Help: FAQs, tutorials, videos, page index and more
Viewing:  Nov 17, 2019

Procedure Coding

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

Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible

|

Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...

Read the article →

Eliminating Consultation Codes?

|

There are a few payers that have joined with CMS in discontinuing payment for consultation codes. Most recently, Cigna stated that, as of October 19, 2019, they will implement a new policy to deny the following consultation codes: 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255. United Healthcare announced they ...

Read the article →

New Codes for Dry Needling

|

Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.

Read the article →

Vaccine Administration - When The Right Vaccine Code is Not Enough

|

Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...

Read the article →

Q/A: How Do I Bill a House Call?

|

Question If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form?  A modifier, or something else? Answer Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...

Read the article →

E-Health is a Big Deal in 2020

|

The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...

Read the article →

Chiropractic 2020 Codes Changes Are Here

|

There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?

Read the article →

Are You Aware of Medicare Advantage Plans Timely Filing Rules?

|

The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

Read the article →

Understanding Payment Indicators

|

Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules.  Here is an article from Regence on their policy statement, describing the rules ...

Read the article →

How to Properly Report Prolonged Evaluation and Management Services

|

Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement? Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...

Read the article →

Healthcare Common Procedure Coding System (HCPCS)

|

There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...

Read the article →

Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

|

Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.

Read the article →

Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?

|

Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...

Read the article →

CMS Proposes to Reverse E/M Stance to Align with AMA Revisions

|

On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...

Read the article →

Denial Management is Key to Profitability

|

Read the article →

The Importance of Medical Necessity

|

ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...

Read the article →

When Can You Bill Orthosis Components Separately?

|

Othoses often have extra components. When can you bill those components separately? For example, can you bill for a suspension sleeve (L2397) with a knee orthosis (e.g., L1810)?

Read the article →

Will the New Low Level Laser Therapy Code Solve Your Billing Issues?

|

Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...

Read the article →

Q/A: Do I Really Need to Have an Interpreter?

|

Question: I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true? Answer:  Yes! There are both state and federal laws that need to be considered. The applicable federal laws are: Title VI of the Civil Rights Act of 1964,  Americans with Disabilities ...

Read the article →

How to Properly Report Monitoring Patients Taking Blood-thinning Medications

|

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.

Read the article →

A United Approach

|

A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...

Read the article →

What Medical Necessity Tools Does Find-A-Code Offer?

|

Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...

Read the article →

Spotlight: Anatomy Images

|

When viewing CPT codes, Find-A-Code offers detailed anatomy images and tables to help with coding. For example 28445 offers a table with information to assist classification of gustilo fractures: Click on the image preview from the code information page to expand the image.

Read the article →

Documentation of E/M services for Neurology (Don't Forget the Cardiology Element)

|

According to Neurology Clinical Practice and NBIC, the neurologic exam is commonly lacking in documentation due to the extensive requirements needed to capture the appropriate revenue. With the lack of precise documentation, it results in a lower level of E/M than that which is more appropriate, which can cost a physician a lot ...

Read the article →

Medicare Approves Reimbursement for Virtual Communication (G2012)

|

Medicare has taken a stand to recognize communication technology-based services by approving two newly defined physicians' services that will significantly help providers who deal with phone calls and patient triage. One of these services includes:  Virtual check-in (G2012), which allows the provider to be reimbursed for communicating with the patient via ...

Read the article →

Medicare Now Reimburses for Remote Monitoring Services (G2010)

|

Medicare's 2019 Final Rule approved HCPCS code G2010 for reimbursement, which allows providers to be paid for remote evaluation of images or recorded video submitted to the provider (also known as "store and forward") to establish whether or not a visit is required. This allows providers to get paid for ...

Read the article →

How to Code Ophthalmologic Services Accurately

|

Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code. According to Article A19881 which was published in 2004 and ...

Read the article →

Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?

|

Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?

Read the article →

Your New Patient Exam Code Could Determine How Many Visits You Get

|

The initial exam is where the provider gathers the information to determine the need for all the care that follows. It is billed most often as an office or outpatient evaluation and management (E/M) code from the 4th edition of the AMA’s Current Procedural Terminology book. There are actually five ...

Read the article →

What to Look for When Auditing Smoking Cessation Services

|

What to Look for When Auditing Smoking Cessation Services

Read the article →

Electrical Stimulation and Electromagnetic Therapy Devices

|

Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.

Read the article →

Facts on Procedure Codes

|

There are two levels of codes used for services and procedures:  Level I Codes are used for Services and Procedures provided by physicians. 5 digit numerical code, example, 99213 - Office or other outpatient visits  Level II Codes are used to bill Medical equipment supplies and transport services. 4 digit Alpha/Numerical code example, ...

Read the article →

Spotlight: ASA Crosswalk

|

Crosswalk from CPT Anesthesia codes (00100-01999) to Surgery and Procedure Codes! Let's look at anesthesia code 00100 as an example. The ASA Crosswalks are available under the Cross-A-Code bar. Click to expand. Look for the ASA CROSSWALK or ASA Reverse CROSSWALK bar. You will also see the CMS and ASA...

Read the article →

Q/A: I’m Being Audited? Is There a Documentation Template I can use?

|

Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942? Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ...

Read the article →

Biofeedback - Is it Medically Necessary?

|

Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational. The majority of payers will list Biofeedback on an exclusions list. Others such as BC ...

Read the article →

Let's Talk High Risk E/M Services

|

Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.   Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...

Read the article →

CPT Announces 2021 E/M Changes

|

In 2018, Medicare announced their plans for revamping the Evaluation and Management coding structure and was met with a rapid response from the medical community, including the AMA and many other organizations. As a result, the Medicare changes implemented in 2019 were mostly documentation-related changes that generally benefited providers but were not ...

Read the article →

What is Medical Necessity and How Does Documentation Support It?

|

We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

Read the article →

Auditing Chiropractic Services

|

Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.

Read the article →

Auditing Ophthalmology and Optometry Exams

|

Auditing Ophthalmology and Optometry Exams If you work in an ophthalmology group or audit ophthalmology then you are most likely aware of the caveats that exist in this specialty. Ophthalmology and Optometry practitioners can select from either the E/M code set or the Ophthalmologic exam code set. Having this knowledge in ...

Read the article →

Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

|

I submitted a claim to the VA and it’s being denied. Why? There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ...

Read the article →

Spinal Cord Stimulator Used for Chronic Pain

|

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 ...

Read the article →

Corrections and Updates

|

One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics. Published Articles We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...

Read the article →

CPT Codes That Include Moderate Sedation (Appendix G)

|

The CPT codes that include moderate sedation have been removed from the CPT code set. These codes include: 99151, 99152, 99153, 99155, 99156, 99157. Please refer to the guidelines for information on how to report these moderate sedation services. ...

Read the article →

FDA Approval Pending Products (Appendix K)

|

The following includes a list of vaccine product codes that are currently pending FDA approval.  When approval status has been granted by the FDA, updated information will be available HERE 90587 90666 90667 90668 90689 90697 ...

Read the article →

Electrodiagnostic Medicine Listing of Sensory, Motor and Mixed Nerves (Appendix J as per AMA)

|

Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves. This summary assigns each sensory, motor, and mixed nerve with its appropriate nerve conduction study code in order to enhance accurate reporting of codes 95907-95913.  Each nerve constitutes one unit of service. Motor Nerves Assigned to Codes 95907-95913   Upper extremity, cervical plexus,andbrachial plexus motor nervesAxillary ...

