"Documentation" & "Procedure Coding" Articles

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

January 11th, 2021

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

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

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

January 5th, 2021

CMS Final Rule Changes E/M Reporting Guidelines

By Wyn Staheli, Director of Research | Published January 5th, 2021

Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.

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 12th, 2020

Medicare Improper Payment Report for Chiropractic (2019)

By Jared Staheli | Published October 12th, 2020

CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report by specialty, chiropractic has the highest Part B improper payment ...

October 12th, 2020

Medicare Improper Payment Report for Behavioral Health Services (2019)

By Jared Staheli | Published October 12th, 2020

CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report, behavioral health services have some of the highest Part ...

October 12th, 2020

Medicare Improper Payment Report (2019)

By Jared Staheli | Published October 12th, 2020

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

September 15th, 2020

More COVID-19 Codes Added as of September 8, 2020

By Wyn Staheli, Director of Research | Published September 15th, 2020

The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.

August 10th, 2020

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

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published August 10th, 2020

Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...

August 7th, 2020

Impact of 2021 Proposed Medicare Fee Schedule on Chiropractic Offices

By Wyn Staheli, Director of Research | Published August 7th, 2020

On August 3, 2020, the proposed Medicare Physician Fee Schedule for 2021 was released. This 1,355 page document includes some sweeping changes to the Medicare program. There are a few items in particular which should be noted by chiropractic offices.

August 5th, 2020

Coding with PCS When There is No Code

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

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

July 28th, 2020

OIG Report Highlights Need to Understand Guidelines

By Wyn Staheli, Director of Research | Published July 28th, 2020

A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.

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.

May 5th, 2020

ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting

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

The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI). The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms. ICD-10-CM Official Coding Guidelines - ...

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 20th, 2020

Dismal OIG Report on Telemedicine

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

Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.

April 2nd, 2020

More Telehealth Changes Announced by CMS

By Wyn Staheli, Director of Research | Published April 2nd, 2020

On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information

March 21st, 2020

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

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2020

The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...

March 17th, 2020

Additional Coronavirus Testing Code Announced

By Wyn Staheli, Director of Research | Published March 17th, 2020

On March 13, 2020, a new CPT code was announced by the American Medical Association (AMA) who maintains the CPT code set. This early release of a CPT code is rare and is effective immediately.

February 20th, 2020

Acupuncture Clarification

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

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

February 19th, 2020

Medicare Begins Covering Acupuncture Services

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

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

February 10th, 2020

A 2020 Radiology Coding Change You Need To Know

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 10th, 2020

The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...

January 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 21st, 2020

Q/A: How do we Bill Massage Services?

By Wyn Staheli, Director of Research | Published January 21st, 2020

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

January 14th, 2020

Billing for Telemedicine in Chiropractic

By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 14th, 2020

Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.

January 9th, 2020

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

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 9th, 2020

Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...

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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

New Codes for Dry Needling

By Wyn Staheli, Director of Research | Published September 30th, 2019

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

September 30th, 2019

Vaccine Administration - When The Right Vaccine Code is Not Enough

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2019

Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...

September 30th, 2019

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

By Wyn Staheli, Director of Research | Published September 30th, 2019

Question If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form? A modifier, or something else? Answer Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...

September 16th, 2019

E-Health is a Big Deal in 2020

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 16th, 2019

The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...

September 9th, 2019

Chiropractic 2020 Codes Changes Are Here

By Wyn Staheli, Director of Research | Published September 9th, 2019

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

August 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 6th, 2019

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

By Wyn Staheli, Director of Research | Published August 6th, 2019

On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...

August 2nd, 2019

The Slippery Slope For CDI Specialists

By Namas | Published August 2nd, 2019 - Last Review/Update August 8th, 2019

Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail. Many of you in this industry are ...

July 22nd, 2019

Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?

By Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA | Published July 22nd, 2019

Question: What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms. Answer: There is no question that these adjustments would be considered ...

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 ...

July 8th, 2019

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

By Wyn Staheli, Director of Research | Published July 8th, 2019

Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...

July 1st, 2019

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

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

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

June 27th, 2019

2018 Medicare Improper Payment Report Shows Slight Improvement but There's Still Work to be Done

By Wyn Staheli, Director of Research | Published June 27th, 2019 - Last Review/Update July 8th, 2019

The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ...

