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Obstetrics|Gynecology Articles and Resources

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HIPAA Final Rule Eliminates HPID and OEID

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Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019.

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And Then There Were Fees...

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Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...

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VA- Reasonable Charges Rules, Notices, & Federal Register

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

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

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CMS says Codes are on the Move!

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Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...

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Why is HIPAA So Important?

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Why is HIPAA So Important? Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...

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Hypertension & ICD-10

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Hypertensive Diseases and ICD-10. Helps and examples for these codes.

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2020 Official ICD-10-CM Coding Guideline Changes Are Here!

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It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...

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Federal Workers Compensation Information

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When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...

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The New ICD-10-CM Code Updates Are Here — Are You Ready?

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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: ...

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CMS and HHS Tighten Enrollment Rules and Increase Penalties

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This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019.  There have been known problems ...

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Are You Aware of Medicare Advantage Plans Timely Filing Rules?

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The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

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Medical ID Theft

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Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

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How to Properly Report Prolonged Evaluation and Management Services

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Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement? Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...

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The OIG Work Plan: What Is It and Why Should I Care?

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The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

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Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage

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Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky. In their notice, Anthem states: "Effective for all commercial ...

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Are These Problems Hurting Your Practice?

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There are many things that can be missed when trying to run an effective and profitable practice. This article covers some important tasks that are often overlooked such as not reviewing your payer contracts or failing to check eligibility.

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5 Ways to Minimize HIPAA Liabilities

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Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...

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Helping Others Understand How to Apply Incident to Guidelines

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Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ...

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

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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. ...

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Small Breaches Can Be Subject to Large Penalties

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Small Breaches Can Be Subject to Large Penalties    We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ...

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How to Properly Report Monitoring Patients Taking Blood-thinning Medications

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

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Extrapolation Policies Apply to RAD-V Audits

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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 ...

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A United Approach

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

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

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Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...

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How to Code Ophthalmologic Services Accurately

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

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

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Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?

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RT and LT Modifier Usage Change (effective 2019-03-01)

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According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...

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An Update on the DHS OIG's Effort to Combat Fraud & Abuse

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An Update on the DHS OIG's Effort to Combat Fraud & Abuse Every year, the Department of Health and Human Services (DHS) Office of Inspector General (OIG) is required by law to release a report detailing the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such ...

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Medicare Revises Their Appeals Process

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On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place: The policy on use of electronic signatures Timing ...

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Medicare Revises Their Appeals Process

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There are policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 taking place June 13, 2019. This will give you a heads up on those changes.

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Let's Talk High Risk E/M Services

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

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What is Medical Necessity and How Does Documentation Support It?

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

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Prepayment Review Battle Plan

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Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. ...

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Q/A: Can I Tell a Medicare Patient Which Option to Check on the ABN?

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Question My patient seemed confused about which of the options they should check. Can I just tell them which one they should check? Answer No! That could be construed as coercion. The official instructions state “Under no circumstances can the notifier decide for the beneficiary which of the 3 checkboxes to select.” Now, this ...

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Pain Codes in ICD-10-CM

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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 ...

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Clearing Up Some Medicare Participation Misunderstandings

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Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ...

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Q/A: How do we Know Which Codes a Payer Will Allow?

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How do we know which codes a payer will allow? The best way to determine the codes (CPT, ICD-10-CM and HCPCS) allowed by a payer is to review their payer policy. While it is good to know the official guidelines (e.g., ICD-10-CM Official Guidelines for Coding and Reporting, AMA Guidelines, Medicare ...

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

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I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"  The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

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

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If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...

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Q/A: Can you Help me Understand the New Medicare Insurance Cards?

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As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.

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UnitedHealthcare to Discontinue Coverage of Consultations

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

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Understanding NCCI Edits

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

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Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

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Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...

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Coding Medicare Initial Preventive Physical Exams (IPPE)

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

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

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

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Attestations Teaching Physicians vs Split Shared Visits

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Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...

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Empowering Medicare Beneficiaries

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BLOG: CMS announced a NEWS release today making it easier to help Medicare Beneficiaries access cost and quality information. CMS announced,  "Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of ...

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2018 Salary Survey

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NAMAS needs your help in capturing salary information for 2018 and developing standards for the industry. This is the information that YOU as an auditor need to share with your employer! Everyone who participates will be entered into a drawing for a chance to win one of many prizes! One winner ...

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Medical Necessity vs. Documentation for Inpatient Services

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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 ...

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Everything You need to Know about Drugs

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

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How to Report Co-Surgeons Using Modifier 62

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

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Are You Protecting Your Dental Practice From Fraud?

