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"Diagnosis Coding" & "Coding" Articles
Click on the title to see the article summary and a link to the full article.
December 8th, 2020
Common Medical to Dental Procedures and Where to Find Them
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ...
December 8th, 2020
Locating Periodontal Disease in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
When coding a diagnosis for periodontal disease, keep in mind there are more options than just chronic or acute. To get started, look at chapter 11, Diseases of the digestive system (K00-K95). Looking at this section a little further, you can see this is where the oral cavity is coded ...
November 18th, 2020
Cross-A-Code Instructions in Find-A-Code
By Raquel Shumway | Published November 18th, 2020
Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
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.
July 15th, 2020
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 15th, 2020
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 14th, 2020
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
June 29th, 2020
HCPCS Codes Were NOT all Created for the Same Purpose
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2020
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 ...
June 29th, 2020
Additional COVID-19 Testing Codes Announced
By Wyn Staheli, Director of Research | Published June 29th, 2020
New coronavirus antigen testing codes announced. These are effective immediately.
June 15th, 2020
Newest Launch - We Now Have Outpatient Facility Pricing!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020
Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...
June 10th, 2020
MEGA - NCCI Edit Changes - WHO Knew?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 10th, 2020
There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included;
291,902 Deleted Procedure to Procedure (PTP) edits
197 Deleted Medically Unlikely ...
May 20th, 2020
Where is the CCI Edit with Modifier 25 on E/M?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 20th, 2020
If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.
The use of Modifier 25 is one example ...
May 18th, 2020
Packaging and Units for Billing Drugs
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 18th, 2020
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 ...
April 21st, 2020
Special COVID Laboratory Specimen Coding Information
By Wyn Staheli, Director of Research | Published April 21st, 2020
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.
April 15th, 2020
New CPT® Codes Approved for COVID-19 Antibody Identification
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 15th, 2020
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
April 13th, 2020
CPT Coding Guidance on New Lab Code for COVID-19
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 13th, 2020
According to the AMA, "The Addition of one Category I Pathology and Laboratory code (87635) for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]) accepted at the March 2020 CPT Editorial Panel meeting.
*Note that code 87635 will be a child code under parent code 87471. It is represented here ...
April 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 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 24th, 2020
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
March 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2020
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
March 2nd, 2020
Coronavirus - What in the World is it and How is it Coded? 2020-02-20
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 2nd, 2020
On December 31, 2019, we learned of a deadly outbreak of an unknown virus, with an unknown cause. We have since learned the virus was identified in Wuhan, China as a novel coronavirus (2019-n-CoV). Until we have more information on the 2019-nCoV, persons with an underlying medical condition are considered high ...
February 19th, 2020
Q/A: Did Noridian Stop Covering the M99.0- Codes?
By Wyn Staheli, Director of Research | Published February 19th, 2020
Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?
February 10th, 2020
A 2020 Radiology Coding Change You Need To Know
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 10th, 2020
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
January 30th, 2020
Medicare Announces Coverage of Acupuncture Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 30th, 2020
On January 21, 2020, a CMS Newsroom press-release read,
This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...
January 9th, 2020
Who Knew? There are Three Types of Add-On Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 9th, 2020
Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...
January 7th, 2020
Denials due to MUE Usage - This May be Why!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 7th, 2020
CMS assigns Medically Unlikely Edits (MUE's) for HCPCS/CPT codes, although not every code has an MUE. MUE edits are used to limit tests and treatments provided to a Medicare patient for a single date of service or for a single line item on a claim form. It is important to understand MUE's are ...
October 7th, 2019
Hypertension & ICD-10
By Raquel Shumway | Published October 7th, 2019
Hypertensive Diseases and ICD-10. Helps and examples for these codes.
October 1st, 2019
Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
October 1st, 2019
The New ICD-10-CM Code Updates Are Here — Are You Ready?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)
A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases.
Chapter 2: ...
September 30th, 2019
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 9th, 2019
Chiropractic 2020 Codes Changes Are Here
By Wyn Staheli, Director of Research | Published September 9th, 2019
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
August 20th, 2019
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
By Aimee Wilcox | Published August 20th, 2019
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial.
As any company who has billed Medicare services can attest, the one-year timely filing ...
August 19th, 2019
Understanding Payment Indicators
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 19th, 2019
Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules. Here is an article from Regence on their policy statement, describing the rules ...
August 13th, 2019
How to Properly Report Prolonged Evaluation and Management Services
By Aimee Wilcox | Published August 13th, 2019
Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?
Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...
August 13th, 2019
Healthcare Common Procedure Coding System (HCPCS)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 13th, 2019
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, ...
July 29th, 2019
Q/A: How do I Bill Mobile Clinic Services?
By Evan Gwilliam DC, MBA, BS, CPC, CCPC, CPC-I, QCC, MCS-P, CPMA, CMHP, AAPC Fellow | Published July 29th, 2019
Question: I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters?
July 15th, 2019
Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?
By Wyn Staheli, Director of Research | Published July 15th, 2019
Question:
It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...
July 9th, 2019
The Importance of Medical Necessity
By Marge McQuade, CMSCS, CHCI, CPOM | Published July 9th, 2019
ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...
June 17th, 2019
Extrapolation Policies Apply to RAD-V Audits
By Aimee Wilcox | Published June 17th, 2019
Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ...
June 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 13th, 2019
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
June 6th, 2019
How to Code Ophthalmologic Services Accurately
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 6th, 2019 - Last Review/Update June 11th, 2019
Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.
According to Article A19881 which was published in 2004 and ...
May 29th, 2019
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 29th, 2019 - Last Review/Update June 4th, 2019
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
May 14th, 2019
Spotlight: QPro Blogs
By Brittney Murdock, QCC, CMCS, CPC | Published May 14th, 2019
Look for important tips and updates for the medical industry on the QPro Blog!
The link to the blog is available from the Medical page under the Industries tab.
Use the search bar to look up topics and specialties.
View the blogs page here.
...
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 23rd, 2019
What is Medical Necessity and How Does Documentation Support It?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
April 22nd, 2019
Auditing Chiropractic Services
By By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
April 22nd, 2019
Q/A: What’s Wrong with the Diagnoses on my Claim?
By Wyn Staheli, Director of Content | Published April 22nd, 2019
Question: I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.
March 29th, 2019
Prolonged Services
By Namas | Published March 29th, 2019 - Last Review/Update April 4th, 2019
Prolonged Services
I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...
March 27th, 2019
Pain Codes in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 27th, 2019
When coding with ICD-10-CM, pain codes can be found in different sections:
The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ...
March 26th, 2019
Add on Codes for CPT (Appendix D)
By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019
For 2019, the following is a list of CPT add-on codes:
01953
19294
33225
37223
61864
76814
93325
97598
01968
19297
33257
37232
61868
76937
93352
97811
01969
20930
33258
37233
62148
76979
93462
97814
10004
20931
33259
37234
62160
76983
93463
99100
10006
20932
33367
37235
63035
77001
93464
99116
10008
20933
33368
37237
63043
77002
93563
99135
10010
20934
33369
37239
63044
77003
93564
99140
10012
20936
33419
37247
63048
77063
93565
99153
10036
20937
33508
37249
63057
77293
93566
99157
11001
20938
33517
37252
63066
78020
93567
99292
11008
20939
33518
37253
63076
78496
93568
99354
11045
20985
33519
38102
63078
78730
93571
99355
11046
22103
33521
38746
63082
81266
93572
99356
11047
22116
33522
38747
63086
81416
93592
99357
11103
22208
33523
38900
63088
81426
93609
99359
11105
22216
33530
43273
63091
81536
93613
99415
11107
22226
33572
43283
63103
82952
93621
99416
11201
22328
33768
43338
63295
86826
93622
99467
11732
22512
33866
43635
63308
87187
93623
99486
11922
22515
33884
44015
63621
87503
93655
99489
13102
22527
33924
44121
64462
87904
93657
99494
13122
22534
33929
44128
64480
88155
93662
99498
13133
22552
33987
44139
64484
88177
94645
99602
13153
22585
34709
44203
64491
88185
94729
99607
14302
22614
34711
44213
64492
88311
94781
0054T
15003
22632
34713
44701
64494
88314
95079
0055T
15005
22634
34714
44955
64495
88332
95873
0076T
15101
22840
34715
47001
64634
88334
95874
0095T
15111
22841
34716
47542
64636
88341
95885
0098T
15116
22842
34808
47543
64643
88350
95886
0163T
15121
22843
34812
47544
64645
88364
95887
0164T
15131
22844
34813
47550
64727
88369
95940
0165T
15136
22845
34820
48400
64778
88373
95941
0174T
15151
22846
34833
49326
64783
88388
95962
01953
15152
22847
34834
49327
64787
90461
95967
01968
15156
22848
35306
49412
64832
90472
95984
01969
15157
22853
35390
49435
64837
90474
96113
0205T
15201
22854
35400
49568
64859
90785
96121
0214T
15221
22858
35500
49905
64872
90833
96131
0215T
15241
22859
35572
50606
64874
90836
96133
0217T
15261
22868
35600
50705
64876
90838
96137
0218T
15272
22870
35681
50706
64901
90840
96139
0222T
15274
26125
35682
51797
64902
90863
96160
0229T
15276
26861
35683
52442
64913
91013
96161
0231T
15278
26863
35685
56606
65757
92547
96361
0290T
15777
27358
35686
57267
66990
92608
96366
0376T
15787
27692
35697
58110
67225
92618
96367
0396T
15847
29826
35700
58611
67320
92621
96368
0397T
16036
31627
36218
59525
67331
92627
96370
0399T
17003
31632
36227
60512
67332
92921
96371
0437T
17312
31633
36228
61316
67334
92925
96375
0439T
17314
31637
36248
61517
67335
92929
96376
0443T
17315
31649
36474
61611
67340
92934
96411
0450T
19001
31651
36476
61641
69990
92938
96415
0466T
19082
31654
36479
61642
74301
92944
96417
0471T
19084
32501
36483
61651
74713
92973
96423
0480T
19086
32506
36907
61781
75565
92974
96570
0482T
19126
32507
36908
61782
75774
92978
96571
0492T
19282
32667
36909
61783
76125
92979
96934
0496T
19284
32668
37185
61797
76802
92998
96935
0513T
19286
32674
37186
61799
76810
93320
96936
0514T
19288
33141
37222
61800
76812
93321
97546
0523T
...
