"CPT Coding" & "HCPCS Coding" & "Procedure Coding" Articles


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


HCPCS Codes Were NOT all Created for the Same Purpose

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Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...

Additional COVID-19 Testing Codes Announced

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New coronavirus antigen testing codes announced. These are effective immediately.

Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab

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The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...

Are NCCI Edits Just for Medicare?

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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 ...

CMS- Reminder COVID Assessment and Specimen Collection

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On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection. CMS has recently sent out reminders on billing for these services, the proper use of the CS modifier on claims, and how they are handling denials due ...

Payment Adjustment Rules for Multiple Procedures and CCI Edits

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Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...

Newest Launch - We Now Have Outpatient Facility Pricing!

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Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...

MEGA - NCCI Edit Changes - WHO Knew?

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There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE).  The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197  Deleted Medically Unlikely ...

Coding with PCS When There is No Code

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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 ...

Watch for Payer Telehealth Coverage Changes

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As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.

Additional Practice Reopening Tips

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As practices begin reopening across the nation, there are several things that need to be considered. Policies and Procedures Manuals need to be updated, malpractice carriers need to be contacted and everyone needs to consider mental health screenings and support.

Packaging and Units for Billing Drugs

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To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number. Take a look at the following J1071 - Injection, testosterone cypionate, 1mg For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL (100 mg/mL = 1 mL and there are ...

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?

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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 ...

Special COVID Laboratory Specimen Coding Information

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With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.

Emergency Room and Ancillary Services

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Billing for an Emergency department is not the same as billing for a hospital or in the provider's office; there are several differences and requirements. For example. the hospital will report a stay with Diagnosis Related Groups (DRG's), which include hospital resources used during the patient's stay, while office visits ...

New CPT® Codes Approved for COVID-19 Antibody Identification

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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.

Medicare Released the Amount they Will pay for COVID Testing Eff 4/14/2020

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CPT Coding Guidance on New Lab Code for COVID-19

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According to the AMA, "The Addition of one Category I Pathology and Laboratory code (87635) for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]) accepted at the March 2020 CPT Editorial Panel meeting. *Note that code 87635 will be a child code under parent code 87471. It is represented here ...

More Telehealth Changes Announced by CMS Chiropractic Offices Should Know About

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On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar.

More Telehealth Changes Announced by CMS

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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

CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes

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Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly.  Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...

Providing Telehealth Services During COVID-19 Crisis

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The rules for providing telehealth services during this pandemic have changed and some requirements have been waived. Please keep in mind that “waiving requirements” does not mean that anything goes. Another important consideration is that Medicare and private payers may likely have different rules so you need to make sure that you know individual payer requirements during this time.

Interprofessional Consult Services

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The recent coronavirus crisis has brought non-face-to-face services to the forefront of coding and billing conversations. With the entire healthcare industry focused on caring for patients during an unprecedented and fast-moving pandemic, the goal of increasing patient access while reducing the risk of spreading infection has become paramount. In this climate, ...

New Biofeedback Codes to replace 90911 Eff 2020-01-01

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CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911. According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate. Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ...

LATEST COVID-19 INFORMATION FOR BILLING NON-FACE-TO-FACE SERVICES

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Healthcare providers and the population at large are concerned about safe access to care considering the COVID-19 pandemic. As a result, we have received many inquiries this week about how to bill for “telehealth” services. Let’s first address that true telehealth services have some pretty stringent requirements from CMS, including that ...

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

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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: ...

Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)

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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 ...

Implementing Telehealth Visits

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The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection. Step ...

Additional Coronavirus Testing Code Announced

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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.

Acupuncture Clarification

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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.

New HCPCS Code for Coronavirus Testing Announced

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Currently, healthcare providers testing patients for Coronavirus must use an unspecified code. To provide better tracking, on February 13, 2020, CMS announced the creation of a new HCPCS code.

Medicare Begins Covering Acupuncture Services

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

A 2020 Radiology Coding Change You Need To Know

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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...

Medicare Announces Coverage of Acupuncture Services

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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 ...

Q/A: How do we Bill Massage Services?

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Question: We are adding a massage therapist soon and have some questions about billing their services.

