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The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019
By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019
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 ...
By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019
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 ...
RT and LT Modifier Usage Change (effective 2019-03-01)
May 21st, 2019
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published May 21st, 2019
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 ...
OIG Announces New Review For Medicare Part B Payments for Podiatry and Ancillary Services
April 23rd, 2019
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 23rd, 2019
Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020. The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.
Part of the ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 7th, 2019
It is not uncommon for a Podiatrist to offer Physical therapy as an ancillary service to help promote healing and convenience for their patients. If this is a part of your practice be sure you are aware of the rules and policies from your local MAC carrier and your payer policies on ...
Nine New Codes for Fine Needle Aspirations (FNA) in 2019
January 4th, 2019
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 4th, 2019
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 ...
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...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 16th, 2018 - Last Review/Update July 17th, 2018
According to CMS changes are coming for E/M codes. A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed ...
CMS Changes Definitions for Therapeutic Shoe Inserts
February 1st, 2018
By Wyn Staheli, Director of Research | Published February 1st, 2018
CMS recently revised their definitions for custom fabricated and therapeutic inserts in order to meet current technology standards. Healthcare providers need to be sure to review the revisions in order to appropriately bill Medicare for inserts. For example, for custom fabricated, molded-to-patient, they have added the following:
iii. For inserts used with ...
Medicare Requiring Specific Modifiers on Therapy Services
January 15th, 2018
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 ...
Q/A: Physical Exam for Military (Specifically Feet)
November 8th, 2017
By Codepedia | Published November 8th, 2017 - Last Review/Update November 21st, 2017
Q: We had a patient come to our podiatry clinic to get a physical for her feet to qualify for ROTC activities. They came back clear of any deformities, defects, etc. Our scribes listed this visit diagnosis as Z00.00 (Encounter for general adult medical examination without abnormal findings) which seems correct ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published April 26th, 2017 - Last Review/Update July 28th, 2017
When reporting dressings for wounds, it is important to indicate if the dressing is the primary or secondary dressing as well the number of wounds the dressing will be used for.
Primary Dressing: May be therapeutic or protective coverings applied to wounds either on the skin or caused by an opening ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 1st, 2017 - Last Review/Update July 28th, 2017
Multi-layered, sustained, graduated, high compression bandage systems are used primarily to treat lymphedema and venous or stasis leg ulcers. A number of graduated, high-compression bandage systems products have been developed, including Profore®, Dyna-Flex®, Surepress®, Setopress®, and other similar product systems.Providers should note that the treatment of lymphedema with the application ...
Documentation: Face to Face for Home Health Certification
February 27th, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 27th, 2017 - Last Review/Update August 16th, 2017
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. ...
By Wyn Staheli, Director of Research | Published February 11th, 2017
The following modifiers are required when reporting medically necessary routine foot care services per Medicare guidelines:
Q7: One Class A finding
Q8: Two Class B findings
Q9: One Class B and two Class C findings
Appropriate: With foot care (podiatry) codes to indicate covered foot care
Inapproriate:
With any code not related to foot care
When the foot ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 2nd, 2016 - Last Review/Update August 1st, 2017
Subungual abscess
Contusion of the nail
Crushing injury of the toe or finger
Painful onychauxis
Painful onychomycosis
Onychocryptosis (ingrown nail)Onychocryptosis occurs most frequently in the big toes. The condition is categorized into:Simple onychocryptosis
Complicated onychocryptosis
The simple or uncomplicated category is caused by pressure on the nail groove by an essentially healthy nail caused by injudicious cutting ...
Coverage Criteria and Medical Necessity with Medicare
March 16th, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 16th, 2016 - Last Review/Update August 3rd, 2017
In the absence of a systemic condition, treatment of mycotic nails may be covered. The treatment of mycotic nails for an ambulatory patient is covered only when the physician attending the patient's mycotic condition documents that (1) there is clinical evidence of mycosis of the toenail, and (2) the patient ...
Clear the Smoke on Debridement and Active Wound Care Codes
February 26th, 2016
By Codapedia | Published February 26th, 2016
Confused about when to choose a debridement code and an active wound code? CPT® 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth. “Depth is...
Pricing is for a single shoe or individual inserts
February 25th, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 25th, 2016
If you are contracted with a payer be sure you recognize that the pricing is for a single shoe or insert.
When billing orthotics it seems to be less confusing to bill two line items, one for the Left - LT and one for the Right Rt.
...
Therapeutic Shoes for Individuals with Diabetes- Document, Prescribe, Furnishing
February 1st, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 1st, 2016
This managing physician must:
• Document in the patient’s medical record that the patient has diabetes;
• Certify that the patient is being treated under a comprehensive plan of care for
diabetes, and that the patient needs diabetic shoes; and
• Document in the patient’s record that the patient has one or more of ...