March 22nd, 2019
Spotlight: CPT to Revenue Codes Crosswalks
By Brittney Murdock, QCC, CMCS, CPC | Published March 22nd, 2019
View CPT to Revenue Code Crosswalks with Cross-A-CodeFirst, enter your CPT code into the Comprehensive search bar. Once you click search, you should be taken to the code definition page. Scroll down to the Cross-A-Code bar and click to expand. Click the UB04 Revenue Codes bar to open the crosswalks....
March 21st, 2019
The Impact of Medical Necessity on High Level E/M Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2019
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...
March 20th, 2019
Type of Bill Code Structure (2018-08-30)
By Find-A-Code | Published March 20th, 2019 - Last Review/Update March 25th, 2019
The UB-04 claim form (also known as CMS 1450) is the standard facility and residential claim form used to report health claims. The Type of Bill is reported in Block No. 4 of the UB04 claim form.
Type of bill codes are four-digit codes that describe the type of bill a ...
March 1st, 2019
Understanding NCCI Edits
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 1st, 2019
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
February 22nd, 2019
Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?
By Wyn Staheli, Director of Research | Published February 22nd, 2019 - Last Review/Update March 5th, 2019
It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them?
February 14th, 2019
Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries
By Aimee Wilcox | Published February 14th, 2019
Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...
February 5th, 2019
Clinical Staff vs. Healthcare Professional
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 5th, 2019
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.
Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges.
Examples of Qualified Healthcare professionals:
(NOTE: this list is not all-inclusive, please refer to your payer ...
February 1st, 2019
Q/A: Can I Bill a Review of X-Rays?
By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published February 1st, 2019
It is not unusual for a healthcare provider to review x-rays taken and professionally read by another entity. Questions arise regarding how to bill this second review. It is essential to keep in mind that the global (complete) service of taking an x-ray is composed of both a professional and ...
January 28th, 2019
Q/A Neonate Coding When Child is Transferred (2019/01/17)
By Codapedia | Published January 28th, 2019
Codapedia Forum - Questions & Answers
Q/A: Neonatologist was at the birth of a very critical child, she billed 99468 and then it was decided to transfer the child to another facility, she also billed 99291 and 99292 x 3. Her time was denied, how should she have billed for the initial ...
January 23rd, 2019
QPro - Medical Certifications
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2019
QPro (Qualified Professionals) is a member support system dedicated to enhancing coding and management through certification for healthcare coders and managers. Through increased knowledge of coding principles, changes in coding policies, and the experiences of fellow coders and managers in resolving office challenges, QPro members confidently code for maximum and ...
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 22nd, 2019
Home Oxygen Therapy
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 3rd, 2019
Are You Ready For the 2019 New Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 3rd, 2019
Many articles have been published regarding the 2019 proposed Evaluation and Management coding changes, but hopefully you have taken the time to review those in detail and be ready for them. If not, here is a link to a Find-A-Code article written by Wyn Staheli (Director of Research) entitled, “Are You Ready ...
January 3rd, 2019
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 7th, 2018
Keeping Up to Date
By NAMAS | Published December 7th, 2018 - Last Review/Update December 20th, 2018
Keeping up to date on coding and documentation changes, is critical for medical coders, billers, auditors, and compliance personnel. Every year American Medical Association (AMA) creates, revises, and deletes CPT codes on January 1st. Same thing occurs with the ICD-10 codes in October. For CPT codes, the intention of the...
November 8th, 2018
Diagnosis Coding for Cardiology
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 8th, 2018
Diseases of the Circulatory system are found in Chapter 9 and reported with I00 through I99 according to the following sections:
Acute rheumatic fever (I00-I02)Chronic rheumatic heart diseases (I05-I09)Hypertensive diseases (I10-I16)Ischemic heart diseases (I20-I25)Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)Other forms of heart disease (I30-I52)Cerebrovascular diseases (I60-I69)Diseases of arteries, ...
October 31st, 2018
How to Use Modifier Indicators with NCCI Edits (2018-10-31)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 31st, 2018
To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator. Medicare may have restrictions on the use of a modifier used to bypass an edit. This important part of coding can alert a payer or ...
October 19th, 2018
Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder
By Wyn Staheli, Director of Research | Published October 19th, 2018 - Last Review/Update December 19th, 2018
The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...
October 11th, 2018
Type of Bill Codes
By Find-A-Code | Published October 11th, 2018
Type of bill codes identifies the type of bill being submitted to a payer. Type of bill codes are four-digit alphanumeric codes that specify different pieces of information on claim form UB-04 or form CMS-1450 and is reported in box 4 on line 1.
First Digit = Leading zero. Ignored by CMSSecond ...
October 4th, 2018
Is cox-flexion distraction billable as 97012
By ChiroCode | Published October 4th, 2018 - Last Review/Update January 17th, 2019
Is cox-flexion distraction billable as 97012? Can you use 97140 and 98941 on the same day?
October 2nd, 2018
Use My Code Set to Save Priced Procedures
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 2nd, 2018
Use My Code Set to save priced procedures to refer to commonly used procedures. Once your CCI edits are done and you have your list of Codes, add notes to My Codes. Add all important information to the Code, for viewing again instead of re-working your most commonly used procedures....
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
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
Q/A: Can I Bill Mechanical Massage?
By Wyn Staheli, Director of Research | Published August 16th, 2018 - Last Review/Update January 30th, 2019
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
August 1st, 2018
Provide Proof of a Qualified Professional with QPro Certifications!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 1st, 2018
QPro - Announces the Launch of an Innovative Testing Site!
Innovation is paving the way once again! Unlike other certification bodies, QPro does not certify the ability to pass a test but instead verifies members qualifications are proven. Test online using real-life coding resources and coding books commonly used in the office setting.
Who can Benefit ...
June 26th, 2018
WHO Said ICD-11 is Coming Soon
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 26th, 2018
Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...
June 14th, 2018
Home Oxygen Therapy -- CMN for Oxygen
By Raquel Shumway | Published June 14th, 2018
The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.
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 30th, 2018
Coding for Strains in ICD 10
By BC Advantage | Published May 30th, 2018 - Last Review/Update June 4th, 2018
According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows....
May 7th, 2018
Q/A: What Code do I Use for Supraspinatus and Infraspinatus Tendonitis?
By Wyn Staheli, Director of Research | Published May 7th, 2018 - Last Review/Update January 28th, 2019
Is there a better code for supraspinatus and infraspinatus tendonitis than the one for a rotator cuff tear?
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?
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 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 12th, 2018
The Coder as the Last, Best Hope for the Right DRG
By Dr. Erica Remer | Published February 12th, 2018 - Last Review/Update April 12th, 2018
f the story doesn't make sense, there is probably something missing. There are a variety of reasons why the DRG might not tell the story of the patient encounter....
February 1st, 2018
How to Code Screening and Diagnostic Colonoscopy
By Natalie Tornese, CPC | Published February 1st, 2018
The following information is from BC Advantage.
Colonoscopy is a common procedure performed byGastroenterologists. CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis" ...
February 1st, 2018
Q and A: Coding Mixed Cardiogenic and Septic Shock
By BC Advantage | Published February 1st, 2018
Q: If the attending documented, "likely mixed cardiogenic and septic shock," can I assign codes R57.0 and R65.21? A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember,...
February 1st, 2018
Important CDI and Coding Updates
By Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS | Published February 1st, 2018
COPD and Pneumonia The requirement for code J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) to be coded first when a patient has pneumonia and COPD has been eliminated as of October 1. The 2018 version of ICD-10-CM replaced the "use additional code" with "code also." According...
February 1st, 2018
Strapping and Kinesio Taping Coding Differences
By Wyn Staheli, Director of Research | Published February 1st, 2018
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally.
Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue.
Coding: ...
February 1st, 2018
Traumatic Subluxation Coding Controversy
By Wyn Staheli, Director of Research | Published February 1st, 2018
There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...
January 31st, 2018
Developing Coding Policies for Compliance
By Marge McQuade, CMSCS, CHCI, CPOM | Published January 31st, 2018
Every physician practice depends upon correct coding and billing for their financial success. Coding drives reimbursement. All of the resources available for coding information and guidance are meaningless without the practice manager translating it into provider-specific coding policies and compliance plan. As a practice manager, you need to develop a ...
