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Find-A-Code Tools and ResourcesCPT CodesCurrent Procedural Terminology® Codes AMA's E/M GuidelinesAMA's Evaluation & Management (E&M) Guides for CPT Codes NCCI Edits Validator™NCCI Edits Validator™ AMA's CPT® Section GuidelinesAMA's CPT® Section Guidelines Medicare NCCI Edits Policy and GuidelinesMedicare NCCI Edits Manual, Transmittals, & Documents Code-A-NoteCode-A-Note Additional Links and ResourcesE/M UniversityE/M University CMS.govCMS.gov Novitas SolutionsMedicare Part B QPro CertificationsBecome a QPro Certified Coder QPro CEUsQPro CEUs available for QPro members Free CEUs Compliant Coding AcademyFree CEUs from Compliant Coding Academy for Find-A-Code Subscribers BC Advantage 20+ CEUsBC Advantage Magazine & CEUs Coding Bilateral SurgeriesCoding Bilateral Surgeries Billing Requirements for OPPSBilling Requirements for OPPS Providers with Multiple Service Locations Select the title to see a summary and a link to the full article. June 28th, 2022 How Extensions to the COVID-19 Public Health Emergency Affect Healthcare ReimbursementBy Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published June 28th, 2022 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. June 23rd, 2022 Why You Should Be Using The Two-Midnight RuleBy David M. Glaser, Esq. | Published June 23rd, 2022 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... June 21st, 2022 2022-06-16-MLNC - ICD-10-CM Diagnosis Codes: Fiscal Year 2023By CMS - MLNConnects | Published June 21st, 2022 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... June 16th, 2022 2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient AccessBy CMS - MLNConnects | Published June 16th, 2022 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 - -... June 14th, 2022 Using Health IT to Support Safer Use and Management of Controlled Substance PrescriptionsBy Chelsea Richwine and Christian Johnson | Published June 14th, 2022 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... June 9th, 2022 The Nuances of the Two-Midnight RuleBy David M. Glaser, Esq. | Published June 9th, 2022 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... June 6th, 2022 Q/A: Service Period for 99490By Chris Woolstenhulme | Published June 6th, 2022
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 ... June 1st, 2022 Reporting CCM and TCM Codes with E/M CodesBy Chris Woolstenhulme | Published June 1st, 2022 - Last Review/Update June 6th, 2022
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 ... May 31st, 2022 How Much Do You Care about the 2022 Care Management Service Changes?By Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 31st, 2022 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. May 26th, 2022 Preventive Medicine Versus E&M Codes: The Same-Day Coding DilemmaBy Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC | Published May 26th, 2022 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,... May 26th, 2022 Care Management BillingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 26th, 2022
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 ... May 24th, 2022 CMS Claims Risk Adjustment Overpayments Commonly Include 10 Specific DiseasesBy Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 24th, 2022 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. May 23rd, 2022 How Would Your Organization Defend This Auditing Accusation?By Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 23rd, 2022 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. May 19th, 2022 Methadone Take-Home Flexibilities Extension GuidanceBy | Published May 19th, 2022 On March 16, 2020, SAMHSA issued an exemption to Opioid Treatment Programs (OTPs) whereby a state could request “a blanket exception for all stable patients in an OTP to receive 28 days of Take-Home doses of the patient’s medication for opioid use disorder.” States could also “request up to 14 days of Take-Home medication for those patients who are less stable but who the OTP believes can safely handle this level of Take-Home medication.”
The exemption will carry on effective upon the expiration of the COVID-19 Public Health Emergency, subject to conditions listed in this article.
May 17th, 2022 Understanding the Basics of Reporting Mammography ServicesBy Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 17th, 2022 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. May 11th, 2022 HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their RightsBy SAMSHA Newsroom | Published May 11th, 2022 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 May 5th, 2022 Moving to Medical Decision-Making as the Key ComponentBy Erica E. Remer, MD, CCDS | Published May 5th, 2022 - Last Review/Update May 9th, 2022 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... May 2nd, 2022 Continuous Glucose Monitors (CGMs) -- New CodesBy Wyn Staheli, Director of Content | Published May 2nd, 2022 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 ... April 27th, 2022 How to Reduce the Risk of Copy and PasteBy Erica E. Remer, MD, CCDS | Published April 27th, 2022 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... April 26th, 2022 Opportunities to Identify Risk Adjustable Chronic Conditions Expands in 2022By Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 26th, 2022 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? April 26th, 2022 Preventive ServicesBy Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT | Published April 26th, 2022 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... April 25th, 2022 The Impact of Coding on Maternal OutcomesBy Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer | Published April 25th, 2022 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... April 25th, 2022 CMS Creates New Code for Over-the-Counter COVID-19 TestBy Raquel Shumway | Published April 25th, 2022 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.” April 22nd, 2022 Substance Use Disorder Treatment Incentive Program Receives Go Ahead From the OIGBy Raquel Shumway | Published April 22nd, 2022 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. April 21st, 2022 2022-03-03-MLNC - 2022 Payment, Quality, & Policy ChangesBy CMS - MLNConnects | Published April 21st, 2022 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... April 19th, 2022 Infuse Yourself with Knowledge on Reporting Therapeutic, Prophylactic, and Diagnostic Injection ServicesBy Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 19th, 2022 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. April 13th, 2022 Hepatic Fibrosis Coding — Are Your Bases Covered?By Raquel Shumway | Published April 13th, 2022 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. March 31st, 2022 $636 Million in Overpayments Made by Medicare to Providers for NeurostimulatorsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2022
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 ... March 29th, 2022 Considering the Impact of Diagnosis Codes in the E/M EncounterBy Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 29th, 2022 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. March 21st, 2022 Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDMBy Stephanie Allard , CPC, CEMA, RHIT | Published March 21st, 2022 - Last Review/Update March 22nd, 2022 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... March 16th, 2022 Refresh Your IV Hydration Coding KnowledgeBy Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 16th, 2022 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. March 16th, 2022 Continuous Glucose Monitoring (CGM) Systems: Leveraging Everyday Tech to Enhance Diabetes ManagementBy Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer | Published March 16th, 2022 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... March 10th, 2022 2022-03-10-MLNC - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELDBy CMS - MLNConnects | Published March 10th, 2022 - Last Review/Update March 22nd, 2022 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 ... February 24th, 2022 Prolonged Services Billed As a Split/Shared VisitBy Raquel Shumway | Published February 24th, 2022 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. February 24th, 2022 Split/Shared Visits No Longer Specific to Medicare Plans in 2022By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 24th, 2022 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. February 11th, 2022 Critical Care Services Changes in the Medicare 2022 Final RuleBy Raquel Shumway | Published February 11th, 2022 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. February 10th, 2022 SDoH Improves Reimbursement and Risk ScoresBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 10th, 2022 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. February 8th, 2022 Will Your Critical Care Services Pass An Audit?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 8th, 2022 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. January 25th, 2022 Dentists; Treating Patients with a Medical ConditionBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 25th, 2022
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 ... January 25th, 2022 Treating the Genitofemoral Nerve?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 25th, 2022 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 ... December 7th, 2021 Müller Muscle Conjunctival Resection Versus External Levator AdvancementBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 7th, 2021 November 11th, 2021 Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 11th, 2021 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 ... November 9th, 2021 Reporting and Auditing Drug Testing ServicesBy Aimee Wilcox CPMA, CCS-P, CST, MA, MT | Published November 9th, 2021 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. October 28th, 2021 Understanding ASCs and APCs: Indicators and Place of ServiceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 28th, 2021 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 ... October 13th, 2021 New Codes for Pediatric COVID VaccinationsBy Jared Staheli | Published October 13th, 2021 On October 6, 2021, the AMA released three new codes to track COVID-19 vaccinations in the pediatric population. October 4th, 2021 Watch out for New ICD-10-CM CodesBy Wyn Staheli, Director of Content | Published October 4th, 2021 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. September 29th, 2021 Injection ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 29th, 2021 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 ... September 28th, 2021 When is it Proper to Bill Nurse Visits using 99211By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 28th, 2021 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 ... September 2nd, 2021 Polysomnography Services Under OIG ScrutinyBy Raquel Shumway | Published September 2nd, 2021 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?
August 12th, 2021 Billing Dental Implants under Medical CoverageBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 12th, 2021 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 ... August 10th, 2021 New Codes for COVID Booster Vaccine & Monoclonal Antibody ProductsBy Wyn Staheli, Director of Research | Published August 10th, 2021 New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment. August 4th, 2021 Understanding How Place of Service Codes WorkBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 4th, 2021
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 ... July 29th, 2021 Medicare's ABN Booklet RevisedBy Wyn Staheli, Director of Content | Published July 29th, 2021 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. June 23rd, 2021 UCR Anesthesia Fee Calculations and Base Units - Now Available!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 23rd, 2021
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 ... June 16th, 2021 Important Changes to Shared/Split ServicesBy Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published June 16th, 2021 - Last Review/Update June 22nd, 2021 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. June 3rd, 2021 Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021By Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published June 3rd, 2021 - Last Review/Update June 7th, 2021 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. June 1st, 2021 Chronic Care Management ServicesBy Wyn Staheli, Director of Content | Published June 1st, 2021 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. May 25th, 2021 PCS Coding for Ankle Fracture - Look Deeper Into the Codes!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 25th, 2021 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 ... May 20th, 2021 Intersegmental Traction — What’s Happening with Roller Tables?By Wyn Staheli, Director of Content | Published May 20th, 2021 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? May 4th, 2021 Comparison of Add-On Code GuidelinesBy Wyn Staheli, Director of Content | Published May 4th, 2021 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. May 3rd, 2021 New Communication Technology-Based Services (CTBS) Codes for NonphysiciansBy Wyn Staheli, Director of Content | Published May 3rd, 2021 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. April 29th, 2021 Coding Lesions and Soft Tissue ExcisionsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 29th, 2021 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 ... April 29th, 2021 58% of Improper Payments due to Medical Necessity for VentilatorsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 29th, 2021 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 ... April 19th, 2021 Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 19th, 2021 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. April 12th, 2021 How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness ExamBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 12th, 2021 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 ... April 8th, 2021 Properly Reporting Imaging Overreads (Including X-Rays)By Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published April 8th, 2021 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. April 1st, 2021 Evaluation & Management (E/M) Webinar Q/ABy Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research | Published April 1st, 2021 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). March 31st, 2021 How Social Determinants of Health (SDOH) Data Enhances Risk AdjustmentBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 31st, 2021 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. March 23rd, 2021 Understanding Skin Biopsy CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 23rd, 2021 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 ... March 18th, 2021 How Reporting E/M Based on Time May Lose MoneyBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 18th, 2021 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 ... March 16th, 2021 Critical Evaluation and Management Changes Recently Announced by AMABy Wyn Staheli, Director of Content | Published March 16th, 2021 - Last Review/Update March 17th, 2021 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. March 10th, 2021 How Social Determinants of Health (SDOH) Data Enhances Risk AdjustmentBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 10th, 2021 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. March 10th, 2021 COVID-19 VaccinesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 10th, 2021 - Last Review/Update May 13th, 2021 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 ... February 17th, 2021 Why CMS Created G2212 for Prolonged Services Instead of 99417By Wyn Staheli, Director of Content | Published February 17th, 2021 - Last Review/Update February 22nd, 2021 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. February 11th, 2021 2021 Medicare Physician Fee Schedule Updates - Do You Really Need to Worry?By Jared Staheli | Published February 11th, 2021 February 3rd, 2021 How To Properly Report Prolonged Services Using 99417 or G2212By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 3rd, 2021 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 ... February 1st, 2021 New Procedure Codes for the Janssen COVID-19 VaccineBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 1st, 2021 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 ... January 15th, 2021 AMA Announcement of Additional COVID Vaccine Codes and Guideline Changes in DecemberBy Wyn Staheli, Director of Content | Published January 15th, 2021 - Last Review/Update January 19th, 2021 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. January 11th, 2021 Good and Bad News Regarding the 2021 Medicare Physician Fee ScheduleBy Wyn Staheli, Director of Content | Published January 11th, 2021 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? January 11th, 2021 Instructions for Looking up IOM References in innoviHealth's HCPCS PublicationBy Wyn Staheli, Director of Content | Published January 11th, 2021 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. January 5th, 2021 CMS Final Rule Changes E/M Reporting GuidelinesBy Wyn Staheli, Director of Content | Published January 5th, 2021 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. December 31st, 2020 CMS Final Rule Changes E/M Reporting GuidelinesBy Wyn Staheli, Director of Content | Published December 31st, 2020 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. December 8th, 2020 Common Medical to Dental Procedures and Where to Find ThemBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020 With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ... December 8th, 2020 CDT and CPT - The Same but Different!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020 Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ... December 8th, 2020 Final Rule on Communications Technology and 2021 Physicians Fee ScheduleBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020 To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ... December 7th, 2020 Clinical Documentation in Find-A-Code!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 7th, 2020
Clinical documentation is one of the most important aspects of coding, Find-A-Code offers documentation tips and requirements in several places. You can find general information with our TIPS and articles or information directly from a particular payer or source. Below are a few examples to help you get started.
