Procedure Coding

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

How Extensions to the COVID-19 Public Health Emergency Affect Healthcare Reimbursement

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Providers need to begin preparations for how to handle a return to pre-COVID-19 public health emergency (PHE) policies. As the saying goes, "you can't put the rabbit back in the hat." Some COVID-19 PHE policies are so well liked it will be very difficult for the government to return to pre-COVID-19 policies. For now, we have at least the promise of a 60-day notice to all governors precipitating the end of the PHE.

Why You Should Be Using The Two-Midnight Rule

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Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...

2022-06-16-MLNC - ICD-10-CM Diagnosis Codes: Fiscal Year 2023

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News - Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 - Men’s Health: Talk to Your Patients About Preventive Services - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes - ICD-10-CM Diagnosis Codes: Fiscal...

2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient Access

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News - COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose - - Biosimilars: Interchangeable Products May Increase Patient Access - - Critical Care Evaluation & Management Services: Comparative Billing Report in May - -...

Using Health IT to Support Safer Use and Management of Controlled Substance Prescriptions

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New ONC data show that, as of 2021, nearly all non-federal acute care hospitals were enabled to electronically prescribe controlled substances (EPCS). According to the American Hospital Association (AHA) Information Technology (IT) Supplement Survey, the proportion of non-federal acute care hospitals enabled for EPCS increased from 67% in...

The Nuances of the Two-Midnight Rule

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When is a patient an inpatient? A reader we’ll call Michelle asked a question during a recent Monitor Mondays broadcast — a question that encapsulated many of them: how can a Medicare patient who stays two midnights for a non-medical reason be an inpatient?  For example, consider a...

Q/A: Service Period for 99490

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Question:  If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim? Answer:   According to CMS, “The service period for CPT 99490 ...

Reporting CCM and TCM Codes with E/M Codes

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When reporting CCM or TCM codes, you will only get reimbursed for what is allowed.  The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...

How Much Do You Care about the 2022 Care Management Service Changes?

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Have you already implemented a care management services program in your provider organization? If not, now may be the time to seriously consider doing so. Significant 2022 changes to the codes and increases in RVUs and reimbursement rates creates an opportunity not only to improve patient care for chronic conditions but will also help your practice increase revenues if done correctly.

Preventive Medicine Versus E&M Codes: The Same-Day Coding Dilemma

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Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms,...

Care Management Billing

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Chronic Care Management (CCM) is taking off, and with new codes and rules, it can get confusing. According to CMS, here are a few guidelines to help you with concurrent billing of CCM services. You can’t report complex CCM and non-complex CCM for the same patient in a calendar month Don‘t report ...

CMS Claims Risk Adjustment Overpayments Commonly Include 10 Specific Diseases

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There are many lessons that can be learned from a single OIG audit report. In this recently-published OIG report, several of the most common documentation and coding errors are pointed out in relation to reporting HCCs for risk adjusted plans. Take a few minutes to review the report and see if improvements within your own organization can be made from what you learn.

How Would Your Organization Defend This Auditing Accusation?

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The Office of Inspector General (OIG) is always working on audits in a pursuit of accurate reporting and reimbursement. A recently published OIG audit report can provide great information on how to protect providers and risk adjustment payers from serious financial losses by showing exactly what the OIG is looking for and how the payer (or provider) may have defended their coding choices. In this article, you will see how the OIG audited the HCC for major depressive disorder and what Anthem did to defend its reporting.

Methadone Take-Home Flexibilities Extension Guidance

On March 16, 2020, SAMHSA issued an exemption to Opioid Treatment Programs (OTPs) whereby a state could request “a blanket exception for all stable patients in an OTP to receive 28 days of Take-Home doses of the patient’s medication for opioid use disorder.” States could also “request up to 14 days of Take-Home medication for those patients who are less stable but who the OTP believes can safely handle this level of Take-Home medication.” The exemption will carry on effective upon the expiration of the COVID-19 Public Health Emergency, subject to conditions listed in this article.