Read the article →

CPT Codes for Reporting Synchronous Telemedicine Services (Appendix P)

|

CPT Codes that may be used for Synchronous Telemedicine Services. The following CPT codes may be used for reporting synchronous telemedicine services when appended by modifier 95.  Procedures on this list involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio and video. 90791 90958 96152 99251 90792 90960 96153 99252 90832 90961 96154 99253 90833 92227 97802 99254 90834 92228 97803 99255 90836 93228 97804 99307 90837 93229 98960 99308 90838 93268 98961 99309 90845 93270 98962 99310 90846 93271 99201 99354 90847 93272 99202 99355 90863 93298 99203 99406 90951 93299 99204 99407 90952 96040 99242 99408 90954 96116 99243 99409 90955 96150 99244 99495 90957 96151 99245 99496 ...

Read the article →

Prolonged Services

|

Prolonged Services I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...

Read the article →

Add on Codes for CPT (Appendix D)

|

For 2019, the following is a list of CPT add-on codes: 01953 19294 33225 37223 61864 76814 93325 97598 01968 19297 33257 37232 61868 76937 93352 97811 01969 20930 33258 37233 62148 76979 93462 97814 10004 20931 33259 37234 62160 76983 93463 99100 10006 20932 33367 37235 63035 77001 93464 99116 10008 20933 33368 37237 63043 77002 93563 99135 10010 20934 33369 37239 63044 77003 93564 99140 10012 20936 33419 37247 63048 77063 93565 99153 10036 20937 33508 37249 63057 77293 93566 99157 11001 20938 33517 37252 63066 78020 93567 99292 11008 20939 33518 37253 63076 78496 93568 99354 11045 20985 33519 38102 63078 78730 93571 99355 11046 22103 33521 38746 63082 81266 93572 99356 11047 22116 33522 38747 63086 81416 93592 99357 11103 22208 33523 38900 63088 81426 93609 99359 11105 22216 33530 43273 63091 81536 93613 99415 11107 22226 33572 43283 63103 82952 93621 99416 11201 22328 33768 43338 63295 86826 93622 99467 11732 22512 33866 43635 63308 87187 93623 99486 11922 22515 33884 44015 63621 87503 93655 99489 13102 22527 33924 44121 64462 87904 93657 99494 13122 22534 33929 44128 64480 88155 93662 99498 13133 22552 33987 44139 64484 88177 94645 99602 13153 22585 34709 44203 64491 88185 94729 99607 14302 22614 34711 44213 64492 88311 94781 0054T 15003 22632 34713 44701 64494 88314 95079 0055T 15005 22634 34714 44955 64495 88332 95873 0076T 15101 22840 34715 47001 64634 88334 95874 0095T 15111 22841 34716 47542 64636 88341 95885 0098T 15116 22842 34808 47543 64643 88350 95886 0163T 15121 22843 34812 47544 64645 88364 95887 0164T 15131 22844 34813 47550 64727 88369 95940 0165T 15136 22845 34820 48400 64778 88373 95941 0174T 15151 22846 34833 49326 64783 88388 95962 01953 15152 22847 34834 49327 64787 90461 95967 01968 15156 22848 35306 49412 64832 90472 95984 01969 15157 22853 35390 49435 64837 90474 96113 0205T 15201 22854 35400 49568 64859 90785 96121 0214T 15221 22858 35500 49905 64872 90833 96131 0215T 15241 22859 35572 50606 64874 90836 96133 0217T 15261 22868 35600 50705 64876 90838 96137 0218T 15272 22870 35681 50706 64901 90840 96139 0222T 15274 26125 35682 51797 64902 90863 96160 0229T 15276 26861 35683 52442 64913 91013 96161 0231T 15278 26863 35685 56606 65757 92547 96361 0290T 15777 27358 35686 57267 66990 92608 96366 0376T 15787 27692 35697 58110 67225 92618 96367 0396T 15847 29826 35700 58611 67320 92621 96368 0397T 16036 31627 36218 59525 67331 92627 96370 0399T 17003 31632 36227 60512 67332 92921 96371 0437T 17312 31633 36228 61316 67334 92925 96375 0439T 17314 31637 36248 61517 67335 92929 96376 0443T 17315 31649 36474 61611 67340 92934 96411 0450T 19001 31651 36476 61641 69990 92938 96415 0466T 19082 31654 36479 61642 74301 92944 96417 0471T 19084 32501 36483 61651 74713 92973 96423 0480T 19086 32506 36907 61781 75565 92974 96570 0482T 19126 32507 36908 61782 75774 92978 96571 0492T 19282 32667 36909 61783 76125 92979 96934 0496T 19284 32668 37185 61797 76802 92998 96935 0513T 19286 32674 37186 61799 76810 93320 96936 0514T 19288 33141 37222 61800 76812 93321 97546 0523T ...

Read the article →

CPT Codes Exempt from Modifier 51 (Appendix E)

|

The following CPT codes are exempt from the use of modifier 51.  These procedures are usually performed with another procedure, however, they may also be a stand-alone procedure.   17004 93456 93618 20697 93503 93631 20974 93600 94610 20975 93602 95905 31500 93603 95992 36620 93610 99151 44500 93612 99152 61007 93615 93451 93616 ...

Read the article →

CPT Codes Exempt from Modifier 63 (Appendix F)

|

The following codes should not be reported with modifier 63. 30540 33946 46735 30545 33947 46740 31520 33978 46742 33470 33949 46744 33502 36415 47700 33503 36420 47701 33505 36450 49215 33506 36456 49491 33610 36460 49492 33611 36510 49495 33619 36660 46196 33647 39503 49600 33670 43313 49605 33690 43314 49606 33694 43520 49610 33730 43831 19611 33732 44055 53025 33735 44126 54000 33736 44127 54150 33750 44128 54160 33755 46070 63700 33762 46705 63702 33778 46715 63704 33786 46716 63706 33922 46730 65820 ...

Read the article →

The Impact of Medical Necessity on High Level E/M Services

|

I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"  The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

Read the article →

How to Report Imaging (X-Rays) of the Thumb

|

If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...

Read the article →

Spotlight: Services Excluded from Global Surgery Payment

|

The following services are excluded from global surgery payment according to Noridian Medicare. These services may be paid for separately. The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial...

Read the article →

Date of Service Reporting for Radiology Services

|

Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.

Read the article →

Billing Guidelines for Repositioning

|

Code 95992 has some very limited payer payment guidelines which need to be understood for proper reimbursement. Many payer policies consider this service bundled with Evaluation and Management Services, therefore, it would not be separately payable if there was an E/M service performed on the same date. Some providers have reported having trouble ...

Read the article →

Answers to Your Auditing & Compliance Questions

|

National Alliance of Medical Auditing Specialists (NAMAS) hosts a forum where auditing and compliance professionals can get answers to their questions, and exchange information with other professionals across the country. Recently, we've received the following question regarding fracture care that we'd like to share below. Q: I recently noticed CPT 26600, ...

Read the article →

Spotlight: GLOBAL Periods

|

A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal post- operative care are bundled into the global surgery fee. Global surgery is not restricted to hospital...

Read the article →

UnitedHealthcare to Discontinue Coverage of Consultations

|

In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255).

Read the article →

Medicare Physician Fee Schedule Indicators

|

Many denials can be avoided when you understand how a payer looks at a code. Find-A-Code puts a lot of this information all on one page. Under Additional Code Information on CPT codes you will find a lot of questions can be answered. In addition to the global policy, uniform...

Read the article →

Understanding NCCI Edits

|

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

Read the article →

Separately Report a "Separate Procedure" with Confidence

|

Many procedures in the CPT® code book are designated "separate procedures," but that doesn't mean you can report those procedures separately in every case. First, you must consider other procedures performed during the same encounter.  "Separate" Might Not Mean What You Think It Does You can always identify a designated separate procedure by the inclusion of "(separate ...