June 14th, 2019

A United Approach

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

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

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 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.

May 6th, 2019

Q/A: If Orthopedic Tests are Negative, do You List Them in Your Treatment Notes?

By Wyn Staheli, Director of Research | Published May 6th, 2019

Question: If orthopedic tests are negative, do you need to still list them in your treatment notes? Answer: Yes. Any tests which are performed by a healthcare provider, regardless of the result, should be documented in the patient record. This record is the only way that a reviewer or another provider ...

April 23rd, 2019

Let's Talk High Risk E/M Services

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019

Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services. Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...

April 23rd, 2019

What is Medical Necessity and How Does Documentation Support It?

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019

We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

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.

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 7th, 2019

Date of Service Reporting for Radiology Services

By Wyn Staheli, Director of Research | Published March 7th, 2019

Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.

March 1st, 2019

Understanding NCCI Edits

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 1st, 2019

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

February 12th, 2019

Coding Medicare Initial Preventive Physical Exams (IPPE)

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 12th, 2019

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

February 1st, 2019

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

By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published February 1st, 2019

It is not unusual for a healthcare provider to review x-rays taken and professionally read by another entity. Questions arise regarding how to bill this second review. It is essential to keep in mind that the global (complete) service of taking an x-ray is composed of both a professional and ...

February 1st, 2019

Physical Therapy Caps Q/A

By Wyn Staheli, Director of Research | Published February 1st, 2019 - Last Review/Update February 4th, 2019

Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...

January 25th, 2019

Medical Necessity vs. Documentation for Inpatient Services

By NAMAS | Published January 25th, 2019 - Last Review/Update January 29th, 2019

Auditing the documentation of inpatient and observation E/M services can often be challenging. Many of the notes we are provided for review include so much information that the note feels like a short novel instead of documentation for one date of service. This over-documentation can make it difficult to see ...

January 24th, 2019

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

By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 24th, 2019 - Last Review/Update February 4th, 2019

Question Which code should I use for a lab interpretation fee? Specifically, I have ordered a female hormone saliva test, and would like to charge a fee for time spent on the interpretation and consult. Answer This type of service generally does not involve a third party, so it may be acceptable to ...

January 23rd, 2019

How to Report Co-Surgeons Using Modifier 62

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2019

Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session. An easy way to explain this is to visualize a patient requiring cervical fusion where ...

January 22nd, 2019

Home Oxygen Therapy

By Raquel Shumway | Published January 22nd, 2019

Home Oxygen Therapy Guidelines

January 14th, 2019

AMA Issues new CMT Information

By Wyn Staheli, Director of Research | Published January 14th, 2019

As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ...

January 14th, 2019

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

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

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

January 10th, 2019

Are You Protecting Your Dental Practice From Fraud?

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

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

January 3rd, 2019

Dry Needling

By Wyn Staheli, Director of Research | Published January 3rd, 2019

The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ...

January 3rd, 2019

2019 Coding Changes for Chiropractic

By Wyn Staheli, Director of Research | Published January 3rd, 2019

The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...

January 3rd, 2019

Welcome 2019 CPT Codes!

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 3rd, 2019

The AMA has released the New, Revised and Deleted CPT codes these are currently available on Find-A-Code. View the entire list of changes on the CODE tab and select CPT. Be sure to review all of the changes effective January 01, 2019. 168 New Codes 72 Deleted Code 51 Revised Codes Here are ...

December 20th, 2018

Flexion-Distraction Billing Clarification

By Wyn Staheli, Director of Research | Published December 20th, 2018

Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article ...

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 30th, 2018

Auditing looking between the lines

By BC Advantage | Published November 30th, 2018 - Last Review/Update January 9th, 2019

When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not...

November 26th, 2018

CMT Fees in 2019

By Wyn Staheli, Director of Research | Published November 26th, 2018 - Last Review/Update January 30th, 2019

Now is the time to prepare. There were some minor reductions to the RVUs for CMT codes 90840-90843. Check here to see what those changes are.

November 8th, 2018

Muscle Testing and Range of Motion Information

By Wyn Staheli, Director of Research | Published November 8th, 2018

Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.

November 7th, 2018

Medi-Cal Coverage Criteria for Hospital Beds and Accessories

By Raquel Shumway | Published November 7th, 2018

Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.