Understanding the Basics of Reporting Mammography Services

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How familiar are you with the coding and documentation requirements for screening and diagnostic mammography? What is diagnostic digital breast tomosynthesis and can you bill for it? This article review the basics of reporting screening, diagnostic, and digital breast tomosynthesis.

HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights

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New Resources to Help People Seeking Care to Understand and Access Protections Offered Under the Parity Law for Mental Health and Substance Use Disorder Benefits

Moving to Medical Decision-Making as the Key Component

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Office billing is now based solely on either MDM or total time. Last week, I declared that it is my opinion that medical decision-making (MDM) should always be one of the components that contributes to selecting (or perhaps, demonstrating) the appropriate level of service (LOS) for the professional...

Continuous Glucose Monitors (CGMs) -- New Codes

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New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing. On December 28, 2021, we published the Medicare DMEPOS final rule in the Federal Register. This addressed the ...

How to Reduce the Risk of Copy and Paste

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Providers should never C&P (copy and paste) material they have not read nor vetted for accuracy. A young Jeopardy! champion died from bilateral pulmonary emboli following a colectomy in January 2021. Following his surgery, it was reported that the surgeon referred to “DVT/VTE Prophylaxis/Anticoagulation” and another note read, “already ordered.” “DVT...

Opportunities to Identify Risk Adjustable Chronic Conditions Expands in 2022

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Medicare made changes to the rules governing concurrently reporting transitional care management services and chronic care management services during the same calendar month. How might this help providers identify chronic conditions that risk adjust?

Preventive Services

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In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding...

The Impact of Coding on Maternal Outcomes

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This area of coding is not so easy. While most maternal deaths are preventable, the rate has been increasing in the United States since 2000. As a matter of fact, the U.S. has twice as many maternal deaths than other high-income countries. To reverse this trend, The Joint...

CMS Creates New Code for Over-the-Counter COVID-19 Test

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COVID-19 testing coverage is expanding with a new code which became effective on April 4, 2022. From that date until the end of the COVID-19 public health emergency (PHE), Medicare is conducting a COVID-19 Test demonstration “to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements.”

Substance Use Disorder Treatment Incentive Program Receives Go Ahead From the OIG

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DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. CM “addresses the brain’s reward response in ways that conventional counseling and medications often cannot.” Over a course of 50 years, it has shown that this program is effective. The OIG, upon analysis, has determined that there is low risk for fraud and abuse and has offered their opinion at the request of DynamiCare Health, Inc.

2022-03-03-MLNC - 2022 Payment, Quality, & Policy Changes

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News - Ambulance Prior Authorization Model Expands April 1 - Nutrition-related Health Conditions: Recommend Medicare Preventive Services - Claims, Pricers, & Codes - HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals - Events - ICD-10 Coordination & Maintenance Committee Meeting — March...

Infuse Yourself with Knowledge on Reporting Therapeutic, Prophylactic, and Diagnostic Injection Services

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Does your documentation meet the standards for reporting therapeutic, prophylactic, and diagnostic infusions and injections? Take a minute to infuse yourself with the information needed to accurately code and sequence these services for maximum reimbursement.

Hepatic Fibrosis Coding — Are Your Bases Covered?

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Patients are generally diagnosed when they reach End Stage Liver Disease (ESLD) by undergoing a liver biopsy. This creates higher healthcare costs and higher risks of complications and mortality. However, newer non-invasive tests now exist that can help in the assessment and early detection of hepatic fibrosis before it reaches the level of cirrhosis.

$636 Million in Overpayments Made by Medicare to Providers for Neurostimulators

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According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES." So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...

Considering the Impact of Diagnosis Codes in the E/M Encounter

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Social Determinants of Health (SDoH) can impact the level of MDM and overall E/M service reported for codes 99202-99215. With new SDoH codes added annually to the ICD-10-CM code set and health equity as a CMS goal, it is important to identify the role of proper diagnosis coding in determining the level of E/M service.

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM

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When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...

Refresh Your IV Hydration Coding Knowledge

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Reporting IV infusion services can be complicated, especially when multiple infusions are reported in a single encounter. Take a few minutes to freshen up your knowledge on IV hydration coding with a review of the guidelines and a few coding scenarios.