Read the article →

Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

|

Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...

Read the article →

Detection by Nucleic Acid (DNA or RNA) - Amplified Probe Technique

|

This question was asked on the following lab codes used for testing during pregnancy. "Can the codes below be billed together?  87491- 59, 87591-59. 87081, 87150." YES- CPT code 87081 is used when a specific pathogen is suspected and is appropriate. YES- (X2) 87150 is used for culture, typing, and identification by nucleic ...

Read the article →

Coding Medicare Initial Preventive Physical Exams (IPPE)

|

The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward. Purpose An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...

Read the article →

Q/A: Do Digital X-rays Have Their Own Codes?

|

Question Are you aware if digital x-ray of the spine requires a different code than plain x-ray?  If so, where can I find the information specific to digital x-ray codes? Answer There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...

Read the article →

Clinical Staff vs. Healthcare Professional

|

State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.  Physician or other qualified healthcare professionals:  Must have a State license, education training showing qualifications as well as facility privileges.  Examples of Qualified Healthcare professionals: (NOTE: this list is not all-inclusive, please refer to your payer ...

Read the article →

Q/A: Can I Bill a Review of X-Rays?

|

It is not unusual for a healthcare provider to review x-rays taken and professionally read by another entity. Questions arise regarding how to bill this second review. It is essential to keep in mind that the global (complete) service of taking an x-ray is composed of both a professional and ...

Read the article →

Physical Therapy Caps Q/A

|

Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...

Read the article →

Q/A Neonate Coding When Child is Transferred (2019/01/17)

|

Codapedia  Forum - Questions & Answers Q/A: Neonatologist was at the birth of a very critical child, she billed 99468 and then it was decided to transfer the child to another facility, she also billed 99291 and 99292 x 3. Her time was denied, how should she have billed for the initial ...

Read the article →

Q/A: Which Code Should I Use for a Lab Interpretation Fee?

|

Question Which code should I use for a lab interpretation fee? Specifically, I have ordered a female hormone saliva test, and would like to charge a fee for time spent on the interpretation and consult. Answer This type of service generally does not involve a third party, so it may be acceptable to ...

Read the article →

Everything You need to Know about Drugs

|

We have it all! Search our WK Drug Database for drugs and pharmaceuticals. When it comes to support and guidance the WK Drug Database offers a paramount search and is conveniently presented in one place.  Pricing  GPIs  NDCs  Billing Codes  Indications/Diseases Packaging Information Active and Inactive and more... Additionally, learn more about drugs and pharmaceuticals that can be used to detect, treat, or monitor ...

Read the article →

How to Report Co-Surgeons Using Modifier 62

|

Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session. An easy way to explain this is to visualize a patient requiring cervical fusion where ...

Read the article →

Home Oxygen Therapy

|

Home Oxygen Therapy Guidelines

Read the article →

What is Virtual Communication (G0071)?

|

Beginning January 1st, 2019 all of our RHC and FQHC organizations have a new CPT code to  consider implementing for their Medicare populous (check per Advantage Plan Administration for coverage). In its current form, this code is not reportable by organizations not meeting the RHC/FQHC designation. The code  isG0071 and is termed ...

Read the article →

AMA Issues new CMT Information

|

As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ...

Read the article →

Q/A: Is G8730 Still Required? Are G Codes Required at all?

|

G8730, when is it required. Many G codes are still active and are required for non-quality reporting.

Read the article →

Are You Protecting Your Dental Practice From Fraud?

|

With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ...

Read the article →

Nine New Codes for Fine Needle Aspirations (FNA) in 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 ...

Read the article →

Dry Needling

|

The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ...

Read the article →

Are You Ready For the 2019 New Codes

|

Many articles have been published regarding the 2019 proposed Evaluation and Management coding changes, but hopefully you have taken the time to review those in detail and be ready for them. If not, here is a link to a Find-A-Code article written by Wyn Staheli (Director of Research) entitled, “Are You Ready ...

Read the article →

2019 Coding Changes for Chiropractic

|

The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...

Read the article →

New Genetic Test for Severe Inherited Conditions

|

For 2019 a new code has been introduced (81443) which represents genetic testing for 15 genes associated with severe, inherited conditions. The results of this test may be used to identify carrier status during prenatal genetic counseling, confirm a clinical diagnosis, or identify at-risk family members for the following severe ...

Read the article →

Welcome 2019 CPT Codes!

|

The AMA has released the New, Revised and Deleted CPT codes these are currently available on Find-A-Code. View the entire list of changes on the CODE tab and select CPT. Be sure to review all of the changes effective January 01, 2019.   168 New Codes 72   Deleted Code 51   Revised Codes Here are ...

Read the article →

The Diabetic Patient and Medical Manifestations

|

Read the article →

Flexion-Distraction Billing Clarification

|

Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article ...

Read the article →

Billing Exercise Equipment

|

While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...

Read the article →

Allergy Immunotherapy Coding Guidelines (CMS) Effective: 01/01/2006

|

Immunotherapy (Allergy Shots) is a medical treatment to used to treat and prevent reactions or desensitize the immune system to specific allergens that trigger allergy symptoms.  Payers have specific coverage guidance and rules for reporting injections, the specific type of antigen(s) provided and how they should be reported.  Below are the coding guidelines from ...

Read the article →

CMT Fees in 2019

|

Now is the time to prepare. There were some minor reductions to the RVUs for CMT codes 90840-90843. Check here to see what those changes are.

Read the article →

Billing 99211 Its not a freebie

|

It seems like a simple code to bill, but CPT 99211 (established patient office visit) is by no means a freebie when it comes to documentation and compliance. This lowest level office visit code is sometimes called a "nurse visit" because CPT does not require that a physician be present...

Read the article →

Muscle Testing and Range of Motion Information

|

Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.

Read the article →

Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?

|

The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...

Read the article →

Medi-Cal Coverage Criteria for Hospital Beds and Accessories

|

Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.

Read the article →

Documentation Requirements for Allergy Testing 10/29/2018

|

Per CMS, First Coast Service Options LCD 33261: Medical record documentation (e.g., history & physical, office/progress notes, procedure report, test results) must include the following information, and be available upon request: A complete medical and immunologic history and appropriate physical exam obtained by face-to-face contact with the patient. The medical necessity for performing ...

Read the article →

Common Allergy CPT Codes and MUEs

|

Below is a list of common CPT codes for Allergy and Immunology. Each code is listed with the following information: Medicare Unlikely Edits (MUEs) for both a Non-Facility (NF) and Facility (F) setting. Professional/Technical Component (PC/TC) Indicator. Key Indicator or Procedure Code Status Indicator, which is a Medicare assigned "Indicator" to each code in ...

Read the article →

Allergy Testing 10/29/2018

|

Allergy testing may be performed due to exaggerated sensitivity or hypersensitivity.  Using findings based on the patient’s complaint and face-to-face exam. Testing may be required to identify and determine a patient's immunologic sensitivity or reaction to certain allergens using certain CPT codes.  According to CMS, LCD 33261, allergy testing can be ...

Read the article →

Pelvic Floor Dysfunction Treatment Coverage

|

Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings. Coverage by payers ...

Read the article →

Q/A: What Codes do I use for CLIA-Waived Tests?

|

Question: I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ...

Read the article →

Prolonged Services Its Not Just About Time

|

Time, as it applies to E/M codes, has often been viewed as an "if/then" proposition. "If" the documentation shows that a majority of the encounter was based on counseling and/or coordination of care, "then" we choose the highest level of service based on the total time of the encounter. However, a ...

