will affect your practice.
- 5 Bootcamp sessions and 18 Symposium sessions
- 14 Presenters including CMS and AMA
- On-demand session videos, purchase as bundles or individually
"Location: All Locations" & "CPT Coding" Articles
Click on the title to see the article summary and a link to the full article.
April 19th, 2021
Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 19th, 2021
Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source?
Answer: This is a great question and one that has been asked by many coders and auditors.
April 12th, 2021
How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 12th, 2021
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
April 8th, 2021
Coding Lesions and Soft Tissue Excisions
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 8th, 2021
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 ...
April 8th, 2021
Properly Reporting Imaging Overreads (Including X-Rays)
By Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published April 8th, 2021
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
April 1st, 2021
Evaluation & Management (E/M) Webinar Q/A
By Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published April 1st, 2021
Find answers to some questions asked by attendees of our recent webinar regarding the changes released by the AMA in their March 9, 2021 Errata and Technical Corrections document in relation to Evaluation & Management (E/M).
March 31st, 2021
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 31st, 2021
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
March 23rd, 2021
Understanding Skin Biopsy Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 23rd, 2021
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
March 18th, 2021
How Reporting E/M Based on Time May Lose Money
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 18th, 2021
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
March 16th, 2021
Critical Evaluation and Management Changes Recently Announced by AMA
By Wyn Staheli, Director of Research | Published March 16th, 2021 - Last Review/Update March 17th, 2021
On March 9, 2021, the American Medical Association (AMA) announced some pretty significant changes in relation to reporting Evaluation and Management (E/M) services, particularly for Office or Other Outpatient Services (99202-99215). The AMA Editorial Panel had previously met to discuss how to address concerns and made changes surrounding Office or Other Outpatient Services which are retroactive to January 1, 2021. Learn more about those changes in this article.
March 10th, 2021
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 10th, 2021
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
March 10th, 2021
COVID-19 Vaccines
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 10th, 2021
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...
February 17th, 2021
Why CMS Created G2212 for Prolonged Services Instead of 99417
By Wyn Staheli, Director of Research | Published February 17th, 2021 - Last Review/Update February 22nd, 2021
This article discusses WHY CMS decided to create code G2212 to be used with prolonged office Evaluation and Management (E/M) services instead of code 99417 as of January 1, 2021. The proposed Medicare Physician Fee Schedule stated that code 99417 would be used so it is essential to understand why they made this change to avoid potential problems with billing these services.
February 11th, 2021
2021 Medicare Physician Fee Schedule Updates - Do You Really Need to Worry?
February 3rd, 2021
How To Properly Report Prolonged Services Using 99417 or G2212
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 3rd, 2021
Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215. While Medicare has agreed to accept the AMA's CPT E/M coding changes, they have formulated an opinion contrary to how CPT calculates time specific ...
February 1st, 2021
New Procedure Codes for the Janssen COVID-19 Vaccine
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 1st, 2021
On January 19, 2021, the AMA announced two new CPT codes for reporting the Janssen Pharmaceutica (a division of Johnson & Johnson) COVID-19 vaccine. Of course, just as with the other COVID-19 vaccines, they must be given FDA approval for Emergency Use Authorization (EUA) to be administered before the codes can be reported.
As is ...
January 21st, 2021
Looking Beyond an Employee's Coding Credentials
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 21st, 2021
In today's ever-changing healthcare environment, it is important that organizations hire coding and reimbursement personnel who enjoy learning. Each year changes are made in how healthcare services are coded and reported from federal and state laws, the code sets themselves, and varying payer policies. During the public health emergency (PHE) ...
January 15th, 2021
AMA Announcement of Additional COVID Vaccine Codes and Guideline Changes in December
By Wyn Staheli, Director of Research | Published January 15th, 2021 - Last Review/Update January 19th, 2021
On Friday, December 17, 2020, the AMA announced several changes in relation to the addition of new codes for the COVID-19 vaccine under development by AstraZeneca and University of Oxford. Codes 91302, 0021A, and 0022A were published on the AMA website and will be effective once they have received Emergency Use Authorization (EUA) from the FDA.
January 11th, 2021
Good and Bad News Regarding the 2021 Medicare Physician Fee Schedule
By Wyn Staheli, Director of Research | Published January 11th, 2021
When the proposed Medicare Physician Fee Schedule came out last year, it really got everyone worried. In a time where we are all facing issues related to COVID, this seemed like a really big problem. Professional organizations lobbied and everyone tried to stop the proposed changes, and the 10.2% decrease didn’t happen, but other changes will still be taking place. So how bad is it really and how will it affect your organization?
January 7th, 2021
CMS Reduces the Exchange User Fee to Support Lower Premiums for the Consumer
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 7th, 2021
It has been no secret that Americans have been complaining about the high cost of health plans since implementation of the Affordable Care Act (ACA). Premiums and deductibles have skyrocketed and in many states are equal to or exceed the cost of their rent or mortgage payments. As such, most ...
January 5th, 2021
CMS Final Rule Changes E/M Reporting Guidelines
By Wyn Staheli, Director of Research | Published January 5th, 2021
Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.
December 31st, 2020
CMS Final Rule Changes E/M Reporting Guidelines
By Wyn Staheli, Director of Research | Published December 31st, 2020
Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.
December 8th, 2020
Common Medical to Dental Procedures and Where to Find Them
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ...
December 8th, 2020
CDT and CPT - The Same but Different!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...
December 8th, 2020
Final Rule on Communications Technology and 2021 Physicians Fee Schedule
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...
December 7th, 2020
Clinical Documentation in Find-A-Code!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 7th, 2020
Clinical documentation is one of the most important aspects of coding, Find-A-Code offers documentation tips and requirements in several places. You can find general information with our TIPS and articles or information directly from a particular payer or source. Below are a few examples to help you get started.
Commercial Payer ...
November 24th, 2020
How Might the New 2021 E/M Guideline Changes Impact Risk Adjustment?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 24th, 2020
While provider organizations are busy learning the new E/M guideline changes being implemented January 1, 2021, Medicare Advantage Organizations (MAOs) are contemplating how the documentation changes for these services may impact risk adjustment coding. To be clear, the new E/M guidelines only pertain to Office and Other Outpatient E/M Services ...
November 11th, 2020
COVID Vaccine Codes Announced
By Wyn Staheli, Director of Research | Published November 11th, 2020 - Last Review/Update November 12th, 2020
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
November 5th, 2020
Are You Aware of the 2021 Star Rating System Updates?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 5th, 2020
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:
Quality of ...
October 26th, 2020
Delving Into the 360 Assessment Fraud Complaint
By Jessica Hocker, CPC, CPB | Published October 26th, 2020
The Department of Justice is pursuing claims of healthcare fraud against Cigna Health-Spring Medicare Advantage plan based on how they used data from their 360 Program in 2012. A review of the allegations may help other payers avoid similar accusations.
October 12th, 2020
What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?
By Aimee Wilcox | Published October 12th, 2020
When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ...
October 8th, 2020
Significant COVID-19 Code Changes as of October 6
By Wyn Staheli, Director of Research | Published October 8th, 2020 - Last Review/Update October 13th, 2020
Significant COVID-19 Code Changes as of October 6
September 15th, 2020
More COVID-19 Codes Added as of September 8, 2020
By Wyn Staheli, Director of Research | Published September 15th, 2020
The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.
August 26th, 2020
Ultrasound - A Complete Exam Must Include the Following
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 26th, 2020
Real time scanning of the kidneys
Abdominal aorta
Common iliac artery origins
Inferior vena cava
Alternaltively, if ultrasonography is being performed to evaluate the urinary tract, examination of the kidneys and urinary bladder constitutes a complete exam. Code 76775 is used when a limited retroperitoneal ultrasound examination is performed.
...
August 24th, 2020
2021 Brings Another Risk Adjustment Calculation Change
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published August 24th, 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...
August 10th, 2020
Coding Injections for Pain Management
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2020
Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.
Trigger Point Injections
Trigger point injections are reported by how many muscles are treated using an ...
August 10th, 2020
Modifier 50 — Four "Must Know" Tips For Getting Paid
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published August 10th, 2020
Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...
August 7th, 2020
Impact of 2021 Proposed Medicare Fee Schedule on Chiropractic Offices
By Wyn Staheli, Director of Research | Published August 7th, 2020
On August 3, 2020, the proposed Medicare Physician Fee Schedule for 2021 was released. This 1,355 page document includes some sweeping changes to the Medicare program. There are a few items in particular which should be noted by chiropractic offices.
July 15th, 2020
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 15th, 2020
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 14th, 2020
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
July 9th, 2020
Payment Adjustment Rules for Multiple Procedures and CCI Edits
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2020
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
June 29th, 2020
Additional COVID-19 Testing Codes Announced
By Wyn Staheli, Director of Research | Published June 29th, 2020
New coronavirus antigen testing codes announced. These are effective immediately.
June 18th, 2020
CMS- Reminder COVID Assessment and Specimen Collection
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 18th, 2020
On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection. CMS has recently sent out reminders on billing for these services, the proper use of the CS modifier on claims, and how they are handling denials due ...
June 15th, 2020
Outpatient Facility Pricing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020
Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...
June 10th, 2020
MEGA - NCCI Edit Changes - WHO Knew?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 10th, 2020
There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included;
291,902 Deleted Procedure to Procedure (PTP) edits
197 Deleted Medically Unlikely ...
June 3rd, 2020
Watch for Payer Telehealth Coverage Changes
By Wyn Staheli, Director of Research | Published June 3rd, 2020
As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.
June 1st, 2020
Additional Practice Reopening Tips
By Wyn Staheli, Director of Research | Published June 1st, 2020
As practices begin reopening across the nation, there are several things that need to be considered. Policies and Procedures Manuals need to be updated, malpractice carriers need to be contacted and everyone needs to consider mental health screenings and support.
May 13th, 2020
Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 13th, 2020
On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states:
“Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...
May 4th, 2020
Additional Telehealth Changes Announced by CMS
By Wyn Staheli, Director of Research | Published May 4th, 2020
On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.
April 20th, 2020
Emergency Room and Ancillary Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 20th, 2020
Billing for an Emergency department is not the same as billing for a hospital or in the provider's office; there are several differences and requirements. For example. the hospital will report a stay with Diagnosis Related Groups (DRG's), which include hospital resources used during the patient's stay, while office visits ...
April 20th, 2020
Dismal OIG Report on Telemedicine
By Wyn Staheli, Director of Research | Published April 20th, 2020
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
April 15th, 2020
New CPT® Codes Approved for COVID-19 Antibody Identification
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 15th, 2020
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
April 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 15th, 2020
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
April 13th, 2020
CPT Coding Guidance on New Lab Code for COVID-19
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 13th, 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 ...
April 13th, 2020
CMS Announces Final 2021 HCC Risk Adjustment Changes
By Wyn Staheli, Director of Research | Published April 13th, 2020
On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) published their final Medicare Advantage (MA) and Part D payment methodologies for CY 2021. Read more to be prepared for these upcoming changes.
April 7th, 2020
More Telehealth Changes Announced by CMS Chiropractic Offices Should Know About
By Wyn Staheli, Director of Research | Published April 7th, 2020
On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar.
April 2nd, 2020
More Telehealth Changes Announced by CMS
By Wyn Staheli, Director of Research | 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
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | 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 30th, 2020
Providing Telehealth Services During COVID-19 Crisis
By Wyn Staheli, Director of Research | 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.
March 27th, 2020
Interprofessional Consult Services
By Namas | 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
New Biofeedback Codes to replace 90911 Eff 2020-01-01
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | 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
By Namas | 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 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | 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 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | 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 20th, 2020
Implementing Telehealth Visits
By Namas | 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
By Wyn Staheli, Director of Research | 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.
February 10th, 2020
A 2020 Radiology Coding Change You Need To Know
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 10th, 2020
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
January 30th, 2020
Medicare Announces Coverage of Acupuncture Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 30th, 2020
On January 21, 2020, a CMS Newsroom press-release read,
This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...
January 21st, 2020
Q/A: How do we Bill Massage Services?
By Wyn Staheli, Director of Research | Published January 21st, 2020
Question: We are adding a massage therapist soon and have some questions about billing their services.
January 14th, 2020
Billing for Telemedicine in Chiropractic
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 14th, 2020
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
January 14th, 2020
Q/A: Can Chiropractors Bill 99211?
By Wyn Staheli, Director of Research | Published January 14th, 2020
Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code...
January 9th, 2020
Who Knew? There are Three Types of Add-On Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 9th, 2020
Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...
January 3rd, 2020
CPT 2020 Changes to Psychiatry Services
By Namas | Published January 3rd, 2020 - Last Review/Update January 7th, 2020
As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and ...
December 20th, 2019
What to look for when auditing moderate sedation codes 99151-99153
By Namas | Published December 20th, 2019 - Last Review/Update January 9th, 2020
What to look for when auditing moderate sedation codes 99151-99153
Physicians performing diagnostic and therapeutic procedures can now separately bill for the provision of moderate sedation services, but there are some interesting wrinkles to be looking for when auditing these services.
Starting in 2017, moderate sedation codes 99151-99157 were created to address ...
December 9th, 2019
Regence: Dental Procedures Under The BlueCard Program?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 9th, 2019
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...
October 18th, 2019
Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible
By Namas | Published October 18th, 2019 - Last Review/Update October 23rd, 2019
Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...
October 10th, 2019
Eliminating Consultation Codes?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 10th, 2019
There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255.
United Healthcare announced they ...
October 1st, 2019
Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
October 1st, 2019
The New ICD-10-CM Code Updates Are Here — Are You Ready?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)
A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases.
Chapter 2: ...
September 30th, 2019
New Codes for Dry Needling
By Wyn Staheli, Director of Research | Published September 30th, 2019
Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.
September 30th, 2019
Vaccine Administration - When The Right Vaccine Code is Not Enough
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2019
Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...
September 30th, 2019
Q/A: How Do I Bill a House Call?
By Wyn Staheli, Director of Research | Published September 30th, 2019
Question
If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form? A modifier, or something else?
Answer
Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...
September 16th, 2019
E-Health is a Big Deal in 2020
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 16th, 2019
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
September 9th, 2019
Chiropractic 2020 Codes Changes Are Here
By Wyn Staheli, Director of Research | Published September 9th, 2019
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
August 20th, 2019
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
By Aimee Wilcox | Published August 20th, 2019
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial.
As any company who has billed Medicare services can attest, the one-year timely filing ...
August 19th, 2019
Understanding Payment Indicators
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 19th, 2019
Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules. Here is an article from Regence on their policy statement, describing the rules ...
August 13th, 2019
How to Properly Report Prolonged Evaluation and Management Services
By Aimee Wilcox | Published August 13th, 2019
Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?
Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...
August 13th, 2019
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
By Wyn Staheli, Director of Research | Published August 13th, 2019
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
August 6th, 2019
CMS Proposes to Reverse E/M Stance to Align with AMA Revisions
By Wyn Staheli, Director of Research | Published August 6th, 2019
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...
July 15th, 2019
Denial Management is Key to Profitability
July 9th, 2019
The Importance of Medical Necessity
By Marge McQuade, CMSCS, CHCI, CPOM | Published July 9th, 2019
ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...
July 8th, 2019
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
By Wyn Staheli, Director of Research | Published July 8th, 2019
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following:
Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...
June 18th, 2019
How to Properly Report Monitoring Patients Taking Blood-thinning Medications
By Wyn Staheli, Director of Research | Published June 18th, 2019 - Last Review/Update June 19th, 2019
Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.
June 17th, 2019
Extrapolation Policies Apply to RAD-V Audits
By Aimee Wilcox | Published June 17th, 2019
Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ...
June 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 13th, 2019
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
June 13th, 2019
Spotlight: Anatomy Images
By Brittney Murdock, QCC, CMCS, CPC | Published June 13th, 2019
When viewing CPT codes, Find-A-Code offers detailed anatomy images and tables to help with coding.
For example 28445 offers a table with information to assist classification of gustilo fractures:
Click on the image preview from the code information page to expand the image.
June 13th, 2019
Documentation of E/M services for Neurology (Don't Forget the Cardiology Element)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 13th, 2019
According to Neurology Clinical Practice and NBIC, the neurologic exam is commonly lacking in documentation due to the extensive requirements needed to capture the appropriate revenue.
With the lack of precise documentation, it results in a lower level of E/M than that which is more appropriate, which can cost a physician a lot ...
June 13th, 2019
Medicare Approves Reimbursement for Virtual Communication (G2012)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 13th, 2019
Medicare has taken a stand to recognize communication technology-based services by approving two newly defined physicians' services that will significantly help providers who deal with phone calls and patient triage. One of these services includes:
Virtual check-in (G2012), which allows the provider to be reimbursed for communicating with the patient via ...
June 6th, 2019
How to Code Ophthalmologic Services Accurately
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 6th, 2019 - Last Review/Update June 11th, 2019
Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.
According to Article A19881 which was published in 2004 and ...
May 29th, 2019
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 29th, 2019 - Last Review/Update June 4th, 2019
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
May 27th, 2019
Your New Patient Exam Code Could Determine How Many Visits You Get
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 27th, 2019 - Last Review/Update June 6th, 2019
The initial exam is where the provider gathers the information to determine the need for all the care that follows. It is billed most often as an office or outpatient evaluation and management (E/M) code from the 4th edition of the AMA’s Current Procedural Terminology book. There are actually five ...
May 24th, 2019
What to Look for When Auditing Smoking Cessation Services
By NAMAS | Published May 24th, 2019 - Last Review/Update June 19th, 2019
What to Look for When Auditing Smoking Cessation Services
May 13th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices
By Raquel Shumway | Published May 13th, 2019 - Last Review/Update May 20th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.
May 8th, 2019
Facts on Procedure Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 8th, 2019
There are two levels of codes used for services and procedures:
Level I Codes are used for Services and Procedures provided by physicians.
5 digit numerical code, example, 99213 - Office or other outpatient visits
Level II Codes are used to bill Medical equipment supplies and transport services.
4 digit Alpha/Numerical code example, ...
May 1st, 2019
Spotlight: ASA Crosswalk
By Brittney Murdock, QCC, CMCS, CPC | Published May 1st, 2019
Crosswalk from CPT Anesthesia codes (00100-01999) to Surgery and Procedure Codes! Let's look at anesthesia code 00100 as an example. The ASA Crosswalks are available under the Cross-A-Code bar. Click to expand. Look for the ASA CROSSWALK or ASA Reverse CROSSWALK bar. You will also see the CMS and ASA...
April 29th, 2019
Q/A: I’m Being Audited? Is There a Documentation Template I can use?
By Wyn Staheli, Director of Research | Published April 29th, 2019
Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?
Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ...
April 24th, 2019
Biofeedback - Is it Medically Necessary?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 24th, 2019
Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational.
The majority of payers will list Biofeedback on an exclusions list. Others such as BC ...
April 23rd, 2019
Let's Talk High Risk E/M Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...
April 23rd, 2019
CPT Announces 2021 E/M Changes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
In 2018, Medicare announced their plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not ...
April 23rd, 2019
What is Medical Necessity and How Does Documentation Support It?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
April 22nd, 2019
Auditing Chiropractic Services
By By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
April 19th, 2019
Auditing Ophthalmology and Optometry Exams
By Namas | Published April 19th, 2019 - Last Review/Update April 23rd, 2019
Auditing Ophthalmology and Optometry Exams
If you work in an ophthalmology group or audit ophthalmology then you are most likely aware of the caveats that exist in this specialty. Ophthalmology and Optometry practitioners can select from either the E/M code set or the Ophthalmologic exam code set. Having this knowledge in ...
April 1st, 2019
Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?
By Wyn Staheli, Director of Research | Published April 1st, 2019
I submitted a claim to the VA and it’s being denied. Why?
There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ...
April 1st, 2019
Spinal Cord Stimulator Used for Chronic Pain
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 1st, 2019
Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes.
ICD-10-CM Diagnosis Codes ...
April 1st, 2019
Corrections and Updates
By Wyn Staheli, Director of Research | Published April 1st, 2019 - Last Review/Update April 2nd, 2019
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics.
Published Articles
We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...
April 1st, 2019
CPT Codes That Include Moderate Sedation (Appendix G)
By Find-A-Code | Published April 1st, 2019 - Last Review/Update April 2nd, 2019
The CPT codes that include moderate sedation have been removed from the CPT code set. These codes include: 99151, 99152, 99153, 99155, 99156, 99157.
Please refer to the guidelines for information on how to report these moderate sedation services.
...
April 1st, 2019
FDA Approval Pending Products (Appendix K)
By Find-A-Code | Published April 1st, 2019 - Last Review/Update April 2nd, 2019
The following includes a list of vaccine product codes that are currently pending FDA approval. When approval status has been granted by the FDA, updated information will be available HERE
90587
90666
90667
90668
90689
90697
...
March 29th, 2019
Prolonged Services
By Namas | Published March 29th, 2019 - Last Review/Update April 4th, 2019
Prolonged Services
I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...
