"Anesthesia|Pain Management" & "Procedure Coding" Articles

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

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?

By Jared Staheli | Published February 11th, 2021

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 ...

January 11th, 2021

Instructions for Looking up IOM References in innoviHealth's HCPCS Publication

By Wyn Staheli, Director of Research | Published January 11th, 2021

These instructions help owners of innoviHealth's HCPCS Coding for 2021 book access the references to Medicare's Internet-only Manuals (IOMs) which are copies of official program instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives.

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.

October 1st, 2020

New Codes for Cytokine Release Syndrome (CRS)

By Wyn Staheli, Director of Research | Published October 1st, 2020 - Last Review/Update October 6th, 2020

New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.

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 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.

August 5th, 2020

Coding with PCS When There is No Code

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 5th, 2020

ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...

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 ...

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.

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 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 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 20th, 2020

Acupuncture Clarification

By Wyn Staheli, Director of Research | Published February 20th, 2020

In the ChiroCode Newsletter released yesterday regarding Medicare coverage of acupuncture, one sentence in particular has let to some confusion. Read more about it here.

February 19th, 2020

Medicare Begins Covering Acupuncture Services

By Wyn Staheli, Director of Research | Published February 19th, 2020

Medicare is changing their policy regarding coverage of acupuncture, but in order to provide these services, you must follow their rules.

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 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 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 ...

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November 25th, 2019

Hypertension ICD-10-CM Code Reporting Table

By Wyn Staheli, Director of Research | Published November 25th, 2019

In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.

October 1st, 2019

Federal Workers Compensation Information

By Wyn Staheli, Director of Research | Published October 1st, 2019

When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...

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 16th, 2019

Medical ID Theft

By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019

Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

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 9th, 2019

The OIG Work Plan: What Is It and Why Should I Care?

By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019

The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

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 12th, 2019

5 Ways to Minimize HIPAA Liabilities

By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019

Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...

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 ...

July 1st, 2019

Q/A: Do I Really Need to Have an Interpreter?

By Wyn Staheli, Director of Research | Published July 1st, 2019

Question: I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true? Answer: Yes! There are both state and federal laws that need to be considered. The applicable federal laws are: Title VI of the Civil Rights Act of 1964, Americans with Disabilities ...

June 14th, 2019

A United Approach

By Namas | Published June 14th, 2019 - Last Review/Update June 18th, 2019

A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...

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.

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 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 ...

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 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 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 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

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 14th, 2019

Q/A: Is G8730 Still Required? Are G Codes Required at all?

By Wyn Staheli, Director of Research | Published January 14th, 2019 - Last Review/Update January 21st, 2019

G8730, when is it required. Many G codes are still active and are required for non-quality reporting.

January 10th, 2019

Are You Protecting Your Dental Practice From Fraud?

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 10th, 2019

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

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

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

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

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 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 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.

October 31st, 2018

Anesthesia and Pain Management

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 31st, 2018 - Last Review/Update November 1st, 2018

Anesthesia and Pain management is under close watch from the OIG according to a report from Anesthesia Business consultants, they stated, "The Health and Human Services Office of Inspector General (HHS OIG) reports in its most recent Semi-annual Report to Congress that in FY 2017 it brought criminal actions against 881 individuals or organizations ...

October 17th, 2018

Wolters Kluwer Drug Pricing

By Find-A-Code | Published October 17th, 2018

Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...

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 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?

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 ...

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.

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 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 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 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?

May 14th, 2018

TKAs to Outpatient What We Have Learned with Q1

By Shannon Cameron, MBA, MHIIM, CPC | Published May 14th, 2018 - Last Review/Update May 24th, 2018

The release of the 2018 Final Rule for the Outpatient Prospective Payment System (OPPS) in November 2017 has created quite a stir across the orthopedic healthcare community. In what has been deemed a questionable decision, the Centers for Medicare and Medicaid Services (CMS) decided to remove Total Knee Arthroplasty...

May 9th, 2018

Preventive Medicine: Initial Preventive Physical Examination

By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018

Preventive Medicine Topics Page Initial Preventive Physical Examination (Medicare Only) Procedure Codes G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation ...

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

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 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 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 28th, 2018

Telemedicine Billing and Reimbursement

By Jared Staheli | Published February 28th, 2018

The opportunities for providers who want to provide telemedicine continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding ...

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 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 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: ...

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 29th, 2018

Anesthesia Documentation Modifiers - Jurisdictions: J8A, J5A, J8B, J5B

By Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018

Documentation Modifiers direct prompt and correct payment of the anesthesia claims submitted. Documentation modifiers (AA, QK, AD, QY, QX and QZ) must be billed in the first modifier field. If a QS modifier applies, it must be in the second modifier field. Processing delays and denials may occur for claims submitted ...

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 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 24th, 2018

HIPAA and the Opioid Crisis

By Wyn Staheli, Director of Research | Published January 24th, 2018

HIPAA and the Opioid Crisis guidance released by HHS.

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 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

Coverage and/or Medical Necessity for the Use of Hyaluronan or Derivitive

By Find-A-Code | Published January 9th, 2018

According to Palmetto GBA, Medicare will cover the cost of the injection and the injected hyaluronate polymer for patients who meet the following clinical criteria: Knee pain associated with radiographic evidence of osteophytes in the knee joint, sclerosis in bone adjacent to the knee, or joint space narrowing. Morning stiffness of less than 30 minutes in duration or crepitus on motion of the ...