Commercial Payer ... November 24th, 2020 How Might the New 2021 E/M Guideline Changes Impact Risk Adjustment?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published November 24th, 2020
While provider organizations are busy learning the new E/M guideline changes being implemented January 1, 2021, Medicare Advantage Organizations (MAOs) are contemplating how the documentation changes for these services may impact risk adjustment coding. To be clear, the new E/M guidelines only pertain to Office and Other Outpatient E/M Services ... November 11th, 2020 COVID Vaccine Codes AnnouncedBy Wyn Staheli, Director of Content | Published November 11th, 2020 - Last Review/Update November 12th, 2020 On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines. October 12th, 2020 What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?By Aimee Wilcox | Published October 12th, 2020
When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ... October 8th, 2020 Significant COVID-19 Code Changes as of October 6By Wyn Staheli, Director of Content | Published October 8th, 2020 - Last Review/Update October 13th, 2020 Significant COVID-19 Code Changes as of October 6 September 15th, 2020 More COVID-19 Codes Added as of September 8, 2020By Wyn Staheli, Director of Content | Published September 15th, 2020 The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well. September 1st, 2020 Not Following the Rules Costs Chiropractor $5 MillionBy Wyn Staheli, Director of Content | Published September 1st, 2020 Every healthcare office needs to know and understand the rules that apply to billing services and supplies. What lessons can we learn from the mistakes of others? What if we have made the same mistake? August 26th, 2020 Ultrasound - A Complete Exam Must Include the FollowingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 26th, 2020 Real time scanning of the kidneys
Abdominal aorta
Common iliac artery origins
Inferior vena cava
Alternaltively, if ultrasonography is being performed to evaluate the urinary tract, examination of the kidneys and urinary bladder constitutes a complete exam. Code 76775 is used when a limited retroperitoneal ultrasound examination is performed.
... August 10th, 2020 Coding Injections for Pain ManagementBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2020
Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.
Trigger Point Injections
Trigger point injections are reported by how many muscles are treated using an ... August 10th, 2020 Modifier 50 — Four "Must Know" Tips For Getting PaidBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published August 10th, 2020 Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional... August 7th, 2020 Impact of 2021 Proposed Medicare Fee Schedule on Chiropractic OfficesBy Wyn Staheli, Director of Content | Published August 7th, 2020 On August 3, 2020, the proposed Medicare Physician Fee Schedule for 2021 was released. This 1,355 page document includes some sweeping changes to the Medicare program. There are a few items in particular which should be noted by chiropractic offices. August 5th, 2020 Coding with PCS When There is No CodeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 5th, 2020 ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ... July 15th, 2020 Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD RehabBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 15th, 2020 The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ... July 14th, 2020 Are NCCI Edits and Modifiers Just for Medicare?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 14th, 2020 The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ... July 9th, 2020 Payment Adjustment Rules for Multiple Procedures and CCI EditsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2020 Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ... June 29th, 2020 HCPCS Codes Were NOT all Created for the Same PurposeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2020 Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ... June 29th, 2020 Additional COVID-19 Testing Codes AnnouncedBy Wyn Staheli, Director of Content | Published June 29th, 2020 New coronavirus antigen testing codes announced. These are effective immediately. June 18th, 2020 CMS- Reminder COVID Assessment and Specimen CollectionBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 18th, 2020
On March 1, 2020, new codes and rules were released to bill for COVID-19 symptom and exposure assessments, as well as specimen collection. CMS has recently sent out reminders on billing for these services, the proper use of the CS modifier on claims, and how they are handling denials due ... June 15th, 2020 Outpatient Facility PricingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020 Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ... June 10th, 2020 MEGA - NCCI Edit Changes - WHO Knew?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 10th, 2020 There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included;
291,902 Deleted Procedure to Procedure (PTP) edits
197 Deleted Medically Unlikely ... June 3rd, 2020 Watch for Payer Telehealth Coverage ChangesBy Wyn Staheli, Director of Content | Published June 3rd, 2020 As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage. June 1st, 2020 Additional Practice Reopening TipsBy Wyn Staheli, Director of Content | Published June 1st, 2020 As practices begin reopening across the nation, there are several things that need to be considered. Policies and Procedures Manuals need to be updated, malpractice carriers need to be contacted and everyone needs to consider mental health screenings and support. May 18th, 2020 Packaging and Units for Billing DrugsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 18th, 2020 To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number.
Take a look at the following
J1071 - Injection, testosterone cypionate, 1mg
For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL
(100 mg/mL = 1 mL and there are ... May 13th, 2020 Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 13th, 2020
On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states:
“Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ... April 21st, 2020 Special COVID Laboratory Specimen Coding InformationBy Wyn Staheli, Director of Content | Published April 21st, 2020 With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies. April 20th, 2020 Emergency Room and Ancillary ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 20th, 2020
Billing for an Emergency department is not the same as billing for a hospital or in the provider's office; there are several differences and requirements. For example. the hospital will report a stay with Diagnosis Related Groups (DRG's), which include hospital resources used during the patient's stay, while office visits ... April 15th, 2020 New CPT® Codes Approved for COVID-19 Antibody IdentificationBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 15th, 2020 On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing. April 15th, 2020 Medicare Released the Amount they Will pay for COVID Testing Eff 4/14/2020By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 15th, 2020 April 13th, 2020 CPT Coding Guidance on New Lab Code for COVID-19By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 13th, 2020 According to the AMA, "The Addition of one Category I Pathology and Laboratory code (87635) for severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) (Coronavirus disease [COVID-19]) accepted at the March 2020 CPT Editorial Panel meeting.
*Note that code 87635 will be a child code under parent code 87471. It is represented here ... April 7th, 2020 More Telehealth Changes Announced by CMS Chiropractic Offices Should Know AboutBy Wyn Staheli, Director of Content | Published April 7th, 2020 On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar. April 2nd, 2020 More Telehealth Changes Announced by CMSBy Wyn Staheli, Director of Content | Published April 2nd, 2020 On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information March 31st, 2020 CMS-Coverage for Therapeutic Shoes for Individuals with DiabetesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2020 Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ... March 30th, 2020 Providing Telehealth Services During COVID-19 CrisisBy Wyn Staheli, Director of Content | Published March 30th, 2020 The rules for providing telehealth services during this pandemic have changed and some requirements have been waived. Please keep in mind that “waiving requirements” does not mean that anything goes. Another important consideration is that Medicare and private payers may likely have different rules so you need to make sure that you know individual payer requirements during this time. March 27th, 2020 Interprofessional Consult ServicesBy Namas | Published March 27th, 2020 - Last Review/Update April 1st, 2020
The recent coronavirus crisis has brought non-face-to-face services to the forefront of coding and billing conversations. With the entire healthcare industry focused on caring for patients during an unprecedented and fast-moving pandemic, the goal of increasing patient access while reducing the risk of spreading infection has become paramount.
In this climate, ... March 26th, 2020 New Biofeedback Codes to replace 90911 Eff 2020-01-01By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 26th, 2020 CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911.
According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate.
Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ... March 26th, 2020 LATEST COVID-19 INFORMATION FOR BILLING NON-FACE-TO-FACE SERVICESBy Namas | Published March 26th, 2020 Healthcare providers and the population at large are concerned about safe access to care considering the COVID-19 pandemic. As a result, we have received many inquiries this week about how to bill for “telehealth” services.
Let’s first address that true telehealth services have some pretty stringent requirements from CMS, including that ... March 24th, 2020 "What is the ICD-10 code for...?" - Search Smarter With Find-A-Code ToolsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 24th, 2020 Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ... March 21st, 2020 Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)By | Published March 21st, 2020 The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ... March 20th, 2020 Implementing Telehealth VisitsBy Namas | Published March 20th, 2020 - Last Review/Update March 23rd, 2020 The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection.
Step ... March 17th, 2020 Additional Coronavirus Testing Code AnnouncedBy Wyn Staheli, Director of Content | Published March 17th, 2020 On March 13, 2020, a new CPT code was announced by the American Medical Association (AMA) who maintains the CPT code set. This early release of a CPT code is rare and is effective immediately. February 20th, 2020 Acupuncture ClarificationBy Wyn Staheli, Director of Content | Published February 20th, 2020 In the ChiroCode Newsletter released yesterday regarding Medicare coverage of acupuncture, one sentence in particular has let to some confusion. Read more about it here. February 20th, 2020 New HCPCS Code for Coronavirus Testing AnnouncedBy Wyn Staheli, Director of Content | Published February 20th, 2020 - Last Review/Update February 26th, 2020 Currently, healthcare providers testing patients for Coronavirus must use an unspecified code. To provide better tracking, on February 13, 2020, CMS announced the creation of a new HCPCS code. February 19th, 2020 Medicare Begins Covering Acupuncture ServicesBy Wyn Staheli, Director of Content | Published February 19th, 2020 Medicare is changing their policy regarding coverage of acupuncture, but in order to provide these services, you must follow their rules. February 10th, 2020 A 2020 Radiology Coding Change You Need To KnowBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 10th, 2020 The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is... January 30th, 2020 Medicare Announces Coverage of Acupuncture ServicesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 30th, 2020 On January 21, 2020, a CMS Newsroom press-release read,
This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ... January 21st, 2020 Q/A: How do we Bill Massage Services?By Wyn Staheli, Director of Content | Published January 21st, 2020 Question: We are adding a massage therapist soon and have some questions about billing their services. January 14th, 2020 Billing for Telemedicine in ChiropracticBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 14th, 2020 Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care. January 14th, 2020 Q/A: Can Chiropractors Bill 99211?By Wyn Staheli, Director of Content | Published January 14th, 2020 Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code... January 9th, 2020 Who Knew? There are Three Types of Add-On CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 9th, 2020
Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ... January 3rd, 2020 CPT 2020 Changes to Psychiatry ServicesBy Namas | Published January 3rd, 2020 - Last Review/Update January 7th, 2020 As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and ... December 30th, 2019 Medicare Changes Bilateral Reporting Rules for Certain SuppliesBy Wyn Staheli, Director of Content | Published December 30th, 2019 - Last Review/Update January 6th, 2020 DME suppliers must bill bilateral supplies with modifiers RT and LT on separate claim lines or they are being rejected. December 20th, 2019 What to look for when auditing moderate sedation codes 99151-99153By Namas | Published December 20th, 2019 - Last Review/Update January 9th, 2020 What to look for when auditing moderate sedation codes 99151-99153
Physicians performing diagnostic and therapeutic procedures can now separately bill for the provision of moderate sedation services, but there are some interesting wrinkles to be looking for when auditing these services.
Starting in 2017, moderate sedation codes 99151-99157 were created to address ... October 18th, 2019 Medically Unlikely Edits (MUEs): Unlikely, But Not Always ImpossibleBy Namas | Published October 18th, 2019 - Last Review/Update October 23rd, 2019 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 ... October 10th, 2019 Eliminating Consultation Codes?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 10th, 2019 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 ... September 30th, 2019 New Codes for Dry NeedlingBy Wyn Staheli, Director of Content | Published September 30th, 2019 Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture. September 30th, 2019 Vaccine Administration - When The Right Vaccine Code is Not EnoughBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2019 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 ... September 30th, 2019 Q/A: How Do I Bill a House Call?By Wyn Staheli, Director of Content | Published September 30th, 2019 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 ... September 16th, 2019 E-Health is a Big Deal in 2020By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 16th, 2019 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 ... September 9th, 2019 Chiropractic 2020 Codes Changes Are HereBy Wyn Staheli, Director of Content | Published September 9th, 2019 There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing? August 20th, 2019 Are You Aware of Medicare Advantage Plans Timely Filing Rules?By Aimee Wilcox | Published August 20th, 2019 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 ... August 19th, 2019 Understanding Payment IndicatorsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 19th, 2019 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 ... August 13th, 2019 How to Properly Report Prolonged Evaluation and Management ServicesBy Aimee Wilcox | Published August 13th, 2019 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 ... August 13th, 2019 Healthcare Common Procedure Coding System (HCPCS)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 13th, 2019 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, ... August 13th, 2019 Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?By Wyn Staheli, Director of Content | Published August 13th, 2019 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. August 13th, 2019 Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published August 13th, 2019 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 ... August 6th, 2019 CMS Proposes to Reverse E/M Stance to Align with AMA RevisionsBy Wyn Staheli, Director of Content | Published August 6th, 2019 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., ... July 15th, 2019 Denial Management is Key to ProfitabilityBy Wyn Staheli, Director of Content | Published July 15th, 2019 July 9th, 2019 The Importance of Medical NecessityBy Marge McQuade, CMSCS, CHCI, CPOM | Published July 9th, 2019 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 ... July 9th, 2019 When Can You Bill Orthosis Components Separately?By Wyn Staheli, Director of Content | Published July 9th, 2019 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)? July 8th, 2019 Will the New Low Level Laser Therapy Code Solve Your Billing Issues?By Wyn Staheli, Director of Content | Published July 8th, 2019 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 ... July 1st, 2019 Q/A: Do I Really Need to Have an Interpreter?By Wyn Staheli, Director of Content | Published July 1st, 2019 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 ... June 18th, 2019 How to Properly Report Monitoring Patients Taking Blood-thinning MedicationsBy Wyn Staheli, Director of Content | Published June 18th, 2019 - Last Review/Update June 19th, 2019 Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services. June 14th, 2019 A United ApproachBy Namas | Published June 14th, 2019 - Last Review/Update June 18th, 2019 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 ... June 13th, 2019 What Medical Necessity Tools Does Find-A-Code Offer?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published June 13th, 2019 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 ... June 13th, 2019 Spotlight: Anatomy ImagesBy Brittney Murdock, QCC, CMCS, CPC | Published June 13th, 2019 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.