Continuous Glucose Monitoring (CGM) Systems: Leveraging Everyday Tech to Enhance Diabetes Management

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However, is the coding for the treatment and management of diabetes being adequately captured? Diabetes mellitus (DM) affects over 400 million people worldwide. It is a chronic disease of inadequate control of blood levels of glucose that affects the body’s ability to turn food into energy. Essentially, the...

2022-03-10-MLNC - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD

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News - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD - Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals - Quality Payment Program: 2020 Performance Information on Care Compare - Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16 ...

Prolonged Services Billed As a Split/Shared Visit

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According to the new Medicare’s 2022 Medicare Physician Fee Schedule Final Rule (MPFS) in some cases, Prolonged Services can now be billed as a split/shared visit.

Split/Shared Visits No Longer Specific to Medicare Plans in 2022

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Medicare is making changes to the reporting guidelines for split or shared services. Some important changes have already gone into effect as of January 1, 2022 and others are scheduled to go into effect in 2023. If your organization reports split or shared services, it’s time to look more closely at how the new rules will affect your compliance policies and reimbursement.

Critical Care Services Changes in the Medicare 2022 Final Rule

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Critical Care Services — Medicare's final ruling has been released. This article discusses the changes to critical care services, including bundled services, concurrent services, global surgery, time spent performing CCS services, and documentation requirements. It also lists the two new modifiers.

SDoH Improves Reimbursement and Risk Scores

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The new guidelines for evaluation and management (E/M) services 99202-99215 refer to social determinants of health (SDoH) on the new or revised Table of Risk. Healthcare professionals have long hoped for the ability to score these problematic patient conditions in a meaningful way, not only for reimbursement, but also for quality of care and treatment options. SDoH codes recently added to the ICD-10-CM codeset continue to impress upon us the importance of identifying and reporting these patient issues and when combined with the new table of risk for scoring the E/M service, can impact reimbursement and care. 

Will Your Critical Care Services Pass An Audit?

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Critical Care Services (CCS) have unique guidelines which may vary between payers. This article explores these differences to help providers to understand what needs to be documented in order to support medical necessity and meet the criteria for the code description.

Dentists; Treating Patients with a Medical Condition

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Understanding a patient's medical condition can have an impact on healing, as well as other problems. Of course, a dentist is not required to diagnose a medical condition such as diabetes.  However, it is in the patient's best interest that the provider is aware of any conditions that may affect ...

Treating the Genitofemoral Nerve?

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Finding which CPT code is appropriate for certain nerves can get complicated. Recently I was asked which CPT code would be used for radiofrequency ablation of the genitofemoral nerve and for a second procedure: release of psoas tendon under ultrasound guidance. Radiofrequency Ablation of the Genitofemoral Nerve I found is there is no code ...

Müller Muscle Conjunctival Resection Versus External Levator Advancement

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Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022

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Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time ...

Reporting and Auditing Drug Testing Services

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Drug testing is a common medical service used to manage prescription medications, verify someone is not taking illegal substances or too much of a prescribed substance, and monitor for toxicity and therapeutic dosing. It is customary for patients in treatment programs for chronic pain management or substance use disorders (SUD) to undergo random urine drug testing (UDT) or urine drug screening (UDS) as part of their individual treatment plan. Drug testing is regulated by federal and state laws (e.g., OSHA, CLIA), which must be carefully adhered to.

Understanding ASCs and APCs: Indicators and Place of Service

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The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

New Codes for Pediatric COVID Vaccinations

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On October 6, 2021, the AMA released three new codes to track COVID-19 vaccinations in the pediatric population.

Watch out for New ICD-10-CM Codes

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New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective on October 1, 2021.

Injection Services

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Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...

When is it Proper to Bill Nurse Visits using 99211

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When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 ‑ 99215 and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit ...

​​Polysomnography Services Under OIG Scrutiny

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The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?

Billing Dental Implants under Medical Coverage

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Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...

New Codes for COVID Booster Vaccine & Monoclonal Antibody Products

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New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.

Understanding How Place of Service Codes Work

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The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...

Medicare's ABN Booklet Revised

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The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.

UCR Anesthesia Fee Calculations and Base Units - Now Available!