January 25th, 2018
Psychiatric Partial Hospitalization Programs
By Wyn Staheli, Director of Research | Published January 25th, 2018
Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...
January 23rd, 2018
NEW on Find-A-Code...National Coverage Determinations (NCDs)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2018 - Last Review/Update January 25th, 2018
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...
January 18th, 2018
What's the definition of an Office Visit and Can I Bill it With a Chiropractic Treatment?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published January 18th, 2018 - Last Review/Update February 4th, 2019
What is the definition of Office Visit? Can It be billed with a Chiropractic Treatment? What about using code 99123 E&M code for office visits? Can we bill of office visits even though we are giving chiropractic care?
January 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 9th, 2018
Antiresorptive Osteonecrosis of the Jaws
By Find-A-Code | Published January 9th, 2018
Osteonecrosis is a serious bone disease caused when the bone is starved of its normal blood supply. Because bone is living tissue, without a good supply of oxygenated blood, it becomes weakened and then dies. Scientists have not been able to identify the exact cause of osteonecrosis of the jaws, but they have ...
January 9th, 2018
Billing Electrotherapy with AcuKnee
By Christine Woolstenhulme | Published January 9th, 2018
This code is commonly used to bill for AcuKnee products. Per AcuKnee, “NMES and electrotherapy may be covered by most insurance providers, provided the following criteria are met;”
Documentation of chronic pain or muscle atrophy 3 months or longer
Must document improvement
Must have physician document medical necessity/Prescription
Appropriate authorization from your insurance provider
Suggested codes when billing
64550 initial electrotherapy education and placement
E0720 Electrotherapy unit itself
E0731 Garment ...
January 9th, 2018
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
Diagnosis Coding with Diagnostic Testing
By Marge McQuade, CMSCS, CHCI, CPOM | Published January 4th, 2018
Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns.
If a physician confirms a diagnosis based on the results of a diagnostic ...
January 4th, 2018
Skilled Therapy, When it's Appropriate and Billable
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators,
"A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ...
January 4th, 2018
Initial Evaluation Codes for PT's and OT's
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation.
These evaluation codes are untimed, billable as one unit.
Do ...
January 4th, 2018
PT and OT Reevaluation Coding
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...
December 28th, 2017
Sleep Testing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 28th, 2017
Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment.
There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All ...
December 28th, 2017
Anesthesia
By Raquel Shumway | Published December 28th, 2017
Anesthesia services fall into one of the following categories ranging from lowest to greatest:
Local or topical anesthesia (not covered here)
Moderate (conscious) sedation (See “Moderate Sedation” on page xx)
Regional anesthesia
General anesthesia
Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. General anesthesia may only ...
December 28th, 2017
DME Documentation Requirements
By Wyn Staheli | Published December 28th, 2017
Properly documenting DME orders is crucial for reimbursement. It should be noted that without meeting the payer requirements, the claim will be denied. For Medicare, the beneficiary will not be responsible for paying for the item if the provider and/or supplier do not meet requirements. Commercial payers have similar policies so carefully ...
December 20th, 2017
Lung Cancer Screening Counseling and Shared Decision Making Visit, and Annual Screening for Lung Cancer with LDCT
By Find-A-Code | Published December 20th, 2017
Effective February 5, 2015, a CMS National Coverage Determination (NCD) added lung cancer screening counseling and shared decision making visit, and for certain beneficiaries, annual screening for lung cancer with Low Dose Computed Tomography (LDCT), as an additional screening service benefit under the Medicare program if all eligibility criteria described ...
December 13th, 2017
AT and GA Modifiers When Billing CMT and Non-covered Codes to Medicare
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published December 13th, 2017 - Last Review/Update February 5th, 2019
Questions regarding using modifiers when billing CMT and non-covered codes to Medicare. We have used AT (Active) and GA (signed ABN) when billing active care for CMT codes 98940-98942 (e.g., 98941-ATGA) in the past. Currently we are told not to bill GA with AT. How do we bill?
December 12th, 2017
Documenting the Location and Correct Coding
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 12th, 2017
The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim.
You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas).
C1 is the first vertebra known as the atlas. The axis-form is ...
December 12th, 2017
THE EOB SAYS “BUNDLED” - NOW WHAT?
By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017
Payers often bundle separate codes together so that they can pay you less. Just because the EOB says the codes are bundled doesn’t mean you have to let the insurance company get away with it. Fight Back!!! How does bundling work? If a patient presents for evaluation of diabetes, and...
December 12th, 2017
Developing Billing & Coding Policies
By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017
The financial health of every medical practice rests upon correctly coded claims. This is true from not only a financial standpoint since coding drives reimbursement, but from a compliance perspective as well. All of the resources available for coding information and guidance are meaningless without the practice manager sifting through...
November 30th, 2017
Coding Carpal Tunnel Syndrome
By Wyn Staheli, Director of Research | Published November 30th, 2017 - Last Review/Update February 5th, 2019
Q: In order to code carpal tunnel syndrome G56.01 or G56.02, does there need to be documentation that nerve conduction (EMG testing) has been performed to confirm the diagnosis?
November 22nd, 2017
Understanding ASC Pricing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 22nd, 2017
ASCs (Ambulatory Surgical Centers) have a separate fee schedule with a base allowed amount that is adjusted for each state using Core Based Statistical Areas (CBSA). Under the ASC payment system, Medicare pays facilities for specific ASC covered surgical procedures, however, there are only certain types of procedures that are eligible for payment ...
October 31st, 2017
Modifier NU
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 31st, 2017 - Last Review/Update February 5th, 2019
Is it necessary to use the modifier NU for all supplies? or is NU part of the code itself? Where should the NU be noted on the 1500 form?
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 6th, 2017
Acronyms and Abbreviations: When You Fall into the Grey Area
By Omega Renne, CPC, CPMA, CPCO, CEMC, CIMC | Published October 6th, 2017 - Last Review/Update February 1st, 2018
We've all been there... you are coding or auditing, and then a note comes up that is not like the ones you've reviewed before. The language is unclear, the acronym(s) could mean so many different things, and it's hard to get a straight answer about whether or not it's supported higher or lower....
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 14th, 2017
Double Dipping in the History of the Evaluation and Management Note
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published September 14th, 2017
There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history.
The subcomponents of history include:
Chief Complaint ...
September 12th, 2017
ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath
By BC Advantage | Published September 12th, 2017 - Last Review/Update January 25th, 2018
This document is intended to be used as a guide to help coding professionals when coding healthcare encounters of those individuals affected by a hurricane.
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?
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
Q/A: What are the Rules for a Fill-in (locum tenens) Doctor?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 17th, 2017 - Last Review/Update February 5th, 2019
A locum tenens provider is one that works in the place of the regular physician for a short duration of time. Guideline typically allows this time period to be a 60 day maximum, when a substitute doctor would be brought in to your office to cover your original doctor's actual schedule during the time he/she is absent.
Read further for more information
August 16th, 2017
Chiropractic's Unique Role in the Opioid Epidemic
By Dr. Ray Foxworth, Certified Medical Compliance Specialist, President of ChiroHealthUSA, Chiropractor | Published August 16th, 2017 - Last Review/Update February 5th, 2019
While scanning my news feed this morning, a few alarming words caught my eye: "Opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since the epidemic began in the early 1980s." Across America, people are talking about chiropractic as a safer alternative to opioid medication for pain relief, and yet, I don't think the magnitude of this opportunity has been realized by most doctors of chiropractic in this country.
August 8th, 2017
Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 8th, 2017 - Last Review/Update February 5th, 2019
My state does not allow me to delegate the supervision of therapeutic exercises (97110). I am the licensed chiropractor. If I provide the constant attendance myself, can I do it for a group of patients? If so, how do I document and bill for this?
August 4th, 2017
Searching With the Comprehensive Search Tool
By Find-A-Code | Published August 4th, 2017
Occasionally, when a customer searches for a code with key words with the comprehensive search, we get feedback that they are not getting the correct results. Some of the main reasons are the correct code set is not selected in the search box.
Other times customers are not searching the keywords and notes. ...
August 1st, 2017
Global Surgery
By Find-A-Code | Published August 1st, 2017 - Last Review/Update January 31st, 2018
The Medicare Learning Network provides guidance on the global surgical package
July 27th, 2017
The Importance of the 7th Character in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 27th, 2017
There is still confusion on the use of the seventh character. Let's clarify a few common areas.
The 7th character represents the physicians encounter, but not the number of visits.
Reporting the phase of treatment the patient is seeing the provider for, but not the number of injuries or number of visits.
The most common ...
July 21st, 2017
Billing for Face-to-Face Counseling
By ChiroCode | Published July 21st, 2017 - Last Review/Update January 31st, 2019
Question: How should I bill for face-to-face Counseling time spent with the patient?
July 13th, 2017
Our Claims are Being Rejected
By ChiroCode | Published July 13th, 2017 - Last Review/Update February 8th, 2019
Question: Our claims are being rejected. We think it is related to our diagnosis codes. What is the reason for this?
July 7th, 2017
Telemedicine: The Next Frontier in Care Delivery
By Valora Gurganious, MBA, CHBA | Published July 7th, 2017 - Last Review/Update January 25th, 2018
Technology is ubiquitous in modern society, and just when we thought that computers could not replace the "human touch" of a healthcare provider, technology is making specialized care accessible to patients anywhere there is an internet connection.