June 13th, 2019 Documentation of E/M services for Neurology (Don't Forget the Cardiology Element)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 13th, 2019 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 ... June 13th, 2019 Medicare Approves Reimbursement for Virtual Communication (G2012)By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published June 13th, 2019 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 ... June 13th, 2019 Medicare Now Reimburses for Remote Monitoring Services (G2010)By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published June 13th, 2019 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 ... June 6th, 2019 How to Code Ophthalmologic Services AccuratelyBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published June 6th, 2019 - Last Review/Update June 11th, 2019 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 ... May 29th, 2019 Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 29th, 2019 - Last Review/Update June 4th, 2019 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? May 27th, 2019 Your New Patient Exam Code Could Determine How Many Visits You GetBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 27th, 2019 - Last Review/Update June 6th, 2019 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 ... May 24th, 2019 What to Look for When Auditing Smoking Cessation ServicesBy NAMAS | Published May 24th, 2019 - Last Review/Update June 19th, 2019 What to Look for When Auditing Smoking Cessation Services May 13th, 2019 Electrical Stimulation and Electromagnetic Therapy DevicesBy Raquel Shumway | Published May 13th, 2019 - Last Review/Update May 20th, 2019 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. May 8th, 2019 Facts on Procedure CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 8th, 2019 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, ... May 1st, 2019 Spotlight: ASA CrosswalkBy Brittney Murdock, QCC, CMCS, CPC | Published May 1st, 2019 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... April 29th, 2019 Q/A: I’m Being Audited? Is There a Documentation Template I can use?By Wyn Staheli, Director of Content | Published April 29th, 2019 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 ... April 24th, 2019 Biofeedback - Is it Medically Necessary?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 24th, 2019 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 ... April 23rd, 2019 Let's Talk High Risk E/M ServicesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 23rd, 2019 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 ... April 23rd, 2019 CPT Announces 2021 E/M ChangesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 23rd, 2019 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 ... April 23rd, 2019 What is Medical Necessity and How Does Documentation Support It?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 23rd, 2019 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 ... April 22nd, 2019 Auditing Chiropractic ServicesBy By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019 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. April 19th, 2019 Auditing Ophthalmology and Optometry ExamsBy Namas | Published April 19th, 2019 - Last Review/Update April 23rd, 2019 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 ... April 1st, 2019 Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?By Wyn Staheli, Director of Content | Published April 1st, 2019 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 ... April 1st, 2019 Spinal Cord Stimulator Used for Chronic PainBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 1st, 2019 Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes.
ICD-10-CM Diagnosis Codes ... April 1st, 2019 Corrections and UpdatesBy Wyn Staheli, Director of Content | Published April 1st, 2019 - Last Review/Update April 2nd, 2019 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 ... April 1st, 2019 CPT Codes That Include Moderate Sedation (Appendix G)By Find-A-Code | Published April 1st, 2019 - Last Review/Update April 2nd, 2019 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.
... April 1st, 2019 FDA Approval Pending Products (Appendix K)By Find-A-Code | Published April 1st, 2019 - Last Review/Update April 2nd, 2019 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
... March 29th, 2019 Prolonged ServicesBy Namas | Published March 29th, 2019 - Last Review/Update April 4th, 2019 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) ... March 26th, 2019 Add on Codes for CPT (Appendix D)By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019 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
... March 26th, 2019 CPT Codes Exempt from Modifier 51 (Appendix E)By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019 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
... March 26th, 2019 CPT Codes That Should Not Be Reported With Modifier 63 (Appendix F)By Find-A-Code | Published March 26th, 2019 - Last Review/Update April 2nd, 2019 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
... March 21st, 2019 The Impact of Medical Necessity on High Level E/M ServicesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 21st, 2019 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. ... March 18th, 2019 How to Report Imaging (X-Rays) of the ThumbBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 18th, 2019 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 ... March 11th, 2019 Spotlight: Services Excluded from Global Surgery PaymentBy Brittney Murdock, QCC, CMCS, CPC | Published March 11th, 2019 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... March 7th, 2019 Date of Service Reporting for Radiology ServicesBy Wyn Staheli, Director of Content | Published March 7th, 2019 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. March 4th, 2019 Billing Guidelines for RepositioningBy Wyn Staheli, Director of Content | Published March 4th, 2019 - Last Review/Update March 6th, 2019 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 ... March 4th, 2019 Answers to Your Auditing & Compliance QuestionsBy Namas | Published March 4th, 2019 - Last Review/Update March 7th, 2019 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, ... March 4th, 2019 Spotlight: GLOBAL PeriodsBy Brittney Murdock, QCC, CMCS, CPC | Published March 4th, 2019 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... March 4th, 2019 UnitedHealthcare to Discontinue Coverage of ConsultationsBy Wyn Staheli, Director of Content | Published March 4th, 2019 - Last Review/Update March 7th, 2019 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). March 4th, 2019 Medicare Physician Fee Schedule IndicatorsBy Brittney Murdock, QCC, CMCS, CPC | Published March 4th, 2019 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... March 1st, 2019 Understanding NCCI EditsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 1st, 2019 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 ... February 22nd, 2019 Separately Report a "Separate Procedure" with ConfidenceBy Namas | Published February 22nd, 2019 - Last Review/Update February 28th, 2019 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 ... February 14th, 2019 Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage BeneficiariesBy Aimee Wilcox | Published February 14th, 2019 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 ... February 13th, 2019 Detection by Nucleic Acid (DNA or RNA) - Amplified Probe TechniqueBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 2019 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 ... February 12th, 2019 Coding Medicare Initial Preventive Physical Exams (IPPE)By | Published February 12th, 2019 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 ... February 7th, 2019 Q/A: Do Digital X-rays Have Their Own Codes?By Wyn Staheli, Director of Content | Published February 7th, 2019 - Last Review/Update February 8th, 2019 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 ... February 5th, 2019 Clinical Staff vs. Healthcare ProfessionalBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 5th, 2019 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 ... February 1st, 2019 Q/A: Can I Bill a Review of X-Rays?By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published February 1st, 2019 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 ... February 1st, 2019 Physical Therapy Caps Q/ABy Wyn Staheli, Director of Content | Published February 1st, 2019 - Last Review/Update February 4th, 2019 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 ... January 28th, 2019 Q/A Neonate Coding When Child is Transferred (2019/01/17)By Codapedia | Published January 28th, 2019 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 ... January 24th, 2019 Q/A: Which Code Should I Use for a Lab Interpretation Fee?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 24th, 2019 - Last Review/Update February 4th, 2019 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 ... January 23rd, 2019 Everything You need to Know about DrugsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2019 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 ... January 23rd, 2019 How to Report Co-Surgeons Using Modifier 62By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 23rd, 2019 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 ... January 22nd, 2019 Home Oxygen TherapyJanuary 14th, 2019 What is Virtual Communication (G0071)?By NAMAS | Published January 14th, 2019 - Last Review/Update January 16th, 2019
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 ... January 14th, 2019 AMA Issues new CMT InformationBy Wyn Staheli, Director of Content | Published January 14th, 2019 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 ... January 14th, 2019 Q/A: Is G8730 Still Required? Are G Codes Required at all?By Wyn Staheli, Director of Content | Published January 14th, 2019 - Last Review/Update January 21st, 2019 G8730, when is it required. Many G codes are still active and are required for non-quality reporting. January 10th, 2019 Are You Protecting Your Dental Practice From Fraud?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 10th, 2019 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 ... January 4th, 2019 Nine New Codes for Fine Needle Aspirations (FNA) in 2019By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 4th, 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 ... January 3rd, 2019 Dry NeedlingBy Wyn Staheli, Director of Content | Published January 3rd, 2019 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 ... January 3rd, 2019 Are You Ready For the 2019 New CodesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 3rd, 2019 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 ... January 3rd, 2019 2019 Coding Changes for ChiropracticBy Wyn Staheli, Director of Content | Published January 3rd, 2019 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 ... January 3rd, 2019 New Genetic Test for Severe Inherited ConditionsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 3rd, 2019 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 ... January 3rd, 2019 Welcome 2019 CPT Codes!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 3rd, 2019 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 ... December 20th, 2018 The Diabetic Patient and Medical ManifestationsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 20th, 2018 December 20th, 2018 Flexion-Distraction Billing ClarificationBy Wyn Staheli, Director of Content | Published December 20th, 2018 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 ... November 29th, 2018 Billing Exercise EquipmentBy Wyn Staheli, Director of Content | Published November 29th, 2018 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 ... November 26th, 2018 Allergy Immunotherapy Coding Guidelines (CMS) Effective: 01/01/2006By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 26th, 2018 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 ... November 26th, 2018 CMT Fees in 2019By Wyn Staheli, Director of Content | Published November 26th, 2018 - Last Review/Update January 30th, 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. November 9th, 2018 Billing 99211 Its not a freebieBy | Published November 9th, 2018 - Last Review/Update November 29th, 2018 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... November 8th, 2018 Muscle Testing and Range of Motion InformationBy Wyn Staheli, Director of Content | Published November 8th, 2018 Be sure to understand the unique code requirements for Muscle and Range of Motion Testing. November 7th, 2018 Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?By Wyn Staheli, Director of Content | Published November 7th, 2018 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 ... November 7th, 2018 Medi-Cal Coverage Criteria for Hospital Beds and AccessoriesBy Raquel Shumway | Published November 7th, 2018 Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required. October 30th, 2018 Documentation Requirements for Allergy Testing 10/29/2018By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 30th, 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 ... October 30th, 2018 Common Allergy CPT Codes and MUEsBy Find-A-Code™ | Published October 30th, 2018 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 ... October 29th, 2018 Allergy Testing 10/29/2018By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 29th, 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 ... October 16th, 2018 Pelvic Floor Dysfunction Treatment CoverageBy Wyn Staheli, Director of Content | Published October 16th, 2018 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 ... October 16th, 2018 Q/A: What Codes do I use for CLIA-Waived Tests?By Wyn Staheli, Director of Content | Published October 16th, 2018 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 ... October 5th, 2018 Prolonged Services Its Not Just About TimeBy BC Advantage | Published October 5th, 2018 - Last Review/Update October 17th, 2018 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 ... October 4th, 2018 Is cox-flexion distraction billable as 97012By ChiroCode | Published October 4th, 2018 - Last Review/Update January 17th, 2019 Is cox-flexion distraction billable as 97012? Can you use 97140 and 98941 on the same day? October 2nd, 2018 Tools and Resources for Life Care PlannersBy Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS | Published October 2nd, 2018 Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on... September 28th, 2018 Chiropractic OIG Audit Recommendations - Lessons LearnedBy Wyn Staheli, Director of Content | Published September 28th, 2018 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 ... September 26th, 2018 Rhizotomy ProceduresBy BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018 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... September 26th, 2018 The Potential Impacts of a Flat Rate EM Reimbursement on our IndustryBy BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018 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... September 24th, 2018 2019 Code Changes are Just Around the Corner - Are You Ready?By Wyn Staheli, Director of Content | Published September 24th, 2018 - Last Review/Update January 28th, 2019 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 ... August 30th, 2018 Keys to Successful Claims FilingBy Noridian Medicare | Published August 30th, 2018 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 ... August 27th, 2018 Pricing for ASC’s and APC’sBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 27th, 2018 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... August 16th, 2018 Importance of Depression ScreeningsBy Wyn Staheli, Director of Content | Published August 16th, 2018 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 ... August 16th, 2018 Medicare Timed Codes GuidelinesBy Wyn Staheli, Director of Content | Published August 16th, 2018 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 ... August 16th, 2018 Using Modifiers 96 and 97By Wyn Staheli, Director of Content | Published August 16th, 2018 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. ... August 16th, 2018 Q/A: Can I Bill Mechanical Massage?By Wyn Staheli, Director of Content | Published August 16th, 2018 - Last Review/Update January 30th, 2019 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. August 15th, 2018 BREAKING NEWS: CMS Proposes to Change E&M CodingBy | Published August 15th, 2018 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 ... July 25th, 2018 CMS Proposes Changes to Evaluation & Management RequirementsBy Wyn Staheli, Director of Content | Published July 25th, 2018 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 ... July 25th, 2018 Q/A: Can I Bill Spinal Decompression Table to Insurance?By Wyn Staheli, Director of Content | Published July 25th, 2018 - Last Review/Update January 28th, 2019 Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended? July 18th, 2018 Provider-Based Facilities and Split Billing: Is Your Facility Being Reimbursed for All Work Performed?By | Published July 18th, 2018 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 ... July 12th, 2018 Q/A: Can You Swap Out 97140 with 97530?By Wyn Staheli, Director of Content | Published July 12th, 2018 - Last Review/Update January 28th, 2019 Codes 97140 and 97530 are not interchangeable. See why. July 9th, 2018 Documentation: Face to Face for Home Health CertificationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018 As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ... June 20th, 2018 Q/A: Should I Bill Massage as 97124 or 97140?By ChiroCode | Published June 20th, 2018 - Last Review/Update January 30th, 2019 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 ... June 14th, 2018 Home Oxygen Therapy -- CMN for OxygenBy Raquel Shumway | Published June 14th, 2018 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. June 13th, 2018 Q/A: Coding for ECG/EKG’sBy Chris Woolstenhulme QCC, CMCS, CPC, CMRS & Marge McQuade | Published June 13th, 2018 - Last Review/Update September 24th, 2018 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 ... June 11th, 2018 Inappropriate Use of Units Costs Practice Over $800,000By Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT | Published June 11th, 2018 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? June 8th, 2018 Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?By Sharon Hoglund, CPC, CPMA, CEMC, CEMA | Published June 8th, 2018 - Last Review/Update July 3rd, 2018 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... June 7th, 2018 The Range of Motion ConundrumBy Gregg Friedman, DC, CCSP | Published June 7th, 2018 - Last Review/Update January 30th, 2019 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 ... June 5th, 2018 Q/A: Coding for Lesion Removal and RepairBy Chris Woolstenhulme QCC, CMCS, CPC, CMRS | Published June 5th, 2018 - Last Review/Update July 9th, 2018 The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that... June 4th, 2018 How Many Modalities Are Too Many?By Dr Evan Gwilliam, Clinical Director for PayDC chiropractic EHR software | Published June 4th, 2018 - Last Review/Update January 30th, 2019 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? June 4th, 2018 Auditing Therapy Evaluation Codes - Not So Quick!By Nancy J Beckley, MS, MBA, CHC | Published June 4th, 2018 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... May 30th, 2018 EM Code Changes in CPT 2018By Amy C. Pritchett, BSHA, CCS, CPC, CPMA, CPC-I, CEDO, CANPC, CASCC, CEDC, CRC, ICDCT-CM/PCS | Published May 30th, 2018 - Last Review/Update June 4th, 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. May 22nd, 2018 AMA vs Medicare rules and the use of the PT modifierBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 22nd, 2018 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 ... May 9th, 2018 Preventive Medicine: General ProceduresBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018 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 ... May 9th, 2018 Preventive Medicine: Alcohol Misuse Screening & CounselingBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening for AnemiaBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Annual Wellness VisitBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Bone Mass MeasurementsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Breast Cancer Genetic ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Breastfeeding SuppliesBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Cardiovascular Disease Screening TestsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Cervical Dysplasia ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Colorectal Cancer ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Contraceptive MethodsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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: ... May 9th, 2018 Preventive Medicine: Counseling to Prevent Tobacco UseBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Depression ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Diabetes ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Diabetes Self-Management TrainingBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Therapy for Fall PreventionBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Glaucoma ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and AdministrationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Hepatitis C Virus (HCV) ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Human Immunodeficiency Virus (HIV) ScreeningBy Brandon Herman, QMC, QMCC, QMBHC, QMPM, QMPoC | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Human Papilomavirus (HPV) Vaccine and ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Influenza Virus Vaccine and AdministrationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Initial Preventive Physical ExaminationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity PreventionBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Lung Cancer ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Newborn Screenings/TestsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Pneumococcal Vaccine and AdministrationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Prostate Cancer ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 - ... May 9th, 2018 Preventive Medicine: Screening for STIs & HIBC to Prevent STIsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening MammographyBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening Pap TestsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening Gynecological ExaminationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening Children for Visual AcuityBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Use of Modifier 33By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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.