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

ICD-10-PCS Coding the Approach

By Find-A-Code | Published January 9th, 2018

When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using. There are seven approaches. They are listed below with their ...

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 ...

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 18th, 2017

Accreditation and Billing for Office Based Surgery (OBS)

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 18th, 2017

The traditional healthcare has seen many changes over the years, one of the newest changes we are seeing is procedures once being done as an inpatient, then as an outpatient and now from the outpatient facility to Office-Based procedures. For an Office or Provider to be eligible to perform Office-Based Surgery the ...

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?

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 27th, 2017

Erythropoietin Stimulating Agents (ESA)

By Wyn Staheli, Director of Research | Published November 27th, 2017

Coverage ESA is typically covered for the following condition(s): Treatment of anemia associated with chronic renal failure (whether or not that patient is on dialysis) Treatment of significant anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy Treatment of anemia due to AZT and/or other Nucleoside Reverse Transcriptase Inhibitors (NRTI) used in treatment of HIV/AIDS Treatment of selected ...

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 ...

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 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 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 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: Alcohol Misuse Screening and Counseling

By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 5th, 2018

The following information from the Medicare Learning Network (MLN) provides guidance on Alcohol Misuse Screening and Counseling.......

August 24th, 2017

Can They Deny Electrical Stimulation by Saying There is no Evidence that it Works?

By Dr Ronald J. Farabaugh | Published August 24th, 2017 - Last Review/Update February 5th, 2019

Topic: Electrical Stimulation (EMS) Question: An orthopedic surgeon/IME recommended a denial for all electrical stimulation (EMS) by stating that "according ODG electrical stimulation is experimental therefore not medically necessary or eligible for reimbursement." Is that true?

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 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?

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?

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

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 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?

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 ...

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 2nd, 2017

Coverage and/or Medical Necessity for the Use of Hyaluronan or Derivitive

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 2nd, 2017 - Last Review/Update August 2nd, 2017

Verify your local coverage determination and medical necessity requirements for the following codes: Hyaluronate Polymers (L33432) - Noridian Medicare J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg J7321 - Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose J7322 - Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg J7323 - Hyaluronan or ...

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 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 ...

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 ...

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 ...

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.

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:

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.

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), ...

July 7th, 2015

Professional Billing Requirements for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11,

By Jared Staheli | Published July 7th, 2015 - Last Review/Update February 5th, 2018

For claims with dates of service on and after October 14, 2011, CMS will allow coverage for annual alcohol misuse screening, 15 minutes, G0442, and behavioral counseling for alcohol misuse, 15 minutes, G0443, only when services are submitted by the following provider specialties found on the provider’s enrollment record: 01 - ...

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

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 ...

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 ...

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 ...

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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Q/A: How do we Bill Massage Services?

Billing for Telemedicine in Chiropractic

Who Knew? There are Three Types of Add-On Codes

Hypertension ICD-10-CM Code Reporting Table

Federal Workers Compensation Information

New Codes for Dry Needling

Vaccine Administration - When The Right Vaccine Code is Not Enough

Q/A: How Do I Bill a House Call?

E-Health is a Big Deal in 2020

Chiropractic 2020 Codes Changes Are Here

Medical ID Theft

How to Properly Report Prolonged Evaluation and Management Services

The OIG Work Plan: What Is It and Why Should I Care?

CMS Proposes to Reverse E/M Stance to Align with AMA Revisions

5 Ways to Minimize HIPAA Liabilities

Will the New Low Level Laser Therapy Code Solve Your Billing Issues?

Q/A: Do I Really Need to Have an Interpreter?

A United Approach

Electrical Stimulation and Electromagnetic Therapy Devices

Auditing Chiropractic Services

Spinal Cord Stimulator Used for Chronic Pain

Date of Service Reporting for Radiology Services

Understanding NCCI Edits

Q/A: Can I Bill a Review of X-Rays?

Physical Therapy Caps Q/A

Q/A: Which Code Should I Use for a Lab Interpretation Fee?

How to Report Co-Surgeons Using Modifier 62

AMA Issues new CMT Information

Q/A: Is G8730 Still Required? Are G Codes Required at all?

Are You Protecting Your Dental Practice From Fraud?

Dry Needling

2019 Coding Changes for Chiropractic

Welcome 2019 CPT Codes!

Flexion-Distraction Billing Clarification

CMT Fees in 2019

Muscle Testing and Range of Motion Information

Anesthesia and Pain Management

Wolters Kluwer Drug Pricing

Pelvic Floor Dysfunction Treatment Coverage

Is cox-flexion distraction billable as 97012

2019 Code Changes are Just Around the Corner - Are You Ready?

Importance of Depression Screenings

Medicare Timed Codes Guidelines

Using Modifiers 96 and 97

Q/A: Can I Bill Mechanical Massage?

Q/A: Can I Bill Spinal Decompression Table to Insurance?

Q/A: Can You Swap Out 97140 with 97530?

Q/A: Should I Bill Massage as 97124 or 97140?

Q/A: Coding for ECG/EKG’s

Inappropriate Use of Units Costs Practice Over $800,000

The Range of Motion Conundrum

How Many Modalities Are Too Many?

TKAs to Outpatient What We Have Learned with Q1

Preventive Medicine: Initial Preventive Physical Examination

Billing Nutrition Counseling in a Chiropractic Setting

Billing Nutrition Counseling

Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?