Billing for Telemedicine in Chiropractic

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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.

Q/A: Can Chiropractors Bill 99211?

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Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code...

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

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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 ...

CPT 2020 Changes to Psychiatry Services

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As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and ...

Medicare Changes Bilateral Reporting Rules for Certain Supplies

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DME suppliers must bill bilateral supplies with modifiers RT and LT on separate claim lines or they are being rejected.

What to look for when auditing moderate sedation codes 99151-99153

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What to look for when auditing moderate sedation codes 99151-99153 Physicians performing diagnostic and therapeutic procedures can now separately bill for the provision of moderate sedation services, but there are some interesting wrinkles to be looking for when auditing these services. Starting in 2017, moderate sedation codes 99151-99157 were created to address ...

Modifier 50 — Four "Must Know" Tips For Getting Paid

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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...

Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible

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Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...

Eliminating Consultation Codes?

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There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255. United Healthcare announced they ...

New Codes for Dry Needling

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Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.

Vaccine Administration - When The Right Vaccine Code is Not Enough

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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 ...

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

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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 ...

E-Health is a Big Deal in 2020

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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 ...

Chiropractic 2020 Codes Changes Are Here

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There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?

Are You Aware of Medicare Advantage Plans Timely Filing Rules?

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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 ...

Understanding Payment Indicators

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Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules.  Here is an article from Regence on their policy statement, describing the rules ...

How to Properly Report Prolonged Evaluation and Management Services

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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 ...

Healthcare Common Procedure Coding System (HCPCS)

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There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...

Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

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Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.

Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?

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Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...

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

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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., ...

Denial Management is Key to Profitability

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The Importance of Medical Necessity

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ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...

When Can You Bill Orthosis Components Separately?

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Othoses often have extra components. When can you bill those components separately? For example, can you bill for a suspension sleeve (L2397) with a knee orthosis (e.g., L1810)?

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

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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 ...

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

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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 ...

How to Properly Report Monitoring Patients Taking Blood-thinning Medications

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Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.

A United Approach

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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 ...

What Medical Necessity Tools Does Find-A-Code Offer?

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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 ...

Spotlight: Anatomy Images

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When viewing CPT codes, Find-A-Code offers detailed anatomy images and tables to help with coding. For example 28445 offers a table with information to assist classification of gustilo fractures: Click on the image preview from the code information page to expand the image.

Documentation of E/M services for Neurology (Don't Forget the Cardiology Element)

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According to Neurology Clinical Practice and NBIC, the neurologic exam is commonly lacking in documentation due to the extensive requirements needed to capture the appropriate revenue. With the lack of precise documentation, it results in a lower level of E/M than that which is more appropriate, which can cost a physician a lot ...

Medicare Approves Reimbursement for Virtual Communication (G2012)

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Medicare has taken a stand to recognize communication technology-based services by approving two newly defined physicians' services that will significantly help providers who deal with phone calls and patient triage. One of these services includes:  Virtual check-in (G2012), which allows the provider to be reimbursed for communicating with the patient via ...

Medicare Now Reimburses for Remote Monitoring Services (G2010)

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Medicare's 2019 Final Rule approved HCPCS code G2010 for reimbursement, which allows providers to be paid for remote evaluation of images or recorded video submitted to the provider (also known as "store and forward") to establish whether or not a visit is required. This allows providers to get paid for ...

How to Code Ophthalmologic Services Accurately

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Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code. According to Article A19881 which was published in 2004 and ...

Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?

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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?

Your New Patient Exam Code Could Determine How Many Visits You Get

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The initial exam is where the provider gathers the information to determine the need for all the care that follows. It is billed most often as an office or outpatient evaluation and management (E/M) code from the 4th edition of the AMA’s Current Procedural Terminology book. There are actually five ...

What to Look for When Auditing Smoking Cessation Services

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What to Look for When Auditing Smoking Cessation Services

Electrical Stimulation and Electromagnetic Therapy Devices

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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.

Facts on Procedure Codes

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There are two levels of codes used for services and procedures:  Level I Codes are used for Services and Procedures provided by physicians. 5 digit numerical code, example, 99213 - Office or other outpatient visits  Level II Codes are used to bill Medical equipment supplies and transport services. 4 digit Alpha/Numerical code example, ...