June 28th, 2017
Code Position Matters, Using the X Place Holder
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 28th, 2017 - Last Review/Update July 26th, 2017
Using the X Place holder is not optional. Be sure you understand how to use it. If the code you are using requires a the Character such as the A - initial encounter, D - subsequent encounter or S- sequela, you understand the "X" Place holder. Not all Codes requiring a 7th ...
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 22nd, 2017
Q/A: What is the ICD-10 Code for Acetabular Labral Tear?
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 22nd, 2017 - Last Review/Update February 8th, 2019
What is the ICD-10 code for acetabular labral tear?
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?
May 5th, 2017
Your MIPS Resources
By Evan Gwilliam, DC, MBA, BS, CPC, CCPC, CPC-I, CPMA, NCICS, MCS-P, QCC, CMHP | Published May 5th, 2017 - Last Review/Update March 5th, 2019
What is MIPS and what now?
May 2nd, 2017
Plain Film Xray Penalty 2017
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 2nd, 2017 - Last Review/Update January 31st, 2019
Watch Another quick tip from the ChiroCode HelpDesk - Plain Film Xray Penalty 2017. Even though this news comes from Medicare, who does not reimburse chiropractic physicians for x-rays, private payers nearly always follow their example. This represents the trend of X-ray reimbursement for all of healthcare.
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 29th, 2017
2014 brings big volume of changes to CCI edits
By Find-A-Code | Published March 29th, 2017
Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes....
March 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.
February 21st, 2017
Telehealth Psychiatric Service
By Wyn Staheli, Director of Research | Published February 21st, 2017
Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych ...
February 16th, 2017
Diagnostic Criteria for Behavioral Health
By Wyn Staheli, Director of Research | Published February 16th, 2017
In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include:
History: This can include the patient's personal history as well as that of the patient's family.
Physical exam: The healthcare provider will try to rule out physical problems ...
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 6th, 2017
Q/A: Would Leaving Box 14 on the 1500 Claim Form Blank Cause Denials?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published February 6th, 2017 - Last Review/Update February 8th, 2019
We have been leaving box 14 on the 1500 claim form blank for Medicare claims and are getting denials. Could this be why?
January 23rd, 2017
Why Should I Document a Differential Diagnosis?
By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP | Published January 23rd, 2017 - Last Review/Update February 8th, 2019
Generating a differential diagnosis — that is, developing a list of the possible conditions that might produce a patient's symptoms and signs — is an important part of clinical reasoning. It allows a provider to perform appropriate testing to rule out possibilities and confirm a final diagnosis.
Courts view the formulation and documentation of a differential diagnosis as evidence of a physician's competence, prudence, and thoughtfulness.
December 21st, 2016
Q/A: E/M Bundled with CMT
By ChiroCode | Published December 21st, 2016 - Last Review/Update February 28th, 2019
What do you do when you are continually getting denials when billing office visit E/M code 99213-25 along with a CMT on dates that we do re-exams? What do you do when an appeal does not seem to work even though clear evidence has been provided that all conditions for the 99213 have been satisfied.?
December 16th, 2016
NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy
By Find-A-Code | Published December 16th, 2016
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The...
December 13th, 2016
Health Risk Assessment
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 13th, 2016
Risk Adjustment models are used to calculate risk scores used in predicting average beneficiaries healthcare expenditures. Currently Medicare Advantage and Prescription Drug programs include a risk adjustment as a component of the bidding and payment process to standardize bids, compare bids, and adjust plan payments. If you are not familiar ...
November 29th, 2016
Medical Billing and Coders Professional Liability
By | Published November 29th, 2016
Companies who regularly handle such sensitive information as patient medical records have a particular responsibility to maintain the confidentiality of the data. Failure to exercise the appropriate degree of care – whether intentional or not – can have a significant adverse financial impact on your firm.
The Federal Health Insurance Portability ...
November 21st, 2016
Best Diagnosis Codes for E-stim
By ChiroCode | Published November 21st, 2016 - Last Review/Update March 5th, 2019
What are the best diagnosis codes for E-stim?
November 19th, 2016
Lack of Medical Necessity
By ChiroCode | Published November 19th, 2016 - Last Review/Update March 5th, 2019
(from page 210 in chapter 3.5 of the 2017 DeskBook) One of the biggest problems providers face when audited is that many services are deemed not medically necessary and are routinely denied. Much of the proof falls back on the medical record.
Here are some specific situations as they may ...
November 9th, 2016
Should I Avoid Billing 97112
By Raquel Shumway | Published November 9th, 2016 - Last Review/Update March 5th, 2019
Question: The Doctor says he was told by a billing company a few years ago to avoid the 97112. So he has been doing 97110 instead. They do the items listed in 97110, but often some of the ones in 97112 as well. His question was, should he actually be avoiding 97112? Or is there simply something he needs to be mindful of when using it?
September 23rd, 2016
Top ICD-10 Code Changes for Chiropractors in 2017
By ChiroCode | Published September 23rd, 2016 - Last Review/Update March 5th, 2019
There are thousands of code changes going into effect on October 1. Here is a list of the the 70 or so that are most relevant to chiropractors.
August 24th, 2016
Getting Ready for new ICD-10 Codes for Chiropractic
By ChiroCode | Published August 24th, 2016 - Last Review/Update March 5th, 2019
ICD-10-CM changes for 2017 include 1,974 new codes, 311 deleted codes, and 425 revised codes. Chiropractors, fortunately, are only affected by about 70 of these changes. And none of them are ground breaking. However, if you report deleted codes, your claims could be denied. Read more to see some examples of the changes
August 16th, 2016
2017 ICD-10-CM and ICD-10-PCS Code Updates
By | Published August 16th, 2016
The 2017 ICD-10-CM and ICD-10-PCS code updates, including a complete list of code titles, are available on the 2017 ICD-10-CM and GEMs and 2017 ICD-10-PCS and GEMs webpages.
August 3rd, 2016
ICD-10 Changes for 2017
By Wyn Staheli, Director of Research | Published August 3rd, 2016
The Centers for Medicare & Medicaid Services (CMS) recently released the Proposed Rule regarding the updates to the ICD-10-CM and ICD-10-PCS code sets for Fiscal Year 2017 which begins October 1, 2016. Comments regarding the proposed ICD changes are due May 6th and CMS has stated that the Final Rule ...
August 3rd, 2016
Financial Hardship Policy
By ChiroCode | Published August 3rd, 2016
The 2016 Chirocode Deskbook offers advice on waivers!
It is improper and illegal to waive co-payments and/or deductibles. For this reason, if you wish to offer some sort of assistance to a patient, the proper way to do so is through an official “Financial Hardship Policy”.
Caution is advised when implementing hardship waivers. ...
August 3rd, 2016
When can I use “unspecified” codes? What about “other”?
By Dr. Evan Gwilliam | Published August 3rd, 2016
The official guidelines for ICD-10-CM define the conventions used in the code set. In section 1.A.6, we learn the following about some common abbreviations in the Tabular List:
August 3rd, 2016
How do I tell if a code is defined as unilateral or bilateral
By Codapedia | Published August 3rd, 2016
There are some procedures which are defined as unilateral procedures, and some defined as bilateral procedures. If the procedure is defined as unilateral but performedbilaterally, then the physician is paid 150% of the fee schedule amount when performed on both sides. If the code is defined as bilateral, there is...
July 29th, 2016
Observation versus inpatient status
By Codapedia | Published July 29th, 2016
Physicians are often confused about whether to bill for observation status or inpatient status for patients admitted to the hospital. There are specific rules in the Medicare Claims Processing Manual, but sometimes the question is: what is the status of the patient? Commercial carriers have long rejected claims when the...
July 29th, 2016
Make sure your smoking cessation services are being coded right
By Codapedia | Published July 29th, 2016
Coding, billing and getting paid for providing smoking cessation services when covered by your payers is almost a no-brainer for any physician practice because, in most cases, cessation services are already being provided to patients who smoke cigarettes. Yet practices consistently don’t take advantage of this opportunity and, when they...
July 29th, 2016
Preventive medicine and office visit, same day
By Codapedia | Published July 29th, 2016
Can I use modifier 25 on an E/M service on the same day as a preventive medicine exam Let’s review what a preventive medicine service is, in order to answer that question. Preventive medicine services are: • The description given by CPT® for “annual physicals” • Divided into new and...
July 29th, 2016
Past medical, family and social history
By | Published July 29th, 2016
When an Evaluation and Management service requires past medical, family and social history, (or one or two of those) here is what needs to be documented, and the rules around using one that is previously documented. Past medical history includes the patient's chronic illnesses, previous illnesses, injuries and surgeries, medications...
July 29th, 2016
Medicare no longer requires facility certification for bariatric surgery
By | Published July 29th, 2016
Thanks to a recent tweak to Medicare policy, facilities are no longer required to be certified in order for bariatric surgery procedures to be covered, CMS announced in a recent transmittal modifying its National Coverage Determination (NCD) on the procedure. The change took effect September 24.Left unchanged in the NCD...
July 29th, 2016
Mini Mental Status Exam-Can you bill for it?