Read the article →

Is cox-flexion distraction billable as 97012

|

Is cox-flexion distraction billable as 97012? Can you use 97140 and 98941 on the same day?

Read the article →

Tools and Resources for Life Care Planners

|

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...

Read the article →

Chiropractic OIG Audit Recommendations - Lessons Learned

|

The OIG recently concluded an audit on a chiropractic office located in Florida and had some significant findings. They recommended the following: Refund to the Federal Government the portion of the estimated $169,737 overpayment for claims for chiropractic services that did not comply with Medicare requirements and are within the 4-year ...

Read the article →

Rhizotomy Procedures

|

The terms “rhizotomy” and “Radiofrequency Ablation” (RFA) both mean “destruction of a nerve.” Another term for this is “neurolysis.” The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve(s). Nerve Destruction choices include the following: Chemical Neurolytic Blocks - These require substances that are...

Read the article →

The Potential Impacts of a Flat Rate EM Reimbursement on our Industry

|

The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the...

Read the article →

2019 Code Changes are Just Around the Corner - Are You Ready?

|

The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...

Read the article →

Keys to Successful Claims Filing

|

There are many factors that can contribute to your success in filing claims and getting reimbursed.  The information below is from the CMS website. Completing Item 12, Patient's or Authorized Person's Signature, on the CMS-1500 form for a non-assigned claim A signature on file (SOF) indicates the supplier has obtained the beneficiary's one-time authorization on ...

Read the article →

Pricing for ASC’s and APC’s

|

For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...

Read the article →

Importance of Depression Screenings

|

Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...

Read the article →

Medicare Timed Codes Guidelines

|

Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time. It should be noted that while ...

Read the article →

Using Modifiers 96 and 97

|

The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...

Read the article →

Q/A: Can I Bill Mechanical Massage?

|

Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.

Read the article →

BREAKING NEWS: CMS Proposes to Change E&M Coding

|

On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware. Where ...

Read the article →

CMS Proposes Changes to Evaluation & Management Requirements

|

It is no secret that providers have long argued that E/M coding is burdensome and does not truly reflect the services provided. This fact is acknowledged by CMS with the following statement "Prior attempts to revise the E/M guidelines were unsuccessful or resulted in additional complexity due to lack of ...

Read the article →

Q/A: Can I Bill Spinal Decompression Table to Insurance?

|

Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?

Read the article →

Provider-Based Facilities and Split Billing: Is Your Facility Being Reimbursed for All Work Performed?

|

Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed.   For ...

Read the article →

CMS Proposed New E/M Codes for Podiatry

|

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 ...

Read the article →

Q/A: Can You Swap Out 97140 with 97530?

|

Codes 97140 and 97530 are not interchangeable. See why.

Read the article →

Documentation: Face to Face for Home Health Certification

|

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 ...

Read the article →

Q/A: Should I Bill Massage as 97124 or 97140?

|

Question The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...

Read the article →

Home Oxygen Therapy -- CMN for Oxygen

|

The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.

Read the article →

Q/A: Coding for ECG/EKG’s

|

Q: Our clinic is owned by a hospital, but there is equipment in the clinic to do ECG/EKG’s. When the test is done here in the clinic, and the provider does the interpretation and report, is 93000 the correct code to bill? The equipment is owned by the clinic and ...

Read the article →

Inappropriate Use of Units Costs Practice Over $800,000

|

A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?

Read the article →

Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?

|

Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed...

Read the article →

The Range of Motion Conundrum

|

As both a chiropractor for 31 years and one who reviews a lot of medical records for the medicolegal arena and has been teaching documentation for many years, the range of motion question comes up frequently. Although we used to get reimbursed very well for a specific range of motion code back in ...

Read the article →

Q/A: Coding for Lesion Removal and Repair

|

The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that...

Read the article →

How Many Modalities Are Too Many?

|

Q: I have a payor who is denying modalities, claiming that they are “excessive”. At a single encounter I billed for: 98940- Chiropractic manipulative treatment (CMT); spinal, 1-2 regions 97110- Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility G0283- Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care 97010- Application of a modality to 1 or more areas; hot or cold packs Is this excessive? How do I know how much is too much?

Read the article →

Auditing Therapy Evaluation Codes - Not So Quick!

|

New evaluation codes for physical therapy (PT) and occupational therapy (OT) codes were made effective 1/1/2017. Three new physical therapy evaluation codes replaced 97001, and three new occupational evaluation codes replaced 97003. Chart 1 - Short Code Descriptors The PT and OT reevaluation codes remain the same but were...

Read the article →

EM Code Changes in CPT 2018

|

It is that time of year again! The time to throw out the old and bring in the new. With the release of the CPT 2018 updates, we will see major changes in coding throughout the E/M section.

Read the article →

AMA vs Medicare rules and the use of the PT modifier

|

Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...

Read the article →

Preventive Medicine: General Procedures

|

Preventive Medicine Topics Page General Procedures Procedure Codes 36415: Collection of venous blood by venipuncture 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List ...

Read the article →

Preventive Medicine: Alcohol Misuse Screening & Counseling

|

Preventive Medicine Topics Page // Alcohol Misuse Screening and Counseling Procedure Codes G0442: Annual alcohol misuse screening, 15 minutes G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes 99408: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to ...

Read the article →

Preventive Medicine: Screening for Anemia

|

Preventive Medicine Topics Page Screening for Anemia Procedure Codes 85004: Blood count; automated differential WBC count 85014: Blood count; hematocrit (Hct) 85013: Blood count; spun microhematocrit 85018: Blood count; hemoglobin (Hgb) 80055: Obstetric panel ICD-10-CM 85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0 80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, ...

Read the article →

Preventive Medicine: Annual Wellness Visit

|

Preventive Medicine Topics Page Annual Wellness Visit Procedure Codes G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 99385: Initial comprehensive preventive medicine evaluation and management of an individual including ...

Read the article →

Preventive Medicine: Bone Mass Measurements

|

Preventive Medicine Topics Page Bone Mass Measurements Procedure Codes G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078: Computed tomography, bone mineral density study, 1 or more ...

Read the article →

Preventive Medicine: Breast Cancer Genetic Screening

|

Preventive Medicine Topics Page Breast Cancer Genetic Screening Procedure Codes 81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 ...

Read the article →

Preventive Medicine: Breastfeeding Supplies

|

Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...

Read the article →

Preventive Medicine: Cardiovascular Disease Screening Tests

|

Preventive Medicine Topics Page Cardiovascular Disease Screening Tests Procedure Codes 80061: Lipid panel. This panel must include the following: Cholesterol, serum, total Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) Triglycerides 82465: Cholesterol, serum, total 83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 84478: Triglycerides 83721: Lipoprotein, direct measurement; LDL cholesterol 83719: Lipoprotein, ...

Read the article →

Preventive Medicine: Cervical Dysplasia Screening

|

Preventive Medicine Topics Page Cervical Dysplasia Screening Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...

Read the article →

Preventive Medicine: Colorectal Cancer Screening

|

Preventive Medicine Topics Page Colorectal Cancer Screening Procedure Codes G0104: Colorectal cancer screening; flexible sigmoidoscopy G0105: Colorectal cancer screening; colonoscopy on individual at high risk G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0122: Colorectal cancer screening; barium ...

Read the article →

Preventive Medicine: Contraceptive Methods

|

Preventive Medicine Topics Page Contraceptive Methods Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...