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

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

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If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ...

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Dry Needling

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

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CMS Finalizes Major Changes to ACO Program

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Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register ...

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Errors Billing Outpatient Services When Patient is also Inpatient

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The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals.  CMS suggests using the following resources to ensure compliance: Medicare Inappropriately Paid Acute-Care Hospitals for ...

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Q/A: Do Croft Guidelines Apply After Time has Passed Since the Accident?

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Question: Do the Croft Guidelines apply to a patient's condition immediately following the collision or are they applicable to a patient's state when they first come to see you? Whether that has been weeks or months since the collision without treatment?

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Reciprocal Billing and Locum Tenens Arrangements Changes

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CMS has made changes to their payment policies for reciprocal billing arrangements and Fee-For-Time compensation arrangements (formerly referred to as locum tenens arrangements). Providers need to be aware of these changes and update their policies as appropriate.

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Wolters Kluwer Drug Pricing

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Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...

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Q/A: What Codes do I use for CLIA-Waived Tests?

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Question: I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ...

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Join QPro Today and Get Certified

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Join QPro Today and Get Certified! To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards. Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...

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Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations

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In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...

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PSAVE Pilot Program - What Does it Mean to You?

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Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?

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Medicare Timed Codes Guidelines

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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 ...

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BREAKING NEWS: CMS Proposes to Change E&M Coding

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On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware. Where ...

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

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Codes 97140 and 97530 are not interchangeable. See why.

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Documentation: Face to Face for Home Health Certification

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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 ...

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Q/A: Do I Have a Patient with Part C sign an ABN if we are Out-of-Network?

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Do we need an ABN if the patient has Part C and we are out-of-network? Read More.

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VA Expands Telehealth

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On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ...

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Why Is Medicare Denying My Claims for Mammography and Breast Biopsies?

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When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out. The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63. The Centers for Medicare & Medicaid Services (CMS) will...

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Preventive Medicine: Breastfeeding Supplies

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Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...

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Preventive Medicine: Cervical Dysplasia Screening

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Preventive Medicine Topics Page Cervical Dysplasia Screening Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...

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Preventive Medicine: Contraceptive Methods

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Preventive Medicine Topics Page Contraceptive Methods Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...

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Documenting DMEs

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As per MLN MM8304,  This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g). Due to concerns ...

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Q/A: Someone Broke into My Office. What do I do Now?

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My office was broken into last night. I use electronic health records, but we do store some protected health information for my patients in paper files. These files are not secured, so the burglars did have access to them. It did not appear that the files were touched as the burglars were looking for cash. What responsibilities to I have to my patients in a situation like this? Do I need to contact them and advise them that their PHI could have been compromised?

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The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims?

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As the Medicare program has grown, the Centers for Medicare and Medicaid Services (CMS) has employed a variety of different claims audit mechanisms to better ensure that the Medicare Trust Fund is protected from waste, fraud and abuse....

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Billing Nutrition Counseling

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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 who may report evaluation and management ...

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Medicare Telemedicine Changes for 2018

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Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.  Originating Site Fee Each ...

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CPT Code for DOT exams

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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?

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Documentation for Ordering Oxygen Supplies and Equipment

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

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Documentation for Negative Pressure Wound Therapy

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

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Documentation for Surgical Dressings

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

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Documentation for Enteral Nutrition

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

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Documentation for Home Blood Glucose Monitors (BGM)

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

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Documentation for Therapeutic CGMs and Related Supplies

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

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Documentation for Bacterial Culture Lab Orders

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

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Documentation and Orders for Respiratory Assistive Device

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

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Documentation and Orders for Laboratory Tests

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

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Documentation for Inpatient Rehabilitation Facilities

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

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New Bipartisian Budget Act of 2018 Provisions

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On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References. Therapy Caps: Some therapy caps (e.g., occupational, physical therapy, speech-language pathology) were discontinued. However, modifier KX will ...

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Telemedicine Billing and Reimbursement

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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 ...

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The Comprehensive Error Rate Testing Program

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

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No HCPCS Code Available? Now What?

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HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes. There are several types of HCPCS level II codes such as: Permanent National Codes Dental Codes Miscellaneous Codes Temporary National ...

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HIPAA Breach Settlements and Ransomware Attacks - Is Your Practice Secure?

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Two recent reports should make providers stop, take notice and make sure their practice's policies and procedures are up-to-date. The first one involves a HIPAA Breach settlement of a company with facilities in several states. The OCR memo stated "In addition to a $3.5 million monetary settlement, a corrective action plan ...