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As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information.   Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units). NOTE: Always ...

Important Changes to Shared/Split Services

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Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.

Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021

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Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.

Chronic Care Management Services

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This article discusses some of the different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death.

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!

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If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...

Intersegmental Traction — What’s Happening with Roller Tables?

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Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?

Comparison of Add-On Code Guidelines

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Add-on codes are codes that are not intended to be reported alone. They are reported with another primary procedure to identify that additional services have been provided in conjunction with that primary procedure. Generally, they include the words “List separately in addition to code.” Interestingly, there are some differences in the instructions/guidelines regarding the use of these codes in the CPT® codebook, the NCCI Policy Manual, and on the CMS website. This article outlines the differences between each of these.

New Communication Technology-Based Services (CTBS) Codes for Nonphysicians

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Medicare continues to expand the number of services provided via technology. There are some interesting new codes for nonphysician practitioners (NPPs) (e.g., psychologists, physical therapists) that became effective on January 1, 2021. Communication Technology-Based Services (CTBS), also known as virtual check-ins, describe specific short provider-patient communications which are initiated by the patient.

Coding Lesions and Soft Tissue Excisions

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There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions. The code selection will be determined upon the following: Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain) Technique Topography (anatomic location) The size Tissue Level Type of closure required Layers ...

58% of Improper Payments due to Medical Necessity for Ventilators

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Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...

Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?

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Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source? Answer: This is a great question and one that has been asked by many coders and auditors.

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam

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Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...

Properly Reporting Imaging Overreads (Including X-Rays)

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hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.

Evaluation & Management (E/M) Webinar Q/A

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Find answers to some questions asked by attendees of our recent webinar regarding the changes released by the AMA in their March 9, 2021 Errata and Technical Corrections document in relation to Evaluation & Management (E/M).

How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment

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The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.

Understanding Skin Biopsy Codes

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A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...

How Reporting E/M Based on Time May Lose Money

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Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...

Critical Evaluation and Management Changes Recently Announced by AMA

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On March 9, 2021, the American Medical Association (AMA) announced some pretty significant changes in relation to reporting Evaluation and Management (E/M) services, particularly for Office or Other Outpatient Services (99202-99215). The AMA Editorial Panel had previously met to discuss how to address concerns and made changes surrounding Office or Other Outpatient Services which are retroactive to January 1, 2021. Learn more about those changes in this article.

How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment

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The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.

COVID-19 Vaccines

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To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...

Why CMS Created G2212 for Prolonged Services Instead of 99417

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This article discusses WHY CMS decided to create code G2212 to be used with prolonged office Evaluation and Management (E/M) services instead of code 99417 as of January 1, 2021. The proposed Medicare Physician Fee Schedule stated that code 99417 would be used so it is essential to understand why they made this change to avoid potential problems with billing these services.

2021 Medicare Physician Fee Schedule Updates - Do You Really Need to Worry?

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How To Properly Report Prolonged Services Using 99417 or G2212

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Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215. While Medicare has agreed to accept the AMA's CPT E/M coding changes, they have formulated an opinion contrary to how CPT calculates time specific ...

New Procedure Codes for the Janssen COVID-19 Vaccine

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On January 19, 2021, the AMA announced two new CPT codes for reporting the Janssen Pharmaceutica (a division of Johnson & Johnson) COVID-19 vaccine. Of course, just as with the other COVID-19 vaccines, they must be given FDA approval for Emergency Use Authorization (EUA) to be administered before the codes can be reported. As is ...

AMA Announcement of Additional COVID Vaccine Codes and Guideline Changes in December

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On Friday, December 17, 2020, the AMA announced several changes in relation to the addition of new codes for the COVID-19 vaccine under development by AstraZeneca and University of Oxford. Codes 91302, 0021A, and 0022A were published on the AMA website and will be effective once they have received Emergency Use Authorization (EUA) from the FDA.

Good and Bad News Regarding the 2021 Medicare Physician Fee Schedule

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When the proposed Medicare Physician Fee Schedule came out last year, it really got everyone worried. In a time where we are all facing issues related to COVID, this seemed like a really big problem. Professional organizations lobbied and everyone tried to stop the proposed changes, and the 10.2% decrease didn’t happen, but other changes will still be taking place. So how bad is it really and how will it affect your organization?