... May 9th, 2018 Preventive Medicine: Dental Caries in ChildrenBy Find-A-Code | Published May 9th, 2018 - Last Review/Update August 2nd, 2018 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 ... April 26th, 2018 Documenting DMEsBy Find-A-Code | Published April 26th, 2018 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 ... April 23rd, 2018 Brooklyn Chiropractor OIG Report - Lessons LearnedBy Wyn Staheli, ChiroCode Director of Research & Dr. Evan Gwilliam, Clinical Director PayDC Software | Published April 23rd, 2018 - Last Review/Update February 28th, 2019 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. April 23rd, 2018 Critical Care DocumentationBy Scott Kraft, CPC, CPMA | Published April 23rd, 2018 - Last Review/Update May 2nd, 2018 Critical care documentation should show critical need for the patient AND immediate action by the provider.... April 19th, 2018 Coverage Criteria for Nonwearable Automatic DefibrillatorsBy Find-A-Code | Published April 19th, 2018 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 ... April 17th, 2018 Q/A: Modifiers for InjectionsBy Nicole Olsen QCC | Published April 17th, 2018 - Last Review/Update July 9th, 2018 I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit.... April 16th, 2018 Indications for Serotypes A and B Botulinum ToxinsBy Find-A-Code | Published April 16th, 2018 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 ... April 12th, 2018 Billing Nutrition Counseling in a Chiropractic SettingBy Wyn Staheli, Director of Content | Published April 12th, 2018 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 ... April 12th, 2018 Billing Nutrition CounselingBy Wyn Staheli, Director of Content | Published April 12th, 2018 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 ... April 9th, 2018 Coverage Criteria for Peripheral Venous ExaminationsBy Find-A-Code | Published April 9th, 2018 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 ... April 9th, 2018 Using Pulmonary Stress TestsBy Find-A-Code | Published April 9th, 2018 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 • ... March 29th, 2018 Medicare Telemedicine Changes for 2018By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 29th, 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 ... March 27th, 2018 Home Oxygen Therapy -- A Face-to-Face EncounterBy Raquel Shumway | Published March 27th, 2018 - Last Review/Update June 14th, 2018 What is required for a Home Oxygen Therapy, Face-to-Face Encounter. March 26th, 2018 Q/A: Which Modifiers to Use When Billing 44005 and 36556 TogetherBy Chris Woolstenhulme QCC, CMCS, CPC, CMRS | Published March 26th, 2018 - Last Review/Update April 11th, 2018 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? March 26th, 2018 Documentation for Evaluation and Management (E/M) ServicesBy | Published March 26th, 2018 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 ... March 21st, 2018 Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?By Wyn Staheli, Director of Research | Published March 21st, 2018 - Last Review/Update January 30th, 2019 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. March 21st, 2018 Q/A: Billing for GI AnesthesiaBy Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 21st, 2018 - Last Review/Update March 27th, 2018 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. March 13th, 2018 When is 97112 Neuromuscular Re-education Billable?By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019 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. March 13th, 2018 CPT Code for DOT examsBy Wyn Staheli, Director of Research | Published March 13th, 2018 - Last Review/Update January 31st, 2019 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? March 9th, 2018 The Comprehensive Error Rate Testing ProgramBy Frank Cohen, MBA, MPA | Published March 9th, 2018 - Last Review/Update April 12th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? March 9th, 2018 Documentation for Negative Pressure Wound TherapyBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy. March 9th, 2018 Documentation for Surgical DressingsBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for surgical dressings.
March 9th, 2018 Documentation for Urological SuppliesBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for urological supplies. March 9th, 2018 Documentation for Enteral NutritionBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ... March 8th, 2018 Documentation for Home Blood Glucose Monitors (BGM)By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 14th, 2018 The Medicare Learning Network provides guidance on how to Prevent Denials for Home Blood Glucose Monitors (BGM)... March 8th, 2018 Documentation for Therapeutic CGMs and Related SuppliesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 14th, 2018 The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related Supplies March 8th, 2018 Documentation for Manual WheelchairsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases.... March 8th, 2018 Documentation for Lower Limb ProsthesisBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 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 ... March 8th, 2018 Documentation for Bacterial Culture Lab TestsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on how to prevent denials of Bacterial Culture Laboratory Tests March 8th, 2018 Documentation for Bacterial Culture Lab OrdersBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests... March 8th, 2018 Documentation for Power Tilt/Recline Seating Systems for WheelchairsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems... March 8th, 2018 Documentation for Ostomy SuppliesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies.... March 8th, 2018 Documentation and Orders for Respiratory Assistive DeviceBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines. March 5th, 2018 Increased Therapy Denials Create Administrative BurdenBy Wyn Staheli, Director of Content | Published March 5th, 2018 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 ... February 28th, 2018 Telemedicine Billing and ReimbursementBy Jared Staheli | Published February 28th, 2018 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 ... February 26th, 2018 Medicare Changes Requirements for Implantable Cardioverter Defibrillators (ICDs)By Wyn Staheli, Director of Content | Published February 26th, 2018 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 ... February 23rd, 2018 The Comprehensive Error Rate Testing ProgramBy Frank Cohen, MBA, MPA | Published February 23rd, 2018 - Last Review/Update February 26th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? February 21st, 2018 No HCPCS Code Available? Now What?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2018 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 ... February 20th, 2018 Consultation Codes Q/ABy ChiroCode | Published February 20th, 2018 - Last Review/Update February 4th, 2019 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? February 13th, 2018 New Modifiers Released in 2018By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 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 ... February 13th, 2018 Payment Rates Increase for Behavioral Health Office ServicesBy Wyn Staheli, Director of Content | Published February 13th, 2018 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 ... February 1st, 2018 Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) CodesBy Find-A-Code | Published February 1st, 2018 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, ... February 1st, 2018 Patients Undergoing a Bone Marrow Transplant (BMT)By Find-A-Code | Published February 1st, 2018 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 ... February 1st, 2018 How to Code Screening and Diagnostic ColonoscopyBy Natalie Tornese, CPC | Published February 1st, 2018 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" ... February 1st, 2018 CMS Changes Definitions for Therapeutic Shoe InsertsBy Wyn Staheli, Director of Content | Published February 1st, 2018 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 ... February 1st, 2018 Strapping and Kinesio Taping Coding DifferencesBy Wyn Staheli, Director of Content | Published February 1st, 2018 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: ... February 1st, 2018 Multiple Diagnostic Imaging Payment ReductionBy Wyn Staheli, Director of Content | Published February 1st, 2018 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 ... February 1st, 2018 Traumatic Subluxation Coding ControversyBy Wyn Staheli, Director of Content | Published February 1st, 2018 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 ... January 31st, 2018 Q/A: Can I Perform 2 Untimed Codes at the Same Time?By Wyn Staheli, Director of Research | Published January 31st, 2018 - Last Review/Update February 4th, 2019 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)? January 31st, 2018 Influenza, Are You Billing Correctly?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 31st, 2018 With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.
Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ... January 29th, 2018 Insufficient Documentation ErrorsBy Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018 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 ... January 29th, 2018 Anesthesia and Fee CalculationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018 - Last Review/Update June 3rd, 2021 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 ... January 29th, 2018 Paravertebral Joint/Nerve Blocks - Diagnostic and TherapeuticBy Find-A-Code | Published January 29th, 2018 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 ... January 29th, 2018 Non-Coronary Vascular Stents: Mesenteric VesselsBy Find-A-Code | Published January 29th, 2018 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 ... January 25th, 2018 Psychiatric Partial Hospitalization ProgramsBy Wyn Staheli, Director of Content | Published January 25th, 2018 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 ... January 23rd, 2018 NEW on Find-A-Code...National Coverage Determinations (NCDs)By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 23rd, 2018 - Last Review/Update January 25th, 2018 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. ... January 18th, 2018 What's the definition of an Office Visit and Can I Bill it With a Chiropractic Treatment?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published January 18th, 2018 - Last Review/Update February 4th, 2019 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? January 18th, 2018 2018 Revisions to Prolonged ServicesBy Wyn Staheli, Director of Content | Published January 18th, 2018 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 ... January 18th, 2018 Medicare's Integrated Behavioral Healthcare Services and Collaborative Care ProgramBy Wyn Staheli, Director of Content | Published January 18th, 2018 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 ... January 16th, 2018 Non-Coronary Vascular Stents: Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infropoliteal arteries)By Find-A-Code | Published January 16th, 2018 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 ... January 16th, 2018 Non-Coronary Vascular Stents: Renal arteryBy Find-A-Code | Published January 16th, 2018 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 ... January 16th, 2018 Non-Coronary Vascular Stents: Brachiocephalic arteriesBy Find-A-Code | Published January 16th, 2018 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 - ... January 15th, 2018 Medicare Requiring Specific Modifiers on Therapy ServicesBy Wyn Staheli, Director of Content | Published January 15th, 2018 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 ... January 15th, 2018 Billing with a GP ModifierBy Wyn Staheli, Director of Research | Published January 15th, 2018 - Last Review/Update January 30th, 2019 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? January 11th, 2018 Intensive Outpatient Treatment (IOP)By Wyn Staheli, Director of Content | Published January 11th, 2018 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 ... January 11th, 2018 Preventative Services: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)By Find-A-Code | Published January 11th, 2018 The following information from the Medicare Learning Network provides guidance on Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) January 10th, 2018 Paravertebral Joint/Nerve DenervationBy Find-A-Code | Published January 10th, 2018 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 ... January 9th, 2018 Conscious (Moderate) SedationBy Find-A-Code | Published January 9th, 2018 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. January 9th, 2018 Diagnosis billing with J0888By Find-A-Code | Published January 9th, 2018 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 ... January 9th, 2018 Coverage and/or Medical Necessity for the Use of Hyaluronan or DerivitiveBy Find-A-Code | Published January 9th, 2018
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 ... January 9th, 2018 Non-Coronary Vascular Stents: Inferior vena cava and iliofemoral veinsBy Find-A-Code | Published January 9th, 2018 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 ... January 9th, 2018 Should ROM Testing be Reported with Evaluation and Management Services?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 9th, 2018 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. January 9th, 2018 Billing Electrotherapy with AcuKneeBy Christine Woolstenhulme | Published January 9th, 2018 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 ... January 9th, 2018 ICD-10-PCS Coding the ApproachBy Find-A-Code | Published January 9th, 2018 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 ... January 9th, 2018 Outpatient Rehabilitation ModifiersBy Jared Staheli | Published January 9th, 2018 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, ... January 9th, 2018 Preventive Medicine with a New PatientBy Find-A-Code | Published January 9th, 2018 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 ... January 5th, 2018 Medicare Reimburses for Discarded/Wasted DrugsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published January 5th, 2018 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. January 4th, 2018 Beware of Limitations When Using Electrical Stimulation - UltrasoundBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 4th, 2018 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 ... January 4th, 2018 Acute Post-Operative Pain ManagementBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Proper Usage of Electrical StimulationBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Initial Evaluation Codes for PT's and OT'sBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 PT and OT Reevaluation CodingBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 General Physical Therapy Modality GuidelinesBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Diathermy eg Microwave Use and DocumentationBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Ultrasound TherapyBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Hydrotherapy GuidelinesBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 99024 for Subsequent Visits Within Global PeriodBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 2017-2018 Influenza (Flu) Resources for Health Care ProfessionalsBy Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Billing Negative Pressure Wound Therapy (NPWT) (disposable device)By Find-A-Code | Published January 4th, 2018 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 ... January 4th, 2018 Mechanical Traction TherapyBy Find-A-Code | Published January 4th, 2018 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 ... January 3rd, 2018 Abuse, Neglect, or MaltreatmentBy Wyn Staheli | Published January 3rd, 2018 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 ... December 28th, 2017 Sleep TestingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 28th, 2017 Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment.