Read the article →

Preventive Medicine: Counseling to Prevent Tobacco Use

|

Preventive Medicine Topics Page Counseling to Prevent Tobacco Use Procedure Codes 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes ICD-10-CM 99406-99407: No specific diagnoses Frequency 99406-99407: 2 attempts a year, ...

Read the article →

Preventive Medicine: Depression Screening

|

Preventive Medicine Topics Page Depression Screening Procedure Codes G0444: Annual depression screening, 15 minutes 96127: Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument ICD-10-CM G0444, 96127: No specific diagnoses Frequency G0444:Once annually 96127: No specific frequency guidelines Additional Information 96127 Only covered for ages ...

Read the article →

Preventive Medicine: Diabetes Screening

|

Preventive Medicine Topics Page Diabetes Screening Procedure Codes 82947: Glucose; quantitative, blood (except reagent strip) 82948: Glucose; blood, reagent strip 82950: Glucose; post glucose dose (includes glucose) 82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to ...

Read the article →

Preventive Medicine: Diabetes Self-Management Training

|

Preventive Medicine Topics Page Diabetes Self-Management Training Procedure Codes G0108: DSMT, individual, per 30 minutes G0109: GDSMT, group (2 or more), per 30 minutes ICD-10-CM G0108-G0109: Contact payer for more specific guidelines Frequency G0108-G0109 Initial year: Up to 10 hours of initial training within a continuous 12-month period Subsequent years: Up to 2 ...

Read the article →

Preventive Medicine: Therapy for Fall Prevention

|

Preventive Medicine Topics Page Therapy for Fall Prevention Procedure Codes 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, ...

Read the article →

Preventive Medicine: Glaucoma Screening

|

Preventive Medicine Topics Page Glaucoma Screening Procedure Codes G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist ICD-10-CM G0117-G0118: Z13.5 Frequency G0117-G0118: Once a year Additional information G0117-G0118 Coverage as is indicated with ...

Read the article →

Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and Administration

|

Preventive Medicine Topics Page Hepatitis B Virus (HBV) Vaccine and Administration Procedure Codes G0010: Administration of hepatitis b vaccine 90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743: Hepatitis ...

Read the article →

Preventive Medicine: Hepatitis C Virus (HCV) Screening

|

Preventive Medicine Topics Page Hepatitis C Virus (HCV) Screening Procedure Codes G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 86804: Hepatitis C antibody; confirmatory test (eg, ...

Read the article →

Preventive Medicine: Human Immunodeficiency Virus (HIV) Screening

|

Preventive Medicine Topics Page Human Immunodeficiency Virus (HIV) Screening Procedure Codes G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 ...

Read the article →

Preventive Medicine: Human Papilomavirus (HPV) Vaccine and Screening

|

Preventive Medicine Topics Page Human Papilomavirus (HPV) Vaccine and Screening Procedure Codes 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, ...

Read the article →

Preventive Medicine: Influenza Virus Vaccine and Administration

|

Preventive Medicine Topics Page Influenza Virus Vaccine and Administration Procedure Codes Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Q2036: Influenza virus vaccine, split virus, when administered to individuals ...

Read the article →

Preventive Medicine: Initial Preventive Physical Examination

|

Preventive Medicine Topics Page Initial Preventive Physical Examination (Medicare Only) Procedure Codes G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation ...

Read the article →

Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention

|

Preventive Medicine Topics Page Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention Procedure Codes G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, ...

Read the article →

Preventive Medicine: Lung Cancer Screening

|

Preventive Medicine Topics Page Lung Cancer Screening Procedure Codes G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) G0297: Low dose ct scan (ldct) for lung cancer screening S8092: Electron beam computed tomography (also ...

Read the article →

Preventive Medicine: Newborn Screenings/Tests

|

Preventive Medicine Topics Page Newborn Screenings/Tests Procedure Codes 82775: Galactose-1-phosphate uridyl transferase; quantitative 83498: Hydroxyprogesterone, 17-d 82017: Acylcarnitines; quantitative, each specimen 82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 82261: Biotinidase, each specimen 83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 83021: Hemoglobin ...

Read the article →

Preventive Medicine: Pneumococcal Vaccine and Administration

|

Preventive Medicine Topics Page Pneumococcal Vaccine and Administration Procedure Codes G0009: Administration of pneumococcal vaccine 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use ICD-10-CM G0009, ...

Read the article →

Preventive Medicine: Prostate Cancer Screening

|

Preventive Medicine Topics Page Prostate Cancer Screening Procedure Codes G0102: Prostate cancer screening; digital rectal examination G0103: Prostate cancer screening; prostate specific antigen test (PSA) ICD-10-CM G0102-G0103: Z12.5 Frequency G0102-G0103: Once annually Additional Information G0102-G0103 Only for males aged 50 and older G0102 Copayment and deductible may apply, consult your payer Find-A-Code™ - Preventive Services - ...

Read the article →

Preventive Medicine: Screening for STIs & HIBC to Prevent STIs

|

Preventive Medicine Topics Page Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs Procedure Codes 86592: Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) 86593: Syphilis test, non-treponemal antibody; quantitative 86631: Antibody; Chlamydia 86632: Antibody; Chlamydia, IgM 86780: Antibody; Treponema pallidum 87110: Culture, chlamydia, any source ...

Read the article →

Preventive Medicine: Screening Mammography

|

Preventive Medicine Topics Page Screening Mammography Procedure Codes 77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057: Screening mammography, bilateral ...

Read the article →

Preventive Medicine: Screening Pap Tests

|

Preventive Medicine Topics Page Screening Pap Tests Procedure Codes G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation ...

Read the article →

Preventive Medicine: Screening Gynecological Examination

|

Preventive Medicine Topics Page Screening Gynecological Examination Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...

Read the article →

Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

|

Preventive Medicine Topics Page Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) Procedure Codes 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real ...

Read the article →

Preventive Medicine: Screening Children for Visual Acuity

|

Preventive Medicine Topics Page Screening Children for Visual Acuity Procedure Codes 99173: Screening test of visual acuity, quantitative, bilateral ICD-10-CM 99173: Z00.121, Z00.129, Z00.100, Z00.101 Frequency 99173: No specific frequency guidelines Additional Information 99173 Not covered by Medicare for preventative care Some policies will only cover as preventive for children, consult your payer Find-A-Code™ - Preventive ...

Read the article →

Preventive Medicine: Use of Modifier 33

|

Preventive Medicine Topics Page The Use of Modifier 33 Modifier 33 is used to indicate Preventive Services to report quality metrics and is informational only, it has no impact on reimbursement. Modifier 33 should be reported only to private payers, Medicare and Medicaid do not recognize this modifier. ...

Read the article →

Preventive Medicine: Dental Caries in Children

|

Preventive Medicine Topics Page Dental Caries in Children Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional ICD-10-CM 99188: No specific diagnoses Frequency 99188: No specific frequency guidelines Additional Information 99188 Covered for children from birth until their seventh birthday Find-A-Code™ - Preventive Services - The information ...

Read the article →

Documenting DMEs

|

As per MLN MM8304,  This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g). Due to concerns ...

Read the article →

Brooklyn Chiropractor OIG Report - Lessons Learned

|

In August of 2017, a Brooklyn chiropractor was ordered to repay $672,805 to Medicare because the reviewer found that 100% of the claims reviewed (from 2011-2012) did not meet medical necessity requirements. The chiropractor enlisted help from two reputable experts who disputed the findings of Medicare’s Professional Reviewer (MPR). However, the OIG maintained that the findings of the original auditor were valid. Since none of us have ½ million in cash just laying around, it is essential to learn, understand, and make changes where appropriate to help audit-proof patient documentation. Read here to learn more.