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Scoring & Reporting Your Audit Findings

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This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week.

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Pre-Existing or Gestational?

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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 ...

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Are Your Computers Vulnerable to Cyber Attacks?

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Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings. On ...

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OIG Reviews Medicare Advantage Claims

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On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that: "Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ...

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Don’t Be Hesitant About Collecting Co-Pays

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If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...

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Multiple Diagnostic Imaging Payment Reduction

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CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...

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Adjusting Your Collection Strategies to HDHPs

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High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations.....

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Mobile Health: Growing Engagement and New Responsibilities

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This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth....

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Influenza, Are You Billing Correctly?

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With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.  Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ...

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Dental and Medical- Controlled Substance Awareness

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As an effort to cut down on opioid abuse and related crimes, in August of 2017 the Attorney General Sessions established a new Department of Justice (DOJ) section called “Opioid Fraud and Abuse Detection Unit”. Due to the serious public health issue and drug overdose deaths, this unit was established and ...

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Referring and Ordering Physician - CMS-1500 Box 17

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Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ...

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Aftercare Z Codes

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Aftercare visit codes cover situations when the initial treatment of a disease has been performed, and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, ...

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Creating a Culture of Compliance in 2018

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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....

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Better Office Communication Leads to Stronger RCM

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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. ...

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Revenue Cycle 101: Reduce your Denials with These Tips

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Your practice seems to be doing everything right. You have a team in place, established your RCM process and you’re submitting claim after claim – but your denial rate isn’t going down....

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HIPAA and the Opioid Crisis

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HIPAA and the Opioid Crisis guidance released by HHS.

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NEW on Find-A-Code...National Coverage Determinations (NCDs)

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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. ...

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Compliance: What is it and Why is it Important

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Compliance. It is one of the buzz words in healthcare that is heard all the time but what is it really, and why is it so important?

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Patient Relationship Codes

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Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following: care episode groups patient condition groups patient relationship categories Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...

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Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines

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The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ...

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Modifiers 54-55, split surgical and postoperative care

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54 -Surgical care only; Surgeon is performing only the preoperative and intra-operative care 55 - Postoperative management only; Physician, other than surgeon, assumes all or part of postoperative care Modifiers should be placed on the surgical code Used on 10 day and 90 day surgical procedures Both the surgeon and the physician providing the postoperative ...

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Abuse, Neglect, or Maltreatment

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According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence: An appropriate code from category T74- (confirmed) or T76- (suspected) Any accompanying mental ...

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Select the webinar title to view a summary and link to the webinar video.

August 29th, 2019 — ICD-10-CM Changes Effective October 1, 2019

Are you aware of the ICD-10-CM code changes set take effect as of October 1, 2020? Do any of them apply to your organization? Which of them will be assigned as an HCC? What are the documentation and coding guidelines applicable to them and which guidelines are changing or being ...

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Telehealth Policies for Medicare and Commercial Payers

Telehealth Policies for Medicare and Commercial Payers

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E/M and the Organ Systems Part 2 of 2

E/M and the Organ Systems Part 2 of 2

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E-M and the Organ Systems (Part 1)

E-M and the Organ Systems (Part 1)

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HCC Coding Tool

How to use Find-A-Code's HCC Coding Tool

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Success with Out-of-Network Billing in Today's Environment Part 2

In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation.

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Success with Out-of-Network Billing in Today's Environment Part 1

In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation.

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Radiology Coding Auditing Dexa Scans for Osteoporosis & Mammograms for the Breast

Learn important coding tips when billing Dexa scans (for osteoporosis) and mammograms (for breast diseases). Coders and clinicians specializing in Radiology, Family Practice, Orthopedics, and OB-GYN will all find useful information for their practice. This is a follow-up from the webinar "Diagnosis of osteoporosis and diseases of the breast".

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Diagnosis of Osteoporosis and Diseases of the Breast

Osteoporosis diagnosis and breast diseases will be covered in this webinar, benefiting coders and clinicians specializing in Radiology, Family Practice, Orthopedics, and OB-GYN. This will prepare participators for the following Find-A-Code webinar on radiology coding, which will explain coding/billing for Dexa scans to detect osteoporosis, and mammogram screening for breast evaluation.

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All About Knee Coding & Auditing

Total knee replacement now acceptable ASC procedure also, not auditing for a year. Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers.

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Evaluation and Management Coding and Auditing

Are you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215).

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Coding and Auditing TeleHealth Services

Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.