There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All ... December 28th, 2017 Cleft Surgical ServicesBy Raquel Shumway | Published December 28th, 2017 Cleft palate and cleft lip diagnoses medical in nature and as such should be reported using the Current Procedural Terminology (CPT) codes instead of the Current Dental Terminology (CDT) codes. As such, Evaluation and Management (EM) services should be reported for the initial encounter with the patient and follow-up care ... December 28th, 2017 Alcohol Misuse Screening and CounselingBy Wyn Staheli | Published December 28th, 2017 Codes G0442 (screening) and G0443 (15 min counseling) are typically a covered preventive service for most payers. As a preventive service, copayment/coinsurance and deductibles are typically waived. These are NOT considered treatment services or sessions for alcoholism or other substance abuse. If the screening results indicate that the patient is dependent and is open to the ... December 28th, 2017 Moderate Sedation Services - CPT has 6 Codes to One Dental CodeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 28th, 2017
When billing a medical code instead of the dental code D9223 -Deep sedation/general anesthesia - each 15 minute increment, consider the following medical codes: (Be sure to review the AMA guidelines to see if they fit the procedure you are doing). If a dental office is doing conscious sedation for a patient ... December 20th, 2017 Lung Cancer Screening Counseling and Shared Decision Making Visit, and Annual Screening for Lung Cancer with LDCTBy Find-A-Code | Published December 20th, 2017 Effective February 5, 2015, a CMS National Coverage Determination (NCD) added lung cancer screening counseling and shared decision making visit, and for certain beneficiaries, annual screening for lung cancer with Low Dose Computed Tomography (LDCT), as an additional screening service benefit under the Medicare program if all eligibility criteria described ... December 13th, 2017 AT and GA Modifiers When Billing CMT and Non-covered Codes to MedicareBy Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published December 13th, 2017 - Last Review/Update February 5th, 2019 Questions regarding using modifiers when billing CMT and non-covered codes to Medicare. We have used AT (Active) and GA (signed ABN) when billing active care for CMT codes 98940-98942 (e.g., 98941-ATGA) in the past. Currently we are told not to bill GA with AT. How do we bill? December 12th, 2017 THE EOB SAYS “BUNDLED” - NOW WHAT?By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017 Payers often bundle separate codes together so that they can pay you less. Just because the EOB says the codes are bundled doesn’t mean you have to let the insurance company get away with it. Fight Back!!! How does bundling work? If a patient presents for evaluation of diabetes, and... December 12th, 2017 E/M DOCUMENTATION Does Your Coding Match Your Documentation???By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017 No matter what your specialty we are all faced with making sure our physician uses the correct E& M Code for what he/she documented. Remember if it wasn’t documented it wasn’t done!!!! That said, when looking at documentation to code E/M services, it’s good to educate the providers to document... November 30th, 2017 Why You Should Stop Using ROM as an Outcome MeasureBy Dr. Ron Feise, Practice Consultant and Coach with RJF Consulting - www.chiroevidence.com | Published November 30th, 2017 - Last Review/Update January 30th, 2019 We received this email from a chiropractic colleague: “I recently attended a
continuing education seminar accredited by a chiropractic college. The presenter
was talking about outcome measures and highly recommended cervical and
lumbar range of motion (ROM) as a good outcome measure for patients with
spinal conditions. But I am hesitant to use ROM, because it seems to be
inconsistent with a patient’s status.”
What does the current research demonstrate? November 27th, 2017 Erythropoietin Stimulating Agents (ESA)By Wyn Staheli, Director of Content | Published November 27th, 2017 Coverage
ESA is typically covered for the following condition(s):
Treatment of anemia associated with chronic renal failure (whether or not that patient is on dialysis)
Treatment of significant anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy
Treatment of anemia due to AZT and/or other Nucleoside Reverse Transcriptase Inhibitors (NRTI) used in treatment of HIV/AIDS
Treatment of selected ... November 24th, 2017 Inpatient critical care: When is it ok to question the medical necessity?By Stephanie Allard, CPC, CEMA, RHIT | Published November 24th, 2017 - Last Review/Update January 31st, 2018 While critical care may be easily identifiable within documentation it is not always clear if it is medically necessary..... November 16th, 2017 Can an Unlicensed Person Perform Physical Therapy Services Such as 97110?By Wyn Staheli, Director of Research | Published November 16th, 2017 - Last Review/Update January 30th, 2019 Can an unlicensed person perform code a 97110 service as long as they're under doctor supervision? I use only PT, ATC, or DC's to perform these codes and I've been told that I don't need such highly qualified therapists to perform therapy. November 15th, 2017 Medicare Offering FREE Resources- Educate Beneficiaries About the New Medicare CardsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 15th, 2017
Medicare is offering FREE resources to help you notify patients about the new Medicare cards. MLN connects newsletter announced the following.
"CMS is starting to conduct a major education campaign about the new card for people with Medicare. Help alert your patients by displaying a poster in your office and giving your patients tear-off sheets or fliers.
Register ... November 10th, 2017 Escharotomy Procedural Cross-Walking CPT to ICD-10-PCSBy Brandon Dee Leavitt QCC, CMCS, CPC, EMT | Published November 10th, 2017 - Last Review/Update November 17th, 2017 An Escharotomy is used for "local treatment of burned surface" per the AMA Guidelines, when incisions are performed on the burn site. Notice, when cross-walking 16035 or 16036 to inpatient codes, Find-A-Code crosswalks lead to Body System H, Operation 8 - Division of the skin, and Operation N - Release of the skin.
A division or release of the skin would be a ... November 7th, 2017 Four Final Rules Affecting CMS Payments for 2018By Wyn Staheli, Director of Content | Published November 7th, 2017 It’s a season for changes. CMS just finalized four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018
HHAs: Payment Changes for 2018
Quality Payment Program Rule for Year 2
This ... November 6th, 2017 New Payment Rulings Could Affect YouBy Wyn Staheli, Director of Content | Published November 6th, 2017 Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ... November 3rd, 2017 Auditing Medical Decision MakingBy Grant Huang, CPC, CPMA | Published November 3rd, 2017 - Last Review/Update January 31st, 2018 With CMS looking to gradually revise its E/M documentation requirements to reduce the burden and complexity they pose to providers, it's a great time to review the trickiest E/M component: medical decision making (MDM).... October 31st, 2017 Correct Coding for Group TherapyBy David Klein CPC, CPMA, CHC | Published October 31st, 2017 - Last Review/Update February 5th, 2019 Recent events regarding delegation of services to ancillary personnel have given rise to concerns regarding the delivery of outpatient physical medicine by Chiropractors, specifically regarding the appropriate use of one-on-one codes as opposed to group therapy code CPT 97150 - Therapeutic procedure(s), group (2 or more individuals). This advisory provides guidance on how to properly use one-on-one and group therapy codes, both independently and together. October 27th, 2017 Speech-Language Pathology Services Policy from UniCareBy Find-A-Code | Published October 27th, 2017 Medically Necessary:
Rehabilitative speech-language pathology (SLP) services are considered medically necessary when ALL of the following criteria are met:
The services are used in the treatment of communication impairment or swallowing disorders resulting from illness*, injury, surgery, or congenital abnormality; and
Based on a plan of care, the therapy sessions achieve a specific ... October 24th, 2017 Q&A: Blue Cross Blue Shield Updating Their Policy on the Application of Therapies by a Chiropractic AssistantBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 24th, 2017 ChiroCode recently received the following inquiry: Blue Cross Blue Shield is updating their policy on the application of therapies by a chiropractic assistant. It is as follows: "Physical Therapy and Chiropractic Billing Guidelines Reminder Physician or Chiropractor “Incident To” Billing of Therapy Services (New) Beginning January 1, 2018, physicians and... October 23rd, 2017 Summary of OIG Reports for ChiropracticBy | Published October 23rd, 2017 The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ... October 20th, 2017 What is the Best Code to use for PNF Stretching of the Hamstrings and Glutes?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 20th, 2017 - Last Review/Update February 8th, 2019 What is the best code to use for PNF stretching of the hamstrings and gluts? The doctor is currently using 97112. October 20th, 2017 A P.A.R.T. TemplateBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 20th, 2017 - Last Review/Update February 5th, 2019 Here at ChiroCode we are often asked for examples of perfect forms to use in the office. As such we have developed some.
October 18th, 2017 Physicians Reciprocal Billing ArrangementsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 18th, 2017 October 13th, 2017 So, How Do You Decide if a Service was Provided?By David Glaser, JD | Published October 13th, 2017 - Last Review/Update January 31st, 2018 An earlier coding tip explained that the oft-repeated "if it isn't written, it wasn't done" is good risk management advice, but not a legal truism..... October 5th, 2017 Q/A: Do we Need to Charge for Non-covered Services Performed Under a Maintenance Visit if we Use the S8990 Code When Billing Medicare?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 5th, 2017 - Last Review/Update February 5th, 2019 Do we need to charge for non-covered services performed under a maintenance visit if we use the S8990 code when billing Medicare? October 5th, 2017 Brace Yourself for New ICD-10 and CPT Codes for 2018!By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 5th, 2017 - Last Review/Update February 5th, 2019 What is new for Chiropractors for 2018? See for yourself the new ICD-10 and CPT Codes. September 30th, 2017 Annual Wellness Visit & Health Risk AssessmentBy Find-A-Code | Published September 30th, 2017 - Last Review/Update October 1st, 2017 Coding tips regarding Annual Wellness Visit and Health Risk Assessments September 25th, 2017 Q/A: What is the Proper Usage of Code 97150?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published September 25th, 2017 - Last Review/Update February 5th, 2019 What is the proper usage of CPT 97150 and what are the documentation requirements for that? September 22nd, 2017 New Policy from UnitedHealthcareBy Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CEMA | Published September 22nd, 2017 - Last Review/Update January 31st, 2018 In the June 2017 UHC Network Bulletin, there was an article that addressed UHC's decision to no longer pay for consultation services..... September 20th, 2017 Bladder/Urothelial Tumor Markers (Jurisdiction F)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 20th, 2017 CMS recently released a new LCD for Jurisdiction F, Bladder/Urothelial Tumor Markers (L36680).
Documentation Requirements
The medical record must clearly identify the number and frequency of bladder marker testing. Medical record documentation must be legible, must be maintained in the patient’s medical record (hard copy or electronic copy), and must meet the ... September 14th, 2017 Double Dipping in the History of the Evaluation and Management NoteBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published September 14th, 2017 There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history.
The subcomponents of history include:
Chief Complaint ... September 12th, 2017 Auditing Prolonged Evaluation and Management ServicesBy Aimee Wilcox | Published September 12th, 2017 - Last Review/Update September 18th, 2017 At times, there are patients who require prolonged face-to-face time with the provider to discuss or be counseled about their condition, plan of care, risks, complications, alternative therapies, or other medical issues. When E/M services go wild, taking significantly longer than the typical time associated with it, that direct face-to-face ... September 8th, 2017 Global Surgical Package: When to Bill and When Not to Bill, that is the QuestionBy Stephanie Allard, CPC, CEMA, RHIT | Published September 8th, 2017 - Last Review/Update January 31st, 2018 The global surgical package is inclusive of the services that would normally be provided to the patient following surgery. Depending on the global period assigned to a CPT code, the pre-operative, intra-operative and post-operative services could be included in the global surgical package..... September 1st, 2017 2017 Physical Therapy Evaluation & Management CodesBy Kathy Price, RHIT, CPC, CCS-P, CPMA | Published September 1st, 2017 - Last Review/Update January 31st, 2018 As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy.... September 1st, 2017 Quick Tip from ChiroCode -- DocumentationBy ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019 Documentation Solutions, a quick tip video by Dr Gwilliam. September 1st, 2017 Evaluation and ManagementBy ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019 Question
In our office when the doctor initially sees a new patient, we bill a new patient code. (99201, 99202, 99203, or 99204) At that time, the doctor gives the patient an X-ray script and informs them to return to the office with their disk for an ROF (review of findings) to go over their results and also to determine their treatment plan, etc. When this happens, can a separate E/M code be billed, like 99211, 99212, 99213, 99214 or is there another code that can be used? September 1st, 2017 Preventive Services: Alcohol Misuse Screening and CounselingBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 5th, 2018 The following information from the Medicare Learning Network (MLN) provides guidance on Alcohol Misuse Screening and Counseling....... September 1st, 2017 Preventive Services: Annual Wellness Visit (AWV)By Find-A-Code | Published September 1st, 2017 - Last Review/Update March 12th, 2018 The following information from the Medicare Learning Network provides guidance on Annual Wellness Visits (AWV) September 1st, 2017 Preventive Services: Bone Mass MeasurementsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Bone Mass Measurements September 1st, 2017 Preventive Services: Cardiovascular Disease Screening TestsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Cardiovascular Disease Screening Tests:
80061 -
Lipid panel, this panel must include the following:
82465 - Cholesterol, serum, total
83718 - Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
84478 - Triglycerides
Z13.6
All Medicare beneficiaries without apparent signs or symptoms ... September 1st, 2017 Preventive Services: Colorectal Cancer ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Colorectal Cancer Screening..... September 1st, 2017 Preventive Services: Counseling to Prevent Tobacco UseBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Counseling to Prevent Tobacco Use.... September 1st, 2017 Health Risk Assessment as Part of Annual Wellness VisitBy Wyn Staheli | Published September 1st, 2017 - Last Review/Update October 16th, 2017 The Health Risk Assessment is a voluntary assessment which may be completed by either the patient or a caregiver. It is typically used in conjunction with an Annual Wellness Visit to help promote better health choices and provide disease prevention services. September 1st, 2017 Preventive Services: Depression ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Depression Screening.... September 1st, 2017 Preventive Services: Diabetes ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Diabetes Screening..... September 1st, 2017 Preventive Services: Diabetes Self-Management Training (DSMT)By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018 The following information from the Medicare Learning Network provides guidance on Diabetes Self-Management Training.... September 1st, 2017 Preventive Services: Glaucoma ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018 The following information from the Medicare Learning Network provides guidance on Glaucoma Screening.... September 1st, 2017 Preventive Services: Hepatitis B Virus (HBV) Vaccine and AdministrationBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018 The following information from the Medicare Learning Network provides guidance on Hepatitis B Virus (HBV) Vaccine and Administration.... September 1st, 2017 Preventive Services: Hepatitis C Virus (HCV) ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Hepatitis C Virus (HCV) Screening.... September 1st, 2017 Preventive Services: Human Immunodeficiency Virus (HIV) ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018 The following information from the Medicare Learning Network provides guidance on Human Immunodeficiency Virus (HIV) Screening.... September 1st, 2017 Preventive Services: Influenza Virus Vaccine and AdministrationBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018 The following information from the Medicare Learning Network provides guidance on Influenza Virus Vaccine and Administration.... September 1st, 2017 Preventive Services: Initial Preventive Physical Examination (IPPE)By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Initial Preventive Physical Examination (IPPE)...... September 1st, 2017 Preventive Services: Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).... September 1st, 2017 Preventive Services: Intensive Behavioral Therapy (IBT) for ObesityBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Intensive Behavioral Therapy (IBT) for Obesity.... September 1st, 2017 Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCTBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT).... September 1st, 2017 Preventive Services: Medical Nutrition Therapy (MNT)By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Medical Nutrition Therapy (MNT).... September 1st, 2017 Preventive Services: Pneumococcal Vaccine and AdministrationBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Pneumococcal Vaccine and Administration.... September 1st, 2017 Preventive Services: Prostate Cancer ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Prostate Cancer Screening.... September 1st, 2017 Preventive Services: Screening for Cervical Cancer with Human Papillomavirus (HPV) TestsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests.... September 1st, 2017 Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs..... September 1st, 2017 Preventive Services: Screening MammographyBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on a Screening Mammography.... September 1st, 2017 Preventive Services: Screening Pap TestsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening Pap Tests.... September 1st, 2017 Preventive Services: Screening Pelvic ExaminationsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening Pelvic Examinations (includes a clinical breast examination).... August 29th, 2017 Quality Measures for Chiropractic - 2017By Wyn Staheli, Director of Content | Published August 29th, 2017 Performance Measurement Codes for Chiropractic:
Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year.