Read the article →

Critical Care Documentation

|

Critical care documentation should show critical need for the patient AND immediate action by the provider....

Read the article →

Coverage Criteria for Nonwearable Automatic Defibrillators

|

According to Noridian and CGS Administrators LCD L33690, a nonwearable automatic defibrillator (E0617) is covered for beneficiaries in two circumstances. They meet either (1) both criteria A and B or (2) criteria C, described below: The beneficiary has one of the following conditions (1-8):A documented episode of cardiac arrest due to ventricular fibrillation, not due to a ...

Read the article →

Q/A: Modifiers for Injections

|

I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit....

Read the article →

Indications for Serotypes A and B Botulinum Toxins

|

According to Novitas LCD L27476, the following indications apply: 1. Blepharospasm and strabismus2. Spastic dystonia or focal dystonias to relieve pain, to assist posturing and walking, to increase range of motion, to assist in the outcome of physical therapy, and/or to reduce spasm thus allowing adequate perineal hygiene.3. Spasmodic dysphonia4. Achalasia and cardiospasm when ...

Read the article →

Billing Nutrition Counseling in a Chiropractic Setting

|

Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ...

Read the article →

Billing Nutrition Counseling

|

Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management ...

Read the article →

Coverage Criteria for Peripheral Venous Examinations

|

According to National Government Services LCD L33627, indications for venous examinations are separated into three major categories: deep vein thrombosis (DVT), chronic venous insufficiency, and vein mapping. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedure(s). Since the signs and symptoms of ...

Read the article →

Using Pulmonary Stress Tests

|

As per Palmetto GBA LCD L33444, exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions. The pulmonary stress test will be considered medically necessary for these conditions:INDICATIONS:Evaluation of exercise tolerance• Determination of functional impairment or capacity • ...

Read the article →

Medicare Telemedicine Changes for 2018

|

Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.  Originating Site Fee Each ...

Read the article →

Home Oxygen Therapy -- A Face-to-Face Encounter

|

What is required for a Home Oxygen Therapy, Face-to-Face Encounter.

Read the article →

Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together

|

I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again?

Read the article →

Documentation for Evaluation and Management (E/M) Services

|

According to WPS, when billing or coding for E/M services you should follow a few guidelines. Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation. Critical Care Visits  Clear indication of patient ...

Read the article →

Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?

|

In order to understand and answer the question, "Why code 99080 is being denied when billed with an E/M Service, it is important to first review the requriements of selecting the appropriate level of Evaluation and Management service and how that relates to reporting a 99080 special report service. Continue reading for better understanding.

Read the article →

Q/A: Billing for GI Anesthesia

|

Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary.

Read the article →

When is 97112 Neuromuscular Re-education Billable?

|

Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.

Read the article →

CPT Code for DOT exams

|

Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?

Read the article →

The Comprehensive Error Rate Testing Program

|

With nearly a million physicians in this country, how do auditing organizations determine whom to audit?

Read the article →

Documentation for Negative Pressure Wound Therapy

|

The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy.

Read the article →

Documentation for Surgical Dressings

|

The Medicare Learning Network provides guidance on required documentation for surgical dressings.

Read the article →

Documentation for Urological Supplies

|

The Medicare Learning Network provides guidance on required documentation for urological supplies.

Read the article →

Documentation for Enteral Nutrition

|

The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ...

Read the article →

Documentation for Home Blood Glucose Monitors (BGM)

|

The Medicare Learning Network provides guidance on how to Prevent Denials for Home Blood Glucose Monitors (BGM)...

Read the article →

Documentation for Therapeutic CGMs and Related Supplies

|

The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related Supplies

Read the article →

Documentation for Manual Wheelchairs

|

The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases....

Read the article →

Documentation for Lower Limb Prosthesis

|

The Medicare Learning Network provides guidance on denials for lower leg prostheses and how to prevent them: For the 2017 report period, most of the improper payments for lower leg prostheses were due to insufficient documentation. For Medicare to cover a lower limb prosthesis claim, the medical record must support the beneficiary’s ...

Read the article →

Documentation for Bacterial Culture Lab Tests

|

The Medicare Learning Network provides guidance on how to prevent denials of Bacterial Culture Laboratory Tests

Read the article →

Documentation for Bacterial Culture Lab Orders

|

The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests...

Read the article →

Documentation for Power Tilt/Recline Seating Systems for Wheelchairs

|

The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems...

Read the article →

Documentation for Ostomy Supplies

|

The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies....

Read the article →

Documentation and Orders for Respiratory Assistive Device

|

The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines.

Read the article →

Increased Therapy Denials Create Administrative Burden

|

Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ...

Read the article →

Telemedicine Billing and Reimbursement

|

The opportunities for providers who want to provide telemedicine continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding ...

Read the article →

Medicare Changes Requirements for Implantable Cardioverter Defibrillators (ICDs)

|

Whenever there is a high-cost item, CMS has historically evaluated usage to determine appropriateness of billing and this is another example. A Decision Memo was released on February 15, 2018 which included the following changes: Changes to who qualifies for a device and the required waiting periods Patient registry no longer required Cardiac magnetic resonance ...

Read the article →

The Comprehensive Error Rate Testing Program

|

With nearly a million physicians in this country, how do auditing organizations determine whom to audit?

Read the article →

No HCPCS Code Available? Now What?

|

HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes. There are several types of HCPCS level II codes such as: Permanent National Codes Dental Codes Miscellaneous Codes Temporary National ...

Read the article →

Consultation Codes Q/A

|

Question Are there consultation codes that can be used for new and existing patients when a review of systems and detailed history is performed but no examination due to the patient's reluctance to make a decision to continue with the visit but has taken up 30-45 minutes of the doctors time?

Read the article →

New Modifiers Released in 2018

|

There were 13 new modifiers released in 2018, be sure you are using them if appropriate.     FY X-ray taken using computed radiography technology/cassette-based imaging    JG Drug or biological acquired with 340b drug pricing program discount    QQ Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was ...

Read the article →

Payment Rates Increase for Behavioral Health Office Services

|

Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...

Read the article →

Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes

|

According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...

Read the article →

Patients Undergoing a Bone Marrow Transplant (BMT)

|

Accoring to Wisconsin Physicians Service Insurance Corporation L34699, when using J2820 for patients undergoing a bone marrow transplant (BMT), 2 diagnosis codes are required:1) Z76.82 Awaiting organ transplant status2) Pick a code from one of these categories: C81- Hodgkin Lymphoma C82- Follicular Lymphoma Non-follicular Lymphoma C83.1- Mantle cell lymphoma C83.3- Diffuse large B-cell lymphoma C83.7- Burkitt lymphoma C83.8- Other (Intravascular large B-cell lymphoma, Primary effusion B-cell lymphoma, or Lymphoid granulomatosis) Mature T/NK-cell lymphomas C84.4- Peripheral T-cell ...

Read the article →

How to Code Screening and Diagnostic Colonoscopy

|

The following information is from BC Advantage. Colonoscopy is a common procedure performed byGastroenterologists. CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis" ...

Read the article →

CMS Changes Definitions for Therapeutic Shoe Inserts

|

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 ...

Read the article →

Strapping and Kinesio Taping Coding Differences

|

There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally. Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue. Coding: ...

Read the article →

Multiple Diagnostic Imaging Payment Reduction

|

CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...

Read the article →

Traumatic Subluxation Coding Controversy

|

There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...

Read the article →

Q/A: Can I Perform 2 Untimed Codes at the Same Time?

|

Question: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?

Read the article →

Influenza, Are You Billing Correctly?

|

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 ...