March 26th, 2019
Add on Codes for CPT (Appendix D)
By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019
For 2019, the following is a list of CPT add-on codes:
01953
19294
33225
37223
61864
76814
93325
97598
01968
19297
33257
37232
61868
76937
93352
97811
01969
20930
33258
37233
62148
76979
93462
97814
10004
20931
33259
37234
62160
76983
93463
99100
10006
20932
33367
37235
63035
77001
93464
99116
10008
20933
33368
37237
63043
77002
93563
99135
10010
20934
33369
37239
63044
77003
93564
99140
10012
20936
33419
37247
63048
77063
93565
99153
10036
20937
33508
37249
63057
77293
93566
99157
11001
20938
33517
37252
63066
78020
93567
99292
11008
20939
33518
37253
63076
78496
93568
99354
11045
20985
33519
38102
63078
78730
93571
99355
11046
22103
33521
38746
63082
81266
93572
99356
11047
22116
33522
38747
63086
81416
93592
99357
11103
22208
33523
38900
63088
81426
93609
99359
11105
22216
33530
43273
63091
81536
93613
99415
11107
22226
33572
43283
63103
82952
93621
99416
11201
22328
33768
43338
63295
86826
93622
99467
11732
22512
33866
43635
63308
87187
93623
99486
11922
22515
33884
44015
63621
87503
93655
99489
13102
22527
33924
44121
64462
87904
93657
99494
13122
22534
33929
44128
64480
88155
93662
99498
13133
22552
33987
44139
64484
88177
94645
99602
13153
22585
34709
44203
64491
88185
94729
99607
14302
22614
34711
44213
64492
88311
94781
0054T
15003
22632
34713
44701
64494
88314
95079
0055T
15005
22634
34714
44955
64495
88332
95873
0076T
15101
22840
34715
47001
64634
88334
95874
0095T
15111
22841
34716
47542
64636
88341
95885
0098T
15116
22842
34808
47543
64643
88350
95886
0163T
15121
22843
34812
47544
64645
88364
95887
0164T
15131
22844
34813
47550
64727
88369
95940
0165T
15136
22845
34820
48400
64778
88373
95941
0174T
15151
22846
34833
49326
64783
88388
95962
01953
15152
22847
34834
49327
64787
90461
95967
01968
15156
22848
35306
49412
64832
90472
95984
01969
15157
22853
35390
49435
64837
90474
96113
0205T
15201
22854
35400
49568
64859
90785
96121
0214T
15221
22858
35500
49905
64872
90833
96131
0215T
15241
22859
35572
50606
64874
90836
96133
0217T
15261
22868
35600
50705
64876
90838
96137
0218T
15272
22870
35681
50706
64901
90840
96139
0222T
15274
26125
35682
51797
64902
90863
96160
0229T
15276
26861
35683
52442
64913
91013
96161
0231T
15278
26863
35685
56606
65757
92547
96361
0290T
15777
27358
35686
57267
66990
92608
96366
0376T
15787
27692
35697
58110
67225
92618
96367
0396T
15847
29826
35700
58611
67320
92621
96368
0397T
16036
31627
36218
59525
67331
92627
96370
0399T
17003
31632
36227
60512
67332
92921
96371
0437T
17312
31633
36228
61316
67334
92925
96375
0439T
17314
31637
36248
61517
67335
92929
96376
0443T
17315
31649
36474
61611
67340
92934
96411
0450T
19001
31651
36476
61641
69990
92938
96415
0466T
19082
31654
36479
61642
74301
92944
96417
0471T
19084
32501
36483
61651
74713
92973
96423
0480T
19086
32506
36907
61781
75565
92974
96570
0482T
19126
32507
36908
61782
75774
92978
96571
0492T
19282
32667
36909
61783
76125
92979
96934
0496T
19284
32668
37185
61797
76802
92998
96935
0513T
19286
32674
37186
61799
76810
93320
96936
0514T
19288
33141
37222
61800
76812
93321
97546
0523T
...
March 26th, 2019
CPT Codes Exempt from Modifier 51 (Appendix E)
By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019
The following CPT codes are exempt from the use of modifier 51. These procedures are usually performed with another procedure, however, they may also be a stand-alone procedure.
17004
93456
93618
20697
93503
93631
20974
93600
94610
20975
93602
95905
31500
93603
95992
36620
93610
99151
44500
93612
99152
61007
93615
93451
93616
...
March 26th, 2019
CPT Codes That Should Not Be Reported With Modifier 63 (Appendix F)
By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019
The following codes should not be reported with modifier 63.
30540
33946
46735
30545
33947
46740
31520
33978
46742
33470
33949
46744
33502
36415
47700
33503
36420
47701
33505
36450
49215
33506
36456
49491
33610
36460
49492
33611
36510
49495
33619
36660
46196
33647
39503
49600
33670
43313
49605
33690
43314
49606
33694
43520
49610
33730
43831
19611
33732
44055
53025
33735
44126
54000
33736
44127
54150
33750
44128
54160
33755
46070
63700
33762
46705
63702
33778
46715
63704
33786
46716
63706
33922
46730
65820
...
March 21st, 2019
The Impact of Medical Necessity on High Level E/M Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2019
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...
March 18th, 2019
How to Report Imaging (X-Rays) of the Thumb
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 18th, 2019
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
March 11th, 2019
Spotlight: Services Excluded from Global Surgery Payment
By Brittney Murdock, QCC, CMCS, CPC | Published March 11th, 2019
The following services are excluded from global surgery payment according to Noridian Medicare. These services may be paid for separately. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial...
March 7th, 2019
Date of Service Reporting for Radiology Services
By Wyn Staheli, Director of Research | Published March 7th, 2019
Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.
March 4th, 2019
Billing Guidelines for Repositioning
By Wyn Staheli, Director of Research | Published March 4th, 2019 - Last Review/Update March 6th, 2019
Code 95992 has some very limited payer payment guidelines which need to be understood for proper reimbursement. Many payer policies consider this service bundled with Evaluation and Management Services, therefore, it would not be separately payable if there was an E/M service performed on the same date. Some providers have reported having trouble ...
March 4th, 2019
Answers to Your Auditing & Compliance Questions
By Namas | Published March 4th, 2019 - Last Review/Update March 7th, 2019
National Alliance of Medical Auditing Specialists (NAMAS) hosts a forum where auditing and compliance professionals can get answers to their questions, and exchange information with other professionals across the country. Recently, we've received the following question regarding fracture care that we'd like to share below.
Q: I recently noticed CPT 26600, ...
March 4th, 2019
Spotlight: GLOBAL Periods
By Brittney Murdock, QCC, CMCS, CPC | Published March 4th, 2019
A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal post- operative care are bundled into the global surgery fee. Global surgery is not restricted to hospital...
March 4th, 2019
UnitedHealthcare to Discontinue Coverage of Consultations
By Wyn Staheli, Director of Research | Published March 4th, 2019 - Last Review/Update March 7th, 2019
In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255).
March 4th, 2019
Medicare Physician Fee Schedule Indicators
By Brittney Murdock, QCC, CMCS, CPC | Published March 4th, 2019
Many denials can be avoided when you understand how a payer looks at a code. Find-A-Code puts a lot of this information all on one page. Under Additional Code Information on CPT codes you will find a lot of questions can be answered. In addition to the global policy, uniform...
March 1st, 2019
Understanding NCCI Edits
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 1st, 2019
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
February 22nd, 2019
Separately Report a "Separate Procedure" with Confidence
By Namas | Published February 22nd, 2019 - Last Review/Update February 28th, 2019
Many procedures in the CPT® code book are designated "separate procedures," but that doesn't mean you can report those procedures separately in every case. First, you must consider other procedures performed during the same encounter.
"Separate" Might Not Mean What You Think It Does
You can always identify a designated separate procedure by the inclusion of "(separate ...
February 14th, 2019
Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries
By Aimee Wilcox | Published February 14th, 2019
Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...
February 13th, 2019
Detection by Nucleic Acid (DNA or RNA) - Amplified Probe Technique
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 2019
This question was asked on the following lab codes used for testing during pregnancy. "Can the codes below be billed together? 87491- 59, 87591-59. 87081, 87150."
YES- CPT code 87081 is used when a specific pathogen is suspected and is appropriate.
YES- (X2) 87150 is used for culture, typing, and identification by nucleic ...
February 12th, 2019
Coding Medicare Initial Preventive Physical Exams (IPPE)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 12th, 2019
The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...
February 7th, 2019
Q/A: Do Digital X-rays Have Their Own Codes?
By Wyn Staheli, Director of Research | Published February 7th, 2019 - Last Review/Update February 8th, 2019
Question
Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes?
Answer
There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...
February 5th, 2019
Clinical Staff vs. Healthcare Professional
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 5th, 2019
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.
Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges.
Examples of Qualified Healthcare professionals:
(NOTE: this list is not all-inclusive, please refer to your payer ...
February 1st, 2019
Q/A: Can I Bill a Review of X-Rays?
By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published February 1st, 2019
It is not unusual for a healthcare provider to review x-rays taken and professionally read by another entity. Questions arise regarding how to bill this second review. It is essential to keep in mind that the global (complete) service of taking an x-ray is composed of both a professional and ...
February 1st, 2019
Physical Therapy Caps Q/A
By Wyn Staheli, Director of Research | Published February 1st, 2019 - Last Review/Update February 4th, 2019
Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...
January 28th, 2019
Q/A Neonate Coding When Child is Transferred (2019/01/17)
By Codapedia | Published January 28th, 2019
Codapedia Forum - Questions & Answers
Q/A: Neonatologist was at the birth of a very critical child, she billed 99468 and then it was decided to transfer the child to another facility, she also billed 99291 and 99292 x 3. Her time was denied, how should she have billed for the initial ...
January 24th, 2019
Q/A: Which Code Should I Use for a Lab Interpretation Fee?
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 24th, 2019 - Last Review/Update February 4th, 2019
Question
Which code should I use for a lab interpretation fee? Specifically, I have ordered a female hormone saliva test, and would like to charge a fee for time spent on the interpretation and consult.
Answer
This type of service generally does not involve a third party, so it may be acceptable to ...
January 23rd, 2019
How to Report Co-Surgeons Using Modifier 62
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2019
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 ...
January 14th, 2019
What is Virtual Communication (G0071)?
By NAMAS | Published January 14th, 2019 - Last Review/Update January 16th, 2019
Beginning January 1st, 2019 all of our RHC and FQHC organizations have a new CPT code to
consider implementing for their Medicare populous (check per Advantage Plan Administration for coverage). In its current form, this code is not reportable by organizations not meeting the RHC/FQHC designation.
The code isG0071 and is termed ...
January 14th, 2019
AMA Issues new CMT Information
By Wyn Staheli, Director of Research | Published January 14th, 2019
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 ...
January 4th, 2019
Nine New Codes for Fine Needle Aspirations (FNA) in 2019
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 4th, 2019
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 ...
January 3rd, 2019
Dry Needling
By Wyn Staheli, Director of Research | Published January 3rd, 2019
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 ...
January 3rd, 2019
Are You Ready For the 2019 New Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 3rd, 2019
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 ...
January 3rd, 2019
2019 Coding Changes for Chiropractic
By Wyn Staheli, Director of Research | Published January 3rd, 2019
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 ...
January 3rd, 2019
New Genetic Test for Severe Inherited Conditions
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 3rd, 2019
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 ...
January 3rd, 2019
Welcome 2019 CPT Codes!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 3rd, 2019
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 ...
December 20th, 2018
The Diabetic Patient and Medical Manifestations
December 20th, 2018
Flexion-Distraction Billing Clarification
By Wyn Staheli, Director of Research | Published December 20th, 2018
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 ...
November 29th, 2018
Billing Exercise Equipment
By Wyn Staheli, Director of Research | Published November 29th, 2018
While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...
November 26th, 2018
Allergy Immunotherapy Coding Guidelines (CMS) Effective: 01/01/2006
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 26th, 2018
Immunotherapy (Allergy Shots) is a medical treatment to used to treat and prevent reactions or desensitize the immune system to specific allergens that trigger allergy symptoms. Payers have specific coverage guidance and rules for reporting injections, the specific type of antigen(s) provided and how they should be reported.
Below are the coding guidelines from ...
November 26th, 2018
CMT Fees in 2019
By Wyn Staheli, Director of Research | Published November 26th, 2018 - Last Review/Update January 30th, 2019
Now is the time to prepare. There were some minor reductions to the RVUs for CMT codes 90840-90843. Check here to see what those changes are.
November 9th, 2018
Billing 99211 Its not a freebie
By | Published November 9th, 2018 - Last Review/Update November 29th, 2018
It seems like a simple code to bill, but CPT 99211 (established patient office visit) is by no means a freebie when it comes to documentation and compliance. This lowest level office visit code is sometimes called a "nurse visit" because CPT does not require that a physician be present...
November 8th, 2018
Muscle Testing and Range of Motion Information
By Wyn Staheli, Director of Research | Published November 8th, 2018
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
November 7th, 2018
Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?
By Wyn Staheli, Director of Research | 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 ...
November 7th, 2018
Q/A: What do I do When my State Doesn't Require Pre-certifications for PI, but the Payer in Another State Does?
By Wyn Staheli, Director of Research | Published November 7th, 2018 - Last Review/Update December 19th, 2018
Question:
In Pennsylvania for Personal Injury cases we do not need to go through specific care paths or get precertification in order to treat patients, however, in New Jersey (NJ), doctors that practice there are required to get that precertification. Our question is that when we bill a New Jersey auto ...
October 30th, 2018
Documentation Requirements for Allergy Testing 10/29/2018
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | 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 ...
October 30th, 2018
Common Allergy CPT Codes and MUEs
By Find-A-Code™ | 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 ...
October 29th, 2018
Allergy Testing 10/29/2018
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | 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 ...
October 16th, 2018
Pelvic Floor Dysfunction Treatment Coverage
By Wyn Staheli, Director of Research | 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 ...
October 16th, 2018
Q/A: What Codes do I use for CLIA-Waived Tests?
By Wyn Staheli, Director of Research | 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 ...
October 5th, 2018
Prolonged Services Its Not Just About Time
By BC Advantage | 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 ...
October 4th, 2018
Is cox-flexion distraction billable as 97012
By ChiroCode | Published October 4th, 2018 - Last Review/Update January 17th, 2019
Is cox-flexion distraction billable as 97012? Can you use 97140 and 98941 on the same day?
October 2nd, 2018
Tools and Resources for Life Care Planners
By Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS | 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...
September 28th, 2018
Chiropractic OIG Audit Recommendations - Lessons Learned
By Wyn Staheli, Director of Research | Published September 28th, 2018
The OIG recently concluded an audit on a chiropractic office located in Florida and had some significant findings. They recommended the following:
Refund to the Federal Government the portion of the estimated $169,737 overpayment for claims for chiropractic services that did not comply with Medicare requirements and are within the 4-year ...
September 26th, 2018
Rhizotomy Procedures
By BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018
The terms “rhizotomy” and “Radiofrequency Ablation” (RFA) both mean “destruction of a nerve.” Another term for this is “neurolysis.” The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve(s). Nerve Destruction choices include the following: Chemical Neurolytic Blocks - These require substances that are...
September 26th, 2018
The Potential Impacts of a Flat Rate EM Reimbursement on our Industry
By BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018
The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the...
September 24th, 2018
2019 Code Changes are Just Around the Corner - Are You Ready?
By Wyn Staheli, Director of Research | Published September 24th, 2018 - Last Review/Update January 28th, 2019
The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...
September 12th, 2018
Join QPro Today and Get Certified
By Find a Code | Published September 12th, 2018
Join QPro Today and Get Certified!
To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards.
Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...
August 27th, 2018
Pricing for ASC’s and APC’s
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 27th, 2018
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
August 16th, 2018
Importance of Depression Screenings
By Wyn Staheli, Director of Research | Published August 16th, 2018
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
August 16th, 2018
Medicare Timed Codes Guidelines
By Wyn Staheli, Director of Research | Published August 16th, 2018
Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time.
It should be noted that while ...
August 16th, 2018
Using Modifiers 96 and 97
By Wyn Staheli, Director of Research | Published August 16th, 2018
The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...
August 16th, 2018
Q/A: Can I Bill Mechanical Massage?
By Wyn Staheli, Director of Research | Published August 16th, 2018 - Last Review/Update January 30th, 2019
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
August 15th, 2018
BREAKING NEWS: CMS Proposes to Change E&M Coding
By | Published August 15th, 2018
On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware.
Where ...
July 25th, 2018
CMS Proposes Changes to Evaluation & Management Requirements
By Wyn Staheli, Director of Research | Published July 25th, 2018
It is no secret that providers have long argued that E/M coding is burdensome and does not truly reflect the services provided. This fact is acknowledged by CMS with the following statement "Prior attempts to revise the E/M guidelines were unsuccessful or resulted in additional complexity due to lack of ...
July 25th, 2018
Q/A: Can I Bill Spinal Decompression Table to Insurance?
By Wyn Staheli, Director of Research | Published July 25th, 2018 - Last Review/Update January 28th, 2019
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
July 18th, 2018
Provider-Based Facilities and Split Billing: Is Your Facility Being Reimbursed for All Work Performed?
By | Published July 18th, 2018
Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed.
For ...
July 16th, 2018
CMS Proposed New E/M Codes for Podiatry
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 16th, 2018 - Last Review/Update July 17th, 2018
According to CMS changes are coming for E/M codes. A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed ...
July 12th, 2018
Q/A: Can You Swap Out 97140 with 97530?
By Wyn Staheli, Director of Research | Published July 12th, 2018 - Last Review/Update January 28th, 2019
Codes 97140 and 97530 are not interchangeable. See why.
June 20th, 2018
Q/A: Should I Bill Massage as 97124 or 97140?
By ChiroCode | Published June 20th, 2018 - Last Review/Update January 30th, 2019
Question
The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...
June 13th, 2018
Q/A: Coding for ECG/EKG’s
By Chris Woolstenhulme QCC, CMCS, CPC, CMRS & Marge McQuade | Published June 13th, 2018 - Last Review/Update September 24th, 2018
Q: Our clinic is owned by a hospital, but there is equipment in the clinic to do ECG/EKG’s. When the test is done here in the clinic, and the provider does the interpretation and report, is 93000 the correct code to bill? The equipment is owned by the clinic and ...
June 11th, 2018
Inappropriate Use of Units Costs Practice Over $800,000
By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published June 11th, 2018
A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?
June 8th, 2018
Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?
By Sharon Hoglund, CPC, CPMA, CEMC, CEMA | Published June 8th, 2018 - Last Review/Update July 3rd, 2018
Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed...
June 7th, 2018
The Range of Motion Conundrum
By Gregg Friedman, DC, CCSP | Published June 7th, 2018 - Last Review/Update January 30th, 2019
As both a chiropractor for 31 years and one who reviews a lot of medical records for the medicolegal arena and has been teaching documentation for many years, the range of motion question comes up frequently. Although we used to get reimbursed very well for a specific range of motion code back in ...
June 5th, 2018
Q/A: Coding for Lesion Removal and Repair
By Chris Woolstenhulme QCC, CMCS, CPC, CMRS | Published June 5th, 2018 - Last Review/Update July 9th, 2018
The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that...
June 4th, 2018
How Many Modalities Are Too Many?
By Dr Evan Gwilliam, Clinical Director for PayDC chiropractic EHR software | Published June 4th, 2018 - Last Review/Update January 30th, 2019
Q: I have a payor who is denying modalities, claiming that they are “excessive”. At a single encounter I billed for:
98940- Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
97110- Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
G0283- Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care
97010- Application of a modality to 1 or more areas; hot or cold packs
Is this excessive? How do I know how much is too much?
June 4th, 2018
Auditing Therapy Evaluation Codes - Not So Quick!
By Nancy J Beckley, MS, MBA, CHC | Published June 4th, 2018
New evaluation codes for physical therapy (PT) and occupational therapy (OT) codes were made effective 1/1/2017. Three new physical therapy evaluation codes replaced 97001, and three new occupational evaluation codes replaced 97003. Chart 1 - Short Code Descriptors The PT and OT reevaluation codes remain the same but were...
May 30th, 2018
EM Code Changes in CPT 2018
By Amy C. Pritchett, BSHA, CCS, CPC, CPMA, CPC-I, CEDO, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS | Published May 30th, 2018 - Last Review/Update June 4th, 2018
It is that time of year again! The time to throw out the old and bring in the new. With the release of the CPT 2018 updates, we will see major changes in coding throughout the E/M section.
May 22nd, 2018
AMA vs Medicare rules and the use of the PT modifier
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 22nd, 2018
Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...
May 9th, 2018
Preventive Medicine: General Procedures
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018
Preventive Medicine Topics Page
General Procedures
Procedure Codes 36415: Collection of venous blood by venipuncture 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List ...
May 9th, 2018
Preventive Medicine: Alcohol Misuse Screening & Counseling
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018
Preventive Medicine Topics Page
// Alcohol Misuse Screening and Counseling
Procedure Codes G0442: Annual alcohol misuse screening, 15 minutes G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes 99408: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to ...
May 9th, 2018
Preventive Medicine: Screening for Anemia
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening for Anemia
Procedure Codes 85004: Blood count; automated differential WBC count 85014: Blood count; hematocrit (Hct) 85013: Blood count; spun microhematocrit 85018: Blood count; hemoglobin (Hgb) 80055: Obstetric panel
ICD-10-CM 85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0 80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, ...
May 9th, 2018
Preventive Medicine: Annual Wellness Visit
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Annual Wellness Visit
Procedure Codes G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 99385: Initial comprehensive preventive medicine evaluation and management of an individual including ...
May 9th, 2018
Preventive Medicine: Bone Mass Measurements
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Bone Mass Measurements
Procedure Codes G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078: Computed tomography, bone mineral density study, 1 or more ...
May 9th, 2018
Preventive Medicine: Breast Cancer Genetic Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Breast Cancer Genetic Screening
Procedure Codes 81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 ...
May 9th, 2018
Preventive Medicine: Cardiovascular Disease Screening Tests
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Cardiovascular Disease Screening Tests
Procedure Codes 80061: Lipid panel. This panel must include the following:
Cholesterol, serum, total
Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
Triglycerides
82465: Cholesterol, serum, total 83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 84478: Triglycerides 83721: Lipoprotein, direct measurement; LDL cholesterol 83719: Lipoprotein, ...
May 9th, 2018
Preventive Medicine: Cervical Dysplasia Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Cervical Dysplasia Screening
Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...
May 9th, 2018
Preventive Medicine: Colorectal Cancer Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Colorectal Cancer Screening
Procedure Codes G0104: Colorectal cancer screening; flexible sigmoidoscopy G0105: Colorectal cancer screening; colonoscopy on individual at high risk G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0122: Colorectal cancer screening; barium ...