October 30th, 2018

Documentation Requirements for Allergy Testing 10/29/2018

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 30th, 2018

Per CMS, First Coast Service Options LCD 33261: Medical record documentation (e.g., history & physical, office/progress notes, procedure report, test results) must include the following information, and be available upon request: A complete medical and immunologic history and appropriate physical exam obtained by face-to-face contact with the patient. The medical necessity for performing ...

October 19th, 2018

We've Always Done It This Way and Other Challenges in Education

By BC Advantage | Published October 19th, 2018 - Last Review/Update November 1st, 2018

As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into...

October 16th, 2018

Pelvic Floor Dysfunction Treatment Coverage

By Wyn Staheli, Director of Research | Published October 16th, 2018

Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings. Coverage by payers ...

October 4th, 2018

Is cox-flexion distraction billable as 97012

By ChiroCode | Published October 4th, 2018 - Last Review/Update January 17th, 2019

Is cox-flexion distraction billable as 97012? Can you use 97140 and 98941 on the same day?

September 24th, 2018

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

By Wyn Staheli, Director of Research | Published September 24th, 2018 - Last Review/Update January 28th, 2019

The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...

August 16th, 2018

Importance of Depression Screenings

By Wyn Staheli, Director of Research | Published August 16th, 2018

Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...

August 16th, 2018

Medicare Timed Codes Guidelines

By Wyn Staheli, Director of Research | Published August 16th, 2018

Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time. It should be noted that while ...

August 16th, 2018

Using Modifiers 96 and 97

By Wyn Staheli, Director of Research | Published August 16th, 2018

The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...

August 16th, 2018

Q/A: Can I Bill Mechanical Massage?

By Wyn Staheli, Director of Research | Published August 16th, 2018 - Last Review/Update January 30th, 2019

Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.

August 3rd, 2018

When Medical Necessity and Medical Decision Making Don't Match

By BC Advantage | Published August 3rd, 2018 - Last Review/Update September 24th, 2018

As coders and auditors, we are taught the documentation guidelines on how to determine medical decision making. However, Medicare is clear that medical necessity is what determines the overall payment. In order to know what to do when medical necessity and medical decision making do not line up, you must...

July 25th, 2018

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

By Wyn Staheli, Director of Research | Published July 25th, 2018 - Last Review/Update January 28th, 2019

Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?

July 18th, 2018

Patients Over Paperwork?! We have Great News!

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 18th, 2018

Spend more time with patients and less time documenting? Great Concept! Document meaningful information? Sound good? CMS is proposing just that! CMS released a new proposal July 12, 2018, focused on streamlining clinician billing and expanding access to high-quality care. The goal is to improve and restore the doctor-patient relationship, modernize Medicare ...

July 12th, 2018

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

By Wyn Staheli, Director of Research | Published July 12th, 2018 - Last Review/Update January 28th, 2019

Codes 97140 and 97530 are not interchangeable. See why.

July 9th, 2018

Documentation: Face to Face for Home Health Certification

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018

As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care. Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...

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 20th, 2018

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

By ChiroCode | Published June 20th, 2018 - Last Review/Update January 30th, 2019

Question The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...

June 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 13th, 2018

Q/A: Coding for ECG/EKG’s

By Chris Woolstenhulme QCC, CMCS, CPC, CMRS & Marge McQuade | Published June 13th, 2018 - Last Review/Update September 24th, 2018

Q: Our clinic is owned by a hospital, but there is equipment in the clinic to do ECG/EKG’s. When the test is done here in the clinic, and the provider does the interpretation and report, is 93000 the correct code to bill? The equipment is owned by the clinic and ...

June 11th, 2018

Inappropriate Use of Units Costs Practice Over $800,000

By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published June 11th, 2018

A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?

June 7th, 2018

The Range of Motion Conundrum

By Gregg Friedman, DC, CCSP | Published June 7th, 2018 - Last Review/Update January 30th, 2019

As both a chiropractor for 31 years and one who reviews a lot of medical records for the medicolegal arena and has been teaching documentation for many years, the range of motion question comes up frequently. Although we used to get reimbursed very well for a specific range of motion code back in ...

June 4th, 2018

How Many Modalities Are Too Many?

