State Specific Medical Coding Resources

articles, webinars, links, files and other resources for state specific coding, reimbursement and compliance

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recent articles

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Understanding UCR Inpatient Fees used on DRG's


tags  Specl: Skilled Nursing    Topic: Care Coordinator    Topic: Fees    Topic: Hospital    Topic: Payment Models    Topic: Practice Management   

HCPCS Codes Were NOT all Created for the Same Purpose


Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...

tags  Topic: CDT (Dental) Codes    Topic: DME    Topic: HCPCS Coding   

Additional COVID-19 Testing Codes Announced


New coronavirus antigen testing codes announced. These are effective immediately.

tags  Topic: Code Updates    Topic: Coding    Topic: COVID-19    Topic: CPT Coding    Topic: Procedure Coding   

Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab


The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...

tags  Specl: Cardiology|Vascular    Specl: Physical Medicine|Physical Therapy    Topic: CPT Coding    Topic: ICD10CM Coding   

Are NCCI Edits Just for Medicare?


The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

tags  Specl: All Specialties    Specl: Anesthesia|Pain Management    Specl: Billing    Specl: Cardiology|Vascular    Specl: Dental    Specl: Dermatology|Plastic Surgery    Specl: Emergency Medicine    Specl: Endocrinology    Specl: ENT|Otolaryngology    Specl: Gastroenterology    Specl: General Surgery    Specl: Home Health|Hospice    Specl: Internal Medicine    Specl: Interventional Radiology    Specl: Laboratory|Pathology    Specl: Neurology|Neurosurgery    Specl: Obstetrics|Gynecology    Specl: Oncology|Hematology    Specl: Ophthalmology    Specl: Optometry    Specl: Oral and Maxillofacial Surgery    Specl: Orthopedics    Specl: Pain Management    Specl: Pediatrics    Specl: Physical Medicine|Physical Therapy    Specl: Podiatry    Specl: Primary Care|Family Care    Specl: Pulmonology    Specl: Radiology    Specl: Rheumatology    Specl: Skilled Nursing    Specl: Urology|Nephrology    Specl: xFAC Specialty Panel Admin    Topic: Coding    Topic: CPT Coding    Topic: Modifier Coding    Topic: MUE - Medical Unlikely Edit   

CMS- Reminder COVID Assessment and Specimen Collection


On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection. CMS has recently sent out reminders on billing for these services, the proper use of the CS modifier on claims, and how they are handling denials due ...

tags  Topic: COVID-19    Topic: CPT Coding   

Payment Adjustment Rules for Multiple Procedures and CCI Edits


Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...

tags  Topic: CPT Coding    Topic: Denial Management    Topic: Modifier Coding    Topic: Practice Management   

Should I Bill Dental or Medical?


While you likely find yourself focusing on fewer patients and more on emergency care, it’s a good time to understand how medical billing can allow patients with active infection in the oral cavity to seek the treatment they need.  Forms need to be filled out correctly, and you must carefully follow ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

Newest Launch - We Now Have Outpatient Facility Pricing!


Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...

tags  Specl: Skilled Nursing    Topic: Billing    Topic: Care Coordinator    Topic: CPT Coding    Topic: Fees    Topic: Physician Billing    Topic: Practice Management    Topic: Reimbursement   

Medical Necessity using Soap can prevent a future audit!


Medical Necessity using Soap can prevent a future audit! How Do I Correctly Document all my notes on every patient regardless of the insurance I am billing? Medically necessary care is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery   

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