Select the title to see a summary and a link to the full article.
December 22nd, 2020
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020
14. Diseases of the genitourinary system (N00-N99)
Code: Description:N00.A Acute nephritic syndrome with C3 glomerulonephritisN01.A Rapidly progressive nephritic syndrome with C3 glomerulonephritisN02.A Recurrent and persistent hematuria with C3 glomerulonephritisN03.A ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2020
Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.
Trigger Point Injections
Trigger point injections are reported by how many muscles are treated using an ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 5th, 2020
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay.
This grouper is included with our Home Health Grouper.
Current groupers/calculators include:
Home Health PDGM (Patient-Driven Grouping Model)
Skilled Nursing Facility PDPM (Patient-Driven Payment Model)
What is it?
According to CMS, In ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 14th, 2020
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 ...
Newest Launch - We Now Have Outpatient Facility Pricing!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020
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 ...
New CPT® Codes Approved for COVID-19 Antibody Identification
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 15th, 2020
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2020
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
Who Qualifies for Chronic Care Management Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 5th, 2020
Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services."
Examples of chronic conditions ...
CMS- Patient Driven Payment Model Effective October 01, 2019
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 19th, 2019
According to CMS, In July 2018, CMS finalized a new case-mix classification model, the Patient-Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.
Using the new Patient-Driven ...
Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019
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. ...
The OIG Work Plan: What Is It and Why Should I Care?
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 Namas | Published July 19th, 2019 - Last Review/Update July 30th, 2019
Critical care services remain to not only be an area of confusion for providers, coders, and auditors, but also a constant target for the carriers for audit. We can sit back and look at critical care and think of all of the ways the code descriptor and/or use could be ...
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 ...
How to Properly Report Monitoring Patients Taking Blood-thinning Medications
By Wyn Staheli, Director of Research | Published June 18th, 2019 - Last Review/Update June 19th, 2019
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.
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 1st, 2019
Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes.
ICD-10-CM Diagnosis Codes ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 27th, 2019
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 ...
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 Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS | Published October 2nd, 2018
Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on...
Documentation: Face to Face for Home Health Certification
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018
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 ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 31st, 2018
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 ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018 - Last Review/Update April 16th, 2020
Fees for anesthesia services are not calculated the same as for other types of procedures. There are four elements to consider when calculating anesthesia fees. Medicare accepts base units and time units; however, depending on the third party payer, they may or may not accept physical status units and/or qualifying circumstances units.
Base Unit (of the CPT code)
Time (in ...
Special Skilled Nursing Facility (SNF) Billing Exceptions for Laboratory Tests PUB-100 40.4
By Find-A-Code | Published January 4th, 2018
When a SNF furnishes laboratory services directly, it must have a Clinical Laboratory Improvement Act (CLIA) number or a CLIA certificate of waiver, and the laboratory itself must be in the portion of the facility so certified. Normally the A/B MAC (A) makes payment under Part B for clinical laboratory ...
Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes:
97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ...
Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCT
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT)....
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 29th, 2017
The OIG sent out an early alert in an effort to create awareness to potential abuse or neglect of Medicare Beneficiaries in skilled nursing facilities. The OIG identified 134 Medicare beneficiaries whose injuries may have been the result of potential abuse or neglect. The beneficiaries reported were treated at the ...
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 4th, 2017
We can look forward to a few prospective payments for Skilled Nursing Facilities, Hospice and Inpatient Rehab; CMS released their final rule and reported on key highlights of the new FY 2018 Medicare payment rules.
CMS States, “The 2018 Skilled Nursing Facility (SNF) Prospective Payment System Final Rule increases Medicare payment rates ...
Respiratory Assist Devices (RAD) E0470 and E0471 - Billing Reminders
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 28th, 2017 - Last Review/Update July 28th, 2017
Add the KX modifier to all claims for RADs and accessories for the first through third months if all thecoverage criteria have been met.
Add the KX modifier to all claims for the fourth month and thereafter if all the coverage criteria have been met and if the physician signed and dated a ...
Documentation: Face to Face for Home Health Certification
By Christine Woolstenhulme, QCC, QMCS, 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. ...