Read the article →

Insufficient Documentation Errors

|

According to CMS ICN 909160, claims are determined to have insufficient documentation errors when the medical documentation  submitted is inadequate to support payment for the services billed, meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary. Claims ...

Read the article →

Anesthesia Fee Calculation

|

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 ...

Read the article →

Paravertebral Joint/Nerve Blocks - Diagnostic and Therapeutic

|

According to Medicare article A50443, a facet joint level refers to the zygapophyseal joint or the two medial branch nerves innervating that zygapophyseal joint. Use CPT codes 64491 and 64492 in conjunction with 64490. Do not report CPT code 64492 more than once per day. Use CPT codes 64494 and 64495 in conjunction with 64493. Do not report CPT code 64495 more than once per day. For injection of ...

Read the article →

Non-Coronary Vascular Stents: Mesenteric Vessels

|

The following information is according to Novitas Solutions L35084. Mesenteric vessels: This includes Acute mesenteric ischemia Chronic mesenteric ischemia Mesenteric thrombosis Dissection or any other vascular insufficiency resulting in gastrointestinal symptoms Stenting of the mesenteric vessels is covered only when angioplasty of the vessels would not suffice and after the patient has had a thorough medical evaluation and management of symptoms, and for whom surgical intervention is the likely ...

Read the article →

Psychiatric Partial Hospitalization Programs

|

Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...

Read the article →

NEW on Find-A-Code...National Coverage Determinations (NCDs)

|

Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...

Read the article →

What's the definition of an Office Visit and Can I Bill it With a Chiropractic Treatment?

|

What is the definition of Office Visit? Can It be billed with a Chiropractic Treatment? What about using code 99123 E&M code for office visits? Can we bill of office visits even though we are giving chiropractic care?

Read the article →

2018 Revisions to Prolonged Services

|

For 2018, there were some changes to the guidelines for prolonged services (99358 and 99359). Providers need to be aware that there were technical corrections made which may not be included in their CPT code book - but they are in FindACode.com effective January 1, 2018. Please note that the ...

Read the article →

Medicare's Integrated Behavioral Healthcare Services and Collaborative Care Program

|

Over the last several years, primary care has begun to integrate behavioral health services to better address shortfalls in patient quality of care. Some of the first codes were the Health and Behavior Assessment/Intervention (96152-96155) codes, which were added in 2002. Since then, many different models have been experimented with and have ...

Read the article →

Non-Coronary Vascular Stents: Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infropoliteal arteries)

|

The following information is according to Novitas Solutions L35084. Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infrapopliteal arteries): This includes: Lifestyle-limiting claudication Focal hemodynamically significant lesion Ischemic rest pain Non-healing tissue ulceration Focal gangrene Stent placement in infrapopliteal vessels is not expected to be often indicated and in those cases the rationale for stent placement must be explained in the record. CPT codes: 37221 37223 37226 37227 37230 37231 37234 37235 ICD-10-CM codes: Type 1 diabetes mellitus E10.51 - with diabetic peripheral angiopathy without gangrene E10.59 - with other circulatory ...

Read the article →

Non-Coronary Vascular Stents: Renal artery

|

The following information is according to Novitas Solutions L35084. Renal artery: Stenting may be indicated for renal artery stenosis causing renovascular hypertension (see below) or renal insufficiency as well as post-transplant renal artery stenosis, arterial aneurysm or dissection. Renal artery angioplasty with or without stenting is covered for renal artery stenosis manifested by at least one of the following conditions: Recurrent (“flash”) pulmonary edema without cardiac ...

Read the article →

Non-Coronary Vascular Stents: Brachiocephalic arteries

|

According to Novitas Solutions L35084 Brachiocephalic arteries (including subclavian, except carotid bifurcation): Stenting may be indicated for treatment of flow-limiting stenosis resulting in conditions such as: Subclavian steal syndrome Upper extremity claudication Ischemic rest pain of the arm and hand Non-healing tissue ulceration Focal gangrene. CPT codes: 37236 37237 ICD-10-CM codes: G45.8 - Other transient cerebral ischemic attacks and related syndromes Unspecified atherosclerosis of native arteries of extremities I70.201 - right leg I70.202 - left leg I70.203 - ...

Read the article →

Medicare Requiring Specific Modifiers on Therapy Services

|

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 ...

Read the article →

Billing with a GP Modifier

|

Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?

Read the article →

Intensive Outpatient Treatment (IOP)

|

Intensive Outpatient Programs (IOPs) are considered to be an intermediate level of care which is commonly considered after the patient has been discharged from inpatient care. For some patients and/or conditions they can also provide an effective level of care when hospitalization is not clinically indicated or preferred. The following ...

Read the article →

Preventative Services: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

|

The following information from the Medicare Learning Network provides guidance on Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

Read the article →

Paravertebral Joint/Nerve Denervation

|

A facet joint is supplied by two medial branch nerves. Each medial branch nerve supplies sensation to one half of each facet joint above and below the spinal nerve of origin. Therefore, both of the two related medial nerve branches for each facet joint must be treated. The CPT codes 64635-64636 have a ...

Read the article →

Conscious (Moderate) Sedation

|

Moderate (Conscious) sedation is a drug-induced state of relaxation in which the patient is typically awake and can respond to verbal commands, but might not be able to speak. A combination of medicines is used and often includes a sedative as well as an anesthetic to block pain.

Read the article →

Diagnosis billing with J0888

|

The following information is from LCD L36276. The diagnosis codes listed below require the use of the EC modifier (ESA administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy) when submitting claims for J0888. In addition, these diagnosis codes are marked with an * indicating they require a dual diagnosis. The ...

Read the article →

Coverage and/or Medical Necessity for the Use of Hyaluronan or Derivitive

|

According to Palmetto GBA, Medicare will cover the cost of the injection and the injected hyaluronate polymer for patients who meet the following clinical criteria: Knee pain associated with radiographic evidence of osteophytes in the knee joint, sclerosis in bone adjacent to the knee, or joint space narrowing. Morning stiffness of less than 30 minutes in duration or crepitus on motion of the ...

Read the article →

Non-Coronary Vascular Stents: Inferior vena cava and iliofemoral veins

|

The following information is according to Novitas Solutions, L35084. Inferior vena cava and iliofemoral veins: This includes vena cava and iliofemoral venous occlusions and stenosis due to the following Post-radiation venous stenosis Congenital stenoses or webs Extrinsic venous compression (May-Thurner syndrome) Thrombophlebitis and symptomatic post-traumatic venous stenosis. CPT codes: 37238 37239 ICD-10-CM codes: Phlebitis and thrombophlebitis I80.10 - of unspecified femoral vein I80.11 - of right femoral vein I80.12 - of left femoral vein I80.13 - of femoral vein, bilateral I80.211 - of right iliac vein I80.212 - of left iliac vein I80.213 - of iliac vein, bilateral I80.219 - of unspecified iliac vein I80.8 - of ...

Read the article →

Should ROM Testing be Reported with Evaluation and Management Services?

|

Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.

Read the article →

Billing Electrotherapy with AcuKnee

|

This code is commonly used to bill for AcuKnee products.  Per AcuKnee, “NMES and electrotherapy may be covered by most insurance providers, provided the following criteria are met;” Documentation of chronic pain or muscle atrophy 3 months or longer Must document improvement Must have physician document medical necessity/Prescription Appropriate authorization from your insurance provider Suggested codes when billing  64550 initial electrotherapy education and placement E0720 Electrotherapy unit itself E0731 Garment ...

Read the article →

ICD-10-PCS Coding the Approach

|

When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using.  There are seven approaches. They are listed below with their ...