By Codapedia | Published July 29th, 2016
There is no CPT® code for the Mini Mental Status Exam. Physicians use the mini mental status exam (MMSE to test a patient's cognitive function. The test is made up of a set of questions, testing the patient’s memory, orientation and arithmetic calculation skills. There is a copyrighted form of...
July 29th, 2016
Hospice Care-Billing for physician services when a patient is on hospice
By Codapedia | Published July 29th, 2016
Patients who sign up with hospice waive their rights to receive Medicare Part B services, and must look to the hospice organization to provide care related to the terminal illness. The hospice provider receives a daily payment to care for the patient on hospice. The patient’s own attending physician, (who...
July 29th, 2016
Coding for pulmonary services
By Codapedia | Published July 29th, 2016
This is an overview of billing for services provided by Pulmonologists. Medicare recognizes Pulmonary Disease as a specialty. The resources section of this article contains the E/M Frequency data from CMS for the latest year available, and the fifty most commonly billed CPT® codes. What are the most common...
July 29th, 2016
Repeat Injections, Can I bill an E/M?
By Codapedia | Published July 29th, 2016
When reporting an office visit in conjunction with an injections/arthrocentesis we need to consider a few factors. First we need to be certain we are accurately applying modifier -25 which is required when a procedure is performed the same day as a procedure. In order to report modifier -25, the...
July 29th, 2016
CODING ARTHROSCOPIC KNEE PROCEDURES
By Codapedia | Published July 29th, 2016
Knee Anatomy: The medical compartment includes: Medial Femoral condyle Medial tibial plateau Medial meniscus The lateral compartment includes: Lateral Femoral condyle Lateral tibial plateau Lateral meniscus The Patellofemoral compartment includes: Patella Patellofemoral joint Intercondylar notch of the femur Suprapatellar pouch Trochlea Arthroscopy: Knee arthroscopy allows the physician to visualize the...
July 29th, 2016
Nursing home discharge services
By Codapedia | Published July 29th, 2016
Either a physician or an NPP may bill for discharge services from a skilled nursing facility or a nursing facility. There are two discharge day management codes from a nursing facility. 99315 is for discharge day management 30 minutes or less, and 99316 is for discharge day management over 30...
July 29th, 2016
Subsequent nursing facility visits
By Codapedia | Published July 29th, 2016
Subsequent nursing facility visits (99307--99310) are services billed for either mandated or medically necessary visits in a skilled nursing facility or nursing facility. (Place of service 31 for a skilled nursing facility or 32 for a nursing facility). These codes may also be used in place of service 54 (Intermediate...
July 29th, 2016
Annual Nursing Facility Assessment
By Codapedia | Published July 29th, 2016
CPT® code 99318 is used to bill an annual nursing facility assessment. It requires three of three of these components: a detailed interval history, a comprehensive exam, and low or moderate medical decision making. This visit is payable once per year for a resident in a nursing facility. It may...
July 29th, 2016
Coding Selective and Non Selective Catheter Placement of Lower Extremity
By Codapedia | Published July 29th, 2016
- In diagnostic catheterization, codes are given simply at the final position of the catheter. This can be simply understood if we know the anatomy of Aorta. As we know, most of the major arteries arise from Aorta for example, Inominate artery, Left common carotid artery, Left subclavian artery, celiac...
July 29th, 2016
Subsequent hospital visits
By Codapedia | Published July 29th, 2016
Hospital services are all defined by CPT® as per day codes, that is, all of the care provided to a hospitalized patient during the calendar day. If a physician (or that physician's covering partner of the same specialty) sees the patient a second time during the calendar day, a second...
July 29th, 2016
Subsequent Observation Services
By Codapedia | Published July 29th, 2016
CPT® released three new E/M services in 2011, to be used for the second and subsequent days that a patient is in observation status in the hospital. The codes are 99224--99226 and they are out of sequence in the CPT® book. They require the same level of documentation as the...
July 29th, 2016
Evaluation and Management Services
By Codapedia | Published July 29th, 2016
According to the CPT® book, E/M services are divided into categories and subcategories. Office services are divided into new and established patient visits. Consultations are divided into outpatient/office consults and inpatient consultations. The E/M services typically have three to five levels of services and these levels are not interchangeable from...
July 29th, 2016
I had a wheezer in the office, can I bill a 99215?
By Codapedia | Published July 29th, 2016
At a coding session at a recent Pri-Med conference a Pediatrician asked this question: "I had wheezer in the office, and he was in the office a long time. I examined him, we did pulxe oximetry measurements, which we never get paid for both before and after a nebulizer treatment....
July 29th, 2016
Visits outside the OB Global Package
By Codapedia | Published July 29th, 2016
The CPT® book defines which services may be billed outside of the global OB package, and what services are included in the package. The start of the maternity care codes in the CPT® book describes the antepartum care services, including frequency and exam.
The American College of Obstetrics and Gynecology (ACOG) ...
July 29th, 2016
Modifier 25
By Codapedia | Published July 29th, 2016
Modifier 25: Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. Refer to the CPT® book for the complete definition. Modifier 25 is appended to the E/M service, never to a procedure. The decision about whether to bill for both...
July 29th, 2016
Sports Physicals
By Codapedia | Published July 29th, 2016
Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope. If the patient presents for a well child visit, and also needs their camp physical filled out,...
July 29th, 2016
Anesthesia and E/M services
By Codapedia | Published July 29th, 2016
Anesthesia services are billed using CPT® codes 00100-01999. These CPT® codes are cross-walked to surgical codes. The crosswalk is available from the American Society of Anesthesiologists at www.asahq.org. Each anesthesia code has a base unit assigned to it. The anesthetist also bills the number of time units, with a single...
July 28th, 2016
New Patient
By Codapedia | Published July 28th, 2016
According to the American Medical Association’s CPT® book, a new patient is a patient who “has never received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years. There is an excellent chart in the front...
July 28th, 2016
QW Modifier for CLIA waived tests
By Codapedia | Published July 28th, 2016
QW is a HCPCS modifier defined as: CLIA waived test. Append it to lab services that are on the CLIA waived test list. Download the up to date list of CLIA waived tests from CMS's web site. The link is the citation. There are two issues: Some tests do not...
July 28th, 2016
Learn Exactly how to Code Twin Pregnancy
By Codapedia | Published July 28th, 2016
- As we know there are OB CPT® codes using for coding Pregnancy procedures. The procedures are divided on weeks of gestation. There are separate CPT® codes for first and second trimesters. The first trimester of pregnancy is week 1 through week 12, or about 3 months. The second trimester...
July 28th, 2016
Do you know New CPT® Code changes in 2016: Read this
By Codapedia | Published July 28th, 2016
- With New year in 2016, we will be having new CPT® codes in diagnostic radiology. Since, we will be having CPT® codes which will replace old CPT® codes, some of the codes will be deleted. Diagnostic Radiology have the lot of changes which I hope will help medical coder...
July 28th, 2016
99213 Established patient visit
By Codapedia | Published July 28th, 2016
There are sample audited notes in resource section. 99213 is an established patient visit which requires 2 of 3 of the following components: An expanded, problem focused history, which is 1-3 HPI elements and 1 system in ROS reviewed An expanded, problem focused exam, which is 6 bullets from 1997...
July 19th, 2016
Documentation Guidelines
By | Published July 19th, 2016
What is the difference between the two sets of Guidelines? There are two major differences. The first is in the history of the present illness (HPI). In the 1995 Guidelines, in order to document a history of the present illness at a detailed level, the clinician must document four elements...
July 13th, 2016
Procedure code set for Procedures ICD-10-PCS to ICD-9-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 13th, 2016
There are some PCS codes that have a GEMS mapping and is available on Find-A-Code, such as ICD-9-CM Vol 3. 02.11, the GEMS mapping can be found in out Map-a-code tool.
See this code mapping to the following PCS codes
CodeDescription00Q20ZZ
Repair Dura Mater, Open Approach
00Q23ZZ
Repair Dura Mater, Percutaneous Approach
00Q24ZZ
Repair Dura Mater, Percutaneous Endoscopic ...
June 28th, 2016
Key Terms in ICD-10
By ChiroCode | Published June 28th, 2016 - Last Review/Update March 5th, 2019
In some places, the ICD-10-CM code set uses words we think we are familiar with. However, a review of the guidelines shows that some of these words have very specific definitions. Here are a few important ones to remember.
June 28th, 2016
Q&A: We Bill Hot/Cold Packs (97010) but are Rarely Reimbursed. Why is This?
By ChiroCode | Published June 28th, 2016 - Last Review/Update March 5th, 2019
97010 is a service that is commonly not covered by payers or if it is covered, reimbursement is very minimal. This is due to a few reasons:
June 16th, 2016
Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?
By ChiroCode | Published June 16th, 2016 - Last Review/Update March 5th, 2019
Q&A: If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes?
June 7th, 2016
Multiple surgical procedures
By Codapedia | Published June 7th, 2016
Multiple Surgical Procedures In some groups, the coder performs all of the steps below. The responsibilities indicated here are opinion of the author, not law, regulation or national policy. Physician Responsibility: 1. List all codes for the procedures performed 2. Note whether the procedures performed were done via the same...
March 28th, 2016
Q&A: Is There a Better Supply Code to Use Than 99070?
By ChiroCode | Published March 28th, 2016 - Last Review/Update March 5th, 2019
Are there more specific codes for supplies rather than using 99070?
