Modifier Coding Articles and Resources

Code Sets

CPT Modifiers

CPT Modifiers

HCPCS Modifiers

HCPCS Modifiers

Find-A-Code's Tools & Resources

NCCI Editor Validator

NCCI Edits Validator

NCCI Edits Policy Manual

Medicare NCCI Edits Manual, Transmittals, & Documents

Additional Links and Resources

Billing Requirements for OPPS

Billing Requirements for OPPS Providers with Multiple Service Locations

Commercial Modifier Tables

Commercial Modifier Tables

Modifier Reference Policy

United Health Care Modifier Reference Policy, Professional

Select the title to see a summary and a link to the full article.

CMS Final Rule Changes E/M Reporting Guidelines

|

Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.

Read the article →

CMS Final Rule Changes E/M Reporting Guidelines

|

Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.

Read the article →

Significant COVID-19 Code Changes as of October 6

|

Significant COVID-19 Code Changes as of October 6

Read the article →

Coding Injections for Pain Management

|

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 ...

Read the article →

Modifier 50 — Four "Must Know" Tips For Getting Paid

|

Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...

Read the article →

Are NCCI Edits and Modifiers 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 ...

Read the article →

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 ...

Read the article →

MEGA - NCCI Edit Changes - WHO Knew?

|

There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE).  The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197  Deleted Medically Unlikely ...

Read the article →

Where is the CCI Edit with Modifier 25 on E/M?

|

If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.  The use of Modifier 25 is one example ...

Read the article →

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?

|

On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...

Read the article →

More Telehealth Changes Announced by CMS Chiropractic Offices Should Know About

|

On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar.

Read the article →

More Telehealth Changes Announced by CMS

|

On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information

Read the article →

CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes

|

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 ...

Read the article →

Providing Telehealth Services During COVID-19 Crisis

|

The rules for providing telehealth services during this pandemic have changed and some requirements have been waived. Please keep in mind that “waiving requirements” does not mean that anything goes. Another important consideration is that Medicare and private payers may likely have different rules so you need to make sure that you know individual payer requirements during this time.

Read the article →

Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)

|

The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...

Read the article →

Implementing Telehealth Visits

|

The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection. Step ...

Read the article →

Billing for Telemedicine in Chiropractic

|

Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.

Read the article →

Denials due to MUE Usage - This May be Why!

|

CMS assigns Medically Unlikely Edits (MUE's) for HCPCS/CPT codes, although not every code has an MUE. MUE edits are used to limit tests and treatments provided to a Medicare patient for a single date of service or for a single line item on a claim form. It is important to understand MUE's are ...

Read the article →

Show older articles ↓


There are more articles. View all articles...

View articles for the current subject by subtopic:




Access to this feature is available in the following products:
  • HCC Plus
  • Find-A-Code Professional
  • Find-A-Code Facility Base


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

Does Telehealth Work in Chiropractic Offices During the Pandemic?

March 31, 2020 Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC UPDATE: Please note that CMS wants you to use modifier 95 INSTEAD of Place of Service (POS) 02 for services rendered during this pandemic. "Report the POS code that would have...

Watch the video →

Chiropractic Manipulative Treatment and Medicare - Part 2

In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.

Watch the video →

Show older webinars ↓


There are more webinars. View all webinars...

View webinars for the current subject by subtopic:


Select the podcast title to view a summary and link to the podcast.

Modifier 59 Supporting Documentation (35min)

Understanding when to apply modifier 59 and how to document to support its application can protect ...

Listen to the podcast →

Modifier 59 Supporting Documentation (14min)

Understanding when to apply modifier 59 and how to document to support its application can protect your organization during an audit. The proper application of modifier 59 can increase revenue by ensuring providers are paid for multiple services rendered to a patient on the same day. However, frequent misapplication of this ...

Listen to the podcast →




suggest a resource

If you know of a resource that should be included here (links, data, etc.) please contact us.

free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.