Pain Assessment and Follow-Up
131
ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ... August 24th, 2017 Q/A: MIPS and G CodesBy Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 24th, 2017 - Last Review/Update February 5th, 2019 We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good? August 24th, 2017 Can They Deny Electrical Stimulation by Saying There is no Evidence that it Works?By Dr Ronald J. Farabaugh | Published August 24th, 2017 - Last Review/Update February 5th, 2019 Topic: Electrical Stimulation (EMS)
Question: An orthopedic surgeon/IME recommended a denial for all electrical stimulation
(EMS) by stating that "according ODG electrical stimulation is experimental therefore not
medically necessary or eligible for reimbursement." Is that true? August 18th, 2017 The Incredible Disappearing ConsultationBy J. Paul Spencer, CPC, COC | Published August 18th, 2017 - Last Review/Update January 25th, 2018 In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255 for inpatient). August 17th, 2017 Quick Tip from the HelpDesk -- Code 97140By ChiroCode | Published August 17th, 2017 - Last Review/Update January 31st, 2019 Watch this short video, "Secrets of 97140 Manual Therapy," to learn all that you need to know about the proper support for 97140.
ChiroCode_DeskBook_Tips_97140 from Innoventrum on Vimeo.
... August 16th, 2017 If It’s Not a Consultation, What Is It?By Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC | Published August 16th, 2017
You thought you had a consultation supported in your documentation, and now you find out that you cannot bill the consultation codes (99241-99245, 99251- 99255). So, what are the top reasons for a consultation not to be supported?
If the payer does not support these codes
If the documentation does not support ... August 15th, 2017 United HealthCare Ending Consultation Reimbursements: Effective October 1st, 2017By NAMAS | Published August 15th, 2017
While Medicare discontinued payment allowance for consultation services (ranges 99241-99245 and 99251-99255) in January 2010, many commercial carriers have continued to cover these services. United Healthcare is now joining Medicare's opinion on consultation services.
In the June 2017 edition of the United HealthCare Bulletin, United Healthcare has announced that effective October ... August 11th, 2017 Do Other States Lower Payments for Crowns by Delta or Blue Cross?By Christine Taxin | Published August 11th, 2017 Question: A subscribers from the State of Michigan has asked this:
Has anyone from other states seen the fees for crowns lowered by Delta or Blue Cross?
Answer: First look at your contracts, and see if there is anything in it that allows for fees to be lowered. Next, look up your ... August 8th, 2017 Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 8th, 2017 - Last Review/Update February 5th, 2019 My state does not allow me to delegate the supervision of therapeutic exercises (97110). I am the licensed chiropractor. If I provide the constant attendance myself, can I do it for a group of patients? If so, how do I document and bill for this? August 4th, 2017 List of Common Unclassified Injectable drugs (this list in not all-inclusive)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 4th, 2017 This is a list of some of the most common Injectable unclassified drugs used with J3490
Antilirium – 1 mg/ml
Ascorbic Acid – 500 mg/ml
Ascorbic Acid – 250 mg/ml
Bacitracin, Intramuscular – 50,000 unit vials
Bacitracin, Intramuscular – 10,000 unit vials
Brevital Sodium – 500 mg/5 ml
Caffeine and Sodium Benzoate – 250 mg/ml
Capastat Sulfate – 1 ... August 4th, 2017 Proposed Telehealth Changes for 2018By Wyn Staheli | Published August 4th, 2017 - Last Review/Update October 4th, 2017
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements from other third-party payers.
Proposed Codes
HCPCS code G0296 ... August 1st, 2017 Requirements for Physicians Orders for DME/HCPCSBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 1st, 2017
Effective July 1, 2013, certain DME/HCPCS codes require a valid detailed written order prior to delivery. There are very specific rules and requirements requiring medical necessity and orders/prescriptions. It is also required to keep a copy in the patients chart. If billing CMS and commercial payers payers, the DME prescribed may be denied ... August 1st, 2017 How to Bill a Dressing ChangeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 1st, 2017
A dressing change may not be billed as either a debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602).
Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. These services are reimbursed as part of a billable procedure code that, commonly but not necessarily, ... August 1st, 2017 Annual Wellness Visit (AWV)By Wyn Staheli, Director of Content | Published August 1st, 2017 Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays. July 28th, 2017 36522 Photopheresis Extracorporeal; Not Payable Without Certain ICD-10-CM CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 28th, 2017 When Outpatient hospitals bill CPT code 36522: (Photopheresis, extracorporeal), it must be billed with the following diagnosis codes:
C84.00 - C84.09 Mycosis fungoides;
C84.10 – C84.19 Sezary’s disease;
T86.20 – T86.298 Complications of heart transplant;
T86.30 – T86.39 Complications of heart-lung transplant;
T86.00 - T86.09 Complications of transplanted bone marrow.
Review your local LCD for billing and coding help.
... July 28th, 2017 Auditing VaccinesBy Paul Chandler | Published July 28th, 2017 - Last Review/Update January 31st, 2018 Auditing vaccines can be difficult, as precise attention needs to be paid to the documentation to extract all variables needed for proper coding. July 26th, 2017 HCPCS Codes - ASP Reporting is done in Units not NDCBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 26th, 2017 HCPCS CODES FOR WHICH ASP REPORTING IS DONE IN UNITS OF MEASURE OTHER THAN AN NDC Updated November 14, 2016
A9587 GALLIUM GA-68, DOTATATE, DIAGNOSTIC, 0.1 MILLICURIE 0.1 millicurie
A9588FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE 1 millicurie
A9606 RADIUM RA-223 DICHLORIDE, THERAPEUTIC, PER MICROCURIE 1 microcurie
C9132 PROTHROMBIN COMPLEX CONCENTRATE (HUMAN), KCENTRA, PER I.U. OF FACTOR IX ACTIVITY 1 IU
C9140 INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (AFSTYLA), 1 I.U. 1 IU
J0256 INJECTION, ALPHA 1 PROTEINASE INHIBITOR ... July 21st, 2017 Billing for Face-to-Face CounselingBy ChiroCode | Published July 21st, 2017 - Last Review/Update January 31st, 2019 Question: How should I bill for face-to-face Counseling time spent with the patient? July 7th, 2017 Telemedicine: The Next Frontier in Care DeliveryBy Valora Gurganious, MBA, CHBA | Published July 7th, 2017 - Last Review/Update January 25th, 2018 Technology is ubiquitous in modern society, and just when we thought that computers could not replace the "human touch" of a healthcare provider, technology is making specialized care accessible to patients anywhere there is an internet connection. June 30th, 2017 Focus Audit Results on the Documentation, Not the EncounterBy Scott Kraft, CPC, CPMA | Published June 30th, 2017
As an auditor, your job is to assess the quality of the documentation created by the provider to determine whether it meets the requirements to bill the code assigned to the service. This task often set us up a potentially adversarial role with the provider, particularly when it comes to ... June 30th, 2017 Documentation: Carrying Forward or Ineffective Use of TemplatesBy Shannon DeConda | Published June 30th, 2017
I often receive questions such as the below from our members regarding E&M scoring:
"I have heard that if information is 'cloned' or 'moved forward' from a previous visit, we should not count that info in scoring. However, I have also read that if a provider moves the info forward and ... June 30th, 2017 Consultation or Transfer of Care, What are the Differences?By Dee MiMauro, CPC, COC, CPMA | Published June 30th, 2017
According to 2017 Current Procedural Terminology (CPT), a Consultation is a type of E&M service provided by a physician at the request of another physician or other appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of ... June 30th, 2017 Laceration RepairsBy Michael Loss, CPC, CPMA | Published June 30th, 2017
Auditing laceration repair is generally an adventure. Most of my auditing work is reviewing the work of our coders rather than providers, but I have audited physicians as well. My present position has limited communication with providers, however we do attempt to get important information back to our clients for ... June 30th, 2017 Treating Diabetic Patients in Your Office?By Shannon DeConda | Published June 30th, 2017
CMS will be rolling out an Expanded Diabetes Prevention Plan January 1, 2018 as well as new Durable Medical Equipment (DME) supply codes for Continuous Glucose Monitors (CGM) July 1, 2017. These services will offer your practice the opportunity to better assist your diabetic patient's needs.
Remember that prior to providing ... June 29th, 2017 New payments for Psychiatric Collaborative Care Services (COCM) from MedicareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2017 Medicare has agreed to make separate payments to physicians and non-physicians for Behavioral Health Integration (BHI) services beginning Jan. 1st, 2017.
Any condition new or pre-existing behavioral health or substance use disorders are eligible. Beneficiaries may have comorbid, chronic, or other medical conditions they are being treated for as well.
Using the ... June 29th, 2017 Prescription Drug Management: Is it a Level 3 or a Level 4?By J. Paul Spencer, CPC, COC | Published June 29th, 2017
If you place four auditors around a table and place a typical established patient visit in front of them, what tends to follow is a scene that resembles less about building consensus and more along the lines of a National Geographic special regarding the hunting habits of hyenas. Perhaps no ... June 27th, 2017 Modifier JW With Drug CodesBy Find-A-Code | Published June 27th, 2017 Modifier JW
In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers ... June 21st, 2017 Q/A: What Modifier Can I Use When Billing Massage Code 97124 With 97140?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published June 21st, 2017 - Last Review/Update February 8th, 2019 Q. Can you tell me what modifier I can use when billing massage code 97124 with 97140? I was using -59, but I am not sure that is correct June 20th, 2017 Changes with DMEBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 20th, 2017
Due to the cost and refills that is required with portable oxygen systems separate payment classes were added in 2007 for oxygen generating portable equipment. Each year, Payment Classes for Oxygen Generating Portable Equipment, Stationary Oxygen Contents, and Portable Oxygen Contents, are adjusted to make additional payment classes for oxygen ... June 14th, 2017 Ultraviolet TherapyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 14th, 2017 - Last Review/Update July 27th, 2017
Treatment of this type is generally used for patients requiring the application of a drying heat. For example, this treatment would be considered reasonable and necessary for the treatment of severe psoriasis where there is limited range of motion.
Only 1 unit of CPT code 97028 is covered per date of service.