March 14th, 2016
Q/A: What is the Best Way to Handle Denials?
By ChiroCode | Published March 14th, 2016 - Last Review/Update March 5th, 2019
What is the best way to handle denials?
March 4th, 2016
What is an 'Other Qualified Healthcare Professional'?
By Wyn Staheli | Published March 4th, 2016
What's the difference between a physician, an other qualified healthcare professional, clinical staff and individual.
February 26th, 2016
Clear the Smoke on Debridement and Active Wound Care Codes
By | Published February 26th, 2016
Confused about when to choose a debridement code and an active wound code? CPT® 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth. “Depth is...
February 24th, 2016
Nebulizer Therapy Billing Reminders - Modifiers, Dispensing Fees, and Orders
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 24th, 2016 - Last Review/Update August 3rd, 2017
The ICD-10-CM code describing the condition necessitating nebulizer therapy must be included on each claim for equipment, accessories, and/or drugs.
When ever a unit dose code is billed, it must have a KO, KP, or KQ modifier. (Exception: The KO, KP, and KQ modifiers should not be used with code J7620.)
When billing miscellaneous equipment or accessories (E1399), the claim must ...
February 15th, 2016
Q&A: How do You Code for a Bilateral Condition, Such as Sciatica?
By ChiroCode | Published February 15th, 2016 - Last Review/Update March 5th, 2019
How do you code for a bilateral condition, such as sciatica?
February 8th, 2016
How do we Know Which Codes a Payer will Allow?
By ChiroCode | Published February 8th, 2016 - Last Review/Update April 26th, 2019
Question:
How do we know which codes a payer will allow?
February 1st, 2016
Will Incident-To in Your Organization Pass a Compliance Audit?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 1st, 2016
Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits.
February 1st, 2016
Definitive Diagnoses - To Code or Not To Code
By Bonnie Schreck | Published February 1st, 2016
For inpatient coding, there are times when the diagnosis(es) cannot be established at the time of admit or throughout the course of the admission. In these cases, they are documented in the medical record as “probable,” “suspected,” “likely,” “questionable,” “possible,” or “rule out” conditions. This guideline is true for certain...
January 8th, 2016
What are External Cause Codes in ICD-10?
By ChiroCode | Published January 8th, 2016 - Last Review/Update September 3rd, 2019
Chapter 20 External Causes of Morbidity includes codes from V00 to Y99. They were greatly expanded in ICD-10-CM.
January 6th, 2016
E/M service prior to a screening colonoscopy
By Codapedia | Published January 6th, 2016
CMS does not pay for an Evaluation and Management service prior to a screening colonoscopy. If a patient calls or is sent from another physician to schedule a screening colonoscopy, do not bill any type of E/M service prior to the procedure. Some commercial carriers also...
January 6th, 2016
EMRs - Coding and Compliance Concerns
By | Published January 6th, 2016
The past year has been an exciting time for healthcare professionals, bringing more changes, opportunities and challenges than ever before. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which is a portion of the American Recovery and Reinvestment Act of 2009,...
January 6th, 2016
Preventive Medicine Services for Medicare Patients
By Codapedia | Published January 6th, 2016
The most widely known fact about Medicare and preventive medicine is that fee-for-service Medicare does not cover an annual physical exam. This is because in its beginning, Medicare was prohibited from paying for routine services. Over the years, Congress has mandated the payment of some screening...
January 6th, 2016
Doing--and coding--for minor procedures in primary care
By Codapedia | Published January 6th, 2016
I asked a Family Physician recently if he did minor procedures in his practice. He said, “I send them all to my partner. Tim loves doing minor procedures, and he’s fast. I don’t bother with them myself.” His partner, by inclination or design, was the designated...
January 6th, 2016
Family meetings without the patient present
By | Published January 6th, 2016
Medicare does not permit a physician practice to bill for family meetings without the patient present. The physician may not bill Medicare, nor may they bill the family member. It is fairly common for the spouse or child of a patient to ask to see the...
January 6th, 2016
Modifier 52 vs. 53 - What's the Difference?
By Codapedia | Published January 6th, 2016
So you’ve read the descriptions for both Modifiers 52 and 53, but you’re still on the fence as to which one is appropriate for a certain surgical case. This brief article will try to better differentiate between these two often-confused modifiers. Modifier 53...
January 6th, 2016
Minor Surgical Procedures - How to document and bill
By Codapedia | Published January 6th, 2016
When performing minor surgical procedures, it is important to document what was done, how it was done, where it was done, why it was done, how deep, how long, and how many. In billing and reporting a procedure, document in the medical record the key components...
January 6th, 2016
Pre-op visits: True or False?
By Codapedia | Published January 6th, 2016
Are the following statements true or false? • The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules. • The surgeon can never be paid to do a pre-op visit if s/he...
January 6th, 2016
Coding Excisions and Wound Repairs
By Codapedia | Published January 6th, 2016
Chart audits frequently examine coding associated with lesion removals and wound repairs. In order to assign the appropriate procedure code, certain documentation must be included in the medical record, such as lesion type, excision size, wound repair, and location. Without these important details, providers...
December 11th, 2015
Hospital discharge, nursing facility admit billable on same day by same provider in most instances
By | Published December 11th, 2015
Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple...
December 11th, 2015
Who Qualifies for TCM Services?
By Codapedia | Published December 11th, 2015
Any patient post-discharge whose medical and/or psychosocial problems are complex enough to require TCM services qualifies for these codes. Here are the specifics: 1. Location: “TCM is for higher-risk patients being discharged from an inpatient or observation status to their home, rest home, or assisted living...
December 3rd, 2015
How to research coding questions with Codapedia.com
By | Published December 3rd, 2015
How to Research Answers to Coding Questions Perform a search of the discussion board or listserv website prior to posting a new question. For your search terms, include specific words such as the diagnostic statement or procedure statement or the specific code number or the...
November 10th, 2015
Watch for new CDT codes in 2016
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 10th, 2015 - Last Review/Update January 23rd, 2017
New codes revisions and deletions effective January 2016
New CDT Codes and Descriptions
D0251 EXTRA-ORAL POSTERIOR RADIOGRAPHIC IMAGE D0422 COL & PREP GENETIC MATERIAL-LAB & REPORT D0423 GENETIC TEST-SUSCEPTIBILITY TO DISEASE D1354 INTERIM CARIES ARRESTING MEDICAMENT APPL D4283 AUTO CONNECTIVE TISSUE GRAFT/EACH ADD TH D4285 NON-AUTO CONNECTIVE TISSUE GRAFT/ADD TH D5221 MAXILLARY PARTIAL-RESIN BASE D5222 MANDIBULAR PARTIAL-RESIN BASE D5223 MAXILLARY ...
October 5th, 2015
ICD-10 Coding Resources and Suggestions
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 5th, 2015
ICD-10 is finally here, it is no longer a myth. Here are a few suggestions to help you with ICD-10 and resources available for you.
Check out Find-A-Code, if you are not familiar with this on-line tool, you will quickly find this to be your most valuable resource during your transition ...
August 31st, 2015
Working with Medicare in the Dental Practice
By Christine Taxin | Published August 31st, 2015
Dental practices that do not work with medical are truly confused when it comes to Medicare. I decided to put together a simple outline of what we should be doing to be compliant with Medicare.
August 19th, 2015
A Dental Guide to Cross-Coding for Oral Cancer Screening
By Christine Taxin Adjunct Professor, University of New York School of Dentistry - Links2Success.biz | Published August 19th, 2015
Dental professionals are a patient’s primary source of screening within the oral cavity; thus attention must be paid to the most common oral malignancy: squamous cell carcinoma. Historically such malignancies were attributed only to patients with a history of extensive alcohol and tobacco use. However, other risk factors such as ...
August 17th, 2015
Clinical Documentation Guidance for ICD-10-CM/PCS
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 17th, 2015
Documentation assessment and gap analysis is important in ICD-10-CM/PCS. Clinical documentation will also affect code assignment and relative weight associated with payment. To read more information on problem areas with documentation issues read AHIMA's article.
...
August 10th, 2015
Manipulation Under Anesthesia in the Office
By | Published August 10th, 2015 - Last Review/Update January 27th, 2017
When manipulation under anesthesia is done in the office instead of a facility, code selection is different.
August 10th, 2015
Lumbar Diagnosis Using ICD-10
By Melinna Giannini | Published August 10th, 2015 - Last Review/Update January 27th, 2017
This article is coming out before the payers have told us which ICD-10 codes will be used for claim submission. However, we have access to the same code set that they do, therefore this is an educated guess at which codes might used by DCs for the lumbar spine. The ...
August 10th, 2015
Can Chiropractors Finally Code a "Subluxation" in ICD-10?
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
There is a word that has long been held as sacred to the Chiropractic profession. It is the so-called vertebral “subluxation.” Throughout ICD-9, which is the diagnostic code set used on claims for the last thirty years, the term “subluxation” is used to describe a partial dislocation,” which is not how it is defined by many Chiropractors. Medicare ...
August 10th, 2015
ICD-10 External Cause Codes Tell the Whole Story
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Beginning October 1, 2015 all claims for health care services in the United States must use ICD‑10 diagnosis codes. ICD‑9 has been the standard since 1979, but has outlived its usefulness. Because of its structure, ICD‑10 provides better data for research and statistical analysis than ICD‑9. Although there is no national mandate to report ...