By Dr Evan Gwilliam, Clinical Director for PayDC chiropractic EHR software | Published June 4th, 2018 - Last Review/Update January 30th, 2019

Q: I have a payor who is denying modalities, claiming that they are “excessive”. At a single encounter I billed for: 98940- Chiropractic manipulative treatment (CMT); spinal, 1-2 regions 97110- Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility G0283- Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care 97010- Application of a modality to 1 or more areas; hot or cold packs Is this excessive? How do I know how much is too much?

May 16th, 2018

Key Performance Indicators Revisited

By Glenn Krauss | Published May 16th, 2018 - Last Review/Update May 24th, 2018

DI's present-day Key Performance Indicators centered upon reimbursement do not truly reflect a meaningful account of performance in impacting the quality, completeness and effectiveness of medical record documentation. Common KPIs include number of physician queries left, number of queries responded to by the physician, number of queries responded to...

May 9th, 2018

Preventive Medicine: Initial Preventive Physical Examination

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

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

April 23rd, 2018

Brooklyn Chiropractor OIG Report - Lessons Learned

By Wyn Staheli, ChiroCode Director of Research & Dr. Evan Gwilliam, Clinical Director PayDC Software | Published April 23rd, 2018 - Last Review/Update February 28th, 2019

In August of 2017, a Brooklyn chiropractor was ordered to repay $672,805 to Medicare because the reviewer found that 100% of the claims reviewed (from 2011-2012) did not meet medical necessity requirements. The chiropractor enlisted help from two reputable experts who disputed the findings of Medicare’s Professional Reviewer (MPR). However, the OIG maintained that the findings of the original auditor were valid. Since none of us have ½ million in cash just laying around, it is essential to learn, understand, and make changes where appropriate to help audit-proof patient documentation. Read here to learn more.

April 23rd, 2018

Critical Care Documentation

By Scott Kraft, CPC, CPMA | Published April 23rd, 2018 - Last Review/Update May 2nd, 2018

Critical care documentation should show critical need for the patient AND immediate action by the provider....

April 19th, 2018

Proper Record Keeping and Documentation

By | Published April 19th, 2018

Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...

April 12th, 2018

Billing Nutrition Counseling in a Chiropractic Setting

By Wyn Staheli, Director of Research | Published April 12th, 2018

Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ...

April 12th, 2018

Billing Nutrition Counseling

By Wyn Staheli, Director of Research | Published April 12th, 2018

March 27th, 2018

Home Oxygen Therapy -- A Face-to-Face Encounter

By Raquel Shumway | Published March 27th, 2018 - Last Review/Update June 14th, 2018

What is required for a Home Oxygen Therapy, Face-to-Face Encounter.

March 26th, 2018

Documentation for Evaluation and Management (E/M) Services

By | Published March 26th, 2018

According to WPS, when billing or coding for E/M services you should follow a few guidelines. Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation. Critical Care Visits Clear indication of patient ...

March 21st, 2018

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

By Wyn Staheli, Director of Research | Published March 21st, 2018 - Last Review/Update January 30th, 2019

In order to understand and answer the question, "Why code 99080 is being denied when billed with an E/M Service, it is important to first review the requriements of selecting the appropriate level of Evaluation and Management service and how that relates to reporting a 99080 special report service. Continue reading for better understanding.

March 13th, 2018

When is 97112 Neuromuscular Re-education Billable?

By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019

Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.

March 13th, 2018

CPT Code for DOT exams

By Wyn Staheli, Director of Research | Published March 13th, 2018 - Last Review/Update January 31st, 2019

Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?

March 9th, 2018

The Comprehensive Error Rate Testing Program

By Frank Cohen, MBA, MPA | Published March 9th, 2018 - Last Review/Update April 12th, 2018

With nearly a million physicians in this country, how do auditing organizations determine whom to audit?

March 9th, 2018

Documentation for Ordering Oxygen Supplies and Equipment

By Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 26th, 2018

The Medicare Learning Network provides guidance on required documentation for Ordering Oxygen Supplies and Equipment.

March 9th, 2018

Documentation for Negative Pressure Wound Therapy

By Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy.

March 9th, 2018

Documentation for Surgical Dressings

By Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for surgical dressings.

March 9th, 2018

Documentation for Enteral Nutrition

By Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ...

March 8th, 2018

Documentation for Home Blood Glucose Monitors (BGM)

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 14th, 2018

The Medicare Learning Network provides guidance on how to Prevent Denials for Home Blood Glucose Monitors (BGM)...