Supportive Documentation ... June 14th, 2017 Billing X-raysBy ChiroCode | Published June 14th, 2017 - Last Review/Update January 30th, 2019 Q. We currently are using an outside radiologist to read all of our x-rays, therefore we have an official report on each x-ray. If we go back to reading our own x-rays, do we need to have a separate official report made? Or is it sufficient to just put the x-ray findings as part of the SOAP? Also, we are questioning the way we are billing our x-rays. Some of us feel like you should be able to bill for taking the x-rays and then reading them as well. June 13th, 2017 Modifier GY for ChiropracticBy ChiroCode | Published June 13th, 2017 - Last Review/Update January 31st, 2019 Q. Is there a modifier that can be added on to CPT codes to show we performed the service even though they are bundled charges or Medicare doesn't pay for them? For example 97140 billed to BCBS or 99202 billed to Medicare. Is the GY modifier for all insurance companies or just Medicare? June 8th, 2017 Facet Joint InjectionsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 8th, 2017 - Last Review/Update July 26th, 2017
Medicare will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for three (3) months or greater) suspected to originate from the facet joint. Facet joint block is one of the methods used to document and confirm suspicions of posterior element biomechanical pain of the ... June 5th, 2017 Modifier 59By Find-A-Code | Published June 5th, 2017 - Last Review/Update July 26th, 2017 Definition - The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. This may represent a different session or patient encounter, different procedure or surgery, different site, ... June 1st, 2017 Is 97112, Neuromuscular Re-education Only for Stroke Recovery?By ChiroCode | Published June 1st, 2017 - Last Review/Update January 31st, 2019 This code is not reserved for stroke recovery, but it could certainly apply when treating some symptoms of a stroke. It is often used for many other conditions so long as medical necessity is present and clearly supported. Consider using this on patients with documented loss of coordination or balance. These might not be everyday cases in a chiropractic clinic, but they certainly would occur from time to time. May 30th, 2017 Q/A: How do I Bill Class 4 Deep Tissue Hot Laser Treatment?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published May 30th, 2017 - Last Review/Update February 8th, 2019 Is there a way to bill out for Class 4 deep tissue hot laser treatments? May 30th, 2017 GA and GY for Medicare BillingBy ChiroCode | Published May 30th, 2017 - Last Review/Update January 31st, 2019 We are using the ABN for non-covered services (such as therapy codes) when the patient is under active care. We are also using the ABN for CMT codes when the patient is under maintenance care. We are now confused about when to use the modifiers GA & GY when billing CMT & therapy codes. Would you please explain when & why each should be used for Active and Maintenance Care? May 12th, 2017 When Using Code 99050 (After Hours)By | Published May 12th, 2017 - Last Review/Update February 8th, 2019 Question: When using code 99050 (after hours), do I just add a amount, example $25.00, to our normal total charges for that patients visit? April 28th, 2017 Can I be Forbidden from Billing 99204 or 99214?By ChiroCode | Published April 28th, 2017 - Last Review/Update January 31st, 2019 Q: An insurer told me that chiropractors cannot bill 99204 or 99214 because those exams "require a level of decision making that would typically only occur in an emergency room." Is this true? Do I have any recourse? April 28th, 2017 DeadlineBy Christine Taxin | Published April 28th, 2017
Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D.
Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. ... April 26th, 2017 Modifiers: Reporting Wound DressingsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 26th, 2017 - Last Review/Update July 28th, 2017
When reporting dressings for wounds, it is important to indicate if the dressing is the primary or secondary dressing as well the number of wounds the dressing will be used for.
Primary Dressing: May be therapeutic or protective coverings applied to wounds either on the skin or caused by an opening ... April 21st, 2017 RadiologyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 21st, 2017 - Last Review/Update July 28th, 2017 All radiology services require proper orders, identifying the diagnosis for which the imaging is being ordered. “Rule out” or “Possible” won’t work for reimbursement purposes because professional services cannot code unconfirmed diagnoses. As such, for those types of services, include the symptom(s) as the diagnosis for which you are seeking ... April 20th, 2017 Billing Dermal Filler InjectionsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 20th, 2017 - Last Review/Update July 28th, 2017
When billing dermal filler injections, separate payment may be made under the OPPS and ASC payment systems for HCPCS G0429- Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy).
Use in addition: Q2026- Injection, radiesse, 0.1 ml, and Q2028 - Injection, sculptra, 0.5 mg
With a diagnosis of B20 - ... April 14th, 2017 Office of Inspector General (OIG) - Compliance Program GuidanceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 14th, 2017 The compliance program guidance documents are listed below.
09-30-2008Supplemental Compliance Program Guidance for Nursing Facilities (73 Fed.Reg. 56832; September 30, 2008)
Compliance Program Guidance for Nursing Facilities (65 Fed. Reg. 14289; March 16, 2000)
11-28-2005Draft Compliance Program Guidance for Recipients of PHS Research Awards (70 Fed.Reg. 71312; November 28, 2005)
NSTC Launches Government-Wide Initiative ... April 6th, 2017 Excluded from the Global OB PackageBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 6th, 2017 - Last Review/Update July 28th, 2017
First three antepartum E&M visits
Laboratory tests
Maternal or fetal echography procedures (CPT codes 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76820, 76821, 76825, 76826, 76827 and 76828)
Amniocentesis, any method (CPT codes 59000 or 59001)
Amniofusion (CPT code 59070)
Chorionic villus sampling (CPT code 59015)
Fetal contraction stress test (CPT code 59020)
Fetal non-stress test (CPT code 59025)
External cephalic version (CPT code 59412)
Insertion of cervical dilator (CPT code 59200) more than 24 hr before delivery
E&M services which is unrelated ... March 30th, 2017 Moderate Sedation Services - CPT has 6 Codes to One Dental CodeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 30th, 2017 - Last Review/Update August 1st, 2017 When billing a medical code instead of the dental code D9223 -Deep sedation/general anesthesia - each 15 minute increment, consider the following medical codes: (Be sure to review the AMA guidelines to see if they fit the procedure you are doing). If a dental office is doing conscious sedation for a patient ... March 29th, 2017 2014 brings big volume of changes to CCI editsBy Find-A-Code | Published March 29th, 2017 Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year. There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes.... March 29th, 2017 Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBookBy Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA | Published March 29th, 2017
The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ... March 28th, 2017 Respiratory Assist Devices (RAD) E0470 and E0471 - Billing RemindersBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 28th, 2017 - Last Review/Update July 28th, 2017 Add the KX modifier to all claims for RADs and accessories for the first through third months if all thecoverage criteria have been met.
Add the KX modifier to all claims for the fourth month and thereafter if all the coverage criteria have been met and if the physician signed and dated a ... March 27th, 2017 Devices Used for Treatment with TMJBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 27th, 2017 - Last Review/Update July 28th, 2017
Dynamic splinting systems or devices are used to assist in restoring physical function and are commonly used for treating TMJ. Injury or joint stiffness are diagnoses that may qualify for medically necessity.
If physical therapy has proven ineffective to restore or improve range of motion, mechanical devices are often a next step.
This ... March 24th, 2017 Are There any Alternatives for Code 97112 Neuromuscular Re-education?By ChiroCode | Published March 24th, 2017 - Last Review/Update January 31st, 2019 Q: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the insurance benefits. March 20th, 2017 Acute Postoperative Pain ManagementBy Wyn Stahel | Published March 20th, 2017 Caution needs to be observed when reporting post-operative pain management (POPM). In accordance with NCCI edits policies, postoperative pain management is considered bundled in the surgical code(s). There are only a few instances where it may be billed separately.
Medicare Global Surgery Rules prevent separate payment for postoperative pain management when ... March 13th, 2017 Reporting Unilateral ProceduresBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 13th, 2017 - Last Review/Update July 28th, 2017
Some procedures are unilateral such as D7840-Condylectomy. It is important to consult with your payer on reporting requirements. Some payers require two separate line items with a LT or RT HCPCS Modifier, while others require only one modifier to be appended to the claim.
When billing a medical code for a Condylectomy, ... March 7th, 2017 Endometrial Sampling (Biopsy)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2017 - Last Review/Update July 28th, 2017
If a procedure such as an excision of a polyp took significant additional time, work, and effort, you could append modifier 22 (unusual procedural service) to add to your fee when using 58100 "Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)."
If a coloposcopy is performed in conjunction, use 58110 in addition to the ... March 7th, 2017 Endocervical Curettage and ColposcopyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2017 - Last Review/Update July 28th, 2017
If you are coding for endocervical curettage only, use 57505 "Endocervical curettage (not done as part of a dilation and curettage)."
If an endometrial sampling (biopsy) was performed in conjunction with a colposcopy, use 57420 "Colposcopy of the entire vagina, with cervix if present," 57421 for "with biopsy(s) of vagina/cervix, or 57452-57461 for "colposcopy of the cervix including upper ... March 3rd, 2017 Using Add-On CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 3rd, 2017 - Last Review/Update July 28th, 2017
There are certain procedures that are carried out in addition to the primary procedure called add-on codes. They describe a specific type of supplemental procedure done in addition that are labeled as add-on codes.
The AMA gives instructions and guidelines with notations such as "List separately in addition to primary procedure" or ... March 3rd, 2017 Chiropractic ManipulationBy Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published March 3rd, 2017 - Last Review/Update February 8th, 2019 Q: If a patient is treated with chiropractic manipulation and it is clinically appropriate but doesn't qualify as medically necessary care, what is the proper way to communicate this when billing the insurance company for the service? March 2nd, 2017 Requirements for Physicians Orders for DME/HCPCSBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017 Effective July 1, 2013, certain DME/HCPCS codes require a valid detailed written order prior to delivery. There are very specific rules and requirements requiring medical necessity and orders/prescriptions. It is also required to keep a copy in the patients chart. If billing CMS and commercial payers payers, the DME prescribed ... March 1st, 2017 Care Plan Oversight ServicesBy Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 1st, 2017 - Last Review/Update January 16th, 2018 Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period.
G0179
MD re-certification HHA PT
May be ... March 1st, 2017 High Compression Bandage System ClarificationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 1st, 2017 - Last Review/Update July 28th, 2017 Multi-layered, sustained, graduated, high compression bandage systems are used primarily to treat lymphedema and venous or stasis leg ulcers. A number of graduated, high-compression bandage systems products have been developed, including Profore®, Dyna-Flex®, Surepress®, Setopress®, and other similar product systems.Providers should note that the treatment of lymphedema with the application ... February 27th, 2017 Documentation: Face to Face for Home Health CertificationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 27th, 2017 - Last Review/Update August 16th, 2017 As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. ... February 24th, 2017 Using Time Span CodesBy Find-A-Code | Published February 24th, 2017 The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period, generally if the service was provided in a different calendar month, the service would qualify for reimbursement.
Modifiers will not override a time span code if it is billed with ... February 23rd, 2017 Care Plan Oversight ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2017 - Last Review/Update August 2nd, 2017
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period.
G0179
MD re-certification HHA ... February 23rd, 2017 Telehealth Growth ContinuesBy Wyn Staheli, Director of Content | Published February 23rd, 2017
Telehealth is proving to be the wave of the future as the number of practices offering these services continues to grow. An online poll by Medical Economics asked those who visited their site about the implementation of telehealth services implemented by their individual practices this year. As of February 2, 2017, the results were significant:
30% ... February 21st, 2017 Telehealth Psychiatric ServiceBy Wyn Staheli, Director of Content | Published February 21st, 2017
Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych ... February 15th, 2017 Insufficient DocumentationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2017 - Last Review/Update August 2nd, 2017 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 are also ... February 10th, 2017 Beware of Limitations When Using Electrical Stimulation - UltrasoundBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 10th, 2017 - Last Review/Update August 2nd, 2017
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 ... February 10th, 2017 Q/A: What is the Proper Code for "Lumbar Decompression?By ChiroCode | Published February 10th, 2017 - Last Review/Update February 8th, 2019 Q: What is the proper code for "Lumbar Decompression? February 2nd, 2017 Coverage and/or Medical Necessity for the Use of Hyaluronan or DerivitiveBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 2nd, 2017 - Last Review/Update August 2nd, 2017
Verify your local coverage determination and medical necessity requirements for the following codes:
Hyaluronate Polymers (L33432) - Noridian Medicare
J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg
J7321 - Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose
J7322 - Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg
J7323 - Hyaluronan or ... February 1st, 2017 Medicare Coverage of Behavioral Health ServicesBy Wyn Staheli, Director of Content | Published February 1st, 2017 January 23rd, 2017 Anesthesia Code Changes in 2017- Epidural Steroid Injections (ESI)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017 Pay close attention to the new 2017 Anesthesia codes there are a few notable changes. There is a new code set for Epidural Steroid Injections (ESI). The difference in the new codes set has a clear distinction on a single injection or a catheter placement for continuous infusion/intermittent bolus and if ... January 23rd, 2017 Mammography Codes Changed in 2017By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017
Pay careful attention to the mammography code changes for 2017.
The following codes have been Deleted:
77055 Mammography; unilateral 77056 Mammography; bilateral 77057 Screening mammography, bilateral (2-view study of each breast)
Below are the Replacement Codes:
77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral 77067 Screening ... January 23rd, 2017 New and Deleted Drug Screen codes for 2017By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017 - Last Review/Update March 8th, 2017 Deleted Codes for Drug Screening, the following codes are no longer valid for services performed on or after January 01, 2017.
Deleted Codes for 2017
80300
Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical ... January 23rd, 2017 New and Deleted Angioplasty Codes for 2017By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 23rd, 2017 The following codes have been Deleted as of January 01, 2017
35450
Transluminal balloon angioplasty, open; renal or other visceral artery
35452
Transluminal balloon angioplasty, open; aortic
35458
Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel
35460
Transluminal balloon angioplasty, open; venous
35471
Transluminal balloon angioplasty, percutaneous; renal or visceral artery
35472
Transluminal balloon angioplasty, percutaneous; aortic
35475
Transluminal balloon angioplasty, percutaneous; ... January 21st, 2017 Moderate Sedation Code Changes for 2017By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 21st, 2017
One of the significant code changes for 2017 included Moderate sedation services. Codes 99143-99145 and 99148-99150 are no longer active codes in 2017. The moderate sedation codes have been replaced with six new codes 99151-99157.
For example:
Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of ... January 12th, 2017 Sleep Studies: Billing with Reduced HoursBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 12th, 2017 - Last Review/Update August 2nd, 2017
When using codes 95800, 95801, 95806, 95807, 95810, and 95811, and fewer than six hours of recording is performed, you must report the reduced services using modifier 52.
Also, when using 95782 and 95783, and fewer than seven hours of recording is performed, modifier 52 would be appended to the appropriate code.
95805 would require modifier 52 if fewer than four hours of recording is performed.
Medicare recognizes the ... January 2nd, 2017 G-Codes eff Jan 01,2017 for additional payment for Psych - Collaborative CareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 2nd, 2017 - Last Review/Update July 26th, 2017 Medicare has agreed to make separate payments to physicians and non-physicians for Behavioral Health Integration (BHI) services beginning Jan. 01, 2017.
