Topics & Specialty Resources

articles, webinars, tips, links and other resources for medical coding, reimbursement and compliance

Facilities & Organizations - ACOs, Hospitals, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Specialties - Cardiology, ENT, Family Practice, etc.States - State specific informationSubjects - Audits, E&M, HIPAA, Practice Management, etc.

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recent articles

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Where is the CCI Edit with Modifier 25 on E/M?


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 ...

tags  Topic: Coding    Topic: Medicare    Topic: Modifier Coding    Topic: Payer Guidelines   

Packaging and Units for Billing Drugs


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 ...

tags  Topic: Auditing    Topic: Billing    Topic: Coding    Topic: HCPCS Coding    Topic: Pharmaceutical   

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?


On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...

tags  Loc: All Locations    Payer: CMS|Medicare    Specl: All Specialties    Topic: COVID-19    Topic: CPT Coding    Topic: Modifier Coding    Topic: Risk Adjustment    Topic: TeleMedicine   

Getting Your Practice Back on Track


As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.

tags  Specl: Chiropractic    Topic: Practice Management   

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


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 - ...

tags  Specl: All Specialties    Topic: Code Updates    Topic: Documentation    Topic: ICD10CM Coding    Topic: Substance Use Disorder   

Additional Telehealth Changes Announced by CMS


On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.

tags  Loc: All Locations    Payer: CMS|Medicare    Specl: All Specialties    Topic: Medicare    Topic: TeleMedicine   

CMS- Change in Funding for COVID-19 Economic Impact


On Sunday night April 26, 2020, CMS announced they will no longer be "accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through HHS’ Provider Relief Fund." The COVID-19 Pandemic has ...

tags  Topic: COVID-19   

Effective Risk Adjustment Requires Accurate Calculations


Risk adjustment is simply a way of making sure that there are sufficient funds to adequately take care of the healthcare needs of a certain population. It’s a predictive modeling methodology based on the diagnoses of the individuals in that population. As payers move to value based models, they heavily rely on risk adjustment to ensure proper funding.

tags  Topic: Risk Adjustment   

COVID-19 Clinical Trial Participation Helps Providers Earn MIPS Credit


All healthcare providers who are currently participating in the MIPS portion of Medicare’s Quality Payment Program may want to participate in the new COVID-19 Clinical Trials improvement activity. Read more about it here.

tags  Topic: COVID-19    Topic: Quality Payment Program   

Special COVID Laboratory Specimen Coding Information


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.

tags  Topic: Coding    Topic: COVID-19    Topic: Documentation    Topic: HCPCS Coding   

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