May 9th, 2018
Preventive Medicine: Contraceptive Methods
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Contraceptive Methods
Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...
May 9th, 2018
Preventive Medicine: Counseling to Prevent Tobacco Use
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Counseling to Prevent Tobacco Use
Procedure Codes 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
ICD-10-CM 99406-99407: No specific diagnoses
Frequency 99406-99407: 2 attempts a year, ...
May 9th, 2018
Preventive Medicine: Depression Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Depression Screening
Procedure Codes G0444: Annual depression screening, 15 minutes 96127: Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
ICD-10-CM G0444, 96127: No specific diagnoses
Frequency G0444:Once annually 96127: No specific frequency guidelines
Additional Information 96127
Only covered for ages ...
May 9th, 2018
Preventive Medicine: Diabetes Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Diabetes Screening
Procedure Codes 82947: Glucose; quantitative, blood (except reagent strip) 82948: Glucose; blood, reagent strip 82950: Glucose; post glucose dose (includes glucose) 82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to ...
May 9th, 2018
Preventive Medicine: Therapy for Fall Prevention
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Therapy for Fall Prevention
Procedure Codes 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, ...
May 9th, 2018
Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and Administration
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Hepatitis B Virus (HBV) Vaccine and Administration
Procedure Codes G0010: Administration of hepatitis b vaccine 90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743: Hepatitis ...
May 9th, 2018
Preventive Medicine: Hepatitis C Virus (HCV) Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Hepatitis C Virus (HCV) Screening
Procedure Codes G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 86804: Hepatitis C antibody; confirmatory test (eg, ...
May 9th, 2018
Preventive Medicine: Human Immunodeficiency Virus (HIV) Screening
By Brandon Herman, QMC, QMCC, QMBHC, QMPM, QMPoC | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Human Immunodeficiency Virus (HIV) Screening
Procedure Codes G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 ...
May 9th, 2018
Preventive Medicine: Human Papilomavirus (HPV) Vaccine and Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Human Papilomavirus (HPV) Vaccine and Screening
Procedure Codes 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, ...
May 9th, 2018
Preventive Medicine: Influenza Virus Vaccine and Administration
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Influenza Virus Vaccine and Administration
Procedure Codes Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Q2036: Influenza virus vaccine, split virus, when administered to individuals ...
May 9th, 2018
Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
Procedure Codes G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, ...
May 9th, 2018
Preventive Medicine: Lung Cancer Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Lung Cancer Screening
Procedure Codes G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) G0297: Low dose ct scan (ldct) for lung cancer screening S8092: Electron beam computed tomography (also ...
May 9th, 2018
Preventive Medicine: Newborn Screenings/Tests
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Newborn Screenings/Tests
Procedure Codes 82775: Galactose-1-phosphate uridyl transferase; quantitative 83498: Hydroxyprogesterone, 17-d 82017: Acylcarnitines; quantitative, each specimen 82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 82261: Biotinidase, each specimen 83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 83021: Hemoglobin ...
May 9th, 2018
Preventive Medicine: Pneumococcal Vaccine and Administration
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Pneumococcal Vaccine and Administration
Procedure Codes G0009: Administration of pneumococcal vaccine 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
ICD-10-CM G0009, ...
May 9th, 2018
Preventive Medicine: Screening for STIs & HIBC to Prevent STIs
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
Procedure Codes 86592: Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) 86593: Syphilis test, non-treponemal antibody; quantitative 86631: Antibody; Chlamydia 86632: Antibody; Chlamydia, IgM 86780: Antibody; Treponema pallidum 87110: Culture, chlamydia, any source ...
May 9th, 2018
Preventive Medicine: Screening Mammography
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Mammography
Procedure Codes 77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057: Screening mammography, bilateral ...
May 9th, 2018
Preventive Medicine: Screening Pap Tests
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Pap Tests
Procedure Codes G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation ...
May 9th, 2018
Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
Procedure Codes 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real ...
May 9th, 2018
Preventive Medicine: Screening Children for Visual Acuity
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Children for Visual Acuity
Procedure Codes 99173: Screening test of visual acuity, quantitative, bilateral
ICD-10-CM 99173: Z00.121, Z00.129, Z00.100, Z00.101
Frequency 99173: No specific frequency guidelines
Additional Information 99173
Not covered by Medicare for preventative care
Some policies will only cover as preventive for children, consult your payer
Find-A-Code™ - Preventive ...
May 9th, 2018
Preventive Medicine: Use of Modifier 33
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
The Use of Modifier 33
Modifier 33 is used to indicate Preventive Services to report quality metrics and is informational only, it has no impact on reimbursement. Modifier 33 should be reported only to private payers, Medicare and Medicaid do not recognize this modifier.
...
May 9th, 2018
Preventive Medicine: Dental Caries in Children
By Find-A-Code | Published May 9th, 2018 - Last Review/Update August 2nd, 2018
Preventive Medicine Topics Page
Dental Caries in Children
Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional
ICD-10-CM 99188: No specific diagnoses
Frequency 99188: No specific frequency guidelines
Additional Information 99188
Covered for children from birth until their seventh birthday
Find-A-Code™ - Preventive Services - The information ...
April 23rd, 2018
Brooklyn Chiropractor OIG Report - Lessons Learned
By Wyn Staheli, ChiroCode Director of Research & Dr. Evan Gwilliam, Clinical Director PayDC Software | Published April 23rd, 2018 - Last Review/Update February 28th, 2019
In August of 2017, a Brooklyn chiropractor was ordered to repay $672,805 to Medicare because the reviewer found that 100% of the claims reviewed (from 2011-2012) did not meet medical necessity requirements. The chiropractor enlisted help from two reputable experts who disputed the findings of Medicare’s Professional Reviewer (MPR). However, the OIG maintained that the findings of the original auditor were valid.
Since none of us have ½ million in cash just laying around, it is essential to learn, understand, and make changes where appropriate to help audit-proof patient documentation.
Read here to learn more.
April 23rd, 2018
Critical Care Documentation
By Scott Kraft, CPC, CPMA | Published April 23rd, 2018 - Last Review/Update May 2nd, 2018
Critical care documentation should show critical need for the patient AND immediate action by the provider....
April 17th, 2018
Q/A: Modifiers for Injections
By Nicole Olsen QCC | Published April 17th, 2018 - Last Review/Update July 9th, 2018
I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit....
April 12th, 2018
Billing Nutrition Counseling in a Chiropractic Setting
By Wyn Staheli, Director of Research | Published April 12th, 2018
Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ...
April 12th, 2018
Billing Nutrition Counseling
By Wyn Staheli, Director of Research | Published April 12th, 2018
Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management ...
April 9th, 2018
Coverage Criteria for Peripheral Venous Examinations
By Find-A-Code | Published April 9th, 2018
According to National Government Services LCD L33627, indications for venous examinations are separated into three major categories: deep vein thrombosis (DVT), chronic venous insufficiency, and vein mapping. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedure(s).
Since the signs and symptoms of ...
April 9th, 2018
Using Pulmonary Stress Tests
By Find-A-Code | Published April 9th, 2018
As per Palmetto GBA LCD L33444, exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions. The pulmonary stress test will be considered medically necessary for these conditions:INDICATIONS:Evaluation of exercise tolerance• Determination of functional impairment or capacity • ...
March 29th, 2018
Medicare Telemedicine Changes for 2018
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 29th, 2018
Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.
Originating Site Fee
Each ...
March 26th, 2018
Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together
By Chris Woolstenhulme QCC, CMCS, CPC, CMRS | Published March 26th, 2018 - Last Review/Update April 11th, 2018
I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again?
March 26th, 2018
Documentation for Evaluation and Management (E/M) Services
By | Published March 26th, 2018
According to WPS, when billing or coding for E/M services you should follow a few guidelines.
Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation.
Critical Care Visits
Clear indication of patient ...
March 21st, 2018
Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?
By Wyn Staheli, Director of Research | Published March 21st, 2018 - Last Review/Update January 30th, 2019
In order to understand and answer the question, "Why code 99080 is being denied when billed with an E/M Service, it is important to first review the requriements of selecting the appropriate level of Evaluation and Management service and how that relates to reporting a 99080 special report service. Continue reading for better understanding.
March 21st, 2018
Q/A: Billing for GI Anesthesia
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 21st, 2018 - Last Review/Update March 27th, 2018
Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary.
March 13th, 2018
When is 97112 Neuromuscular Re-education Billable?
By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019
Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.
March 13th, 2018
CPT Code for DOT exams
By Wyn Staheli, Director of Research | Published March 13th, 2018 - Last Review/Update January 31st, 2019
Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?
March 9th, 2018
The Comprehensive Error Rate Testing Program
By Frank Cohen, MBA, MPA | Published March 9th, 2018 - Last Review/Update April 12th, 2018
With nearly a million physicians in this country, how do auditing organizations determine whom to audit?
March 8th, 2018
Documentation for Bacterial Culture Lab Tests
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018
The Medicare Learning Network provides guidance on how to prevent denials of Bacterial Culture Laboratory Tests
March 8th, 2018
Documentation for Bacterial Culture Lab Orders
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018
The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests...
March 5th, 2018
Increased Therapy Denials Create Administrative Burden
By Wyn Staheli, Director of Research | Published March 5th, 2018
Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ...
February 26th, 2018
Medicare Changes Requirements for Implantable Cardioverter Defibrillators (ICDs)
By Wyn Staheli, Director of Research | Published February 26th, 2018
Whenever there is a high-cost item, CMS has historically evaluated usage to determine appropriateness of billing and this is another example. A Decision Memo was released on February 15, 2018 which included the following changes:
Changes to who qualifies for a device and the required waiting periods
Patient registry no longer required
Cardiac magnetic resonance ...
February 23rd, 2018
The Comprehensive Error Rate Testing Program
By Frank Cohen, MBA, MPA | Published February 23rd, 2018 - Last Review/Update February 26th, 2018
With nearly a million physicians in this country, how do auditing organizations determine whom to audit?
February 20th, 2018
Consultation Codes Q/A
By ChiroCode | Published February 20th, 2018 - Last Review/Update February 4th, 2019
Question
Are there consultation codes that can be used for new and existing patients when a review of systems and detailed history is performed but no examination due to the patient's reluctance to make a decision to continue with the visit but has taken up 30-45 minutes of the doctors time?
February 13th, 2018
New Modifiers Released in 2018
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 2018
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 ...
February 13th, 2018
Payment Rates Increase for Behavioral Health Office Services
By Wyn Staheli, Director of Research | Published February 13th, 2018
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 ...
February 1st, 2018
Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes
By Find-A-Code | Published February 1st, 2018
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, ...
February 1st, 2018
How to Code Screening and Diagnostic Colonoscopy
By Natalie Tornese, CPC | Published February 1st, 2018
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" ...
February 1st, 2018
Don’t Be Hesitant About Collecting Co-Pays
By | Published February 1st, 2018
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 ...
February 1st, 2018
Strapping and Kinesio Taping Coding Differences
By Wyn Staheli, Director of Research | Published February 1st, 2018
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally.
Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue.
Coding: ...
February 1st, 2018
Multiple Diagnostic Imaging Payment Reduction
By Wyn Staheli, Director of Research | Published February 1st, 2018
CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...
February 1st, 2018
Traumatic Subluxation Coding Controversy
By Wyn Staheli, Director of Research | Published February 1st, 2018
There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...
January 31st, 2018
Q/A: Can I Perform 2 Untimed Codes at the Same Time?
By Wyn Staheli, Director of Research | Published January 31st, 2018 - Last Review/Update February 4th, 2019
Question: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?
January 31st, 2018
Influenza, Are You Billing Correctly?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 31st, 2018
With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.
Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ...
January 29th, 2018
Insufficient Documentation Errors
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018
According to CMS ICN 909160, claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed, meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.
Claims ...
January 29th, 2018
Anesthesia and Fee Calculation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018 - Last Review/Update April 16th, 2020
Fees for anesthesia services are not calculated the same as for other types of procedures. There are four elements to consider when calculating anesthesia fees. Medicare accepts base units and time units; however, depending on the third party payer, they may or may not accept physical status units and/or qualifying circumstances units.
Base Unit (of the CPT code)
Time (in ...
January 29th, 2018
Paravertebral Joint/Nerve Blocks - Diagnostic and Therapeutic
By Find-A-Code | Published January 29th, 2018
According to Medicare article A50443, a facet joint level refers to the zygapophyseal joint or the two medial branch nerves innervating that zygapophyseal joint. Use CPT codes 64491 and 64492 in conjunction with 64490. Do not report CPT code 64492 more than once per day. Use CPT codes 64494 and 64495 in conjunction with 64493. Do not report CPT code 64495 more than once per day. For injection of ...
January 29th, 2018
Non-Coronary Vascular Stents: Mesenteric Vessels
By Find-A-Code | Published January 29th, 2018
The following information is according to Novitas Solutions L35084.
Mesenteric vessels: This includes
Acute mesenteric ischemia
Chronic mesenteric ischemia
Mesenteric thrombosis
Dissection or any other vascular insufficiency resulting in gastrointestinal symptoms
Stenting of the mesenteric vessels is covered only when angioplasty of the vessels would not suffice and after the patient has had a thorough medical evaluation and management of symptoms, and for whom surgical intervention is the likely ...
January 25th, 2018
Psychiatric Partial Hospitalization Programs
By Wyn Staheli, Director of Research | Published January 25th, 2018
Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...
January 23rd, 2018
NEW on Find-A-Code...National Coverage Determinations (NCDs)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2018 - Last Review/Update January 25th, 2018
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...
January 18th, 2018
What's the definition of an Office Visit and Can I Bill it With a Chiropractic Treatment?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published January 18th, 2018 - Last Review/Update February 4th, 2019
What is the definition of Office Visit? Can It be billed with a Chiropractic Treatment? What about using code 99123 E&M code for office visits? Can we bill of office visits even though we are giving chiropractic care?
January 18th, 2018
2018 Revisions to Prolonged Services
By Wyn Staheli, Director of Research | Published January 18th, 2018
For 2018, there were some changes to the guidelines for prolonged services (99358 and 99359). Providers need to be aware that there were technical corrections made which may not be included in their CPT code book - but they are in FindACode.com effective January 1, 2018. Please note that the ...
January 18th, 2018
Medicare's Integrated Behavioral Healthcare Services and Collaborative Care Program
By Wyn Staheli, Director of Research | Published January 18th, 2018
Over the last several years, primary care has begun to integrate behavioral health services to better address shortfalls in patient quality of care. Some of the first codes were the Health and Behavior Assessment/Intervention (96152-96155) codes, which were added in 2002. Since then, many different models have been experimented with and have ...
January 16th, 2018
Non-Coronary Vascular Stents: Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infropoliteal arteries)
By Find-A-Code | Published January 16th, 2018
The following information is according to Novitas Solutions L35084.
Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infrapopliteal arteries): This includes:
Lifestyle-limiting claudication
Focal hemodynamically significant lesion
Ischemic rest pain
Non-healing tissue ulceration
Focal gangrene
Stent placement in infrapopliteal vessels is not expected to be often indicated and in those cases the rationale for stent placement must be explained in the record.
CPT codes:
37221
37223
37226
37227
37230
37231
37234
37235
ICD-10-CM codes:
Type 1 diabetes mellitus
E10.51 - with diabetic peripheral angiopathy without gangrene
E10.59 - with other circulatory ...
January 16th, 2018
Non-Coronary Vascular Stents: Renal artery
By Find-A-Code | Published January 16th, 2018
The following information is according to Novitas Solutions L35084.
Renal artery: Stenting may be indicated for renal artery stenosis causing renovascular hypertension (see below) or renal insufficiency as well as post-transplant renal artery stenosis, arterial aneurysm or dissection. Renal artery angioplasty with or without stenting is covered for renal artery stenosis manifested by at least one of the following conditions:
Recurrent (“flash”) pulmonary edema without cardiac ...
January 16th, 2018
Non-Coronary Vascular Stents: Brachiocephalic arteries
By Find-A-Code | Published January 16th, 2018
According to Novitas Solutions L35084
Brachiocephalic arteries (including subclavian, except carotid bifurcation): Stenting may be indicated for treatment of flow-limiting stenosis resulting in conditions such as:
Subclavian steal syndrome
Upper extremity claudication
Ischemic rest pain of the arm and hand
Non-healing tissue ulceration
Focal gangrene.
CPT codes:
37236
37237
ICD-10-CM codes:
G45.8 - Other transient cerebral ischemic attacks and related syndromes
Unspecified atherosclerosis of native arteries of extremities
I70.201 - right leg
I70.202 - left leg
I70.203 - ...
January 15th, 2018
Medicare Requiring Specific Modifiers on Therapy Services
By Wyn Staheli, Director of Research | Published January 15th, 2018
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
Services furnished under the Outpatient ...
January 15th, 2018
Billing with a GP Modifier
By Wyn Staheli, Director of Research | Published January 15th, 2018 - Last Review/Update January 30th, 2019
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
January 10th, 2018
Paravertebral Joint/Nerve Denervation
By Find-A-Code | Published January 10th, 2018
A facet joint is supplied by two medial branch nerves. Each medial branch nerve supplies sensation to one half of each facet joint above and below the spinal nerve of origin. Therefore, both of the two related medial nerve branches for each facet joint must be treated. The CPT codes 64635-64636 have a ...
January 9th, 2018
Conscious (Moderate) Sedation
By Find-A-Code | Published January 9th, 2018
Moderate (Conscious) sedation is a drug-induced state of relaxation in which the patient is typically awake and can respond to verbal commands, but might not be able to speak. A combination of medicines is used and often includes a sedative as well as an anesthetic to block pain.
January 9th, 2018
Non-Coronary Vascular Stents: Inferior vena cava and iliofemoral veins
By Find-A-Code | Published January 9th, 2018
The following information is according to Novitas Solutions, L35084.
Inferior vena cava and iliofemoral veins: This includes vena cava and iliofemoral venous occlusions and stenosis due to the following
Post-radiation venous stenosis
Congenital stenoses or webs
Extrinsic venous compression (May-Thurner syndrome)
Thrombophlebitis and symptomatic post-traumatic venous stenosis.
CPT codes:
37238
37239
ICD-10-CM codes:
Phlebitis and thrombophlebitis
I80.10 - of unspecified femoral vein
I80.11 - of right femoral vein
I80.12 - of left femoral vein
I80.13 - of femoral vein, bilateral
I80.211 - of right iliac vein
I80.212 - of left iliac vein
I80.213 - of iliac vein, bilateral
I80.219 - of unspecified iliac vein
I80.8 - of ...
January 9th, 2018
Should ROM Testing be Reported with Evaluation and Management Services?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 9th, 2018
Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.
January 9th, 2018
Billing Electrotherapy with AcuKnee
By Christine Woolstenhulme | Published January 9th, 2018
This code is commonly used to bill for AcuKnee products. Per AcuKnee, “NMES and electrotherapy may be covered by most insurance providers, provided the following criteria are met;”
Documentation of chronic pain or muscle atrophy 3 months or longer
Must document improvement
Must have physician document medical necessity/Prescription
Appropriate authorization from your insurance provider
Suggested codes when billing
64550 initial electrotherapy education and placement
E0720 Electrotherapy unit itself
E0731 Garment ...
January 9th, 2018
Outpatient Rehabilitation Modifiers
By Jared Staheli | Published January 9th, 2018
Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries.
For services delivered under an outpatient plan of care use modifier:
GN for speech-language pathology
GO for occupational therapy
GP for physical therapy
In addition to using the correct modifier, ...
January 9th, 2018
Preventive Medicine with a New Patient
By Find-A-Code | Published January 9th, 2018
When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required.
New Patient: A patient that has not received any professional services i.e., E&M or any other face to face service from the physician or group within the ...
January 5th, 2018
Medicare Reimburses for Discarded/Wasted Drugs
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 5th, 2018
Your organization may be leaking revenue without realizing the leak can be stopped. If your organization purchases single-use packets or single dose vials for individual patient use and ends up discarding some of the drug, Medicare has now authorized payment for the discarded or wasted portion. Stop leaking revenue today by reading this article and implementing the guidance provided here.
January 4th, 2018
Beware of Limitations When Using Electrical Stimulation - Ultrasound
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 4th, 2018
Ultrasound is often used to reduce inflammation, and improve the flexibility of connective tissue. This is done by applying sound waves to produce heat and/or vibration. Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the requirements for ...
January 4th, 2018
Acute Post-Operative Pain Management
By Find-A-Code | Published January 4th, 2018
CPT codes 62320, 62322 should be used when the analgesia is delivered by a single injection.These codes should only be used when the catheter or injection is not used for administration of anesthesia during the operative procedure. Modifier 59 should be used when billing these services to indicate that the catheter or injection was a ...
January 4th, 2018
Proper Usage of Electrical Stimulation
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment.
97032 is a constant attendance electrical stimulation modality ...
January 4th, 2018
Initial Evaluation Codes for PT's and OT's
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation.
These evaluation codes are untimed, billable as one unit.
Do ...
January 4th, 2018
PT and OT Reevaluation Coding
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...
January 4th, 2018
General Physical Therapy Modality Guidelines
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention.
CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ...
January 4th, 2018
Diathermy eg Microwave Use and Documentation
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ...
January 4th, 2018
Ultrasound Therapy
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to
3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ...
January 4th, 2018
Hydrotherapy Guidelines
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ...
January 4th, 2018
99024 for Subsequent Visits Within Global Period
By Find-A-Code | Published January 4th, 2018
Beginning July 1, 2017, there are 293 procedure codes with 10 and 90 day global days which will require practices with ten or more providers in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio and Oregon to use 99024 for subsequent visits within the global period. Many of these procedures are ...
