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Nov 1st, 2022
Modifier FT
by Wyn Staheli, Director of Content - innoviHealth
As of January 1, 2022, CMS created a new modifier for an unrelated E/M visit during a postoperative period. It was revised as of April 1, 2022. Learn more about the appropriate use of modifier FT.
Oct 24th, 2022
2023 Evaluation & Management Updates Free Webinar
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.
Sep 15th, 2022
Emergency Department - APC Reimbursement Method
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...
Sep 6th, 2022
The Secret to Billing Endoscopic Procedures
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Billing endoscopic procedures can be confusing, but coding rules will assist in this process. Most of the coding principles we will review are the same as any other type of coding; however, endoscopic procedures are paid differently. This article will address the process of how to find the correct code ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
Aug 8th, 2022
Before Requesting a Review on Modifiers, Read This!
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Generally, there is uniformity in the use of modifiers between payers. However, this is not always the case; you may see a difference in payer policies and how modifiers are handled. One way to know if a modifier can be used according to CMS rules can be found when using ...
Aug 4th, 2022
Billing and Coding: Bone Mass Measurement
by Amanda Ballif
Guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Have you heard the saying, "I am getting paid, so I must be doing something right!" Claims get processed and paid incorrectly all the time; the fact is you may be doing something wrong even if you are getting paid! If you don't understand how the physician fee schedule works, ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
Jul 7th, 2022
New Audio-Only Telehealth Guidance to Meet HIPAA Rules
by U.S. Department of Health & Human Services
Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We all experience coding situations that make us stop and rethink our coding path. Do we have the most current information on this situation? Does the payer contract change the way we must report the service? Are we missing something? Each of us experience simple to complex coding issues in our work and sometimes it is just nice to collaborate and discuss them openly to see how they may be resolved. Have you ever questioned the proper use of major depressive disorder codes versus the newly added (2021) depression, unspecified code? Take a look at what the OIG said about these codes and how the payer responded.
by CMS - MLNConnects
News - Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 - Men’s Health: Talk to Your Patients About Preventive Services - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes - ICD-10-CM Diagnosis Codes: Fiscal...
May 19th, 2022
Methadone Take-Home Flexibilities Extension Guidance
by SAMSHA Newsroom
On March 16, 2020, SAMHSA issued an exemption to Opioid Treatment Programs (OTPs) whereby a state could request “a blanket exception for all stable patients in an OTP to receive 28 days of Take-Home doses of the patient’s medication for opioid use disorder.” States could also “request up to 14 days of Take-Home medication for those patients who are less stable but who the OTP believes can safely handle this level of Take-Home medication.”
The exemption will carry on effective upon the expiration of the COVID-19 Public Health Emergency, subject to conditions listed in this article.
May 17th, 2022
Understanding the Basics of Reporting Mammography Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
How familiar are you with the coding and documentation requirements for screening and diagnostic mammography? What is diagnostic digital breast tomosynthesis and can you bill for it? This article review the basics of reporting screening, diagnostic, and digital breast tomosynthesis.
by Raquel Shumway
DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. CM “addresses the brain’s reward response in ways that conventional counseling and medications often cannot.” Over a course of 50 years, it has shown that this program is effective. The OIG, upon analysis, has determined that there is low risk for fraud and abuse and has offered their opinion at the request of DynamiCare Health, Inc.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Does your documentation meet the standards for reporting therapeutic, prophylactic, and diagnostic infusions and injections? Take a minute to infuse yourself with the information needed to accurately code and sequence these services for maximum reimbursement.
Apr 12th, 2022
Monitoring Changes to Telehealth in 2022
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
SUMMARY: Did you realize telehealth services increased by 11,000% between 2019-2020? Once again the newest CPT and HCPCS updates address telehealth changes for 2022 with new modifiers and guidelines for reporting. With such an increase in usage, the OIG has also identified significant fraud.
Mar 16th, 2022
Refresh Your IV Hydration Coding Knowledge
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Reporting IV infusion services can be complicated, especially when multiple infusions are reported in a single encounter. Take a few minutes to freshen up your knowledge on IV hydration coding with a review of the guidelines and a few coding scenarios.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Jul 7th, 2022
Dealing with the Little Coding Conundrums
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 14th, 2022
Reporting Telemedicine Services by Aimee Wilcox
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
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.Jul 6th, 2018
Coding and Auditing Wound Care
by Find-A-Code™
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.May 16th, 2018
All About Knee Coding & Auditing
by Find-A-Code™
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.Apr 26th, 2018
Anatomy of the Knee
by Find-A-Code™
Coders and billers in orthopedic practices must understand the knee extensively. Join Dee to master the anatomy of the knee joint, and understand how it applies to ICD-10-CM diagnosis coding.Mar 29th, 2018
Coding and Auditing TeleHealth Services
by Find-A-Code™
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.Mar 15th, 2018
The Proper Way to Report Surgical Modifiers
by Find-A-Code™
Applying the wrong modifier to a surgical procedure can cause a claim to deny or put you at risk of over-payment and accusations of fraud and abuse. Join Aimee as she demonstrates the proper use of surgical modifiers.Feb 8th, 2018
The Proper Way to Report Modifiers
by Find-A-Code™
Modifier 25 has long been a coding conundrum and an auditor's gold mine. Don't risk take-backs, penalties, or accusations of fraud and abuse. Join Aimee in this webinar on how to properly report modifier 25 and have confidence in your code reporting.Jan 25th, 2018
Surgical Coding and Auditing
by Find-A-Code™
Ever wonder what an auditor is looking for when they review your surgical coding? Join Aimee and review the basic rules and documentation requirements. We’ll tear apart a couple of operative reports, code them, review NCCI edits, modifiers, and more. Get an idea of how you are doing and things you may want to incorporate into your practice to be better prepared when an audit comes your way. Also, we’ll review our cool Code-A-Note tool and how it can help you locate CPT and ICD-10-CM codes quickly. This tool is great for new coders, coders new to a specialty, difficult coding situations, or anyone who just wants a second opinion on their code options.Aug 2nd, 2017
The Proper Application of Modifiers - Part 1
by Find-A-Code™
The Proper Application of Modifiers - Part 1Aug 2nd, 2017
The Proper Application of Modifiers - Part 2
by Find-A-Code™
The Proper Application of Modifiers - Part 2Feb 14th, 0003
Use the Right Modifiers for Chiropractic Billing
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Do you really know when to use the 59 modifier? What about the AT? There are relatively few modifiers to consider when it comes to chiropractic billing and coding, but some payers have their own rules and it can be tricky to know when to use one modifier and not another. In this exciting webinar, Dr. Evan Gwilliam, a certified coder, will clear up all the questions you have about the modifiers you need to consider.Links and resources by topic.
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