Mandatory Submission of Staffing Data via PBJ Begins July 1 for Long – Term care facilities
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2016
Electronic submission of staffing data through the Payroll-Based Journal (PBJ) is required of all long-term care facilities starting July 1. The last day to submit data for fiscal quarter four (July 1 through September 30) is November 14, 2016. Nursing homes can register now in the PBJ system to prepare:
Obtain ...
Skilled nursing facilities paid for participating in new program, starting the summer of 2016
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 19th, 2016
Medicare plans to start a Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), beginning fiscal year 2019. This program will be used to promote better clinical outcomes for skilled nursing facility patients and improve care during their stay at a skilled nursing facility. Skilled nursing facilities will be paid for participating. ...
Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP) - Beginning 2019
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 25th, 2016
Medicare plans to start a Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), beginning fiscal year 2019. This program will be used to promote better clinical outcomes for skilled nursing facility patients and improve care during their stay at a skilled nursing facility. Skilled nursing facilities will be paid for participating. ...
Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) Form - Free
By Find-A-Code | Published March 8th, 2016
The purpose of this form is to help you make an informed choice about whether or not you want to receive these items or services, knowing that you might have to pay for them yourself. Before you make a decision about your options, you should read this entire notice carefully.
...
Clear the Smoke on Debridement and Active Wound Care Codes
By | 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...
Nebulizer Therapy Billing Reminders - Modifiers, Dispensing Fees, and Orders
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 24th, 2016 - Last Review/Update August 3rd, 2017
The ICD-10-CM code describing the condition necessitating nebulizer therapy must be included on each claim for equipment, accessories, and/or drugs.
When ever a unit dose code is billed, it must have a KO, KP, or KQ modifier. (Exception: The KO, KP, and KQ modifiers should not be used with code J7620.)
When billing miscellaneous equipment or accessories (E1399), the claim must ...
Levels of Care Data Required on the Institutional Claim to Medicare Contractor
By | Published August 3rd, 2015
With the exception of payment for physician services, Medicare payment for hospice care is made at one of four predetermined rates for each day that a Medicare beneficiary is under the care of the hospice. The four rates are prospective rates; there are no retroactive adjustments other than the application ...
Correct Coding: Braces (Orthoses) Attached to Wheelchairs
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017
Joint DME MAC and PDAC Publication
Recently, claims for braces attached to wheelchairs have been submitted using HCPCS code K0108 - WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED. K0108 is not the correct HCPCS code to use for these items.
CMS has clarified the distinction between braces (orthoses) and durable medical equipment (DME) under Medicare Part ...
Evaluation and Management (EM) in the Skilled Nursing Facility
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Evaluation and Management (EM) in the Skilled Nursing Facility
The first time I remember visiting a skilled nursing facility was after my grandmother's stroke. She was rehabilitating there, trying to learn to speak again. Once she was back to her normal activities, she returned to our home where she was taken ...
Consolidated Billing (CB) for SNF (Skilled Nursing Facilities) - Exceptions
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 13th, 2014 - Last Review/Update August 9th, 2017
SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services listed below). CB for SNF resembles the bundling requirement for Inpatient Hospital Services, assigning the facility responsible for the entire package except for certain services that are specifically excluded.
Physicians' services furnished to ...
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January 23rd, 2018
How to PREVENT and HEAL Dental Problems so You Can Enjoy a Healthy Body and Life
In this webinar Dr. Jorgensen will share with you the REAL causes of dental disease and techniques for prevention and healing. You will also learn about dental problems that may be making you or your patients SICK, how to identify them, and what can be done to help them get better. Finally, she will tell you about cutting edge dental and health practices you need to know about to improve your patient's health, and how to find a dentist that can provide this care. Don't miss this life-changing webinar!
Select the podcast title to view a summary and link to the podcast.
August 25th, 2020
Do You Have All the Right Dental Resources Needed to Succeed in Dental Medical Billing and Coding?
Discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success).
Some of the resources and tools they discuss will help you with your dental coding/billing and education.
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