January 4th, 2018
2017-2018 Influenza (Flu) Resources for Health Care Professionals
By Find-A-Code | Published January 4th, 2018
Per CMS: Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies. Annual Part B deductible and coinsurance amounts do not apply.
Payment allowance limits for personal flu and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished ...
January 4th, 2018
Billing Negative Pressure Wound Therapy (NPWT) (disposable device)
By Find-A-Code | Published January 4th, 2018
Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes:
97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ...
January 4th, 2018
Mechanical Traction Therapy
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ...
December 28th, 2017
Sleep Testing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 28th, 2017
Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment.
There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All ...
December 28th, 2017
Cleft Surgical Services
By Raquel Shumway | Published December 28th, 2017
Cleft palate and cleft lip diagnoses medical in nature and as such should be reported using the Current Procedural Terminology (CPT) codes instead of the Current Dental Terminology (CDT) codes. As such, Evaluation and Management (EM) services should be reported for the initial encounter with the patient and follow-up care ...
December 28th, 2017
Alcohol Misuse Screening and Counseling
By Wyn Staheli | Published December 28th, 2017
Codes G0442 (screening) and G0443 (15 min counseling) are typically a covered preventive service for most payers. As a preventive service, copayment/coinsurance and deductibles are typically waived. These are NOT considered treatment services or sessions for alcoholism or other substance abuse. If the screening results indicate that the patient is dependent and is open to the ...
December 28th, 2017
Moderate Sedation Services - CPT has 6 Codes to One Dental Code
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 28th, 2017
When billing a medical code instead of the dental code D9223 -Deep sedation/general anesthesia - each 15 minute increment, consider the following medical codes: (Be sure to review the AMA guidelines to see if they fit the procedure you are doing). If a dental office is doing conscious sedation for a patient ...
December 13th, 2017
AT and GA Modifiers When Billing CMT and Non-covered Codes to Medicare
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published December 13th, 2017 - Last Review/Update February 5th, 2019
Questions regarding using modifiers when billing CMT and non-covered codes to Medicare. We have used AT (Active) and GA (signed ABN) when billing active care for CMT codes 98940-98942 (e.g., 98941-ATGA) in the past. Currently we are told not to bill GA with AT. How do we bill?
December 12th, 2017
THE EOB SAYS “BUNDLED” - NOW WHAT?
By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017
Payers often bundle separate codes together so that they can pay you less. Just because the EOB says the codes are bundled doesn’t mean you have to let the insurance company get away with it. Fight Back!!! How does bundling work? If a patient presents for evaluation of diabetes, and...
December 12th, 2017
E/M DOCUMENTATION Does Your Coding Match Your Documentation???
By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017
No matter what your specialty we are all faced with making sure our physician uses the correct E& M Code for what he/she documented. Remember if it wasn’t documented it wasn’t done!!!! That said, when looking at documentation to code E/M services, it’s good to educate the providers to document...
November 30th, 2017
Why You Should Stop Using ROM as an Outcome Measure
By Dr. Ron Feise, Practice Consultant and Coach with RJF Consulting - www.chiroevidence.com | Published November 30th, 2017 - Last Review/Update January 30th, 2019
We received this email from a chiropractic colleague: “I recently attended a
continuing education seminar accredited by a chiropractic college. The presenter
was talking about outcome measures and highly recommended cervical and
lumbar range of motion (ROM) as a good outcome measure for patients with
spinal conditions. But I am hesitant to use ROM, because it seems to be
inconsistent with a patient’s status.”
What does the current research demonstrate?
November 24th, 2017
Inpatient critical care: When is it ok to question the medical necessity?
By Stephanie Allard, CPC, CEMA, RHIT | Published November 24th, 2017 - Last Review/Update January 31st, 2018
While critical care may be easily identifiable within documentation it is not always clear if it is medically necessary.....
November 16th, 2017
Can an Unlicensed Person Perform Physical Therapy Services Such as 97110?
By Wyn Staheli, Director of Research | Published November 16th, 2017 - Last Review/Update January 30th, 2019
Can an unlicensed person perform code a 97110 service as long as they're under doctor supervision? I use only PT, ATC, or DC's to perform these codes and I've been told that I don't need such highly qualified therapists to perform therapy.
November 15th, 2017
Medicare Offering FREE Resources- Educate Beneficiaries About the New Medicare Cards
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 15th, 2017
Medicare is offering FREE resources to help you notify patients about the new Medicare cards. MLN connects newsletter announced the following.
"CMS is starting to conduct a major education campaign about the new card for people with Medicare. Help alert your patients by displaying a poster in your office and giving your patients tear-off sheets or fliers.
Register ...
November 10th, 2017
Escharotomy Procedural Cross-Walking CPT to ICD-10-PCS
By Brandon Dee Leavitt QCC, CMCS, CPC, EMT | Published November 10th, 2017 - Last Review/Update November 17th, 2017
An Escharotomy is used for "local treatment of burned surface" per the AMA Guidelines, when incisions are performed on the burn site. Notice, when cross-walking 16035 or 16036 to inpatient codes, Find-A-Code crosswalks lead to Body System H, Operation 8 - Division of the skin, and Operation N - Release of the skin.
A division or release of the skin would be a ...
November 7th, 2017
Four Final Rules Affecting CMS Payments for 2018
By Wyn Staheli, Director of Research | Published November 7th, 2017
It’s a season for changes. CMS just finalized four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018
HHAs: Payment Changes for 2018
Quality Payment Program Rule for Year 2
This ...
November 6th, 2017
New Payment Rulings Could Affect You
By Wyn Staheli, Director of Research | Published November 6th, 2017
Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...
November 3rd, 2017
Auditing Medical Decision Making
By Grant Huang, CPC, CPMA | Published November 3rd, 2017 - Last Review/Update January 31st, 2018
With CMS looking to gradually revise its E/M documentation requirements to reduce the burden and complexity they pose to providers, it's a great time to review the trickiest E/M component: medical decision making (MDM)....
October 31st, 2017
Correct Coding for Group Therapy
By David Klein CPC, CPMA, CHC | Published October 31st, 2017 - Last Review/Update February 5th, 2019
Recent events regarding delegation of services to ancillary personnel have given rise to concerns regarding the delivery of outpatient physical medicine by Chiropractors, specifically regarding the appropriate use of one-on-one codes as opposed to group therapy code CPT 97150 - Therapeutic procedure(s), group (2 or more individuals). This advisory provides guidance on how to properly use one-on-one and group therapy codes, both independently and together.
October 27th, 2017
Speech-Language Pathology Services Policy from UniCare
By Find-A-Code | Published October 27th, 2017
Medically Necessary:
Rehabilitative speech-language pathology (SLP) services are considered medically necessary when ALL of the following criteria are met:
The services are used in the treatment of communication impairment or swallowing disorders resulting from illness*, injury, surgery, or congenital abnormality; and
Based on a plan of care, the therapy sessions achieve a specific ...
October 24th, 2017
Q&A: Blue Cross Blue Shield Updating Their Policy on the Application of Therapies by a Chiropractic Assistant
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 24th, 2017
ChiroCode recently received the following inquiry: Blue Cross Blue Shield is updating their policy on the application of therapies by a chiropractic assistant. It is as follows: "Physical Therapy and Chiropractic Billing Guidelines Reminder Physician or Chiropractor “Incident To” Billing of Therapy Services (New) Beginning January 1, 2018, physicians and...
October 23rd, 2017
Summary of OIG Reports for Chiropractic
By | Published October 23rd, 2017
The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ...
October 20th, 2017
What is the Best Code to use for PNF Stretching of the Hamstrings and Glutes?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 20th, 2017 - Last Review/Update February 8th, 2019
What is the best code to use for PNF stretching of the hamstrings and gluts? The doctor is currently using 97112.
October 20th, 2017
A P.A.R.T. Template
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 20th, 2017 - Last Review/Update February 5th, 2019
Here at ChiroCode we are often asked for examples of perfect forms to use in the office. As such we have developed some.
October 13th, 2017
So, How Do You Decide if a Service was Provided?
By David Glaser, JD | Published October 13th, 2017 - Last Review/Update January 31st, 2018
An earlier coding tip explained that the oft-repeated "if it isn't written, it wasn't done" is good risk management advice, but not a legal truism.....
October 5th, 2017
Q/A: Do we Need to Charge for Non-covered Services Performed Under a Maintenance Visit if we Use the S8990 Code When Billing Medicare?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 5th, 2017 - Last Review/Update February 5th, 2019
Do we need to charge for non-covered services performed under a maintenance visit if we use the S8990 code when billing Medicare?
October 5th, 2017
Brace Yourself for New ICD-10 and CPT Codes for 2018!
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 5th, 2017 - Last Review/Update February 5th, 2019
What is new for Chiropractors for 2018? See for yourself the new ICD-10 and CPT Codes.
September 30th, 2017
Annual Wellness Visit & Health Risk Assessment
By Find-A-Code | Published September 30th, 2017 - Last Review/Update October 1st, 2017
Coding tips regarding Annual Wellness Visit and Health Risk Assessments
September 25th, 2017
Q/A: What is the Proper Usage of Code 97150?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published September 25th, 2017 - Last Review/Update February 5th, 2019
What is the proper usage of CPT 97150 and what are the documentation requirements for that?
September 22nd, 2017
New Policy from UnitedHealthcare
By Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CEMA | Published September 22nd, 2017 - Last Review/Update January 31st, 2018
In the June 2017 UHC Network Bulletin, there was an article that addressed UHC's decision to no longer pay for consultation services.....
September 20th, 2017
Bladder/Urothelial Tumor Markers (Jurisdiction F)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 20th, 2017
CMS recently released a new LCD for Jurisdiction F, Bladder/Urothelial Tumor Markers (L36680).
Documentation Requirements
The medical record must clearly identify the number and frequency of bladder marker testing. Medical record documentation must be legible, must be maintained in the patient’s medical record (hard copy or electronic copy), and must meet the ...
September 14th, 2017
Double Dipping in the History of the Evaluation and Management Note
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published September 14th, 2017
There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history.
The subcomponents of history include:
Chief Complaint ...
September 12th, 2017
Auditing Prolonged Evaluation and Management Services
By Aimee Wilcox | Published September 12th, 2017 - Last Review/Update September 18th, 2017
At times, there are patients who require prolonged face-to-face time with the provider to discuss or be counseled about their condition, plan of care, risks, complications, alternative therapies, or other medical issues. When E/M services go wild, taking significantly longer than the typical time associated with it, that direct face-to-face ...
September 8th, 2017
Global Surgical Package: When to Bill and When Not to Bill, that is the Question
By Stephanie Allard, CPC, CEMA, RHIT | Published September 8th, 2017 - Last Review/Update January 31st, 2018
The global surgical package is inclusive of the services that would normally be provided to the patient following surgery. Depending on the global period assigned to a CPT code, the pre-operative, intra-operative and post-operative services could be included in the global surgical package.....
September 1st, 2017
2017 Physical Therapy Evaluation & Management Codes
By Kathy Price, RHIT, CPC, CCS-P, CPMA | Published September 1st, 2017 - Last Review/Update January 31st, 2018
As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy....
September 1st, 2017
Quick Tip from ChiroCode -- Documentation
By ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019
Documentation Solutions, a quick tip video by Dr Gwilliam.
September 1st, 2017
Evaluation and Management
By ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019
Question
In our office when the doctor initially sees a new patient, we bill a new patient code. (99201, 99202, 99203, or 99204) At that time, the doctor gives the patient an X-ray script and informs them to return to the office with their disk for an ROF (review of findings) to go over their results and also to determine their treatment plan, etc. When this happens, can a separate E/M code be billed, like 99211, 99212, 99213, 99214 or is there another code that can be used?
September 1st, 2017
Preventive Services: Annual Wellness Visit (AWV)
By Find-A-Code | Published September 1st, 2017 - Last Review/Update March 12th, 2018
The following information from the Medicare Learning Network provides guidance on Annual Wellness Visits (AWV)
September 1st, 2017
Preventive Services: Bone Mass Measurements
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Bone Mass Measurements
September 1st, 2017
Preventive Services: Cardiovascular Disease Screening Tests
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Cardiovascular Disease Screening Tests:
80061 -
Lipid panel, this panel must include the following:
82465 - Cholesterol, serum, total
83718 - Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
84478 - Triglycerides
Z13.6
All Medicare beneficiaries without apparent signs or symptoms ...
September 1st, 2017
Preventive Services: Colorectal Cancer Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Colorectal Cancer Screening.....
September 1st, 2017
Preventive Services: Counseling to Prevent Tobacco Use
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Counseling to Prevent Tobacco Use....
September 1st, 2017
Health Risk Assessment as Part of Annual Wellness Visit
By Wyn Staheli | Published September 1st, 2017 - Last Review/Update October 16th, 2017
The Health Risk Assessment is a voluntary assessment which may be completed by either the patient or a caregiver. It is typically used in conjunction with an Annual Wellness Visit to help promote better health choices and provide disease prevention services.
September 1st, 2017
Preventive Services: Diabetes Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Diabetes Screening.....
September 1st, 2017
Preventive Services: Hepatitis B Virus (HBV) Vaccine and Administration
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018
The following information from the Medicare Learning Network provides guidance on Hepatitis B Virus (HBV) Vaccine and Administration....
September 1st, 2017
Preventive Services: Human Immunodeficiency Virus (HIV) Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018
The following information from the Medicare Learning Network provides guidance on Human Immunodeficiency Virus (HIV) Screening....
September 1st, 2017
Preventive Services: Influenza Virus Vaccine and Administration
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018
The following information from the Medicare Learning Network provides guidance on Influenza Virus Vaccine and Administration....
September 1st, 2017
Preventive Services: Medical Nutrition Therapy (MNT)
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Medical Nutrition Therapy (MNT)....
September 1st, 2017
Preventive Services: Pneumococcal Vaccine and Administration
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Pneumococcal Vaccine and Administration....
September 1st, 2017
Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs.....
September 1st, 2017
Preventive Services: Screening Mammography
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on a Screening Mammography....
August 29th, 2017
Quality Measures for Chiropractic - 2017
By Wyn Staheli, Director of Research | Published August 29th, 2017
Performance Measurement Codes for Chiropractic:
Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year.
Pain Assessment and Follow-Up
131
ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...
August 18th, 2017
The Incredible Disappearing Consultation
By J. Paul Spencer, CPC, COC | Published August 18th, 2017 - Last Review/Update January 25th, 2018
In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255 for inpatient).
August 17th, 2017
Quick Tip from the HelpDesk -- Code 97140
By ChiroCode | Published August 17th, 2017 - Last Review/Update January 31st, 2019
Watch this short video, "Secrets of 97140 Manual Therapy," to learn all that you need to know about the proper support for 97140.
ChiroCode_DeskBook_Tips_97140 from Innoventrum on Vimeo.
...
August 16th, 2017
If It’s Not a Consultation, What Is It?
By Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC | Published August 16th, 2017
You thought you had a consultation supported in your documentation, and now you find out that you cannot bill the consultation codes (99241-99245, 99251- 99255). So, what are the top reasons for a consultation not to be supported?
If the payer does not support these codes
If the documentation does not support ...
August 15th, 2017
United HealthCare Ending Consultation Reimbursements: Effective October 1st, 2017
By NAMAS | Published August 15th, 2017
While Medicare discontinued payment allowance for consultation services (ranges 99241-99245 and 99251-99255) in January 2010, many commercial carriers have continued to cover these services. United Healthcare is now joining Medicare's opinion on consultation services.
In the June 2017 edition of the United HealthCare Bulletin, United Healthcare has announced that effective October ...
August 11th, 2017
Do Other States Lower Payments for Crowns by Delta or Blue Cross?
By Christine Taxin | Published August 11th, 2017
Question: A subscribers from the State of Michigan has asked this:
Has anyone from other states seen the fees for crowns lowered by Delta or Blue Cross?
Answer: First look at your contracts, and see if there is anything in it that allows for fees to be lowered. Next, look up your ...
August 8th, 2017
Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 8th, 2017 - Last Review/Update February 5th, 2019
My state does not allow me to delegate the supervision of therapeutic exercises (97110). I am the licensed chiropractor. If I provide the constant attendance myself, can I do it for a group of patients? If so, how do I document and bill for this?
August 4th, 2017
Proposed Telehealth Changes for 2018
By Wyn Staheli | Published August 4th, 2017 - Last Review/Update October 4th, 2017
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements from other third-party payers.
Proposed Codes
HCPCS code G0296 ...
August 1st, 2017
How to Bill a Dressing Change
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 1st, 2017
A dressing change may not be billed as either a debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602).
Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. These services are reimbursed as part of a billable procedure code that, commonly but not necessarily, ...
August 1st, 2017
Annual Wellness Visit (AWV)
By Wyn Staheli, Director of Research | Published August 1st, 2017
Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays.
July 28th, 2017
36522 Photopheresis Extracorporeal; Not Payable Without Certain ICD-10-CM Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 28th, 2017
When Outpatient hospitals bill CPT code 36522: (Photopheresis, extracorporeal), it must be billed with the following diagnosis codes:
C84.00 - C84.09 Mycosis fungoides;
C84.10 – C84.19 Sezary’s disease;
T86.20 – T86.298 Complications of heart transplant;
T86.30 – T86.39 Complications of heart-lung transplant;
T86.00 - T86.09 Complications of transplanted bone marrow.
Review your local LCD for billing and coding help.
...
July 28th, 2017
Auditing Vaccines
By Paul Chandler | Published July 28th, 2017 - Last Review/Update January 31st, 2018
Auditing vaccines can be difficult, as precise attention needs to be paid to the documentation to extract all variables needed for proper coding.
July 21st, 2017
Billing for Face-to-Face Counseling
By ChiroCode | Published July 21st, 2017 - Last Review/Update January 31st, 2019
Question: How should I bill for face-to-face Counseling time spent with the patient?
July 7th, 2017
Telemedicine: The Next Frontier in Care Delivery
By Valora Gurganious, MBA, CHBA | Published July 7th, 2017 - Last Review/Update January 25th, 2018
Technology is ubiquitous in modern society, and just when we thought that computers could not replace the "human touch" of a healthcare provider, technology is making specialized care accessible to patients anywhere there is an internet connection.
June 30th, 2017
Focus Audit Results on the Documentation, Not the Encounter
By Scott Kraft, CPC, CPMA | Published June 30th, 2017
As an auditor, your job is to assess the quality of the documentation created by the provider to determine whether it meets the requirements to bill the code assigned to the service. This task often set us up a potentially adversarial role with the provider, particularly when it comes to ...
June 30th, 2017
Documentation: Carrying Forward or Ineffective Use of Templates
By Shannon DeConda | Published June 30th, 2017
I often receive questions such as the below from our members regarding E&M scoring:
"I have heard that if information is 'cloned' or 'moved forward' from a previous visit, we should not count that info in scoring. However, I have also read that if a provider moves the info forward and ...
June 30th, 2017
Consultation or Transfer of Care, What are the Differences?
By Dee MiMauro, CPC, COC, CPMA | Published June 30th, 2017
According to 2017 Current Procedural Terminology (CPT), a Consultation is a type of E&M service provided by a physician at the request of another physician or other appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of ...
June 30th, 2017
Laceration Repairs
By Michael Loss, CPC, CPMA | Published June 30th, 2017
Auditing laceration repair is generally an adventure. Most of my auditing work is reviewing the work of our coders rather than providers, but I have audited physicians as well. My present position has limited communication with providers, however we do attempt to get important information back to our clients for ...
June 29th, 2017
Prescription Drug Management: Is it a Level 3 or a Level 4?
By J. Paul Spencer, CPC, COC | Published June 29th, 2017
If you place four auditors around a table and place a typical established patient visit in front of them, what tends to follow is a scene that resembles less about building consensus and more along the lines of a National Geographic special regarding the hunting habits of hyenas. Perhaps no ...
June 21st, 2017
Q/A: What Modifier Can I Use When Billing Massage Code 97124 With 97140?
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published June 21st, 2017 - Last Review/Update February 8th, 2019
Q. Can you tell me what modifier I can use when billing massage code 97124 with 97140? I was using -59, but I am not sure that is correct
June 14th, 2017
Ultraviolet Therapy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 14th, 2017 - Last Review/Update July 27th, 2017
Treatment of this type is generally used for patients requiring the application of a drying heat. For example, this treatment would be considered reasonable and necessary for the treatment of severe psoriasis where there is limited range of motion.
Only 1 unit of CPT code 97028 is covered per date of service.
Supportive Documentation ...
June 14th, 2017
Billing X-rays
By ChiroCode | Published June 14th, 2017 - Last Review/Update January 30th, 2019
Q. We currently are using an outside radiologist to read all of our x-rays, therefore we have an official report on each x-ray. If we go back to reading our own x-rays, do we need to have a separate official report made? Or is it sufficient to just put the x-ray findings as part of the SOAP? Also, we are questioning the way we are billing our x-rays. Some of us feel like you should be able to bill for taking the x-rays and then reading them as well.
June 13th, 2017
Modifier GY for Chiropractic
By ChiroCode | Published June 13th, 2017 - Last Review/Update January 31st, 2019
Q. Is there a modifier that can be added on to CPT codes to show we performed the service even though they are bundled charges or Medicare doesn't pay for them? For example 97140 billed to BCBS or 99202 billed to Medicare. Is the GY modifier for all insurance companies or just Medicare?
June 8th, 2017
Facet Joint Injections
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 8th, 2017 - Last Review/Update July 26th, 2017
Medicare will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for three (3) months or greater) suspected to originate from the facet joint. Facet joint block is one of the methods used to document and confirm suspicions of posterior element biomechanical pain of the ...
June 5th, 2017
Modifier 59
By Find-A-Code | Published June 5th, 2017 - Last Review/Update July 26th, 2017
Definition - The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. This may represent a different session or patient encounter, different procedure or surgery, different site, ...