March 8th, 2018

Documentation for Therapeutic CGMs and Related Supplies

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 14th, 2018

The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related Supplies

March 8th, 2018

Documentation for Manual Wheelchairs

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases....

March 8th, 2018

Documentation for Lower Limb Prosthesis

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning Network provides guidance on denials for lower leg prostheses and how to prevent them: For the 2017 report period, most of the improper payments for lower leg prostheses were due to insufficient documentation. For Medicare to cover a lower limb prosthesis claim, the medical record must support the beneficiary’s ...

March 8th, 2018

Documentation for Bacterial Culture Lab Tests

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning Network provides guidance on how to prevent denials of Bacterial Culture Laboratory Tests

March 8th, 2018

Documentation for Bacterial Culture Lab Orders

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests...

March 8th, 2018

Documentation for Power Tilt/Recline Seating Systems for Wheelchairs

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems...

March 8th, 2018

Documentation for Ostomy Supplies

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies....

March 8th, 2018

Documentation for Home Health Services (Part A non DRG)

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018

The Medical Learning Network provides coverage guidance, which should be documented, for home health services.

March 8th, 2018

Documentation and Orders for Respiratory Assistive Device

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines.

March 8th, 2018

Documentation and Orders for Laboratory Tests

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for ordering laboratory tests.

March 8th, 2018

Documentation for Skilled Nursing Facilities

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF).

March 8th, 2018

Documentation for Inpatient Rehabilitation Facilities

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018

The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).

March 5th, 2018

Increased Therapy Denials Create Administrative Burden

By Wyn Staheli, Director of Research | Published March 5th, 2018

Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ...

February 28th, 2018

Telemedicine Billing and Reimbursement

By Jared Staheli | Published February 28th, 2018

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

February 26th, 2018

Medicare Changes Requirements for Implantable Cardioverter Defibrillators (ICDs)

By Wyn Staheli, Director of Research | Published February 26th, 2018

Whenever there is a high-cost item, CMS has historically evaluated usage to determine appropriateness of billing and this is another example. A Decision Memo was released on February 15, 2018 which included the following changes: Changes to who qualifies for a device and the required waiting periods Patient registry no longer required Cardiac magnetic resonance ...

February 20th, 2018

Consultation Codes Q/A

By ChiroCode | Published February 20th, 2018 - Last Review/Update February 4th, 2019

Question Are there consultation codes that can be used for new and existing patients when a review of systems and detailed history is performed but no examination due to the patient's reluctance to make a decision to continue with the visit but has taken up 30-45 minutes of the doctors time?

February 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

Pre-Existing or Gestational?

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 1st, 2018

It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)? Trimester: When did the pregnancy-related condition develop? Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia) Code examples: O99.011 Anemia ...

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

Q/A: Can I Perform 2 Untimed Codes at the Same Time?

By Wyn Staheli, Director of Research | Published January 31st, 2018 - Last Review/Update February 4th, 2019

Question: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?

January 29th, 2018

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

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

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

January 26th, 2018

Creating a Culture of Compliance in 2018

By Sean M. Weiss, CHC, CEMA, CMCO, CP MA, CPC-P, CMPE, CPC | Published January 26th, 2018 - Last Review/Update February 7th, 2018

This year (2018), health care organizations (Hospitals, Health Systems and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency....

January 25th, 2018

Psychiatric Partial Hospitalization Programs

By Wyn Staheli, Director of Research | Published January 25th, 2018

Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...

January 24th, 2018

Better Office Communication Leads to Stronger RCM

By Ashley Choate | Published January 24th, 2018 - Last Review/Update March 29th, 2018

According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ...

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

GeneSight Psychotropic Testing and Documentation

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

According to Wisconsin Physicians Service Insurance Corporation, there is limited coverage for the GeneSight® Psychotropic (AssureRx Health, Inc, Mason, OH) gene panel. GeneSight® testing may only be ordered by licensed psychiatrists or neuropsychiatrists contemplating an alteration in neuropsychiatric medication for patients diagnosed with major depressive disorder (MDD) (in accordance with DSM IV/V criteria) who are suffering with refractory moderate to ...

January 9th, 2018

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

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

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

January 9th, 2018

Should ROM Testing be Reported with Evaluation and Management Services?

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 9th, 2018

Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.

January 9th, 2018

ICD-10-PCS Coding the Approach

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

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

January 4th, 2018