Spotlight: ASA Crosswalk

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Crosswalk from CPT Anesthesia codes (00100-01999) to Surgery and Procedure Codes! Let's look at anesthesia code 00100 as an example. The ASA Crosswalks are available under the Cross-A-Code bar. Click to expand. Look for the ASA CROSSWALK or ASA Reverse CROSSWALK bar. You will also see the CMS and ASA...

Q/A: I’m Being Audited? Is There a Documentation Template I can use?

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Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942? Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ...

Biofeedback - Is it Medically Necessary?

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Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational. The majority of payers will list Biofeedback on an exclusions list. Others such as BC ...

Let's Talk High Risk E/M Services

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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 ...

CPT Announces 2021 E/M Changes

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In 2018, Medicare announced their plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not ...

What is Medical Necessity and How Does Documentation Support It?

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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 ...

Auditing Chiropractic Services

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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.

Auditing Ophthalmology and Optometry Exams

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Auditing Ophthalmology and Optometry Exams If you work in an ophthalmology group or audit ophthalmology then you are most likely aware of the caveats that exist in this specialty. Ophthalmology and Optometry practitioners can select from either the E/M code set or the Ophthalmologic exam code set. Having this knowledge in ...

Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

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I submitted a claim to the VA and it’s being denied. Why? There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ...

Spinal Cord Stimulator Used for Chronic Pain

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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 ...

Corrections and Updates

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One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics. Published Articles We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...

CPT Codes That Include Moderate Sedation (Appendix G)

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The CPT codes that include moderate sedation have been removed from the CPT code set. These codes include: 99151, 99152, 99153, 99155, 99156, 99157. Please refer to the guidelines for information on how to report these moderate sedation services. ...

FDA Approval Pending Products (Appendix K)

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The following includes a list of vaccine product codes that are currently pending FDA approval.  When approval status has been granted by the FDA, updated information will be available HERE 90587 90666 90667 90668 90689 90697 ...

Electrodiagnostic Medicine Listing of Sensory, Motor and Mixed Nerves (Appendix J as per AMA)

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Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves. This summary assigns each sensory, motor, and mixed nerve with its appropriate nerve conduction study code in order to enhance accurate reporting of codes 95907-95913.  Each nerve constitutes one unit of service. Motor Nerves Assigned to Codes 95907-95913   Upper extremity, cervical plexus,andbrachial plexus motor nervesAxillary ...

Prolonged Services

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Prolonged Services I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...

Add on Codes for CPT (Appendix D)