Read the article →

Outpatient Rehabilitation Modifiers

|

Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries. For services delivered under an outpatient plan of care use modifier: GN for speech-language pathology GO for occupational therapy GP for physical therapy In addition to using the correct modifier, ...

Read the article →

Preventive Medicine with a New Patient

|

When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required. New Patient:  A patient that has not received any professional services i.e., E&M  or any other face to face service from the physician or group within the ...

Read the article →

Medicare Reimburses for Discarded/Wasted Drugs

|

Your organization may be leaking revenue without realizing the leak can be stopped. If your organization purchases single-use packets or single dose vials for individual patient use and ends up discarding some of the drug, Medicare has now authorized payment for the discarded or wasted portion. Stop leaking revenue today by reading this article and implementing the guidance provided here.

Read the article →

Beware of Limitations When Using Electrical Stimulation - Ultrasound

|

Ultrasound is often used to reduce inflammation, and improve the flexibility of connective tissue.  This is done by applying sound waves to produce heat and/or vibration.  Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the requirements for ...

Read the article →

Acute Post-Operative Pain Management

|

CPT codes 62320, 62322 should be used when the analgesia is delivered by a single injection.These codes should only be used when the catheter or injection is not used for administration of anesthesia during the operative procedure. Modifier 59 should be used when billing these services to indicate that the catheter or injection was a ...

Read the article →

Proper Usage of Electrical Stimulation

|

According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment. 97032 is a constant attendance electrical stimulation modality ...

Read the article →

Initial Evaluation Codes for PT's and OT's

|

According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation. These evaluation codes are untimed, billable as one unit. Do ...

Read the article →

PT and OT Reevaluation Coding

|

According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...

Read the article →

General Physical Therapy Modality Guidelines

|

According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention. CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ...

Read the article →

Diathermy eg Microwave Use and Documentation

|

According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ...

Read the article →

Ultrasound Therapy

|

According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to 3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ...

Read the article →

Hydrotherapy Guidelines

|

According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ...

Read the article →

99024 for Subsequent Visits Within Global Period

|

Beginning July 1, 2017, there are 293 procedure codes with 10 and 90 day global days which will require practices with ten or more providers in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio and Oregon to use 99024 for subsequent visits within the global period. Many of these procedures are ...

Read the article →

2017-2018 Influenza (Flu) Resources for Health Care Professionals

|

Per CMS:  Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies. Annual Part B deductible and coinsurance amounts do not apply. Payment allowance limits for  personal flu and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished ...

Read the article →

Billing Negative Pressure Wound Therapy (NPWT) (disposable device)

|

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 ...

Read the article →

Mechanical Traction Therapy

|

According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ...

Read the article →

Abuse, Neglect, or Maltreatment

|

According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence: An appropriate code from category T74- (confirmed) or T76- (suspected) Any accompanying mental ...

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 Coder
  • Find-A-Code Professional
  • Find-A-Code Facility Base


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

Understanding Incident-To

Understanding Incident-To

Watch the video →

May 14th, 2019: Confusing Codes for Chiropractors - 97110 versus 97112 versus 97530

In this webinar, you'll get a deep dive into three therapeutic procedure codes. Dr. Gwilliam, a chiropractor and certified professional coder, will take you thorough the ins and outs of therapeutic exercises, activities, and neuromuscular reeducation. They will be compared and contrasted with examples to make sure everyone leaves with the confidence to document and bill them correctly.

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 →

Chiropractic Manipulative Treatment (CMT) Coding and Documentation (Part 1)

The most used codes in chiropractic are 98940, 98941, 98942, and 98943. In this webinar, Dr. Gwilliam will go over the fundamentals of these codes and make sure you are proficient with them. They probably play a bigger part of your practice than any other code, so it is worth it to make sure you are reporting them correctly. By the end of this presentation you will be able to diagnose, document, and code properly for CMT, as well as avoid common mistakes.

Watch the video →

Neuromuscular Reeducation, Massage Therapy - Proper Use, Documentation and Coding

In this webinar, Dr. Howard Levinson (Forensic Consultant) will address the erroneous use and billing of Neuromuscular Reeducation, Massage Therapy and Hydrotherapy in chiropractic clinics. He will offer strategies regarding how these services may be used appropriately in the chiropractic setting and provide documentation and coding information.

Watch the video →

Coding and Auditing for Upper Extremity Procedures

In this webinar, Aimee will review coding and auditing information for procedures commonly performed on the upper extremities and how to locate vital information that could help prevent coding errors and reduce risk in case of an audit.

Watch the video →

Billing Other Services with CMT

Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA June 19, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Are you getting denials from payers for things that they say are bundled into chiropractic manipulative treatment (CMT) codes? ...

Watch the video →

The Most Expensive Documentation Mistakes Chiropractors Make

Notes need to give payers the information they need in order to adjudicate your claims. Do your notes include what they need to see? Can you standardize and simplify your note taking process to decrease your administrative burden? In this webinar, Dr. Gwilliam, Certified Coder, Certified Professional Medical Auditor, and Clinical Director for PayDC Chiropractic EHR Software, will show you how to make it easy. He will review examples and boost your confidence that you are doing things correctly.

Watch the video →

Coding and Documenting Physical Therapy Treatment Modalities

Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA May 22nd, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Ever wonder how to get paid for that e-stim or ultrasound? Do payers give you a hard time and ...

Watch the video →

All About Knee Coding & Auditing

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.

Watch the video →

How X-rays Help Create an Evidence Based Practice

Learn: - Which history and exam findings determine which x-ray views to order - How biomechanical measurements result in better patient care - The results of a new chiropractic survey how digital radiography impacts patient care plans.

Watch the video →

Anatomy of the Knee

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.

Watch the video →

Documenting Diagnoses Like a Peer Reviewer, Take 2

In his last ChiroCode Webinar, Dr. Gwilliam went over the details of three conditions that are covered by the Diagnosis and Documentation cards available in the ChiroCode store. By popular demand, Dr. Gwilliam has agreed to come back and cover three more. The goal is to show you how to ensure that the code you select matches the documentation created at the encounter. You don’t need to research all of the guidelines for each code in the ICD-10 Tabular List. It has already been done for you. You’ll find out which objective tests to perform and even which CPT codes make the most sense to link to the diagnoses you pick. If you can’t wait for the presentation, pick up your copy of the cards from ChiroCode.com/store today!

Watch the video →

Evaluation and Management Coding and Auditing

Are you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215).

Watch the video →

Coding and Auditing TeleHealth Services

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.

Watch the video →

How to Add Acupuncture to a Chiropractic Office

In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to add Acupuncture services to a Chiropractic office. Topics include how to find and employ acupuncturists, CPT/ICD-10 coding, 15 minute increments vs the 8 minute rule, how to bill for office visits on same day as acupuncture and how to create an acupuncture billing and coding policy manual.

Watch the video →

Surgical Coding and Auditing

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.

Watch the video →

Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

Watch the video →

What is RBRVS and How Can It Benefit Your Organization

What is RBRVS and How Can It Benefit Your Organization

Watch the video →

Show older webinars ↓


There are more webinars. View all webinars...

View webinars for the current subject by subtopic:


Reimbursement Guides
2020 Edition

Find-A-Code's 2020 specialty specific Reimbursement Guides give you the coding, billing, and documentation support you need to get paid properly and keep it.

  • Medicare
  • Procedure & Supply codes
  • Documentation
  • Compliance
  • HCC information
  • ICD-10-CM codes



suggest a resource

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

Free Demo
Schedule Your Demo Today
Pricing
Starting at $10/month
Sign In
Welcome back!