August 10th, 2015
Adjunctive (Add-On) Codes
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Stop losing hard-earned dollars. Too often, dollars are left on the table at billing time. Adjunctive codes for associated services should be added when they are appropriate. Here are a few examples of coding that are often overlooked.
97014 & 97032 Electrical Stimulation Supplies
According to the Relative Value Update Committee (RUC), ...
August 3rd, 2015
Notice of Election (NOE) - Form CMS - 1450 (Rev. 3118)
By Find-A-Code | Published August 3rd, 2015
When a Medicare beneficiary elects hospice services, hospices must complete form locators identified in section 20.1.2 for the Uniform (Institutional Provider) Bill (Form CMS-1450), which is an election notice.
In addition, the hospice must complete the Form CMS-1450 when the election is for a patient who has changed an election from one ...
July 20th, 2015
Hospice Pre - Election Evaluation and Counseling Services (Rev. 2258)
By Find-A-Code | Published July 20th, 2015
Effective January 1, 2005, Medicare allows payment to a hospice for specified hospice pre-election evaluation and counseling services when furnished by a physician who is either the medical director of or employee of the hospice.
Medicare covers a one-time only payment on behalf of a beneficiary who is terminally ill, (defined ...
July 20th, 2015
Payment Jurisdiction Among A/B MACs (B) for Services Paid Under the Physician Fee Schedule and Anesthesia Services (Rev. 3086)
By Find-A-Code | Published July 20th, 2015
(Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014) The jurisdiction for processing a request for payment for services paid under the Medicare Physician Fee Schedule (MPFS) and for anesthesia services is ...
July 10th, 2015
Independent Laboratory Specimen Drawing (Rev. 3071, 12-22-14)
By Jared Staheli | Published July 10th, 2015
Medicare allows separate charges made by laboratories for drawing or collecting specimens whether or not the specimens are referred to hospitals or independent laboratories. The laboratory does not bill for routine handling charges where a specimen is referred by one laboratory to another.
Medicare allows payment for a specimen collection fee ...
July 10th, 2015
Coding Requirements for Specimen Collection (Rev. 3056, 12-01-14)
By Jared Staheli | Published July 10th, 2015
The following HCPCS codes and terminology must be used:
• 36415 – Collection of venous blood by venipuncture.
• G0471 – Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency ...
July 6th, 2015
Coding and Payment of DSMT Services (Rev. 1255, 07-02-07)
By Jared Staheli | Published July 6th, 2015
The following HCPCS codes are used to report DSMT:
• G0108 - Diabetes outpatient self-management training services, individual, per 30 minutes.
• G0109 - Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.
The type of service for these codes is 1.
Payment to physicians and providers for outpatient DSMT ...
July 6th, 2015
Coding Requirements for IBT for CVD Furnished on or After November 8, 2011 (Rev. 2432, 11-08-11)
By Jared Staheli | Published July 6th, 2015
The following is the applicable Healthcare Procedural Coding System (HCPCS) code for IBT for CVD:
G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
Contractors shall not apply deductibles or coinsurance to claim lines containing HCPCS code G0446.
...
June 29th, 2015
Diagnosis Coding for Prostate Cancer Screening Tests and Procedures (Rev. 1, 10-01-03)
By Jared Staheli | Published June 29th, 2015
Prostate cancer screening digital rectal examinations and screening Prostate Specific Antigen (PSA) blood tests must be billed using screening (“V”) code V76.44 (Special Screening for Malignant Neoplasms, Prostate).
...
June 17th, 2015
ICD-10 training: Coding for diabetes
By Find-A-Code | Published June 17th, 2015
In order to understand diabetes coding in ICD-10, it’s worth making a comparison of the structural differences between ICD-9-CM and ICD-10-CM.
Diabetes mellitus (DM) codes in ICD-10-CM are combination codes that include the type of DM, the body system affected, and the complication affecting that body system as part of the code description. Subcategory levels first ...
June 17th, 2015
ICD-10 PCS - Coding System
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 17th, 2015
ICD-10-PCS has a seven character alphanumeric code structure. Each character contains up to 34 possible values. Each value represents a specific option for the general character definition (e.g., stomach is one of the values for the body part character). The ten digits 0-9 and the 24 letters A-H,J-N and P-Z ...
June 15th, 2015
General Inpatient Requirements (Rev. 1, 10-01-03)
By Find-A-Code | Published June 15th, 2015
HO-400, HO-400.G, HO-403, HO-412
The hospital may bill only for services provided. If the provider billing system initiates billing based on services ordered, the provider must confirm that the service has been provided before billing either the carrier or intermediary (FI).
The provider agreement to participate in the program requires the provider ...
May 30th, 2015
Multiple External Cause Coding Guidelines
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 30th, 2015 - Last Review/Update August 8th, 2017
More than one external cause code is required to fully describe the external cause of an illness or injury. The assignment of external cause codes should be sequenced in the following priority: If two or more events cause separate injuries, an external cause code should be assigned for each cause.
The ...
May 11th, 2015
Modifier 33
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 11th, 2015 - Last Review/Update January 30th, 2017
Modifier 33 for Preventive Care
With the implementation of modifier 33 and its complicated and unique description, many coders have wondered how to properly apply it. Let's review the information we have on the modifier and see if we can better understand how and when to use it.
Modifier 33 was created ...
May 11th, 2015
How To Report Co-Surgeons and Assistant Surgeon Modifiers
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 11th, 2015 - Last Review/Update January 30th, 2017
Some surgeries require the expertise of more than one surgeon or may require the assistance of another surgeon to ensure adequate care is given and the surgery is a success.
Let's review a couple terms:
Co-Surgeon: When two surgeons act as primary surgeon for a specific procedure. Each acts as the primary surgeon ...
April 15th, 2015
Medicare Updates Preventive Exam and Wellness Visit Information
By Wyn Staheli, Director of Research | Published April 15th, 2015 - Last Review/Update June 9th, 2016
Medicare has updated their provider educational tools for the Initial Preventive Physical Examination (IPPE) and the Annual Wellness Visit (AWV). These tools were designed to help providers gain a greater understanding of these services. Learn what the required elements for these services as well as important coverage and coding information.
CLICK ...
March 9th, 2015
Billing Imminuzation for Pneumococcal, Influenza, and Hepatitis B with Medicare
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
The current diagnosis pointer for, Influenza, Pneumococcal or Hepatitis B vaccines is ICD-10-CM code Z23. Listed are tips for coding, and also the diagnosis pointers used for claims previous to 10/01/15:
Influenza: G0008
Procedure codes:
90630
90653-90662
90672-90674
90685-90688
Medicare codes:
Q2034-Q2039
Expired diagnosis code:
V04.81
Pneumococcal: G0009
Procedure codes:
90670
90732
Expired diagnosis code:
V03.82
Hepatitis B: G0010
Procedure codes
90739-90747
Expired diagnosis code
V05.3
Both Influenza and Pneumococcal Vaccines received in same visit: G0008 with G0009
Procedure codes:
(See previous)
Expired diagnosis code:
V06.6 (effective 10/01/06 - 09/30/15)
Extra Tips:
Be sure ...
February 26th, 2015
Chiropractic Billing 101: A Basic Guide
By | Published February 26th, 2015 - Last Review/Update January 27th, 2017
Director of Communications, ChiroCode
In my 20 years of professional bull riding I have had many highs and lows. There were times when the rankest of bulls couldn’t throw me and times when I couldn’t ride a rocking chair. When in a slump, what always worked for me, and for the ...
February 26th, 2015
Levels of Supervision Required by Medicare
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 26th, 2015 - Last Review/Update March 2nd, 2016
Be sure you know and understand the levels of supervision required so as not to result in non-compliance audits, possible fines and take-backs. Supervision requirements may also affect your documentation requirements; be sure to document the presence during the procedure or performance if it requires personal supervision.
Find-A-Code has levels of supervision ...
February 26th, 2015
Codes for Coverage: Locum Tenens & Reciprocal Billing
By ChiroCode | Published February 26th, 2015 - Last Review/Update January 27th, 2017
Presenting Problem
Some doctors fail to code properly for a temporary doctor who is covering an office, or for mutual coverage with a colleague.
History/Subjective
It is a common practice for doctors in solo practice to find someone to “cover” for them while they are away from the office for a temporary or extended period of time.
During such ...
February 15th, 2015
Underdosing - a New Clinical Concept in ICD-10 codes T36 – T50
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2015 - Last Review/Update March 1st, 2016
T36-T50 Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50)
Underdosing is a clinical concept new to ICD-10. Underdosing identifies situations referring to the practice of a patient taking less medication as prescribed by a physician, or a physician prescribing less than what is prescribed by ...
December 4th, 2014
Vacuum Erection Devices (VED)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016
Vacuum pumps coded L7900 must demonstrate a capability to generate a negative pressure in the range of greater than 3.9 and less than 17 inches of mercury (100 and 432 mmHg, respectively). All devices coded L7900 for reimbursement by Medicare must include a vacuum limiter such that a maximum vacuum ...
December 4th, 2014
Collagen Surgical Dressings - Coding Verification Review Requirement
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016
In the case of collagen dressings coded A6021, A6022, A6023 and A6024, the predominate component must be collagen.