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For 2019, the following is a list of CPT add-on codes: 01953 19294 33225 37223 61864 76814 93325 97598 01968 19297 33257 37232 61868 76937 93352 97811 01969 20930 33258 37233 62148 76979 93462 97814 10004 20931 33259 37234 62160 76983 93463 99100 10006 20932 33367 37235 63035 77001 93464 99116 10008 20933 33368 37237 63043 77002 93563 99135 10010 20934 33369 37239 63044 77003 93564 99140 10012 20936 33419 37247 63048 77063 93565 99153 10036 20937 33508 37249 63057 77293 93566 99157 11001 20938 33517 37252 63066 78020 93567 99292 11008 20939 33518 37253 63076 78496 93568 99354 11045 20985 33519 38102 63078 78730 93571 99355 11046 22103 33521 38746 63082 81266 93572 99356 11047 22116 33522 38747 63086 81416 93592 99357 11103 22208 33523 38900 63088 81426 93609 99359 11105 22216 33530 43273 63091 81536 93613 99415 11107 22226 33572 43283 63103 82952 93621 99416 11201 22328 33768 43338 63295 86826 93622 99467 11732 22512 33866 43635 63308 87187 93623 99486 11922 22515 33884 44015 63621 87503 93655 99489 13102 22527 33924 44121 64462 87904 93657 99494 13122 22534 33929 44128 64480 88155 93662 99498 13133 22552 33987 44139 64484 88177 94645 99602 13153 22585 34709 44203 64491 88185 94729 99607 14302 22614 34711 44213 64492 88311 94781 0054T 15003 22632 34713 44701 64494 88314 95079 0055T 15005 22634 34714 44955 64495 88332 95873 0076T 15101 22840 34715 47001 64634 88334 95874 0095T 15111 22841 34716 47542 64636 88341 95885 0098T 15116 22842 34808 47543 64643 88350 95886 0163T 15121 22843 34812 47544 64645 88364 95887 0164T 15131 22844 34813 47550 64727 88369 95940 0165T 15136 22845 34820 48400 64778 88373 95941 0174T 15151 22846 34833 49326 64783 88388 95962 01953 15152 22847 34834 49327 64787 90461 95967 01968 15156 22848 35306 49412 64832 90472 95984 01969 15157 22853 35390 49435 64837 90474 96113 0205T 15201 22854 35400 49568 64859 90785 96121 0214T 15221 22858 35500 49905 64872 90833 96131 0215T 15241 22859 35572 50606 64874 90836 96133 0217T 15261 22868 35600 50705 64876 90838 96137 0218T 15272 22870 35681 50706 64901 90840 96139 0222T 15274 26125 35682 51797 64902 90863 96160 0229T 15276 26861 35683 52442 64913 91013 96161 0231T 15278 26863 35685 56606 65757 92547 96361 0290T 15777 27358 35686 57267 66990 92608 96366 0376T 15787 27692 35697 58110 67225 92618 96367 0396T 15847 29826 35700 58611 67320 92621 96368 0397T 16036 31627 36218 59525 67331 92627 96370 0399T 17003 31632 36227 60512 67332 92921 96371 0437T 17312 31633 36228 61316 67334 92925 96375 0439T 17314 31637 36248 61517 67335 92929 96376 0443T 17315 31649 36474 61611 67340 92934 96411 0450T 19001 31651 36476 61641 69990 92938 96415 0466T 19082 31654 36479 61642 74301 92944 96417 0471T 19084 32501 36483 61651 74713 92973 96423 0480T 19086 32506 36907 61781 75565 92974 96570 0482T 19126 32507 36908 61782 75774 92978 96571 0492T 19282 32667 36909 61783 76125 92979 96934 0496T 19284 32668 37185 61797 76802 92998 96935 0513T 19286 32674 37186 61799 76810 93320 96936 0514T 19288 33141 37222 61800 76812 93321 97546 0523T ...

CPT Codes Exempt from Modifier 51 (Appendix E)

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The following CPT codes are exempt from the use of modifier 51.  These procedures are usually performed with another procedure, however, they may also be a stand-alone procedure.   17004 93456 93618 20697 93503 93631 20974 93600 94610 20975 93602 95905 31500 93603 95992 36620 93610 99151 44500 93612 99152 61007 93615 93451 93616 ...

CPT Codes That Should Not Be Reported With Modifier 63 (Appendix F)

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The following codes should not be reported with modifier 63. 30540 33946 46735 30545 33947 46740 31520 33978 46742 33470 33949 46744 33502 36415 47700 33503 36420 47701 33505 36450 49215 33506 36456 49491 33610 36460 49492 33611 36510 49495 33619 36660 46196 33647 39503 49600 33670 43313 49605 33690 43314 49606 33694 43520 49610 33730 43831 19611 33732 44055 53025 33735 44126 54000 33736 44127 54150 33750 44128 54160 33755 46070 63700 33762 46705 63702 33778 46715 63704 33786 46716 63706 33922 46730 65820 ...

The Impact of Medical Necessity on High Level E/M Services

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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. ...

How to Report Imaging (X-Rays) of the Thumb

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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 ...

Spotlight: Services Excluded from Global Surgery Payment

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The following services are excluded from global surgery payment according to Noridian Medicare. These services may be paid for separately. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial...

Date of Service Reporting for Radiology Services

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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.

Billing Guidelines for Repositioning

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Code 95992 has some very limited payer payment guidelines which need to be understood for proper reimbursement. Many payer policies consider this service bundled with Evaluation and Management Services, therefore, it would not be separately payable if there was an E/M service performed on the same date. Some providers have reported having trouble ...