Wound Care & Debridement- Provided by Physician, NPP or as Incident-to Services
January 29th, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2016
Providers must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required ...
By Find-A-Code | Published December 18th, 2015 - Last Review/Update December 12th, 2018
Definition:
Modifier Q7: One Class A finding
Modifier Q8: Two Class B findings
Modifier Q9: Once class B and two class C findings
Appropriate Usage:
With foot care (podiatry) codes to indicate covered foot care
Inappropriate Usage:
One any code not related to foot care
When the foot care is for routine care, and not medically necessary
Class Findings
Class A Findings
Non ...
Conditions or Exceptions that might justify coverage of foot care
October 8th, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 8th, 2015 - Last Review/Update August 7th, 2017
When using G0127 keep in mind routine foot/nail care is generally excluded from coverage under Medicare, however there are some exceptions:
Click here to read the entire article
Although not intended as a comprehensive list, the following metabolic, neurologic,and peripheral vascular diseases (with synonyms in parentheses) most commonly represent the underlying conditions that might ...
How To Report Co-Surgeons and Assistant Surgeon Modifiers
May 11th, 2015
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 11th, 2015 - Last Review/Update January 30th, 2017
Some surgeries require the expertise of more than one surgeon or may require the assistance of another surgeon to ensure adequate care is given and the surgery is a success.
Let's review a couple terms:
Co-Surgeon: When two surgeons act as primary surgeon for a specific procedure. Each acts as the primary surgeon ...
Plantar Fasciitis: Medical Necessity and Cross Codes
March 16th, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 16th, 2015 - Last Review/Update August 9th, 2017
Prior to treatment you must determine Medical Necessity.
Be sure conservative therapy/treatment was previously done and documented for at least 6 months and proven to be unsuccessful.
NSAIDS - at least 4 weeks ineffective or contraindicated
Physical Therapy such as taping and stretching
Activity modification
Splints used at night for more that 4 weeks
Corticosteroid injection
Arch Supports, ...
Billing Imminuzation for Pneumococcal, Influenza, and Hepatitis B with Medicare
March 9th, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
The current diagnosis pointer for, Influenza, Pneumococcal or Hepatitis B vaccines is ICD-10-CM code Z23. Listed are tips for coding, and also the diagnosis pointers used for claims previous to 10/01/15:
Influenza: G0008
Procedure codes:
90630
90653-90662
90672-90674
90685-90688
Medicare codes:
Q2034-Q2039
Expired diagnosis code:
V04.81
Pneumococcal: G0009
Procedure codes:
90670
90732
Expired diagnosis code:
V03.82
Hepatitis B: G0010
Procedure codes
90739-90747
Expired diagnosis code
V05.3
Both Influenza and Pneumococcal Vaccines received in same visit: G0008 with G0009
Procedure codes:
(See previous)
Expired diagnosis code:
V06.6 (effective 10/01/06 - 09/30/15)
Extra Tips:
Be sure ...
Wound Care - Are you using the most appropriate codes?
March 9th, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
If you often use 11042-11047, be sure you are using the correct codes. If you are preparing the site for surgery, these would not be the correct codes to use. In addition, when using codes 11042-11047, be sure to document the size of the wound; use this set of codes only if ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017
In February 2012, The Center for Medicare and Medicaid Services (CMS) issued guidance that initially identified specific Healthcare Common Procedure Coding System (HCPCS) codes that were considered Off-the-Shelf (OTS) orthoses. The list of HCPCS codes that were finalized as part of this review as OTS orthotics, effective January 1, 2014, ...
Durable Medical Equipment, Prosthetics, Orthotics and Supplies
August 7th, 2014
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017
Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.  We have given you some basic information to get you started including modifiers and how CMS views DMEPOS, please ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published July 31st, 2014 - Last Review/Update January 25th, 2017
Medicare Podiatry Services This article covers routine care of the foot as well as care related to underlying systemic conditions such as metabolic, neurologic or peripheral vascular disease, or injury, ulcers, wounds, and infections. ...
Join Aimee Wilcox for a webinar which covers common procedures performed on the foot and ankle, how to code correctly for them, and what could trigger an audit.
Join Brandon Leavitt as we master the anatomy of the foot and ankle and common diseases and injuries which are found with this joint. We will also cover how these terms are described in ICD-10-CM.
In this webinar, Brandon Leavitt will review the anatomy of wounds from injury, disease, and other conditions and the proper ICD-10-CM coding for them. A review of pressure and non-pressure, and venous stasis ulcers, burns, corrosions, neoplasms, and other diseases affecting the integument will be presented.
In this webinar, Aimee will review wound care coding and auditing information for wound care services, including proper modifier use, NCCI edits, Medicare coverage guidelines, and documentation requirements.
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