Effective for claims with dates of service on or after June 1, 2013, the only products which may be billed to Medicare using code A6021, A6022, A6023 and A6024 are those for which ...
December 4th, 2014
Correct Coding MyoPro® (Myomo, Inc.) Assist Device
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have evaluated the MyoPro® upper extremity assist device and determined that it falls within the Durable Medical Equipment (DME) benefit category. Claims for MyoPro® should be submitted using the DME miscellaneous code E1399.
Suppliers are reminded that when submitting claims for items ...
December 3rd, 2014
Coding for Laser Therapy
By | Published December 3rd, 2014 - Last Review/Update January 30th, 2017
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnosis code.
Coverage for laser, as with any other service, is strictly dependent upon the ...
November 21st, 2014
Modifier 50
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 21st, 2014 - Last Review/Update January 30th, 2017
Modifier Review: Modifier -50
Modifier 50 is used to report a procedure performed bilaterally.
Example: The patient underwent bilateral tympanostomy with insertion of ventilating tubes.
If you look up the CPT code 69433, you will see it is a unilateral procedure and there are instructions telling you to append modifier -50 if ...
November 21st, 2014
What is an LMRP and Where Can I Find Them?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 21st, 2014 - Last Review/Update March 1st, 2016
Local Medical Review Policies (LMRPs) were converted to LCDs. This was done as a result of the Benefits Improvement and Protection Act of 2000 (BIPA 2000). The difference between LCDs and previously written LMRPs is that LCDs contain only reasonable and necessary conditions of coverage as allowed under section 1862(a)(1)(A) ...
November 21st, 2014
Coding for Laser Therapy
By | Published November 21st, 2014 - Last Review/Update January 30th, 2017
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the ...
November 17th, 2014
Medicare's Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services
By Wyn Staheli, Director of Research | Published November 17th, 2014 - Last Review/Update January 6th, 2017
Medicare understands that there are individuals who may not meet the diagnostic criteria for substance abuse, but who are still at risk. To help identify these individuals and take steps to keep them from reaching the level of abuse, Medicare has established a program called the Screening, Brief Intervention, and ...
November 10th, 2014
Drip Line Tip: External Cause and Unspecified codes in ICD-10
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 10th, 2014 - Last Review/Update August 9th, 2017
Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a State-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20, External Causes ...
November 5th, 2014
Is Modifier -59 going away?
By | Published November 5th, 2014 - Last Review/Update January 30th, 2017
Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that "CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”
The new codes are:
October 20th, 2014
Clarification of Equipment and Approach in Coding
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 20th, 2014 - Last Review/Update January 30th, 2017
When determining the type of approach taken in a surgical procedure, it is important to review not only the title of the report but also the body of the report to locate the method used.
Somewhere in the body of the report, and always preferably in the title, scope, endoscope, endoscopy ...
October 16th, 2014
Piriformis Injections
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Piriformis Injections
The piriformis muscle is a small muscle that attaches at the sacrum, travels across the pelvis and attaches to the top of the femur. It is an external rotator of the hip and leg, which allows the leg and hip to move outward. The sciatic nerve is comprised of ...
October 16th, 2014
CT (Computed Tomography) Enterography
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Computed Tomography (CT) Enterography
CT enterography is not a specific procedure but rather a protocol used with CT abdomen, CT pelvis or CT abdomen and pelvis. It uses CT imaging and two types of contrast to better visualize the anatomy of the interior small intestines.
For years endoscopic techniques were the ...
October 16th, 2014
Present on Admission (POA) Indicator
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
To group diagnoses into the proper DRG, CMS needs to capture a Present on Admission (POA) Indicator for all claims involving inpatient admissions to general acute care hospitals. Use the UB-04 Data Specifications Manual and the ICD-9-CM Official Guidelines for Coding and Reporting to facilitate the assignment of the POA indicator ...
October 16th, 2014
Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital-acquired conditions. CMS has titled the provision “Hospital-Acquired Conditions and Present on Admission Indicator Reporting” (HAC & POA).
Read more about it here: Medicare learning network fact sheet, ICN 901045 ...
October 16th, 2014
HACs and Codes List 2012
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
For a list of HACs and Codes
Medicare learning network ICN 901045 October 2012
(This list was current with Medicare when published October 2012)
Affected Hospitals
The Hospital-Acquired Conditions payment provision applies only to IPPS hospitals. At this time, the following hospitals are EXEMPT from the HAC payment provision:
Critical Access Hospitals (CAHs)
Long-Term Care Hospitals ...
October 16th, 2014
Final Hospital - Acquired Conditions ( HACs) FY 2014
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
For a list of the 2014 Final Hospital - Acquired Conditions HACs
Click here: FY 2014 Final Hospital -Acquired Conditions (HACs)
...
October 16th, 2014
ABN FAQ for Chiropractic Care
By | Published October 16th, 2014 - Last Review/Update November 29th, 2017
What is the ABN form used for?
The Advanced Beneficiary Notice of Non-Coverage (ABN) is the Notice of Liability that is required to be provided to Medicare patients in the event that the service(s) rendered to them are expected to not be covered. For chiropractic, reason for non-coverage is generally due ...
October 9th, 2014
Modifier 24
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 9th, 2014 - Last Review/Update January 30th, 2017
Modifier -24
When a patient is seen during a global (postoperative) period for something unrelated to the surgery for which the global period applies, modifier -24 is appended to the evaluation and management (EM) service.
The insurance may deny payment for the EM service; however, if the notes for that service ...
September 30th, 2014
Fill In Doctor: Locum Tenens
By | Published September 30th, 2014 - Last Review/Update January 30th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ...
September 18th, 2014
Other Medical Code Sets Find-A-Code Content
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 18th, 2014 - Last Review/Update January 30th, 2017
How many code sets are there?
Find-A-Code Content
Did you know?
Along with the ever so popular code sets we are so familiar with and use every day such as:
ICD-9, ICD-10, DRG’s, CPT, HCPCS, ICD-9 Vol. 3, CDT, ICD-10 PCS, APC and NDC codes,
Find-A-Code has lists of many other code sets (To access ...
September 15th, 2014
Medicare Definition of Timed Codes
By Wyn Staheli, Director of Research | Published September 15th, 2014 - Last Review/Update July 12th, 2016
Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. Medicare Claims Processing Manual, Chapter 5 clarification included here.
September 15th, 2014
Can Chiropractors Bill 99211?
By | Published September 15th, 2014 - Last Review/Update January 30th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse's code, is not really made for the physician to use. In fact, the AMA, ...
July 31st, 2014
GP Modifier for Physio Therapy Services
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
The -GP modifier needs to be appended to physio-therapy codes when submitting Medicare claims. However, be aware of differing policies for different types of payers. Chiropractors typically use the following Physical Medicine codes from the CPT book: 97010 thru 97799 (except for 97597-97610 for active wound care management). The current ...
July 16th, 2014
Hospital Medical Coders Must Switch To The ICD-10-PCS Codes For Billing Purposes
By David Berky | Published July 16th, 2014 - Last Review/Update January 25th, 2017
For numerous years, United States doctor's offices, medical clinics and hospitals have been using the standard ICD-9-CM on medical forms for inpatient procedures. This code, developed by the World Health Organization (WHO - the "ICD-9") and modified by the use (the "CM"), is used by medical professionals for billing and ...
May 2nd, 2014
CMS Makes ICD-10 Announcement
By | Published May 2nd, 2014 - Last Review/Update January 25th, 2017
On the evening of April 30th, the release of the 2015 Inpatient Prospective Payment System Proposed Rule included three separate references to the implementation of ICD-10:
1. "The ICD-10-CM/PCS transition is scheduled to take place on October 1, 2015. After that date, we will collect non-electronic health record-based quality measure data coded only in ICD-10-CM/PCS." - page 648
2. "ICD-10 will officially be implemented on October 1, 2015." - page 1065
3. "ICD-10-CM/PCS will officially be implemented on October 1, 2015." - page 1074
Today, May 2, 2014, CMS released the following statement:
February 13th, 2014
Muscle Testing Table
By | Published February 13th, 2014 - Last Review/Update August 3rd, 2018
Muscle and Range of Motion Testing guidelines have recently been clarified in the AMA CPT Assistant. Muslce Testing Table included
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 ...
September 11th, 2013
ICD-10 Coding Possibilities for Chiropractic Physicians
By Evan M Wsilliam, DC, CPC, CCPC, NCICS, CCCPC, CPC-I, MCS-P, CPMA | Published September 11th, 2013 - Last Review/Update January 27th, 2017
Right now, it’s hard to say which ICD-10 codes third-party payers will select as medically necessary, but we can make an educated guess based on information from a few sources. More detail is expected from Medicare before the end of 2013. For doctors of chiropractic (DCs), the natural place to start is with the relatively short list of frequently used ICD-9-CM codes for submitting claims. We’ll investigate a handful of diagnosis codes that Medicare recognizes as medically necessary and explore ICD-10-CM code possibilities.
April 12th, 2013
Chiropractic Coding & Billing Training - Which Course Is Right For You?
By | Published April 12th, 2013 - Last Review/Update January 27th, 2017
Often times we get calls at ChiroCode from offices looking for training. Sometimes it is due to employee turnover and other times it is from a new office trying to get started. And everyone is looking for affordable help!
There are hundreds of seminars and clinics available for training if you ...
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