Instructions for Looking up IOM References in innoviHealth's HCPCS Publication

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These instructions help owners of innoviHealth's HCPCS Coding for 2021 book access the references to Medicare's Internet-only Manuals (IOMs) which are copies of official program instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives.

CMS Final Rule Changes E/M Reporting Guidelines

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

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

June 2, 2022 : Coding 2022 Care Management Services

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May 5, 2022 : Do Minor Procedures Feel like Major Work?

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April 14 2022 : Reporting Telemedicine Services by Aimee Wilcox

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March 3, 2022 - Split/Shared & Incident-to Evaluation and Management Changes for 2022

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February 8, 2022 - Medicare Audit, Do-it-yourself

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Are your ICD-10 and CPT codes competing?

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AMA Announced New E/M Guideline Changes on March 9, 2021 Retroactively Effective to January 1, 2021

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How to Select an E/M Service Based on Time & Prolonged Services

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1995 E/M Guidelines1997 E/M Guidelines2019 CPT E/M and Prolonged Services Code and Guideline ChangesACA & Choosing Wisely®- "Five Things Clinicians and Patients Should Question”Alcohol Use Disorders Identification Test Guidelines for Use in Primary CareAnnual Wellness Visit (AWV) by CMSBehavioral Health Integration ServicesBehavioral Health Integration Services Fact Sheet by CMSBilling Nutrition Counseling in a Chiropractic SettingCan I Perform 2 Untimed Codes at the Same Time?Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs)Care Plan Oversight (CPO) services information by CGS MedicareCertificate of Medical Necessity CMS-848 — Transcutaneous Electrical Nerve Stimulator (TENS)Clinical Practice Guideline for the Management of Substance Use DisordersCMS - NCCI Edits Policy DownloadCMS - pment, Prosthetics/Orthotics, and Supplies Fee Schedule > Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule Durable Medical Equipment, Prosthetics/Orthotics, and SupplieCMS Clinical Decision Support MechanismsCMS Provider Minute: Psychiatry and PsychotherapyCMS' Chronic Care Management Health Care Professional ToolkitDMEPOS Competitive Bidding Program - Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists Fact SheetDraft Compliance Program Guidance for Recipients of PHS Research AwardsE/M Audit Card for ChiropracticE/M Training Video for ChiropracticFederal Opioid Treatment StandardsHCPCS Code Change Request ApplicationHCPCS General Information - by CMSHealth Behavior Assessment and Intervention Billing and Coding Guide by the APAHome Oxygen Therapy BookletHospice Medicare Billing Codes Sheet by CGS MedicareInitial Preventive Physical Examination (IPPE)Medicare Begins Covering Acupuncture ServicesMLN - Billing and Payment Policies for Negative Pressure Wound Therapy (NPWT) Using a Disposable DeviceMLN Matters Number: MM3927MLN Matters: Cataract Removal with Medicare Part BMLN: Medicare Vision Services Fact SheetMusculoskeletal System Definitions for codes 20005-29999NCCI EditsNCCI Edits Validator Tool by Find-A-CodeNoridian Review of A5500 (Therapeutic Shoes)Normal Joint Range of Motion Study by CDCOpioid Treatment ProgramsOto ProceduresProcedure Coding Topics PageProcedure Coding Topics Page - ChiropracticQuick Reference Chart by CMS: G-codes and Modifiers for Therapy Functional ReportingScreening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol MisuseScreening Pap Tests and Pelvic ExaminationsScreening Pap Tests and Pelvic Examinations by CMSScreening, Brief Intervention, and Referral to Treatment (SBIRT) ServicesSearch ICD-9, ICD-10 and HCPCS Codes by FindACode.comThe Coders Handbook by PMICThe Range of Motion ConundrumUncommon Codes for Chiropractic OfficesUnitedHealthcare Telehealth Services: Care Provider Coding GuidanceWill the New Low Level Laser Therapy Code Solve Your Billing Issues?




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