June 1st, 2017
Is 97112, Neuromuscular Re-education Only for Stroke Recovery?
By ChiroCode | Published June 1st, 2017 - Last Review/Update January 31st, 2019
This code is not reserved for stroke recovery, but it could certainly apply when treating some symptoms of a stroke. It is often used for many other conditions so long as medical necessity is present and clearly supported. Consider using this on patients with documented loss of coordination or balance. These might not be everyday cases in a chiropractic clinic, but they certainly would occur from time to time.
May 30th, 2017
Q/A: How do I Bill Class 4 Deep Tissue Hot Laser Treatment?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published May 30th, 2017 - Last Review/Update February 8th, 2019
Is there a way to bill out for Class 4 deep tissue hot laser treatments?
May 30th, 2017
GA and GY for Medicare Billing
By ChiroCode | Published May 30th, 2017 - Last Review/Update January 31st, 2019
We are using the ABN for non-covered services (such as therapy codes) when the patient is under active care. We are also using the ABN for CMT codes when the patient is under maintenance care. We are now confused about when to use the modifiers GA & GY when billing CMT & therapy codes. Would you please explain when & why each should be used for Active and Maintenance Care?
May 12th, 2017
When Using Code 99050 (After Hours)
By | Published May 12th, 2017 - Last Review/Update February 8th, 2019
Question: When using code 99050 (after hours), do I just add a amount, example $25.00, to our normal total charges for that patients visit?
April 28th, 2017
Can I be Forbidden from Billing 99204 or 99214?
By ChiroCode | Published April 28th, 2017 - Last Review/Update January 31st, 2019
Q: An insurer told me that chiropractors cannot bill 99204 or 99214 because those exams "require a level of decision making that would typically only occur in an emergency room." Is this true? Do I have any recourse?
April 28th, 2017
Deadline
By Christine Taxin | Published April 28th, 2017
Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D.
Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. ...
April 21st, 2017
Radiology
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 21st, 2017 - Last Review/Update July 28th, 2017
All radiology services require proper orders, identifying the diagnosis for which the imaging is being ordered. “Rule out” or “Possible” won’t work for reimbursement purposes because professional services cannot code unconfirmed diagnoses. As such, for those types of services, include the symptom(s) as the diagnosis for which you are seeking ...
April 14th, 2017
Office of Inspector General (OIG) - Compliance Program Guidance
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 14th, 2017
The compliance program guidance documents are listed below.
09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008)
Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000)
11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005)
NSTC Launches Government-Wide Initiative ...
April 6th, 2017
Excluded from the Global OB Package
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 6th, 2017 - Last Review/Update July 28th, 2017
First three antepartum E&M visits
Laboratory tests
Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828)
Amniocentesis, any method (CPT codes 59000 or 59001)
Amniofusion (CPT code 59070)
Chorionic villus sampling (CPT code 59015)
Fetal contraction stress test (CPT code 59020)
Fetal non-stress test (CPT code 59025)
External cephalic version (CPT code 59412)
Insertion of cervical dilator (CPT code 59200) more than 24 hr before delivery
E&M services which is unrelated ...
March 30th, 2017
Moderate Sedation Services - CPT has 6 Codes to One Dental Code
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 30th, 2017 - Last Review/Update August 1st, 2017
When billing a medical code instead of the dental code D9223 -Deep sedation/general anesthesia - each 15 minute increment, consider the following medical codes: (Be sure to review the AMA guidelines to see if they fit the procedure you are doing). If a dental office is doing conscious sedation for a patient ...
March 29th, 2017
2014 brings big volume of changes to CCI edits
By Find-A-Code | Published March 29th, 2017
Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes....
March 29th, 2017
Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook
By Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA | Published March 29th, 2017
The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ...
March 24th, 2017
Are There any Alternatives for Code 97112 Neuromuscular Re-education?
By ChiroCode | Published March 24th, 2017 - Last Review/Update January 31st, 2019
Q: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the insurance benefits.
March 20th, 2017
Acute Postoperative Pain Management
By Wyn Stahel | Published March 20th, 2017
Caution needs to be observed when reporting post-operative pain management (POPM). In accordance with NCCI edits policies, postoperative pain management is considered bundled in the surgical code(s). There are only a few instances where it may be billed separately.
Medicare Global Surgery Rules prevent separate payment for postoperative pain management when ...
March 13th, 2017
Reporting Unilateral Procedures
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 13th, 2017 - Last Review/Update July 28th, 2017
Some procedures are unilateral such as D7840-Condylectomy. It is important to consult with your payer on reporting requirements. Some payers require two separate line items with a LT or RT HCPCS Modifier, while others require only one modifier to be appended to the claim.
When billing a medical code for a Condylectomy, ...
March 7th, 2017
Endometrial Sampling (Biopsy)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2017 - Last Review/Update July 28th, 2017
If a procedure such as an excision of a polyp took significant additional time, work, and effort, you could append modifier 22 (unusual procedural service) to add to your fee when using 58100 "Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)."
If a coloposcopy is performed in conjunction, use 58110 in addition to the ...
March 7th, 2017
Endocervical Curettage and Colposcopy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2017 - Last Review/Update July 28th, 2017
If you are coding for endocervical curettage only, use 57505 "Endocervical curettage (not done as part of a dilation and curettage)."
If an endometrial sampling (biopsy) was performed in conjunction with a colposcopy, use 57420 "Colposcopy of the entire vagina, with cervix if present," 57421 for "with biopsy(s) of vagina/cervix, or 57452-57461 for "colposcopy of the cervix including upper ...
March 3rd, 2017
Using Add-On Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 3rd, 2017 - Last Review/Update July 28th, 2017
There are certain procedures that are carried out in addition to the primary procedure called add-on codes. They describe a specific type of supplemental procedure done in addition that are labeled as add-on codes.
The AMA gives instructions and guidelines with notations such as "List separately in addition to primary procedure" or ...
March 1st, 2017
Care Plan Oversight Services
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 1st, 2017 - Last Review/Update January 16th, 2018
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period.
G0179
MD re-certification HHA PT
May be ...
March 1st, 2017
High Compression Bandage System Clarification
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 1st, 2017 - Last Review/Update July 28th, 2017
Multi-layered, sustained, graduated, high compression bandage systems are used primarily to treat lymphedema and venous or stasis leg ulcers. A number of graduated, high-compression bandage systems products have been developed, including Profore®, Dyna-Flex®, Surepress®, Setopress®, and other similar product systems.Providers should note that the treatment of lymphedema with the application ...
February 24th, 2017
Using Time Span Codes
By Find-A-Code | Published February 24th, 2017
The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period, generally if the service was provided in a different calendar month, the service would qualify for reimbursement.
Modifiers will not override a time span code if it is billed with ...
February 23rd, 2017
Care Plan Oversight Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2017 - Last Review/Update August 2nd, 2017
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period.
G0179
MD re-certification HHA ...
February 23rd, 2017
Telehealth Growth Continues
By Wyn Staheli, Director of Research | Published February 23rd, 2017
Telehealth is proving to be the wave of the future as the number of practices offering these services continues to grow. An online poll by Medical Economics asked those who visited their site about the implementation of telehealth services implemented by their individual practices this year. As of February 2, 2017, the results were significant:
30% ...
February 21st, 2017
Telehealth Psychiatric Service
By Wyn Staheli, Director of Research | Published February 21st, 2017
Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych ...
February 15th, 2017
Insufficient Documentation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2017 - Last Review/Update August 2nd, 2017
Claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed - meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.
Claims are also ...
February 10th, 2017
Beware of Limitations When Using Electrical Stimulation - Ultrasound
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 10th, 2017 - Last Review/Update August 2nd, 2017
Ultrasound is often used to reduce inflammation and improve the flexibility of connective tissue. This is done by applying sound waves to produce heat and/or vibration. Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the ...
February 10th, 2017
Q/A: What is the Proper Code for "Lumbar Decompression?
By ChiroCode | Published February 10th, 2017 - Last Review/Update February 8th, 2019
Q: What is the proper code for "Lumbar Decompression?
February 1st, 2017
Medicare Coverage of Behavioral Health Services
January 23rd, 2017
Anesthesia Code Changes in 2017- Epidural Steroid Injections (ESI)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017
Pay close attention to the new 2017 Anesthesia codes there are a few notable changes. There is a new code set for Epidural Steroid Injections (ESI). The difference in the new codes set has a clear distinction on a single injection or a catheter placement for continuous infusion/intermittent bolus and if ...
January 23rd, 2017
Mammography Codes Changed in 2017
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017
Pay careful attention to the mammography code changes for 2017.
The following codes have been Deleted:
77055 Mammography; unilateral 77056 Mammography; bilateral 77057 Screening mammography, bilateral (2-view study of each breast)
Below are the Replacement Codes:
77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral 77067 Screening ...
January 23rd, 2017
New and Deleted Drug Screen codes for 2017
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017 - Last Review/Update March 8th, 2017
Deleted Codes for Drug Screening, the following codes are no longer valid for services performed on or after January 01, 2017.
Deleted Codes for 2017
80300
Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical ...
January 23rd, 2017
New and Deleted Angioplasty Codes for 2017
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017
The following codes have been Deleted as of January 01, 2017
35450
Transluminal balloon angioplasty, open; renal or other visceral artery
35452
Transluminal balloon angioplasty, open; aortic
35458
Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel
35460
Transluminal balloon angioplasty, open; venous
35471
Transluminal balloon angioplasty, percutaneous; renal or visceral artery
35472
Transluminal balloon angioplasty, percutaneous; aortic
35475
Transluminal balloon angioplasty, percutaneous; ...
January 21st, 2017
Moderate Sedation Code Changes for 2017
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 21st, 2017
One of the significant code changes for 2017 included Moderate sedation services. Codes 99143-99145 and 99148-99150 are no longer active codes in 2017. The moderate sedation codes have been replaced with six new codes 99151-99157.
For example:
Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of ...
January 12th, 2017
Sleep Studies: Billing with Reduced Hours
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 12th, 2017 - Last Review/Update August 2nd, 2017
When using codes 95800, 95801, 95806, 95807, 95810, and 95811, and fewer than six hours of recording is performed, you must report the reduced services using modifier 52.
Also, when using 95782 and 95783, and fewer than seven hours of recording is performed, modifier 52 would be appended to the appropriate code.
95805 would require modifier 52 if fewer than four hours of recording is performed.
Medicare recognizes the ...
December 21st, 2016
Q/A: E/M Bundled with CMT
By ChiroCode | Published December 21st, 2016 - Last Review/Update February 28th, 2019
What do you do when you are continually getting denials when billing office visit E/M code 99213-25 along with a CMT on dates that we do re-exams? What do you do when an appeal does not seem to work even though clear evidence has been provided that all conditions for the 99213 have been satisfied.?
December 19th, 2016
Benchmarks
By Wyn Staheli, Director of Research | Published December 19th, 2016
Benchmarking is simply a standard or point of reference against which things may be compared or assessed. For all businesses, it is a way of comparing your business processes to another business in the same industry to determine where shortfalls exist or improvements can be made to maintain profitability.
December 16th, 2016
NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy
By Find-A-Code | Published December 16th, 2016
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The...
December 7th, 2016
Workers Compensation
By Wyn Staheli, Director of Research | Published December 7th, 2016
Workers’ Compensation is for work related illness or injuries on the job. The employer pays for insurance which covers medical costs incurred, and replaces lost wages. Fees are based on a specific fee schedule that varies by state.
There are three possible scenarios regarding workers’ compensation: the patient is covered by ...
December 6th, 2016
Billing for Prosthesis Designed and Prepared by the Dentist
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 6th, 2016 - Last Review/Update August 2nd, 2017
For maxillofacial services, if a prosthesis is provided, and is designed and prepared by the dentist, the Medicare Part B carrier may be billed with CPT codes 21076 through 21089. If the prosthesis is prepared by an outside laboratory, the laboratory bill goes to the Durable Medical Equipment Regional Carrier (DMERC), with Level ...
December 6th, 2016
Oral Maxillofacial Prosthesis (A53496)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 6th, 2016 - Last Review/Update August 1st, 2017
Implants, which could be considered dental but are being inserted to secure, attach, or support the maxillofacial prosthesis, will be covered when the prosthesis is to be used secondary to maxillofacial surgery or repair of traumatic injury. Use CPT code 21299 to bill the implants with an explanation of the intended use. ...
December 4th, 2016
2017 CPT Updates Bring Big Changes to Physical Therapy
By Misty Tinch, RHIT, CPC, CPMA | Published December 4th, 2016 - Last Review/Update August 17th, 2017
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The new ...
November 29th, 2016
E/M 101
By BC Advantage | Published November 29th, 2016 - Last Review/Update December 8th, 2016
E/M stands for "evaluation and management". E/M coding is the process by which provider-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for "current procedural terminology." These are the numeric codes which are submitted to insurers for payment. Most billable procedures have their own CPT ...
November 29th, 2016
New Mapping Tool - CPT/HCPCS Medicare Denial Rates & Average Charges
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 29th, 2016
Use this tool as a part of an important strategy to improve your processes and stay ahead of denials. Check your most commonly used codes to give your practice a heads up on denial rates and average charges. This is a quick way to view a group of codes or ...
November 21st, 2016
Best Diagnosis Codes for E-stim
By ChiroCode | Published November 21st, 2016 - Last Review/Update March 5th, 2019
What are the best diagnosis codes for E-stim?
November 19th, 2016
Lack of Medical Necessity
By ChiroCode | Published November 19th, 2016 - Last Review/Update March 5th, 2019
(from page 210 in chapter 3.5 of the 2017 DeskBook) One of the biggest problems providers face when audited is that many services are deemed not medically necessary and are routinely denied. Much of the proof falls back on the medical record.
Here are some specific situations as they may ...
November 9th, 2016
Should I Avoid Billing 97112
By Raquel Shumway | Published November 9th, 2016 - Last Review/Update March 5th, 2019
Question: The Doctor says he was told by a billing company a few years ago to avoid the 97112. So he has been doing 97110 instead. They do the items listed in 97110, but often some of the ones in 97112 as well. His question was, should he actually be avoiding 97112? Or is there simply something he needs to be mindful of when using it?
November 2nd, 2016
Avulsion of Nails and Treatment of Ingrown Nails
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 2nd, 2016 - Last Review/Update August 1st, 2017
Subungual abscess
Contusion of the nail
Crushing injury of the toe or finger
Painful onychauxis
Painful onychomycosis
Onychocryptosis (ingrown nail)Onychocryptosis occurs most frequently in the big toes. The condition is categorized into:Simple onychocryptosis
Complicated onychocryptosis
The simple or uncomplicated category is caused by pressure on the nail groove by an essentially healthy nail caused by injudicious cutting ...
October 28th, 2016
Auditing Same Day Psychotherapy and E&M Services: The Time Trap
By Scott Kraft, CPC, CPMA | Published October 28th, 2016 - Last Review/Update August 17th, 2017
A problem-focused E/M service and the provision of psychotherapy on the same date of service are both separately payable, when medically necessary. A typical scenario is when the
provider treats the patient's diagnoses by documenting the appropriate level of history, exam and medical decision making - such as a decision to ...
October 27th, 2016
Sedation used on a Dental Patient for a medical procedure
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 27th, 2016 - Last Review/Update August 1st, 2017
When you need to bill a medical code instead of the dental code D9223, consider the following medical codes, and be sure to review the AMA guidelines to see if they fit the procedure you are doing. If a dental office is doing conscious Sedation for over 5 years old there is ...
October 26th, 2016
Using Physical Status Modifiers with Anesthesia Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 26th, 2016 - Last Review/Update August 1st, 2017
These six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in the CPT codebook to distinguish among various levels of complexity of the anesthesia service provided.Example: 00100-P1Physical Status modifiers are represented by the initial letter ‘P’ followed by a single digit from 1 to 6 ...
October 14th, 2016
Injections and Infusions
By Jessica Franzese, CPC, CPMA | Published October 14th, 2016 - Last Review/Update August 17th, 2017
Injection and infusion codes can be tricky. In this auditing tip, we'll break them down and help to make them a little easier to understand. Let's start first with the basics. Injections and infusion codes can be found in the medicine section of the CPT® book, codes 96360-96549. They are ...
October 5th, 2016
You can charge for Advanced Care Planning (ACP)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 5th, 2016
Did you know you could be charging for Advanced Care Planning (ACP). Effective January 1, 2016, payment for the service described by CPT code 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or ...
October 3rd, 2016
Upper Eyelid Blepharoplasty and Blepharoptosis Repair
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 3rd, 2016 - Last Review/Update August 1st, 2017
The Centers for Medicare & Medicaid Services (CMS) payment policy does not allow separate payment for a blepharoplasty procedure (CPT codes 15822, 15823) in addition to a blepharoptosis procedure (CPT codes 67901-67908) ontheipsilateral upper eyelid. Any removal of upper eyelid skin in the context of an upper eyelid blepharoptosis surgery is considered apart of ...
October 3rd, 2016
Upper Eyelid Blepharoplasty and Blepharoptosis Repair (update eff 10/01/2017)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 3rd, 2016 - Last Review/Update August 2nd, 2017
The Centers for Medicare & Medicaid Services (CMS) payment policy does not allow separate payment for a blepharoplasty procedure (CPT codes 15822, 15823) in addition to a blepharoptosis procedure (CPT codes 67901-67908) ontheipsilateral upper eyelid. Any removal of upper eyelid skin in the context of an upper eyelid blepharoptosis surgery is considered apart of ...
September 16th, 2016
Measure Up: Wound Measurements & Debridement Auditing
By Grant Huang, CPC, CPMA | Published September 16th, 2016 - Last Review/Update August 17th, 2017
Wound care can be a tricky arena for auditors, but if there's any one element that providers tend to skimp on, it's wound measurements. Getting wound measurements right is crucial, but providers can sometimes be slapdash with documenting their measurements. Let's review what's required in terms of measurements for the ...
August 23rd, 2016
Smoking and tobacco cessation counseling, covered indications and # of visits
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 23rd, 2016 - Last Review/Update August 2nd, 2017
Nationally Covered Indications:Effective for claims with dates of service on or after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;2. Who are competent and alert at the time that ...
August 10th, 2016
Differentiate the Extraordinary Work Performed During the Intraoperative or Postoperative Periods
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 2nd, 2017
The code for complex cataract surgery (CPT code 66982) is intended to differentiate the extraordinary work performed during the intraoperative or postoperative periods in a subset of cataract operations including, and not limited to, the following:
A miotic pupil which will not dilate sufficiently to allow adequate visualization of the lens in ...
August 10th, 2016
Visual Field Examination
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 2nd, 2017
The following information from one Medicare payer includes indications and limiatations of coverage as well as Medical Necessity standards for visual field examinations.
92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or ...
August 10th, 2016
Fundus Photography and Extended Ophthalmoscopy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
92225
Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial
92226
Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent
92227
Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral ...
August 10th, 2016
Blepharoplasty: Medically Necessary Documentation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
The following information from one Medicare payer provides guidance on properly coding and documenting blepharoplasty procedures.
Blepharoplasty proceduresandrepairofblepharoptosis are covered when performed for the following functional indications. All other uses would be considered cosmetic.
1. Lower lid blepharoplasty (CPT 15820 and 15821) is considered as medically necessary when documentation:
supports horizontal lower eyelid laxity of medial and ...
August 10th, 2016
Guidance for the Use of Codes in Physical Medicine - Pub-100
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
The following provides guidance about the use of codes 96105, 97026, 97150, 97545, 97546, and G0128.
• CPT Codes 96105, 97545, and 97546.
Providers report code 96105, assessment of aphasia with interpretation and report in 1-hour units. This code represents formal evaluation of aphasia with an instrument such as the Boston Diagnostic Aphasia Examination. If this formal assessment is performed during treatment, ...
August 3rd, 2016
Billing Units
By Wyn Staheli, Director of Research | Published August 3rd, 2016
Are you billing units correctly? This article outlines important considerations to ensure that claims are submitted properly.
July 29th, 2016
Make sure your smoking cessation services are being coded right
By Codapedia | Published July 29th, 2016
Coding, billing and getting paid for providing smoking cessation services when covered by your payers is almost a no-brainer for any physician practice because, in most cases, cessation services are already being provided to patients who smoke cigarettes. Yet practices consistently don’t take advantage of this opportunity and, when they...
July 29th, 2016
Preventive medicine and office visit, same day
By Codapedia | Published July 29th, 2016
Can I use modifier 25 on an E/M service on the same day as a preventive medicine exam Let’s review what a preventive medicine service is, in order to answer that question. Preventive medicine services are: • The description given by CPT® for “annual physicals” • Divided into new and...
July 29th, 2016
Medicare no longer requires facility certification for bariatric surgery
By | Published July 29th, 2016
Thanks to a recent tweak to Medicare policy, facilities are no longer required to be certified in order for bariatric surgery procedures to be covered, CMS announced in a recent transmittal modifying its National Coverage Determination (NCD) on the procedure. The change took effect September 24.Left unchanged in the NCD...
July 29th, 2016
Mini Mental Status Exam-Can you bill for it?
By Codapedia | Published July 29th, 2016
There is no CPT® code for the Mini Mental Status Exam. Physicians use the mini mental status exam (MMSE to test a patient's cognitive function. The test is made up of a set of questions, testing the patient’s memory, orientation and arithmetic calculation skills. There is a copyrighted form of...
July 29th, 2016
CODING ARTHROSCOPIC KNEE PROCEDURES
By Codapedia | Published July 29th, 2016
Knee Anatomy: The medical compartment includes: Medial Femoral condyle Medial tibial plateau Medial meniscus The lateral compartment includes: Lateral Femoral condyle Lateral tibial plateau Lateral meniscus The Patellofemoral compartment includes: Patella Patellofemoral joint Intercondylar notch of the femur Suprapatellar pouch Trochlea Arthroscopy: Knee arthroscopy allows the physician to visualize the...
