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"Anesthesia|Pain Management" Articles
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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 ...
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.
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...
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 ...
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.
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 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 ...
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 ...
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 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 ...
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...
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...
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 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 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 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 ...
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 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 ...
October 26th, 2016
Using Physical Status Modifiers with Anesthesia Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 26th, 2016 - Last Review/Update August 1st, 2017
These six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in the CPT codebook to distinguish among various levels of complexity of the anesthesia service provided.Example: 00100-P1Physical Status modifiers are represented by the initial letter ‘P’ followed by a single digit from 1 to 6 ...
October 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 ...
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