"Location: All Locations" & "ICD9v3 Coding" Articles

Click on the title to see the article summary and a link to the full article.

February 9th, 2021

Why Reporting E/M Based on Time May Not Be Beneficial

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 9th, 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 ...

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 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 ...

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 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 12th, 2020

Medicare Improper Payment Report (2019)

By Jared Staheli | Published October 12th, 2020

The Medicare Improper Payment Report for 2019 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July ...

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...

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

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

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.

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 ...

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 ...

older articles ↓

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 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: ...

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 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 ...

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 ...

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?

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

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 ...

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 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 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 ...

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 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

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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. ...

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 1st, 2017

Medicare Improper Payment Report for Chiropractic (2016)

By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017

The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ...

September 1st, 2017

Medicare Improper Payment Report for Behavioral Health Services (2016)

By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017

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....

July 14th, 2017

Don’t Overlook Diagnosis Codes During Coding Audits

By Betty Stump, MHA, RHIT, CPC, CCS-P, CPMA, CDIP | Published July 14th, 2017

Coding auditors focus much of their attention exclusively on C.P.T. codes during the review process. After all, codes reported for E and M visits, surgical procedures, and diagnostic services are what generate revenue to the provider or facility. Even more importantly, errors in reporting these services are frequently what give ...

June 8th, 2017

Billing Medicare for Certain Replaced Devices

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 8th, 2017 - Last Review/Update July 26th, 2017

When billing for certain replaced devices, Medicare payments should be reduced when a replacement device (cardiac or otherwise) is received by a hospital at a reduced cost (including no cost), or with a credit that is 50 percent or greater than the cost of the device. Correct billing in such situations ...

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 ...

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 ...

July 13th, 2016

Procedure code set for Procedures ICD-10-PCS to ICD-9-CM

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 13th, 2016

There are some PCS codes that have a GEMS mapping and is available on Find-A-Code, such as ICD-9-CM Vol 3. 02.11, the GEMS mapping can be found in out Map-a-code tool. See this code mapping to the following PCS codes CodeDescription00Q20ZZ Repair Dura Mater, Open Approach 00Q23ZZ Repair Dura Mater, Percutaneous Approach 00Q24ZZ Repair Dura Mater, Percutaneous Endoscopic ...

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 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

American Dental Association releases new guidelines on gum disease treatment

By Christine Taxin | Published January 29th, 2016

The new guidelines recommend using SRP for initial treatment of patients with periodontitis. According to new guidelines from the American Dental Association (ADA), dentists treating patients with chronicperiodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing(SRP), deep cleaning...

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...

December 21st, 2015

Characteristics of High Risk and How Often Test can be Performed

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 21st, 2015 - Last Review/Update August 7th, 2017

According to Medicares Pub-100, 60 - Colorectal Cancer Screening Ref: AB-03-114; Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month ...

December 1st, 2015

Burnout and Emergency Medicine

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 1st, 2015

When it comes to Burnout, Emergency Medicine is hit the Hardest according to MedPage Today. The results come from a survey of burnout among U.S. Physicians. The mean average on those reporting burnout was 45.8%. The emergency physicians were certainly reporting higher burnout at more than 60%. There are many factors contributing to the emergency physician’s burnout, such as the intense environment, economic pressures from healthcare, as well as Medicare's quality indicators, which make doctors accountable for things they have no control over.

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 ...

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 10th, 2015

MSN - Specifications for Section 3: Claims (Rev. 3210, 04-16-15)

By Jared Staheli | Published August 10th, 2015

A. Section Title POSITION This subsection contains information of a fixed size. It is fixed in width but may vary in overall length. The content area begins (0˝, 0.22˝), 7 points from the baseline of the content described above under the Headers for Other Pages subsection. It is full-page or 540 points in ...

August 3rd, 2015

Notice of Election (NOE) - Form CMS - 1450 (Rev. 3118)

By Find-A-Code | Published August 3rd, 2015

When a Medicare beneficiary elects hospice services, hospices must complete form locators identified in section 20.1.2 for the Uniform (Institutional Provider) Bill (Form CMS-1450), which is an election notice. In addition, the hospice must complete the Form CMS-1450 when the election is for a patient who has changed an election from one ...

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

Payment Jurisdiction Among A/B MACs (B) for Services Paid Under the Physician Fee Schedule and Anesthesia Services (Rev. 3086)

By Find-A-Code | Published July 20th, 2015

(Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014) The jurisdiction for processing a request for payment for services paid under the Medicare Physician Fee Schedule (MPFS) and for anesthesia services is ...

July 17th, 2015