July 29th, 2016
Nursing home discharge services
By Codapedia | Published July 29th, 2016
Either a physician or an NPP may bill for discharge services from a skilled nursing facility or a nursing facility. There are two discharge day management codes from a nursing facility. 99315 is for discharge day management 30 minutes or less, and 99316 is for discharge day management over 30...
July 29th, 2016
Subsequent nursing facility visits
By Codapedia | Published July 29th, 2016
Subsequent nursing facility visits (99307--99310) are services billed for either mandated or medically necessary visits in a skilled nursing facility or nursing facility. (Place of service 31 for a skilled nursing facility or 32 for a nursing facility). These codes may also be used in place of service 54 (Intermediate...
July 29th, 2016
Annual Nursing Facility Assessment
By Codapedia | Published July 29th, 2016
CPT® code 99318 is used to bill an annual nursing facility assessment. It requires three of three of these components: a detailed interval history, a comprehensive exam, and low or moderate medical decision making. This visit is payable once per year for a resident in a nursing facility. It may...
July 29th, 2016
Coding Selective and Non Selective Catheter Placement of Lower Extremity
By Codapedia | Published July 29th, 2016
- In diagnostic catheterization, codes are given simply at the final position of the catheter. This can be simply understood if we know the anatomy of Aorta. As we know, most of the major arteries arise from Aorta for example, Inominate artery, Left common carotid artery, Left subclavian artery, celiac...
July 29th, 2016
Subsequent hospital visits
By Codapedia | Published July 29th, 2016
Hospital services are all defined by CPT® as per day codes, that is, all of the care provided to a hospitalized patient during the calendar day. If a physician (or that physician's covering partner of the same specialty) sees the patient a second time during the calendar day, a second...
July 29th, 2016
Subsequent Observation Services
By Codapedia | Published July 29th, 2016
CPT® released three new E/M services in 2011, to be used for the second and subsequent days that a patient is in observation status in the hospital. The codes are 99224--99226 and they are out of sequence in the CPT® book. They require the same level of documentation as the...
July 29th, 2016
Evaluation and Management Services
By Codapedia | Published July 29th, 2016
According to the CPT® book, E/M services are divided into categories and subcategories. Office services are divided into new and established patient visits. Consultations are divided into outpatient/office consults and inpatient consultations. The E/M services typically have three to five levels of services and these levels are not interchangeable from...
July 29th, 2016
I had a wheezer in the office, can I bill a 99215?
By Codapedia | Published July 29th, 2016
At a coding session at a recent Pri-Med conference a Pediatrician asked this question: "I had wheezer in the office, and he was in the office a long time. I examined him, we did pulxe oximetry measurements, which we never get paid for both before and after a nebulizer treatment....
July 29th, 2016
Sports Physicals
By Codapedia | Published July 29th, 2016
Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope. If the patient presents for a well child visit, and also needs their camp physical filled out,...
July 29th, 2016
Anesthesia and E/M services
By Codapedia | Published July 29th, 2016
Anesthesia services are billed using CPT® codes 00100-01999. These CPT® codes are cross-walked to surgical codes. The crosswalk is available from the American Society of Anesthesiologists at www.asahq.org. Each anesthesia code has a base unit assigned to it. The anesthetist also bills the number of time units, with a single...
July 28th, 2016
New Patient
By Codapedia | Published July 28th, 2016
According to the American Medical Association’s CPT® book, a new patient is a patient who “has never received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years. There is an excellent chart in the front...
July 28th, 2016
OIG Work Plan to look at excessive patient billing, place of service errors
By | Published July 28th, 2016
The 2014 OIG Work Plan has finally been released and, while it doesn’t have a lot of new issues for physician practices, there are definitely some areas worth your attention to avoid future compliance hassles. If you’ve been wondering where it’s been, the OIG decided to change the timing of...
July 28th, 2016
Category of Code Selection
By Codapedia | Published July 28th, 2016
Does anyone remember the good old days, when you didn't need to know the patient's insurance to select a category of code? Now, correct selection of an E/M category of code requires the clinician and coder to consider: Where the service was performed The status of the patient (Observation vs...
July 28th, 2016
Using Modifer -59
By Codapedia | Published July 28th, 2016
By Crystal Reeves, CPC, CMPE, Principal Modifier -59 is probably one of the most misunderstood, misused, and most-feared of all CPT® modifiers. Some practices avoid using it all together because they don’t want to be guilty of unbundling. Some practices do not use it because they are not at all...
July 28th, 2016
E-prescribing pay cuts loom for some in 2014, 2015
By Codapedia | Published July 28th, 2016
Some practices may find 2014 immediately off to the wrong foot when their Medicare payments are reduced by 2 percent for failing to participate successfully in Medicare’s E-prescribing Incentive Program. Unfortunately, at this point successfully claiming an exemption may be the only way to stave off the cut for non-reporters,...
July 28th, 2016
Learn Exactly how to Code Twin Pregnancy
By Codapedia | Published July 28th, 2016
- As we know there are OB CPT® codes using for coding Pregnancy procedures. The procedures are divided on weeks of gestation. There are separate CPT® codes for first and second trimesters. The first trimester of pregnancy is week 1 through week 12, or about 3 months. The second trimester...
July 28th, 2016
Do you know New CPT® Code changes in 2016: Read this
By Codapedia | Published July 28th, 2016
- With New year in 2016, we will be having new CPT® codes in diagnostic radiology. Since, we will be having CPT® codes which will replace old CPT® codes, some of the codes will be deleted. Diagnostic Radiology have the lot of changes which I hope will help medical coder...
July 28th, 2016
99213 Established patient visit
By Codapedia | Published July 28th, 2016
There are sample audited notes in resource section. 99213 is an established patient visit which requires 2 of 3 of the following components: An expanded, problem focused history, which is 1-3 HPI elements and 1 system in ROS reviewed An expanded, problem focused exam, which is 6 bullets from 1997...
July 22nd, 2016
Testing for Influenza
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 22nd, 2016 - Last Review/Update August 4th, 2017
There are several types of testing that distinguishes between influenza virus types A and B and several changes in codes in 2016.
For direct observation to detect an infectious agent by immunoassay use:
87804- Infectious agent antigen detection by immunoassay with direct optical observation; Influenza.
If the specimen is tested for both Type ...
June 28th, 2016
Q&A: We Bill Hot/Cold Packs (97010) but are Rarely Reimbursed. Why is This?
By ChiroCode | Published June 28th, 2016 - Last Review/Update March 5th, 2019
97010 is a service that is commonly not covered by payers or if it is covered, reimbursement is very minimal. This is due to a few reasons:
June 28th, 2016
NAMAS - Study the Rules Before Auditing E&M Services by Teaching Physicians
By Find-A-Code | Published June 28th, 2016
If you work for a facility that utilizes residents, then you will need to understand the requirements for reporting teaching physician services. The Office of Inspector General (OIG) has had hospital teaching physician activities on their work plan repeatedly, and therefore it should be on your radar as well to ...
June 24th, 2016
Study the Rules Before Auditing E&M Services by Teaching Physicians
By Sara San Pedro, CPC, CEMC, CPMA | Published June 24th, 2016 - Last Review/Update August 17th, 2017
If you work for a facility that utilizes residents, then you will need to understand the requirements for reporting teaching physician services. The Office of Inspector General (OIG) has had hospital teaching physician activities on their work plan repeatedly, and therefore it should be on your radar as well to ...
June 23rd, 2016
What Are Unproven, Investigational or Experimental Procedures?
By Brandy Brimhall CPC CMCO CPCO CCCPC CPMA | Published June 23rd, 2016
Many specialties, including chiropractors, perform services that may be deemed "experimental, investigational and unproven." Individual payer coverage determinations, as well as state boards, generally offer specific information defining this type of procedure and any other notice or guideline that providers must be aware of and adhere to.The terms "unproven, experimental ...
June 16th, 2016
Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?
By ChiroCode | Published June 16th, 2016 - Last Review/Update March 5th, 2019
Q&A: If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes?
June 9th, 2016
Pass-Through Payments, how they work and Device Category Codes List
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2016 - Last Review/Update August 4th, 2017
If you want to know if a DRUG is a Pass through drug - Find-A-Code has that information on the code information page under FEES and APC Fee information
A pass through payment for a drug is Medicare reimbursement paid in addition to an ASC's facility fee, however, CMS limits the eligibility ...
June 7th, 2016
A dental guide to cross-coding for oral cancer screening
By Christine Taxin | Published June 7th, 2016 - Last Review/Update January 30th, 2017
It is possible to bill medical insurance in the dental office for oral cancer testing. This will show you how
May 27th, 2016
Documentation Criteria: Medicare Physicals
By Jeanette Anderson, CPC, CPMA | Published May 27th, 2016 - Last Review/Update August 16th, 2017
When billing annual Medicare physicals, it's very important to know the status of the patient, determining when they became eligible, and/or if they've seen another provider for any of these services as the initial visit codes are once in a lifetime codes and will be denied if they have already ...
May 25th, 2016
May be a Payable Code for Dental Procedures under Medical Policy
By Christine Taxin | Published May 25th, 2016
The following list may be payable Codes for Dental Procedures under a patients Medical Policy. Be sure to verify with the payer for benefit coverage and exclusions.
ICD-10-CM Diagnosis Codes
B00.2 Herpesviral gingivostomatitis and pharyngotonsilitis
K00.0 Andontia
K00.1 Supernumerary Tooth
K00.2 Abnormalites of size and form of tooth
K00.3 Mottled Teeth
K00.4 Disturbances in tooth formation
K00.5 Hereditary ...
May 3rd, 2016
Using the SBIRT
By Wyn Staheli, Director of Research | Published May 3rd, 2016
Screening, Brief Intervention, and Referral to Treatment (SBIRT) services are an effective tool for healthcare providers to identify, reduce, and prevent problematic substance use disorders. Healthcare practices can help their patients and improve their integrated care standards with the proper use of the SBIRT.
April 29th, 2016
Adaptive Behavior Coding
By Wyn Staheli, Director of Research | Published April 29th, 2016 - Last Review/Update April 9th, 2018
Information about Adaptive Behavior Coding for Members.
April 25th, 2016
The Use of Modifier 50
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 25th, 2016 - Last Review/Update August 4th, 2017
Modifier Review: Modifier -50
Modifier 50 is used to report a procedure performed bilaterally.
Example: The patient underwent bilateral tympanostomy with insertion of ventilating tubes.
If you look up the CPT code 69433, you will see it is a unilateral procedure and there are instructions telling you to append modifier -50 if it is ...
March 28th, 2016
Q&A: Is There a Better Supply Code to Use Than 99070?
By ChiroCode | Published March 28th, 2016 - Last Review/Update March 5th, 2019
Are there more specific codes for supplies rather than using 99070?
March 25th, 2016
Auditing Smoking Cessation Services
By John Burns, CPC, CPC-I, CEMC, CPMA | Published March 25th, 2016 - Last Review/Update August 16th, 2017
Most payers do indeed recognize smoking and tobacco cessation services as a covered health insurance benefit. We have found that some providers perform these services without fully understanding the reimbursement opportunities, while others claim such services without adequately documenting to support them. Medicare, for example, will pay for two (2) ...
March 23rd, 2016
Added Thoughts on Medical Necessity & Determining Appropriate Levels of Care
By Stephen R. Levinson, M.D., CHCA ASA, LLC | Published March 23rd, 2016
February’s Find-A-Code Newsletter provided a superb summary of the importance of Medical Necessity in determining the appropriate level of care warranted during a given Evaluation and Management service. The author also accurately identified the “Nature of the Presenting Problem(s)” as the E/M system’s measure of medical necessity, because it medically ...
March 7th, 2016
Discarded Drugs and Biologicals
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2016 - Last Review/Update August 3rd, 2017
When a portion of a drug must be discarded, Medicare allows payment for amount administered as well as the discarded portion. Your Medicare carrier may require you to use modifier JW. The JW modifier is to be applied only to the portion discarded. Multi-use vials are not subject to payment for discarded amounts.
Take ...
March 4th, 2016
Medicare Improper Payment Report for Behavioral Health Services (2014)
By Wyn Staheli, Director of Research | Published March 4th, 2016
Medicare Improper Payment Report information regarding Behavioral Health Services
February 26th, 2016
Clear the Smoke on Debridement and Active Wound Care Codes
By | Published February 26th, 2016
Confused about when to choose a debridement code and an active wound code? CPT® 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth. “Depth is...
February 26th, 2016
Auditing for Cerumen Removal Codes 69209, 69210
By Scott Kraft | Published February 26th, 2016 - Last Review/Update August 16th, 2017
2016 brings changes to how physician practices bill for the removal of impacted cerumen, including a new CPT code. The rules that apply to the two cerumen removal codes now available for use mean that auditors will need to scrutinize the documentation closely in order to ensure codes are being ...
February 23rd, 2016
ABN is required - (if you anticipate payer will deny or is not medically necessary)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2016 - Last Review/Update August 3rd, 2017
An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1st, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, ...
February 17th, 2016
Getting Paid When Reporting Unlisted Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 17th, 2016 - Last Review/Update August 4th, 2017
Using unlisted codes can be quite labor intensive, but if you are prepared and understand ahead of time about using unlisted codes you will have a higher success rate of reimbursement.
Verify the payers guidelines - Be sure your code selection it is a payable code; if it is not a payable code ...
February 17th, 2016
TeleMedicine Terms and Definitions and who can bill - Using Modifiers
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 17th, 2016 - Last Review/Update August 4th, 2017
Medical practitioners who can bill for a covered Telehealth service vary by state law, but they may include:
physician,
nurse practitioner,
physician assistant,
nurse midwife,
clinical nurse specialist,
clinical psychologist,
clinical social worker, and
registered dietician or nutrition professional
Distant or Hub site: Site at which the physician or other licensed practitioner delivering the service is located at the time the ...
February 15th, 2016
List of approved ICD-10 codes for Mental Health Providers - Washington State Medicaid
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2016
The agency covers the below outpatient services to treat conditions that fall within the ICD diagnosis code range for mental health. For billing purposes, providers are required to use the most specific code available.
The agency also covers preventative mental health care, if the most specific code is used.
See the agency’s ...
February 12th, 2016
Behavioral Heath Treatment/Services - Documentation Requirements
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 12th, 2016 - Last Review/Update August 4th, 2017
Reason for referral.
Tests administered, scoring/interpretation, and time involved.
Present evaluation.
Diagnosis (or suspected diagnosis that was the basis for the testing if no mental/neurocognitive illness was found).
Recommendations for interventions, if necessary.
Identity of person performing service.
...
February 12th, 2016
Patient Status: Hospital Inpatient vs. Observation
By Jeanette Anderson, CPC, CPMA | Published February 12th, 2016 - Last Review/Update August 16th, 2017
As an auditor, we must ensure that the documentation supports the selected use of codes for reimbursement. When auditing hospital encounters, the patient status serves as the basis for the code selection and therefore must be clearly documented. This ensures that the hospital is able to collect appropriate reimbursement.
During an ...
February 1st, 2016
Will Incident-To in Your Organization Pass a Compliance Audit?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 1st, 2016
Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits.
January 29th, 2016
Announcing Find-A-Codes newest addition - Medical /Lab Test Information
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016
Announcing Find-A-Codes Newest product: Medical /Lab Test Information, available with your Find-A-Code subscription.Test information includes:
overview of the test
utility - when/why/how the test is used
diseases the test is often used to detect or monitor
specimen collection methods/procedures
testing methodology
usual turnaround time
interpretation of test results
reference ranges for test results (normal, abnormal, etc.)
diagnosis and billing ...
January 29th, 2016
Wound Care & Debridement- Provided by Physician, NPP or as Incident-to Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016
Providers must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required ...
January 29th, 2016
Certificate for Provider - Performed Microscopy Procedures
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016
Effective January 19, 1993, a laboratory that holds a certificate for provider-performed microscopy procedures may perform only those tests specified as provider-performed microscopy procedures and waived tests, as described below, and no others.
HCPCS Code Test
Q0111
Wet mounts, including preparations of vaginal, cervical or skin
specimens
Q0112
All potassium hydroxide (KOH)
preparations
Q0113
Pinworm examinations
Q0114
Fern test
Q0115
Post-coital direct, qualitative ...
January 6th, 2016
E/M service prior to a screening colonoscopy
By Codapedia | Published January 6th, 2016
CMS does not pay for an Evaluation and Management service prior to a screening colonoscopy. If a patient calls or is sent from another physician to schedule a screening colonoscopy, do not bill any type of E/M service prior to the procedure. Some commercial carriers also...
January 6th, 2016
Don’t expect to see payment any time soon for ‘telephone consults’
By Codapedia | Published January 6th, 2016
Four new CPT® codes that got some attention when the 2014 CPT® changes were released late last year were a new E/M code series, 99446-99449, designed to be reported when a consulting provider offered a telephone or Internet E/M service that included a verbal and written...
January 6th, 2016
Preventive Medicine Services for Medicare Patients
By Codapedia | Published January 6th, 2016
The most widely known fact about Medicare and preventive medicine is that fee-for-service Medicare does not cover an annual physical exam. This is because in its beginning, Medicare was prohibited from paying for routine services. Over the years, Congress has mandated the payment of some screening...
January 6th, 2016
Doing--and coding--for minor procedures in primary care
By Codapedia | Published January 6th, 2016
I asked a Family Physician recently if he did minor procedures in his practice. He said, “I send them all to my partner. Tim loves doing minor procedures, and he’s fast. I don’t bother with them myself.” His partner, by inclination or design, was the designated...
January 6th, 2016
Modifiers in Postoperative Periods
By Codapedia | Published January 6th, 2016
Modifiers in Postoperative Periods Introduction Documenting the events of a patient visit is not always the simplest and most straightforward of processes. Many variables affect which information must be included in order to report a procedure or service accurately. Global periods are one of those...
January 6th, 2016
Reporting Administration Codes with Vaccines
By Codapedia | Published January 6th, 2016
When it comes to billing for vaccines, the rules for reporting administration codes can be tricky. Reporting the right vaccine code alone is not enough to guarantee proper billing. Most billing scenarios allow providers to charge for both the vaccine product and the administration of the vaccine itself. However, there...
January 6th, 2016
Coding Excisions and Wound Repairs
By Codapedia | Published January 6th, 2016
Chart audits frequently examine coding associated with lesion removals and wound repairs. In order to assign the appropriate procedure code, certain documentation must be included in the medical record, such as lesion type, excision size, wound repair, and location. Without these important details, providers...
January 6th, 2016
Use of binocular microscopy in the office
By Codapedia | Published January 6th, 2016
Binocular Microscopy Question: Our physicians want to report binocular microscopy in addition to minor ear procedures when they use the microscope in the office. For example, removing ear wax or placing tubes, and mastoid debridements. Can binocular microscopy be reported in addition to the minor procedure...
December 21st, 2015
Colorectal Cancer Screening; Barium Enema; as an Alternative to G0104, Screening Sigmoidoscopy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 21st, 2015 - Last Review/Update August 7th, 2017
G0106 - Colorectal Cancer Screening; Barium Enema; as an Alternative to G0104, Screening Sigmoidoscopy Screening barium enema examinations may be paid as an alternative to a screening sigmoidoscopy (code G0104). The same frequency parameters for screening sigmoidoscopies (see those codes above) apply.In the case of an individual aged 50 or over, payment may be ...
December 11th, 2015
Money In Your Pocket: Balance Bill
By Codapedia | Published December 11th, 2015
The Comprehensive Error Rate Testing (CERT) program Medicare uses to assess the accuracy of provider billing has uncovered a big source for mistakes – documentation problems when a patient is receiving psychotherapy services on the same date as an E/M encounter, according to CMS. There are...
December 11th, 2015
CMS: Lot of errors billing psychotherapy services when E/M visit is involved
By Codapedia | Published December 11th, 2015
The Comprehensive Error Rate Testing (CERT) program Medicare uses to assess the accuracy of provider billing has uncovered a big source for mistakes – documentation problems when a patient is receiving psychotherapy services on the same date as an E/M encounter, according to CMS. There are...
December 11th, 2015
CMS NCD drops clinical trial requirement for FDG PET scans for solid tumors
By Codapedia | Published December 11th, 2015
Patients no longer need to be in a CMS-approved clinical trial for physician practices to get paid for doing as many as four FDG PET scans for solid tumors – one for an initial treatment strategy and three to guide subsequent treatments, according to CMS...
December 11th, 2015
Hospital discharge, nursing facility admit billable on same day by same provider in most instances
By | Published December 11th, 2015
Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple...
December 11th, 2015
Who Qualifies for TCM Services?
By Codapedia | Published December 11th, 2015
Any patient post-discharge whose medical and/or psychosocial problems are complex enough to require TCM services qualifies for these codes. Here are the specifics: 1. Location: “TCM is for higher-risk patients being discharged from an inpatient or observation status to their home, rest home, or assisted living...
December 3rd, 2015
Amazing tips for coding CPT® code for Angiogram
By Codapedia | Published December 3rd, 2015
Basics about CPT® code for Angiogram For percutaneous surgery, it is very important to code the angiography codes for studying the arteries or veins. In interventional radiology, we have many CPT® codes for angiograms that are specific are each artery or vein. These Angiogram procedure codes...
December 2nd, 2015
99212--established patient visit - Sample audited notes
By | Published December 2nd, 2015
Established patient visits all require 2 out of 3 of history, exam, medical decision making 99212: History required is problem focused: 1-3 HPI elements Exam required is problem focused: 1 body area/organ system examined from the 1995 exam, or one bullet from the multi-specialty exam...
