Medical Specialties
articles, webinars, links, files and other resources related to coding, reimbursement and compliance for medical specialties
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recent articles
Select the title to see a summary and a link to the full article.
May 20th, 2020
Where is the CCI Edit with Modifier 25 on E/M?
| 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
| 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 ...
May 13th, 2020
Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?
| Published May 13th, 2020
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 ...
May 12th, 2020
Getting Your Practice Back on Track
| Published May 12th, 2020
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.
May 5th, 2020
ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting
| 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 - ...
May 4th, 2020
Additional Telehealth Changes Announced by CMS
| Published May 4th, 2020
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.
April 27th, 2020
CMS- Change in Funding for COVID-19 Economic Impact
| Published April 27th, 2020
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 ...
April 27th, 2020
Effective Risk Adjustment Requires Accurate Calculations
| Published April 27th, 2020
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.
April 22nd, 2020
COVID-19 Clinical Trial Participation Helps Providers Earn MIPS Credit
| Published April 22nd, 2020
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.
April 21st, 2020
Special COVID Laboratory Specimen Coding Information
| 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.
Quick, Current, Complete - www.findacode.com