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Using Find-A-Codes Anatomy Images

Diagnosis coding is difficult when clinician documentation does not match up with the definitions found in the ICD-10-CM code set. Find-A-Code's anatomy images educate both coders and students - bridging the gap between coders and clinicians while simplifying code selection.

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FAC Updates Plus Tools for HCC Coding Chart Review February

Join Taylor to see how you can access free CEUs in 3 clicks, included with top-tier Find-A-Code subscriptions! Also highlighting our New and Improved NCDs system, and how to use the WK Drug Database for HCC Coding/Chart Review

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Learn How to Optimize Your Subscription, Searching and More

Be more productive, work smarter not harder using Find-A-Code. With so much to offer, it is important to understand how to navigate our site to get the most out of your subscription.

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2018 Updates and New Tools

2018 Find-A-Code updates and new tools

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Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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The Importance of Gathering Organizing and Using Fee Schedules

The Importance of Gathering Organizing and Using Fee Schedules

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Using Find-A-Code's New Evaluation and Management Calculator Tool

Using Find-A-Code's New Evaluation and Management Calculator Tool

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HCC Risk Adjustment

HCC Risk Adjustment

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How to Check NCCI Edits Using FindACode

How to Check NCCI Edits Using FindACode

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ICD-10-CM Updates for the Auditor, a NAMAS webinar

ICD-10-CM Updates for the Auditor, a NAMAS webinar

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ICD-10-CM Training - Session 08

ICD-10-CM Training - Session 08

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ICD-10-CM Training - Session 07

ICD-10-CM Training - Session 07

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ICD-10-CM Training - Session 05

ICD-10-CM Training - Session 05

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ICD-10-CM Training - Session 36

ICD-10-CM Training - Session 36

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ICD-10-CM Training - Session 35

ICD-10-CM Training - Session 35

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ICD-10-CM Training - Session 34

ICD-10-CM Training - Session 34

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ICD-10-CM Training - Session 33

ICD-10-CM Training - Session 33

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ICD-10-CM Training - Session 04

ICD-10-CM Training - Session 04

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ICD-10-CM Training - Session 32

ICD-10-CM Training - Session 32

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ICD-10-CM Training - Session 31

ICD-10-CM Training - Session 31

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ICD-10-CM Training - Session 03

ICD-10-CM Training - Session 03

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ICD-10-CM Training - Session 02

ICD-10-CM Training - Session 02

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ICD-10-CM Training - Session 30

ICD-10-CM Training - Session 30

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ICD-10-CM Training - Session 29

ICD-10-CM Training - Session 29

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ICD-10-CM Training - Session 28

ICD-10-CM Training - Session 28

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ICD-10-CM Training - Session 27

ICD-10-CM Training - Session 27

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ICD-10-CM Training - Session 01

ICD-10-CM Training - Session 01

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ICD-10-CM Training - Session 26

ICD-10-CM Training - Session 26

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ICD-10-CM Training - Session 25

ICD-10-CM Training - Session 25

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ICD-10-CM Training - Session 24

ICD-10-CM Training - Session 24

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ICD-10-CM Training - Session 23

ICD-10-CM Training - Session 23

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ICD-10-CM Training - Session 22

ICD-10-CM Training - Session 22

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ICD-10-CM Training - Session 21

ICD-10-CM Training - Session 21

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ICD-10-CM Training - Session 20

ICD-10-CM Training - Session 20

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ICD-10-CM Training - Session 19

ICD-10-CM Training - Session 19

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ICD-10-CM Training - Session 18

ICD-10-CM Training - Session 18

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ICD-10-CM Training - Session 17

ICD-10-CM Training - Session 17

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ICD-10-CM Training - Session 16

ICD-10-CM Training - Session 16

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ICD-10-CM Training - Session 15

ICD-10-CM Training - Session 15

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ICD-10-CM Training - Session 14

ICD-10-CM Training - Session 14

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ICD-10-CM Training - Session 13

ICD-10-CM Training - Session 13

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ICD-10-CM Training - Session 11

ICD-10-CM Training - Session 11

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ICD-10-CM Training - Session 10

ICD-10-CM Training - Session 10

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ICD-10-CM Training - Session 09

ICD-10-CM Training - Session 09

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Obstetrics/Gynecology Resources

  • Reimbursement Guide
  • ICD-10-CM Specialty Specific Code Book
  • Quick Coding Reference Cards
  • Provider Documentation Guides
  • ICD-10-CM Comprehensive Code Books
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