December 2nd, 2015
Yet another new auditor looking at Part B claims
By Codapedia | Published December 2nd, 2015
Recovery Audit Contractors (RACs) may be about to take a break while CMS awards new contracts, but don’t rest on your laurels. CMS has handed out yet another auditor contract for a single auditor, known as a Supplemental Medical Review Contractor (SMRC) to do nationwide claims...
November 19th, 2015
Documentation Guidelines - E/M auditing
By | Published November 19th, 2015
What is the difference between the two sets of Guidelines?
There are two major differences. The first is in the history of the present illness (HPI). In the 1995 Guidelines, in order to document a history of the present illness at a detailed level, the clinician must document ...
November 19th, 2015
Medical Necessity is not Medical Decision Making
By | Published November 19th, 2015
I can count on two consistent issues in coding audits. Doctors report that their patients are, in general, sicker than patients in other practices. Coders report that their physicians are, in general, worse documenters than physicians in other practices and select codes that are too high based on ...
November 19th, 2015
E/M service with no exam
By Codapedia | Published November 19th, 2015
Does an E/M service require an exam? It depends on the category of service.
Established patients and subsequent hospital visits require two out of three of the key components, history, exam and medical decision making. Any two components at the level of documentation required determines the level of ...
November 13th, 2015
Using ICD-10-CM Z-codes
By Evan M. Gwilliam DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA, Christine Woolstenhulme, CMRS | Published November 13th, 2015
Chapter 21 of ICD-10-CM is titled "Factors Influencing Health Status and Contact with Health Services". They cover codes in the categories from Z00 to Z99. This chapter is used for encounters with health care providers where the patients have no current illnesses or injury. For example, a patient may present at ...
October 20th, 2015
Modifiers – Reimbursement or Informational? Modifier Training
October 13th, 2015
Pricing Modifier
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 13th, 2015 - Last Review/Update August 7th, 2017
Place the modifiers listed below (except modifiers with an *) to the right of the procedure code in Item 24D on the CMS 1500 claim form or for ANSI X12 4010 electronic claims submission use segment 2-370-SV101-3.
Processing delays can occur for claims submitted without the pricing modifier in the first modifier position. ...
October 5th, 2015
Reporting Laterality Still Requires Modifiers
By Wyn Staheli, Director of Research | Published October 5th, 2015
One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).
Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology ...
September 25th, 2015
Bone Mass Measurements (BMMs)
By Find-A-Code | Published September 25th, 2015
Listed is a summary of the revisions and additions to Chapter 13 of the Medicare Claims Processing Manual and Chapter 15 of the Medicare Benefit Policy Manual.
CHAPTER 13
Effective for dates of service on and after January 1, 2007, the CY 2007 Physician Fee Schedule final rule expanded the number of ...
September 21st, 2015
Documentation and Medical Necessity - Ablative Treatment for Spinal Pain - UHC Medical Policy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 21st, 2015 - Last Review/Update August 7th, 2017
According to UnitedHealthcares policy: For chronic cervical, thoracic and lumbar pain, Thermal radiofrequency ablation of facet joint nerves is proven and medically necessary when confirmed by the following:
Temperature 60 degrees Celsius or more;
Duration of ablation 40 - 90 seconds
Positive response to medial branch block injection at the side and level of the proposed ...
September 21st, 2015
Documentation and Reimbursement for Testing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 21st, 2015 - Last Review/Update August 7th, 2017
The medical record must contain documentation that the testing is expected to influence treatment of the condition toward which the testing is directed. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition that warrants the test(s).
TC - Technical component Modifier may be ...
September 11th, 2015
Medicare Makes Moderate Sedation Payable
By Find-A-Code | Published September 11th, 2015
Medicare Makes Moderate Sedation Payable
Christine Taxin
Should your primary care physicians ever find cause to perform moderate sedation, you’ll be interested in a new Medicare policy that may make it payable as of Oct. 1. Medicare Pub. 100-04 Transmittal 1324 finally makes Medicare policy consistent with the fee schedule pricing for ...
August 20th, 2015
Covered Bariatric Surgery Procedures
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 20th, 2015
Covered Bariatric Surgery Procedures
Effective for services on or after February 21, 2006, Medicare has determined that the following bariatric surgery procedures are reasonable and necessary under certain conditions for the treatment of morbid obesity.
The patient must have a body-mass index (BMI) 35, have at least one co-morbidity related to ...
August 19th, 2015
Billing injections on the same day as an E/M service
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 19th, 2015
But increasingly, payers are being just as reflexive when it comes to denying the E/M service, saying that it's bundled into the injection.
What's the truth? While there are many instances when the E/M service is bundled into the injection service, there are probably just as many instances when these denials ...
August 19th, 2015
A Dental Guide to Cross-Coding for Oral Cancer Screening
By Christine Taxin Adjunct Professor, University of New York School of Dentistry - Links2Success.biz | Published August 19th, 2015
Dental professionals are a patient’s primary source of screening within the oral cavity; thus attention must be paid to the most common oral malignancy: squamous cell carcinoma. Historically such malignancies were attributed only to patients with a history of extensive alcohol and tobacco use. However, other risk factors such as ...
August 10th, 2015
Manipulation Under Anesthesia in the Office
By | Published August 10th, 2015 - Last Review/Update January 27th, 2017
When manipulation under anesthesia is done in the office instead of a facility, code selection is different.
August 10th, 2015
Documentation Requirements for Therapy Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015
Documentation Requirements for Therapy Services, indicates that the amount of time for each specific intervention/modality provided to the patient is not required to be documented in the Treatment Note. However, the total number of timed minutes must be documented. These examples indicate how to count the appropriate number of units ...
August 10th, 2015
Orthognathic Surgery - Medical Policy Criteria - Regence
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015
Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury.
[1] Note: This policy does not address the surgical ...
August 10th, 2015
Audit Fighting Tactics
By Tom Necela, DC, CPC, CPMA, CCP-P | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Four Tactics or tips to help you fight back when you are audited or have your claims reviewed. They are effective and easy to use.
August 10th, 2015
Can Chiropractors Bill 99211?
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse’s code, is not really made for the physician to use. In fact, the AMA, CPT ...
August 10th, 2015
Adjunctive (Add-On) Codes
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Stop losing hard-earned dollars. Too often, dollars are left on the table at billing time. Adjunctive codes for associated services should be added when they are appropriate. Here are a few examples of coding that are often overlooked.
97014 & 97032 Electrical Stimulation Supplies
According to the Relative Value Update Committee (RUC), ...
August 7th, 2015
TMJ Medical Necesity and Documentation- Aetna
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2015 - Last Review/Update August 7th, 2017
Notes: Most Aetna HMO plans exclude coverage for treatment of temporomandibular disorders (TMD) and temporomandibular joint (TMJ) dysfunction
For plans that cover treatment of TMD and TMJ dysfunction, requests for TMJ surgery require review by Aetna's Oral and Maxillofacial Surgery patient management unit. Reviews must include submission of a problem-specific history ...
August 7th, 2015
Orthognathic Surgery - Medical Policy Criteria - Regence
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2015 - Last Review/Update August 7th, 2017
Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury.
[1] Note: This policy does not address the surgical ...
August 3rd, 2015
Method for Computing Fee Schedule Amount (Rev. 1, 10-01-03)
By | Published August 3rd, 2015
B3-15006
The CMS continually updates, refines, and alters the methods used in computing the fee schedule amount. For example, input from the American Academy of Ophthalmology has led to alterations in the supplies and equipment used in the computation of the fee schedule for selected procedures. Likewise, new research has changed ...
July 20th, 2015
Hospice Pre - Election Evaluation and Counseling Services (Rev. 2258)
By Find-A-Code | Published July 20th, 2015
Effective January 1, 2005, Medicare allows payment to a hospice for specified hospice pre-election evaluation and counseling services when furnished by a physician who is either the medical director of or employee of the hospice.
Medicare covers a one-time only payment on behalf of a beneficiary who is terminally ill, (defined ...
July 10th, 2015
Coding Requirements for Specimen Collection (Rev. 3056, 12-01-14)
By Jared Staheli | Published July 10th, 2015
The following HCPCS codes and terminology must be used:
• 36415 – Collection of venous blood by venipuncture.
• G0471 – Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency ...
July 10th, 2015
Certificate for Provider-Performed Microscopy Procedures (Rev. 865, 07-03-06)
By Jared Staheli | Published July 10th, 2015
Effective January 19, 1993, a laboratory that holds a certificate for provider-performed microscopy procedures may perform only those tests specified as provider-performed microscopy procedures and waived tests, as described below, and no others.
HCPCS Code
Test
Q0111
Wet mounts, including preparations of vaginal, cervical or skin specimens
Q0112
All potassium hydroxide (KOH) preparations
Q0113
Pinworm examinations
Q0114
Fern test
Q0115
Post-coital direct, ...
July 10th, 2015
Anatomic Pathology Services (Rev. 1, 10-01-03)
By Jared Staheli | Published July 10th, 2015
Clinical laboratory tests include some services described as anatomic pathology services in CPT (i.e., certain cervical, vaginal, or peripheral blood smears). The CPT code 85060 is used only when a physician interprets an abnormal peripheral blood smear for a hospital inpatient or a hospital outpatient, and the hospital is responsible ...
July 10th, 2015
National Minimum Payment Amounts for Cervical or Vaginal Smear Clinical Laboratory Tests (Rev. 1, 10-01-03)
By Jared Staheli | Published July 10th, 2015
For cervical or vaginal smear clinical laboratory tests, payment is the lesser of the local fee or the national limitation amount, but not less than the national minimum payment amount (NMPA). However, in no case may payment for these tests exceed actual charges. The Part B deductible and coinsurance do ...
July 10th, 2015
Organ or Disease Oriented Panels (Rev. 1451, 07-07-08)
By Jared Staheli | Published July 10th, 2015
Organ or disease panels must be paid at the lower of the billed charge, the fee amount for the panel, or the sum of the fee amounts for all components. When panels contain one or more automated tests, the contractor determines the correct price for the panel by comparing the ...
July 10th, 2015
CPT Codes Subject to and Not Subject to the Clinical Laboratory Fee Schedule (Rev. 1, 10-01-03)
By Jared Staheli | Published July 10th, 2015
For fee schedule purposes, clinical laboratory services include most laboratory tests listed in codes 80048-89399 of CPT-1996. The CMS issues an update to the laboratory fee schedule each year, with information about whether prices have been determined by CMS or whether the individual carrier must determine the allowable charge.
Codes not ...
July 10th, 2015
Procedures Not Subject to Fee Schedule When Billed With Blood Products (Rev. 1, 10-01-03)
By Find-A-Code | Published July 10th, 2015
The following codes are not subject to fee schedule limitations when submitted for payment on the same bill with charges for blood products. Rather, assume they are to be used for blood matching and not for diagnostic purposes.
Codes: 86901, 86905, 86930-86932, 86920-86922, 86890, 86870, 86891, 86880-86886, 86971, and 86930.
If no ...
July 10th, 2015
Not Otherwise Classified Clinical Laboratory Tests (Rev. 1, 10-01-03)
By Find-A-Code | Published July 10th, 2015
The following codes for unlisted or not otherwise classified (NOC) clinical laboratory tests are not subject to the NLA:
81099 87999 84999 88299 85999 89399 86999
The NOC codes shall suspend for review and the carrier shall determine a price for them.
...
July 9th, 2015
Automated Multi-Channel Chemistry (AMCC) Tests for ESRD Beneficiaries (Rev. 3116, 04-06-15)
By Jared Staheli | Published July 9th, 2015
Instructions for Services Provided on and After January 1, 2011
Section 153b of the MIPPA requires that all ESRD-related laboratory tests must be reported by the ESRD facility whether provided directly or under arrangements with an independent laboratory. When laboratory services are billed by providers other than the ESRD facility and ...
July 9th, 2015
A Local B/MAC/Carrier Receives a Claim for an RRB Beneficiary (Rev. 2474, Issued: 05-18-12)
By Find-A-Code | Published July 9th, 2015
When a local contractor (Part B MAC or carrier) receives a Form CMS-1500 or electronic claim that is identified as a RRB claim for Medicare payment that should be processed by the RRB contractor, the claim shall be returned as unprocessable. Use the following messages:
CARC 109 – Claim not covered ...
July 7th, 2015
When to Report 70332 For TMJ Imaging Procedures
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 7th, 2015 - Last Review/Update August 7th, 2017
Question: When going through radiology codes for TMJ, I saw different codes for imaging studies of the TMJ. Can you please tell me the difference between 70328, 70330 and 70332?
Michigan Subscriber
Answer: If the documentation indicates a TMJ x-ray in two projections of one side, one film with the mouth open, and one with the mouth ...
July 6th, 2015
A/B Medicare Administrative Contractor (MAC) and Contractor Billing Requirements for the IPPE (Rev. 2159, 04-04-11)
By Jared Staheli | Published July 6th, 2015
Effective for dates of service on and after January 1, 2005, through December 31, 2008, contractors shall recognize the HCPCS codes G0344, G0366, G0367, and G0368 shown above in §80.1 for an IPPE. The type of service (TOS) for each of these codes is as follows:
G0344: TOS = 1
G0366: TOS ...
July 6th, 2015
HCPCS Coding for Diabetes Screening (Rev. 457, 04-04-05)
By Jared Staheli | Published July 6th, 2015
The following HCPCS codes are to be billed for diabetes screening:
82947 – Glucose, quantitative, blood (except reagent strip)
82950 – post-glucose dose (includes glucose)
82951 – tolerance test (GTT), three specimens (includes glucose)
...
July 6th, 2015
Carrier Billing Requirements for Diabetes Screening (Rev. 457, 04-04-05)
By Jared Staheli | Published July 6th, 2015
Effective for dates of service January 1, 2005 and later, carriers shall recognize the above HCPCS codes for diabetes screening.
Carriers shall pay for diabetes screening once every 12 months for a beneficiary that is not pre-diabetic. Carriers shall pay for diabetes screening at a frequency of once every 6 months ...
July 6th, 2015
Modifier Requirements for Pre-diabetes (Rev. 457, 04-04-05)
By Jared Staheli | Published July 6th, 2015
A claim that is submitted for diabetes screening and the beneficiary meets the definition of pre-diabetes shall be submitted in the following manner:
The line item shall contain 82497, 82950 or 82951 with a diagnosis code of V77.1 reported in the header. In addition, modifier “TS” (follow-up service) – shall be ...
July 6th, 2015
Fiscal Intermediary (FI) Billing Requirements for Diabetes Screening (Rev. 457, 04-04-05)
By Jared Staheli | Published July 6th, 2015
Effective for dates of service January 1, 2005 and later, FIs shall recognize the above HCPCS codes for diabetes screening.
FIs shall pay for diabetes screening once every 12 months for a beneficiary that is not pre-diabetic. FIs shall pay for diabetes screening at a frequency of once every 6 months ...
July 6th, 2015
HCPCS Coding for Cardiovascular Disease Screening for Diabetes Screening (Rev. 408, 01-03-05)
By Jared Staheli | Published July 6th, 2015
The following HCPCS codes are to be billed for Cardiovascular Disease Screening:
80061 – Lipid Panel
82465 – Cholesterol, serum or whole blood, total
83718 – Lipoprotein, direct measurement, high density cholesterol
84478 – Triglycerides
...
July 6th, 2015
Carrier Billing Requirements for Diabetes Screening (Rev. 408, 01-03-05)
By Jared Staheli | Published July 6th, 2015
Effective for dates of service, January 1, 2005, and later, carriers shall recognize the above HCPCS codes for Cardiovascular Disease Screening.
Carriers shall pay for Cardiovascular Disease Screening once every 60 months.
A claim that is submitted for Cardiovascular Disease Screening shall be submitted in the following manner:
The line item shall contain ...
July 6th, 2015
Fiscal Intermediary (FI) Billing Requirements for Diabetes Screening (Rev. 408, 01-03-05)
By Jared Staheli | Published July 6th, 2015
Effective for dates of service, January 1, 2005, and later, intermediaries shall recognize the above HCPCS codes for Cardiovascular Disease Screening.
FIs shall pay for Cardiovascular Disease Screening once every 60 months.
A claim that is submitted for Cardiovascular Disease Screening shall be submitted in the following manner:
The line item shall contain ...
July 6th, 2015
Payment Method for HIV Screening Tests (Rev. 2199, 07-06-10)
By Jared Staheli | Published July 6th, 2015
Payment for HIV screening is under the Medicare Clinical Laboratory Fee Schedule for TOBs 12X, 13X, 14X, 22X, and 23X beginning January 1, 2011. For TOB 85X payment is based on reasonable cost. Deductible and coinsurance do not apply. Between December 8, 2009, and April 4, 2010, these services can ...
July 6th, 2015
Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)
By Jared Staheli | Published July 6th, 2015
The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for those individuals who use tobacco but do not have signs or symptoms of tobacco-related disease. These are in addition to the two CPT codes 99406 and 99407 that currently are ...
July 6th, 2015
Carrier Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)
By Jared Staheli | Published July 6th, 2015
Carriers shall pay for counseling to prevent tobacco use services billed with code G0436 or G0437 for dates of service on or after January 1, 2011. Carriers shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010 through December 31, ...
July 6th, 2015
Fiscal Intermediary (FI) Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)
By Jared Staheli | Published July 6th, 2015
The FIs shall pay for counseling to prevent tobacco use services with codes G0436 and G0437 for dates of service on or after January 1, 2011. FIs shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010, through December 31, ...
July 6th, 2015
Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)
By Jared Staheli | Published July 6th, 2015
When denying claims for counseling to prevent tobacco use services submitted without diagnosis codes 305.1 or V15.82, contractors shall use the following messages:
MSN 15.4: The information provided does not support the need for this service or item.
MSN Spanish Version: La informaciónproporcionada no confirma la necesidadparaesteservicio o artículo
RARC M64 - Missing/incomplete/invalid ...
July 6th, 2015
Healthcare Common Procedure Coding System (HCPCS) Codes for Screening for STIs and HIBC to Prevent STIs (Rev. 2476, 02-27-12)
By Jared Staheli | Published July 6th, 2015
Effective for claims with dates of service on and after November 8, 2011, the claims processing instructions for payment of screening tests for STI will apply to the following HCPCS codes:
• Chlamydia: 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800 (used for combined chlamydia and gonorrhea testing)
• Gonorrhea: 87590, ...
July 5th, 2015
Payment for Colorectal Cancer Screening (Rev. 3232, 01-05-15)
By Jared Staheli | Published July 5th, 2015
Payment is under the MPFS except as follows:
• Fecal occult blood tests (82270* (G0107*) and G0328) are paid under the clinical diagnostic lab fee schedule except reasonable cost is paid to all non-OPPS hospitals, including CAHs, but not IHS hospitals billing on TOB 83x. IHS hospitals billing on TOB 83x ...
July 5th, 2015
Deductible and Coinsurance for Colorectal Cancer Screening (Rev. 3232, 01-05-15)
By Jared Staheli | Published July 5th, 2015
There is no deductible and no coinsurance or copayment for the fecal occult blood tests (G0107 and G0328), flexible sigmoidoscopy (G0104), colonoscopy on individual at high risk (G0105), and colonoscopy on individual not meeting criteria of high risk (G0121). When a screening colonoscopy becomes a diagnostic colonoscopy anesthesia code 00810 ...
July 5th, 2015
HCPCS Codes, Frequency Requirements, and Age Requirements (If Applicable) - Colorectal Cancer Screening (Rev. 3096, 11-18-14)
By Jared Staheli | Published July 5th, 2015
Effective for services furnished on or after January 1, 1998, the following codes are used for colorectal cancer screening services:
• 82270* (G0107*) - Colorectal cancer screening; fecal-occult blood tests, 1-3 simultaneous determinations;
• G0104 - Colorectal cancer screening; flexible sigmoidoscopy;
• G0105 - Colorectal cancer screening; colonoscopy on individual at high risk;
• ...
July 5th, 2015
Common Working Files (CWF) Edits for Colorectal Cancer Screening (Rev. 1062, 01-02-07)
By Jared Staheli | Published July 5th, 2015
Effective for dates of service January 1, 1998, and later, CWF will edit all colorectal screening claims for age and frequency standards. The CWF will also edit FI claims for valid procedure codes (G0104, G0105, G0106, 82270* (G0107*), G0120, G0121, G0122, and G0328) and for valid bill types. The CWF ...
July 5th, 2015
Ambulatory Surgical Center (ASC) Facility Fee for Colorectal Cancer Screening (Rev. 1160, 07-02-07)
By Jared Staheli | Published July 5th, 2015
CPT code 45378, which is used to code a diagnostic colonoscopy, is on the list of procedures approved by Medicare for payment of an ambulatory surgical center facility under §1833(I) of the Act. CPT code 45378 is currently assigned to ASC payment group 2. Code G0105, colorectal cancer screening; colonoscopy ...
July 5th, 2015
Billing Requirements for Claims Submitted to FIs for Colorectal Cancer Screening (Rev. 1953, 10-04-10)
By Jared Staheli | Published July 5th, 2015
Follow the general bill review instructions in Chapter 25. Hospitals use the ANSI X12N 837I to bill the FI or on the hardcopy Form CMS-1450. Hospitals bill revenue codes and HCPCS codes as follows:
Screening Test/Procedure
Revenue Code
HCPCS Code
TOB
Fecal Occult blood test
030X
82270***
(G0107***),
G0328
12X, 13X,
14X**, 22X, 23X,
83X, 85X
Barium enema
032X
G0106,
G0120,
G0122
12X, 13X,
22X, 23X,
85X****
Flexible Sigmoidoscopy
*
G0104
12X, 13X,
22X, 23X,
83X, ...
July 5th, 2015
MSN Messages for Colorectal Cancer Screening (Rev. 1062, 01-02-07)
By Jared Staheli | Published July 5th, 2015
The following MSN messages are used (See Chapter 21 for the Spanish versions of these messages):
A. If a claim for a screening fecal-occult blood test, a screening flexible sigmoidoscopy, or a barium enema is being denied because of the age of the beneficiary, MSN message 18.13 is used.