Answers to Your Auditing & Compliance Questions

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National Alliance of Medical Auditing Specialists (NAMAS) hosts a forum where auditing and compliance professionals can get answers to their questions, and exchange information with other professionals across the country. Recently, we've received the following question regarding fracture care that we'd like to share below. Q: I recently noticed CPT 26600, ...

Spotlight: GLOBAL Periods

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A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal post- operative care are bundled into the global surgery fee. Global surgery is not restricted to hospital...

UnitedHealthcare to Discontinue Coverage of Consultations

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In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255).

Medicare Physician Fee Schedule Indicators

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Many denials can be avoided when you understand how a payer looks at a code. Find-A-Code puts a lot of this information all on one page. Under Additional Code Information on CPT codes you will find a lot of questions can be answered. In addition to the global policy, uniform...

Understanding NCCI Edits

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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 ...

Separately Report a "Separate Procedure" with Confidence

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Many procedures in the CPT® code book are designated "separate procedures," but that doesn't mean you can report those procedures separately in every case. First, you must consider other procedures performed during the same encounter.  "Separate" Might Not Mean What You Think It Does You can always identify a designated separate procedure by the inclusion of "(separate ...

Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

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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 ...

Detection by Nucleic Acid (DNA or RNA) - Amplified Probe Technique

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This question was asked on the following lab codes used for testing during pregnancy. "Can the codes below be billed together?  87491- 59, 87591-59. 87081, 87150." YES- CPT code 87081 is used when a specific pathogen is suspected and is appropriate. YES- (X2) 87150 is used for culture, typing, and identification by nucleic ...

Coding Medicare Initial Preventive Physical Exams (IPPE)

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The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward. Purpose An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...

Q/A: Do Digital X-rays Have Their Own Codes?

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Question Are you aware if digital x-ray of the spine requires a different code than plain x-ray?  If so, where can I find the information specific to digital x-ray codes? Answer There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...

Clinical Staff vs. Healthcare Professional

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State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.  Physician or other qualified healthcare professionals:  Must have a State license, education training showing qualifications as well as facility privileges.  Examples of Qualified Healthcare professionals: (NOTE: this list is not all-inclusive, please refer to your payer ...

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

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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 ...

Physical Therapy Caps Q/A

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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 ...

Q/A Neonate Coding When Child is Transferred (2019/01/17)

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Codapedia  Forum - Questions & Answers Q/A: Neonatologist was at the birth of a very critical child, she billed 99468 and then it was decided to transfer the child to another facility, she also billed 99291 and 99292 x 3. Her time was denied, how should she have billed for the initial ...

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

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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 ...

Everything You need to Know about Drugs

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We have it all! Search our WK Drug Database for drugs and pharmaceuticals. When it comes to support and guidance the WK Drug Database offers a paramount search and is conveniently presented in one place.  Pricing  GPIs  NDCs  Billing Codes  Indications/Diseases Packaging Information Active and Inactive and more... Additionally, learn more about drugs and pharmaceuticals that can be used to detect, treat, or monitor ...

How to Report Co-Surgeons Using Modifier 62

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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 ...

Home Oxygen Therapy

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Home Oxygen Therapy Guidelines

What is Virtual Communication (G0071)?

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Beginning January 1st, 2019 all of our RHC and FQHC organizations have a new CPT code to  consider implementing for their Medicare populous (check per Advantage Plan Administration for coverage). In its current form, this code is not reportable by organizations not meeting the RHC/FQHC designation. The code  isG0071 and is termed ...

AMA Issues new CMT Information

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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 ...

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

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

Are You Protecting Your Dental Practice From Fraud?

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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 ...

Nine New Codes for Fine Needle Aspirations (FNA) in 2019

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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 ...

Dry Needling

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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 ...

Are You Ready For the 2019 New Codes

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Many articles have been published regarding the 2019 proposed Evaluation and Management coding changes, but hopefully you have taken the time to review those in detail and be ready for them. If not, here is a link to a Find-A-Code article written by Wyn Staheli (Director of Research) entitled, “Are You Ready ...

2019 Coding Changes for Chiropractic

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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 ...

New Genetic Test for Severe Inherited Conditions

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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 ...

Welcome 2019 CPT Codes!

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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 ...


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