This service is ...
June 25th, 2015
Table of Preventive and Screening Services (Rev. 3232, 01-05-15)
By Jared Staheli | Published June 25th, 2015
Service
CPT/HCPCS Code
Long Descriptor
USPSTF Rating
Coins./ Deductible
Initial Preventive Physical Examination, IPPE
G0402
Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment
*Not Rated
WAIVED
Initial Preventive Physical Examination, IPPE
G0403
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with ...
June 25th, 2015
CWF A/B Crossover Edits for FI/AB MAC and Carrier/AB MAC Claims (Rev. 2824, 04-07-14)
By Jared Staheli | Published June 25th, 2015
When CWF receives a claim from the carrier/AB MAC, it will review Part B outpatient claims history to verify that a duplicate claim has not already been posted.
CWF will edit on the beneficiary HIC number; the date of service; the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, ...
June 19th, 2015
Dental and Oral Surgical Procedures - UNITEDHEALTHCARE Coverage
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 19th, 2015 - Last Review/Update August 8th, 2017
The following is found in Oxfords Dental policy.
Oxford's Dental Department will review requests for dental services rendered:
for the following services when delivered in conjunction with dental services:
Dental services
Oral surgical services
Anesthesia services delivered in conjunction with dental services.
by practitioners of the following specialties: oral/maxillofacial surgery
pediatric dentistry
endodontics
orthodontices
NOTE: All other specialties require Medical Director ...
June 18th, 2015
Provider Billing for Prosthetic and Orthotic Devices (Rev. 2629, 02-05-13)
By Jared Staheli | Published June 18th, 2015
See § 01 for definition of provider.
These items consist of all prosthetic and orthotic devices excluding parenteral/enteral nutritional supplies and equipment and intraocular lenses.
Prosthetics and orthotic devices are included in the Part A PPS rate unless specified as being outside the rate. For SNFs, customized prosthetic devices that are not ...
June 9th, 2015
Covered Codes for Bariatric Surgery
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2015 - Last Review/Update August 17th, 2017
CMS has determined that the following procedures will be covered for beneficiaries who have a body-mass index (BMI) ≥ 35, have at least one co-morbidity related to obesity, have been previously unsuccessful with medical treatment of obesity, and this medical information must be documented in the patient's medical record.
Submitted claims ...
June 9th, 2015
Covered Codes for Bariatric Surgery
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2015 - Last Review/Update August 8th, 2017
CMS has determined that the following procedures will be covered for beneficiaries who have a body-mass index (BMI) ≥ 35, have at least one co-morbidity related to obesity, have been previously unsuccessful with medical treatment of obesity, and this medical information must be documented in the patient's medical record.
Submitted claims ...
May 11th, 2015
Isodose Planning Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 11th, 2015 - Last Review/Update February 18th, 2016
Teletherapy isodose planning codes 77305-77315 and brachytherapy isodose planning codes 77326-77328, which are frequently reported with the basic radiation dosimetry calculation code 77300, were identified in the codes inherently performed together 75 percent of the time or greater, as the planning codes now universally require performance of dosimetry calculation as ...
April 23rd, 2015
Alcohol Screening to Reduce Misuse
By Wyn Staheli, Director of Research | Published April 23rd, 2015 - Last Review/Update June 9th, 2016
April is Alcohol Awareness Month and April 9 is National Alcohol Screening Day. Because alcohol misuse contributes to a variety of both social and medical problems, this day was set aside as a way to reach out, educate and increase awareness in communities. By screenings and other initiatives, at-risk individuals ...
April 17th, 2015
2015 Guidelines, Diagnosis Pregnancy and Antepartum
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 17th, 2015 - Last Review/Update February 3rd, 2017
Services provided to diagnose pregnancy are to be reported separately and not considered a part of antepartum care given to the patient. Be sure to report the E/M visits separately as of the 2015 revised guidelines.
The services normally provided in uncomplicated maternity cases include antepartum care, delivery as well as ...
March 16th, 2015
Plantar Fasciitis: Medical Necessity and Cross Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2015 - Last Review/Update August 9th, 2017
Prior to treatment you must determine Medical Necessity.
Be sure conservative therapy/treatment was previously done and documented for at least 6 months and proven to be unsuccessful.
NSAIDS - at least 4 weeks ineffective or contraindicated
Physical Therapy such as taping and stretching
Activity modification
Splints used at night for more that 4 weeks
Corticosteroid injection
Arch Supports, ...
March 9th, 2015
Billing Imminuzation for Pneumococcal, Influenza, and Hepatitis B with Medicare
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
The current diagnosis pointer for, Influenza, Pneumococcal or Hepatitis B vaccines is ICD-10-CM code Z23. Listed are tips for coding, and also the diagnosis pointers used for claims previous to 10/01/15:
Influenza: G0008
Procedure codes:
90630
90653-90662
90672-90674
90685-90688
Medicare codes:
Q2034-Q2039
Expired diagnosis code:
V04.81
Pneumococcal: G0009
Procedure codes:
90670
90732
Expired diagnosis code:
V03.82
Hepatitis B: G0010
Procedure codes
90739-90747
Expired diagnosis code
V05.3
Both Influenza and Pneumococcal Vaccines received in same visit: G0008 with G0009
Procedure codes:
(See previous)
Expired diagnosis code:
V06.6 (effective 10/01/06 - 09/30/15)
Extra Tips:
Be sure ...
March 9th, 2015
Wound Care - Are you Using the Most Appropriate Codes?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
If you often use 11042-11047, be sure you are using the correct codes. If you are preparing the site for surgery, these would not be the correct codes to use. In addition, when using codes 11042-11047, be sure to document the size of the wound; use this set of codes only if ...
February 26th, 2015
Levels of Supervision Required by Medicare
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 26th, 2015 - Last Review/Update March 2nd, 2016
Be sure you know and understand the levels of supervision required so as not to result in non-compliance audits, possible fines and take-backs. Supervision requirements may also affect your documentation requirements; be sure to document the presence during the procedure or performance if it requires personal supervision.
Find-A-Code has levels of supervision ...
February 21st, 2015
Coding for Vaccine Administration
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update March 1st, 2016
Information on Medicare Vaccine Coverage
Medicare Part B Vaccine Coverage
Medicare Part D Vaccine Coverage
Vaccine Coding
Vaccines Administered at Well-child Visits
When vaccines are provided as part of a well-child encounter, the ICD-9 guidelines instruct that code V20.2 (routine infant or child health check) includes immunizations appropriate to the patient's age. A code from ...
February 21st, 2015
UnitedHealthcare to Require Functional Limitation Reporting
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update March 1st, 2016
Effective August 1, 2014, the UnitedHealthcare Medicare Advantage Plans from UnitedHealthcare will implement the new Medicare Outpatient Therapy Functional Limitation Reporting requirement. The reporting scenarios will be similar to Medicare functional limitation reporting.
Announced in the UnitedHealthcare May 2014 Bulletin, contracted physical, occupational, and speech therapist claims with dates of service ...
February 21st, 2015
Billing Requirements for G0466, G0467, G0468, G0469 or G0470 - MLN
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update February 18th, 2016
Basic Billing Requirements
When reporting an encounter/visit for payment, the claim (77X TOB) must contain a FQHC specific payment code (G0466, G0467, G0468, G0469 or G0470) that corresponds to the type of visit.
FQHC specific payment specific codes G0466, G0467 and G0468 must be reported under revenue code 052X or under ...
February 13th, 2015
Chiropractic Services - Aetna Clinical Policy Bulletin
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 2015 - Last Review/Update March 1st, 2016
AETNA
Clinical Policy Bulletin: Chiropractic Services
Number: 0107
http://www.aetna.com/cpb/medical/data/100_199/0107.html
Policy
Note: Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details.
Aetna considers chiropractic services medically necessary when all of the following criteria are met:
The member has a neuromusculoskeletal disorder; and
The medical necessity for treatment is clearly documented; and
Improvement is ...
February 9th, 2015
Coding And Billing For JETREA - Physician Office
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 9th, 2015 - Last Review/Update August 9th, 2017
The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is ...
February 9th, 2015
Coding And Billing For JETREA® - Hospital Outpatient Department
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 9th, 2015 - Last Review/Update August 9th, 2017
The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is ...
January 29th, 2015
Claims Processing Resources
By | Published January 29th, 2015 - Last Review/Update February 1st, 2017
A clean claim is vital to the processing and payment of your claims. The "cleaner" the claim, the faster you will receive payment. It is the responsibility of the provider to understand what is needed and required by the carrier; then provide that information.
You need to understand the following concepts:
Claim Followup ...
January 28th, 2015
Modifier XU Fact Sheet
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 8th, 2017
Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the service was not part of the usual components of the main service
Use Modifier ...
January 28th, 2015
Modifier XS Fact Sheet
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 9th, 2017
Separate Structure, A Service That Is Distinct Because It Was Performed on A Separate Organ/Structure
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided on different organs/structures
Use Modifier XS with the Column 2 procedure code in the NCCI files
Use Modifier XS only when there ...
January 28th, 2015
Modifier XP Fact Sheet
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 9th, 2017
Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided by different practitioners in the same group practice
Use Modifier XP with the Column 2 procedure code in the ...
January 28th, 2015
Modifier XE Fact Sheet
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 9th, 2017
Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided during separate patient/provider encounter
Use Modifier XE with the Column 2 procedure code in the NCCI files
Use Modifier XE only when there ...
January 17th, 2015
Diagnosis Coding Resources
By | Published January 17th, 2015 - Last Review/Update January 30th, 2017
Proper documentation of a patient's condition(s) is essential to the reimburement process. Section G-Diagnosis Coding of the ChiroCode Deskbook contains a more thorough discussion of diagnosis coding. ICD-9-CM is the HIPAA required code set for diagnosis coding until October 1, 2015 when ICD-10-CM becomes the new standard. We recommend the ...
January 16th, 2015
Billing for Split Unit of Blood
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 16th, 2015 - Last Review/Update March 1st, 2016
Billing for Split Unit of Blood
(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, implementation: 04-07-08)
HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split, and some portion of the unit is transfused to one patient while the other portions are transfused to other patients ...
December 3rd, 2014
Coding for Laser Therapy
By | Published December 3rd, 2014 - Last Review/Update January 30th, 2017
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnosis code.
Coverage for laser, as with any other service, is strictly dependent upon the ...
November 21st, 2014
Modifier 50
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 21st, 2014 - Last Review/Update January 30th, 2017
Modifier Review: Modifier -50
Modifier 50 is used to report a procedure performed bilaterally.
Example: The patient underwent bilateral tympanostomy with insertion of ventilating tubes.
If you look up the CPT code 69433, you will see it is a unilateral procedure and there are instructions telling you to append modifier -50 if ...
November 21st, 2014
Coding for Laser Therapy
By | Published November 21st, 2014 - Last Review/Update January 30th, 2017
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the ...
November 7th, 2014
Q & A: 97022 and Dry Hydromassage
By | Published November 7th, 2014 - Last Review/Update January 30th, 2017
Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do not select a ...
October 22nd, 2014
Q & A: 97022 and Dry Hydromassage
By | Published October 22nd, 2014 - Last Review/Update January 27th, 2017
Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do ...
October 16th, 2014
Piriformis Injections
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Piriformis Injections
The piriformis muscle is a small muscle that attaches at the sacrum, travels across the pelvis and attaches to the top of the femur. It is an external rotator of the hip and leg, which allows the leg and hip to move outward. The sciatic nerve is comprised of ...
October 16th, 2014
CT (Computed Tomography) Enterography
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Computed Tomography (CT) Enterography
CT enterography is not a specific procedure but rather a protocol used with CT abdomen, CT pelvis or CT abdomen and pelvis. It uses CT imaging and two types of contrast to better visualize the anatomy of the interior small intestines.
For years endoscopic techniques were the ...
October 16th, 2014
Evaluation and Management (EM) in the Skilled Nursing Facility
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Evaluation and Management (EM) in the Skilled Nursing Facility
The first time I remember visiting a skilled nursing facility was after my grandmother's stroke. She was rehabilitating there, trying to learn to speak again. Once she was back to her normal activities, she returned to our home where she was taken ...
October 16th, 2014
ABN FAQ for Chiropractic Care
By | Published October 16th, 2014 - Last Review/Update November 29th, 2017
What is the ABN form used for?
The Advanced Beneficiary Notice of Non-Coverage (ABN) is the Notice of Liability that is required to be provided to Medicare patients in the event that the service(s) rendered to them are expected to not be covered. For chiropractic, reason for non-coverage is generally due ...
October 9th, 2014
Modifier 24
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 9th, 2014 - Last Review/Update January 30th, 2017
Modifier -24
When a patient is seen during a global (postoperative) period for something unrelated to the surgery for which the global period applies, modifier -24 is appended to the evaluation and management (EM) service.
The insurance may deny payment for the EM service; however, if the notes for that service ...
September 15th, 2014
Medicare Definition of Timed Codes
By Wyn Staheli, Director of Research | Published September 15th, 2014 - Last Review/Update July 12th, 2016
Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. Medicare Claims Processing Manual, Chapter 5 clarification included here.
September 15th, 2014
Can Chiropractors Bill 99211?
By | Published September 15th, 2014 - Last Review/Update January 30th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse's code, is not really made for the physician to use. In fact, the AMA, ...
August 26th, 2014
Q & A: What is the Definition of "New Patient" for Billing Evaluation and Management (E/M) Services?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 26th, 2014 - Last Review/Update August 9th, 2017
Q: What is the definition of "new patient" for billing evaluation and management (E/M) services?
A: Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice ...
August 6th, 2014
The Proper Use of Evaluation and Management CPT Code 99211
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published August 6th, 2014 - Last Review/Update January 25th, 2017
The Proper Use of Evaluation and Management CPT Code 99211 When properly used and reported, evaluation and management service code 99211 can be useful, time saving and profitable. The description for code 99211 reads, “Office or other outpatient visit for the evaluation and management of an established patient, that may ...
July 31st, 2014
Sphenopalatine Ganglion Blocks
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 31st, 2014 - Last Review/Update January 25th, 2017
The sphenoplatatine ganglion, more often referred to as the pterygopalatine ganglion (also Meckel’s ganglion or nasal ganglion) is located within the pterygopalatine fossa. You can locate that place by putting your fingers at the temporomandibular joint in front of your ears and then slightly moving your fingers up until ...
July 31st, 2014
Fill In Doctor: Locum Tenens
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ...
July 31st, 2014
Can Chiropractors Bill 99211?
By | Published July 31st, 2014 - Last Review/Update January 25th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged. The 99211 code, also known as the nurse's code, is not really made for the physician to use. ...
July 31st, 2014
GP Modifier for Physio Therapy Services
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
The -GP modifier needs to be appended to physio-therapy codes when submitting Medicare claims. However, be aware of differing policies for different types of payers. Chiropractors typically use the following Physical Medicine codes from the CPT book: 97010 thru 97799 (except for 97597-97610 for active wound care management). The current ...
July 31st, 2014
Question & Answer on CPT code 37765 documentation requirements & preauthorization
By Michelle Herbert, CPC | Published July 31st, 2014 - Last Review/Update January 25th, 2017
Question: is there a sample note to code 37765, our surgeon does Answer: Most third party payers are requiring a pre authorization on these vein codes. Provider documentation must include the failed conservative treatment. The following is the documentation and authorization requirements 1. A 3â€month trial of conservative therapy such ...
July 31st, 2014
Microphlebectomy for the Treatment of Varicose Veins
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 31st, 2014 - Last Review/Update January 27th, 2017
Varicose veins can be troubling for the many people who suffer from them. Pain, itching, heavy and tired legs and swelling can make varicosities next to intolerable. Fortunately, there are several treatment options available. Microphlebectomy, sometimes referred to as "stab phlebectomy," is often performed on varicosities that are too small to ...
July 31st, 2014
How Do You Report a CT of the Renals?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 31st, 2014 - Last Review/Update January 25th, 2017
People with kidney stones may suffer from severe abdominal pain, low back pain, painful urination, hematuria, nausea and vomiting while others with kidney stones, small enough to pass on their own, may have no symptoms at all. There are several tools used to diagnose kidney stones: Urinalysis can show the ...
July 31st, 2014
Repeat Procedures on the Same Day - When to Report Modifiers -76 and -77
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 31st, 2014 - Last Review/Update January 25th, 2017
Have you ever had a claim deny as a ‘duplicate service’ only to find out upon further review that it was actually performed twice on the same day? This occurs more often than you realize and it is fairly easy to correct the error and get the claim paid. Modifiers ...
July 31st, 2014
When It's Appropriate to Document a Comprehensive Patient History
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 31st, 2014 - Last Review/Update January 25th, 2017
When It’s Appropriate to Document a Comprehensive Patient History by Aimee Wilcox, MA, CST, CCS-P Have you ever wondered when it is appropriate to document a comprehensive past medical, family and social history (PFSH) or if the necessity of doing so will be questioned during an audit? Well, providers ...
July 24th, 2014
Are Medicare fees going up? Or down?
By | Published July 24th, 2014 - Last Review/Update January 29th, 2016
Are Medicare fees going up? Or down? Results for the following:
Sequestration
Chiropractic Demonstration Project
Electronic Health Record/Meaningful Use
Physician Quality Reporting System - PQRS
Value-Based Modifier
July 24th, 2014
Are Medicare fees going up? Or down?
By | Published July 24th, 2014 - Last Review/Update January 25th, 2017
PAMA (up 0.5%)
On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014 (PAMA). Within this law, Congress instituted changes that went into effect on July 1, 2014. The law provided for a 0.5% update for claims with dates of service on or after ...
July 16th, 2014
The Impact of ICD-10 Coding System on Medical Billing
By David Berky | Published July 16th, 2014 - Last Review/Update January 25th, 2017
Learn how the introduction of ICD-10 will impact the coding and billing of medical diagnosis and procedure.
July 16th, 2014
Coding Facet Joint Injections
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 16th, 2014 - Last Review/Update January 25th, 2017
If you work in pain management, anesthesia or interventional radiology, you are probably keenly aware of the changes that have occurred over the past three years with facet joint injection coding and its effect on your bottom line. A facet joint injection is a diagnostic procedure used to determine if ...
July 16th, 2014
Coding Screening Mammograms
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 16th, 2014 - Last Review/Update January 25th, 2017
Mammography is a method of taking x-ray images of the breasts to identify tumors or abnormalities in the tissues that may indicate breast cancer. Screening Mammography: Screenings are performed on otherwise healthy individuals to look for cancer or precursors to cancer of the breasts. Early detection of breast cancer ...
July 16th, 2014
Computed Tomography (CT) Enterography
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published July 16th, 2014 - Last Review/Update January 27th, 2017
CT enterography is not a specific procedure but rather a protocol used with CT abdomen, CT pelvis or CT abdomen and pelvis. It uses CT imaging and two types of contrast to better visualize the anatomy of the interior small intestines. For years endoscopic techniques were the only tools available ...
July 16th, 2014
G0402: Medicare Preventive Visit
By | Published July 16th, 2014 - Last Review/Update January 25th, 2017
Medicare covers a one-time Initial Preventive Physical Examination (IPPE), also referred to as the “Welcome to Medicare†visit.  IPPE is a unique benefit available only to patients newly enrolled in the Medicare Program and must be received within the first 12 months of the effective date of their Medicare Part ...
January 1st, 2014
Testing & Screening Tools
By Wyn Staheli, Director of Research | Published January 1st, 2014 - Last Review/Update October 4th, 2017
There are numerous types of behavioral health screening tools for healthcare providers. Some, like the AUDIT and SBIRT are especially applicable to primary care providers caring for Medicare beneficiaries.
This page includes some general information and resources for some of these screening tools. Let us know if you would like others included ...
November 8th, 2013
Modifiers –Reimbursement or Informational?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 8th, 2013 - Last Review/Update November 3rd, 2017
Modifiers are used to help describe the encounter, and used to further explain the procedure to the payer. Modifiers will be used if the procedure does not fit or clearly explain the entire encounter.
There are two types of modifiers:
Informational modifiers that do not impact reimbursement
Pricing or Payment modifiers that ...
July 25th, 2013
Medicare Considering Paying DCs for E/M Services
By | Published July 25th, 2013 - Last Review/Update January 27th, 2017
A notice in the July 19, 2013 Federal Register, has a VERY important clause for all Doctors of Chiropractic! The Centers for Medicare and Medicaid Services (CMS) has asked for comment on whether or not Doctors of Chiropractic should be paid for Evaluation and Management (E/M) services. Keep in mind ...
July 8th, 2013
Denials for 97140 (Manual Therapy)? Here's the story.
By | Published July 8th, 2013 - Last Review/Update January 27th, 2017
The ChiroCode Institute has received several inquiries over the last few months regarding a denial for 97140 (Manual therapy—such as myofascial release or trigger point therapy) when billed with 98940-98942 (Chiropractic Manipulative Treatment - CMT) on the same visit. Most payers follow Medicare’s guidelines for the use of this code, ...
December 31st, 2001
Commonly Asked Chiropractic Coding Questions
By ChiroCode | Published December 31st, 2001 - Last Review/Update August 19th, 2015
Commonly Asked Questions:
1. Retention of Records
2. 97140 Denials
3. Exercise Equipment
4. Coding for BioFreeze
5. 97014 or G0283
6. Billing for additional insurance forms
7. Report of Findings
8. Laser therapy
9. Spinal Decompression
10. Diagnosis Coding – 4th and 5th digit
11. Re-Reading X-rays
12. Outcomes Assessment Questionnaires
13. Accounts Receivable
14. 15-Minute Units
15. E/M and CMT
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