Any condition new or pre-existing behavioral health or substance use disorders are eligible. Beneficiaries may have comorbid, chronic, or other medical conditions they are being treated for as well.
Using the ... December 30th, 2016 How APC Payment Rates Are SetBy Brittney Murdock, QCC, CMCS, CPC | Published December 30th, 2016 The payment rates for most separately payable medical and surgical services are determined by multiplying the prospectively established scaled relative weight for the service’s clinical APC by a conversion factor (CF) to arrive at a national unadjusted payment rate for the APC. December 21st, 2016 Q/A: E/M Bundled with CMTBy ChiroCode | Published December 21st, 2016 - Last Review/Update February 28th, 2019 What do you do when you are continually getting denials when billing office visit E/M code 99213-25 along with a CMT on dates that we do re-exams? What do you do when an appeal does not seem to work even though clear evidence has been provided that all conditions for the 99213 have been satisfied.? December 19th, 2016 BenchmarksBy Wyn Staheli, Director of Content | Published December 19th, 2016 Benchmarking is simply a standard or point of reference against which things may be compared or assessed. For all businesses, it is a way of comparing your business processes to another business in the same industry to determine where shortfalls exist or improvements can be made to maintain profitability. December 16th, 2016 NAMAS: 2017 CPT Updates Bring Big Changes to Physical TherapyBy Find-A-Code | Published December 16th, 2016 For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The... December 7th, 2016 Workers CompensationBy Wyn Staheli, Director of Content | Published December 7th, 2016 Workers’ Compensation is for work related illness or injuries on the job. The employer pays for insurance which covers medical costs incurred, and replaces lost wages. Fees are based on a specific fee schedule that varies by state.
There are three possible scenarios regarding workers’ compensation: the patient is covered by ... December 6th, 2016 Oral Maxillofacial Prosthesis (A53496)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 6th, 2016 - Last Review/Update August 1st, 2017
Implants, which could be considered dental but are being inserted to secure, attach, or support the maxillofacial prosthesis, will be covered when the prosthesis is to be used secondary to maxillofacial surgery or repair of traumatic injury. Use CPT code 21299 to bill the implants with an explanation of the intended use. ... December 4th, 2016 2017 CPT Updates Bring Big Changes to Physical TherapyBy Misty Tinch, RHIT, CPC, CPMA | Published December 4th, 2016 - Last Review/Update August 17th, 2017
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The new ... November 29th, 2016 E/M 101By BC Advantage | Published November 29th, 2016 - Last Review/Update December 8th, 2016 E/M stands for "evaluation and management". E/M coding is the process by which provider-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for "current procedural terminology." These are the numeric codes which are submitted to insurers for payment. Most billable procedures have their own CPT ... November 29th, 2016 New Mapping Tool - CPT/HCPCS Medicare Denial Rates & Average ChargesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 29th, 2016
Use this tool as a part of an important strategy to improve your processes and stay ahead of denials. Check your most commonly used codes to give your practice a heads up on denial rates and average charges. This is a quick way to view a group of codes or ... November 21st, 2016 Best Diagnosis Codes for E-stimBy ChiroCode | Published November 21st, 2016 - Last Review/Update March 5th, 2019 What are the best diagnosis codes for E-stim? November 19th, 2016 Lack of Medical NecessityBy ChiroCode | Published November 19th, 2016 - Last Review/Update March 5th, 2019 (from page 210 in chapter 3.5 of the 2017 DeskBook) One of the biggest problems providers face when audited is that many services are deemed not medically necessary and are routinely denied. Much of the proof falls back on the medical record.
Here are some specific situations as they may ... November 9th, 2016 Should I Avoid Billing 97112By Raquel Shumway | Published November 9th, 2016 - Last Review/Update March 5th, 2019 Question: The Doctor says he was told by a billing company a few years ago to avoid the 97112. So he has been doing 97110 instead. They do the items listed in 97110, but often some of the ones in 97112 as well. His question was, should he actually be avoiding 97112? Or is there simply something he needs to be mindful of when using it? November 2nd, 2016 Avulsion of Nails and Treatment of Ingrown NailsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 2nd, 2016 - Last Review/Update August 1st, 2017
Subungual abscess
Contusion of the nail
Crushing injury of the toe or finger
Painful onychauxis
Painful onychomycosis
Onychocryptosis (ingrown nail)Onychocryptosis occurs most frequently in the big toes. The condition is categorized into:Simple onychocryptosis
Complicated onychocryptosis
The simple or uncomplicated category is caused by pressure on the nail groove by an essentially healthy nail caused by injudicious cutting ... October 28th, 2016 Auditing Same Day Psychotherapy and E&M Services: The Time TrapBy Scott Kraft, CPC, CPMA | Published October 28th, 2016 - Last Review/Update August 17th, 2017
A problem-focused E/M service and the provision of psychotherapy on the same date of service are both separately payable, when medically necessary. A typical scenario is when the
provider treats the patient's diagnoses by documenting the appropriate level of history, exam and medical decision making - such as a decision to ... October 27th, 2016 Sedation used on a Dental Patient for a medical procedureBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 27th, 2016 - Last Review/Update August 1st, 2017
When you need to bill a medical code instead of the dental code D9223, consider the following medical codes, and be sure to review the AMA guidelines to see if they fit the procedure you are doing. If a dental office is doing conscious Sedation for over 5 years old there is ... October 26th, 2016 Using Physical Status Modifiers with Anesthesia CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 26th, 2016 - Last Review/Update August 1st, 2017
These six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in the CPT codebook to distinguish among various levels of complexity of the anesthesia service provided.Example: 00100-P1Physical Status modifiers are represented by the initial letter ‘P’ followed by a single digit from 1 to 6 ... October 14th, 2016 Injections and InfusionsBy Jessica Franzese, CPC, CPMA | Published October 14th, 2016 - Last Review/Update August 17th, 2017
Injection and infusion codes can be tricky. In this auditing tip, we'll break them down and help to make them a little easier to understand. Let's start first with the basics. Injections and infusion codes can be found in the medicine section of the CPT® book, codes 96360-96549. They are ... October 5th, 2016 You can charge for Advanced Care Planning (ACP)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 5th, 2016
Did you know you could be charging for Advanced Care Planning (ACP). Effective January 1, 2016, payment for the service described by CPT code 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or ... October 3rd, 2016 Upper Eyelid Blepharoplasty and Blepharoptosis RepairBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 3rd, 2016 - Last Review/Update August 1st, 2017
The Centers for Medicare & Medicaid Services (CMS) payment policy does not allow separate payment for a blepharoplasty procedure (CPT codes 15822, 15823) in addition to a blepharoptosis procedure (CPT codes 67901-67908) ontheipsilateral upper eyelid. Any removal of upper eyelid skin in the context of an upper eyelid blepharoptosis surgery is considered apart of ... October 3rd, 2016 Upper Eyelid Blepharoplasty and Blepharoptosis Repair (update eff 10/01/2017)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 3rd, 2016 - Last Review/Update August 2nd, 2017 The Centers for Medicare & Medicaid Services (CMS) payment policy does not allow separate payment for a blepharoplasty procedure (CPT codes 15822, 15823) in addition to a blepharoptosis procedure (CPT codes 67901-67908) ontheipsilateral upper eyelid. Any removal of upper eyelid skin in the context of an upper eyelid blepharoptosis surgery is considered apart of ... September 30th, 2016 Medicare Condition Code 44By Jeanette Anderson, CPC, CPMA | Published September 30th, 2016 - Last Review/Update August 17th, 2017
Medicare Condition Code 44 is used when an inpatient admission needs to be changed to outpatient status. There are some instances where a Medicare patient was admitted to the hospital with an inpatient status, but upon review it is deemed more appropriate for the entire encounter to be an outpatient ... September 16th, 2016 Measure Up: Wound Measurements & Debridement AuditingBy Grant Huang, CPC, CPMA | Published September 16th, 2016 - Last Review/Update August 17th, 2017
Wound care can be a tricky arena for auditors, but if there's any one element that providers tend to skimp on, it's wound measurements. Getting wound measurements right is crucial, but providers can sometimes be slapdash with documenting their measurements. Let's review what's required in terms of measurements for the ... August 23rd, 2016 Smoking and tobacco cessation counseling, covered indications and # of visitsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 23rd, 2016 - Last Review/Update August 2nd, 2017
Nationally Covered Indications:Effective for claims with dates of service on or after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;2. Who are competent and alert at the time that ... August 16th, 2016 Functional Limitation Reporting Codes and ModifiersBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 16th, 2016
The following G-codes are used for reporting on claims for Medicare Part B and must be used with a severity/complexity modifier, the use of G-codes are enforced and required beginning Jan. 01, 2013, claims will be returned or rejected if they do not contain the required functional G-Code/modifier information.
There are ... August 10th, 2016 Differentiate the Extraordinary Work Performed During the Intraoperative or Postoperative PeriodsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 2nd, 2017
The code for complex cataract surgery (CPT code 66982) is intended to differentiate the extraordinary work performed during the intraoperative or postoperative periods in a subset of cataract operations including, and not limited to, the following:
A miotic pupil which will not dilate sufficiently to allow adequate visualization of the lens in ... August 10th, 2016 Visual Field ExaminationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 2nd, 2017
The following information from one Medicare payer includes indications and limiatations of coverage as well as Medical Necessity standards for visual field examinations.
92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or ... August 10th, 2016 Fundus Photography and Extended OphthalmoscopyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
92225
Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial
92226
Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent
92227
Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral ... August 10th, 2016 Blepharoplasty: Medically Necessary DocumentationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
The following information from one Medicare payer provides guidance on properly coding and documenting blepharoplasty procedures.
Blepharoplasty proceduresandrepairofblepharoptosis are covered when performed for the following functional indications. All other uses would be considered cosmetic.
1. Lower lid blepharoplasty (CPT 15820 and 15821) is considered as medically necessary when documentation:
supports horizontal lower eyelid laxity of medial and ... August 10th, 2016 Guidance for the Use of Codes in Physical Medicine - Pub-100By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
The following provides guidance about the use of codes 96105, 97026, 97150, 97545, 97546, and G0128.
• CPT Codes 96105, 97545, and 97546.
Providers report code 96105, assessment of aphasia with interpretation and report in 1-hour units. This code represents formal evaluation of aphasia with an instrument such as the Boston Diagnostic Aphasia Examination. If this formal assessment is performed during treatment, ... August 3rd, 2016 Billing UnitsBy Wyn Staheli, Director of Content | Published August 3rd, 2016 Are you billing units correctly? This article outlines important considerations to ensure that claims are submitted properly. July 29th, 2016 Make sure your smoking cessation services are being coded rightBy Codapedia | Published July 29th, 2016 Coding, billing and getting paid for providing smoking cessation services when covered by your payers is almost a no-brainer for any physician practice because, in most cases, cessation services are already being provided to patients who smoke cigarettes. Yet practices consistently don’t take advantage of this opportunity and, when they... July 29th, 2016 Preventive medicine and office visit, same dayBy | Published July 29th, 2016 Can I use modifier 25 on an E/M service on the same day as a preventive medicine exam Let’s review what a preventive medicine service is, in order to answer that question. Preventive medicine services are: • The description given by CPT® for “annual physicals” • Divided into new and... July 29th, 2016 Medicare no longer requires facility certification for bariatric surgeryBy | Published July 29th, 2016 Thanks to a recent tweak to Medicare policy, facilities are no longer required to be certified in order for bariatric surgery procedures to be covered, CMS announced in a recent transmittal modifying its National Coverage Determination (NCD) on the procedure. The change took effect September 24.Left unchanged in the NCD... July 29th, 2016 Mini Mental Status Exam-Can you bill for it?By Codapedia | Published July 29th, 2016 There is no CPT® code for the Mini Mental Status Exam. Physicians use the mini mental status exam (MMSE to test a patient's cognitive function. The test is made up of a set of questions, testing the patient’s memory, orientation and arithmetic calculation skills. There is a copyrighted form of... July 29th, 2016 CODING ARTHROSCOPIC KNEE PROCEDURESBy Codapedia | Published July 29th, 2016 Knee Anatomy: The medical compartment includes: Medial Femoral condyle Medial tibial plateau Medial meniscus The lateral compartment includes: Lateral Femoral condyle Lateral tibial plateau Lateral meniscus The Patellofemoral compartment includes: Patella Patellofemoral joint Intercondylar notch of the femur Suprapatellar pouch Trochlea Arthroscopy: Knee arthroscopy allows the physician to visualize the... July 29th, 2016 Nursing home discharge servicesBy Codapedia | Published July 29th, 2016 Either a physician or an NPP may bill for discharge services from a skilled nursing facility or a nursing facility. There are two discharge day management codes from a nursing facility. 99315 is for discharge day management 30 minutes or less, and 99316 is for discharge day management over 30... July 29th, 2016 Subsequent nursing facility visitsBy Codapedia | Published July 29th, 2016 Subsequent nursing facility visits (99307--99310) are services billed for either mandated or medically necessary visits in a skilled nursing facility or nursing facility. (Place of service 31 for a skilled nursing facility or 32 for a nursing facility). These codes may also be used in place of service 54 (Intermediate... July 29th, 2016 Annual Nursing Facility AssessmentBy Codapedia | Published July 29th, 2016 CPT® code 99318 is used to bill an annual nursing facility assessment. It requires three of three of these components: a detailed interval history, a comprehensive exam, and low or moderate medical decision making. This visit is payable once per year for a resident in a nursing facility. It may... July 29th, 2016 Coding Selective and Non Selective Catheter Placement of Lower ExtremityBy Codapedia | Published July 29th, 2016 - In diagnostic catheterization, codes are given simply at the final position of the catheter. This can be simply understood if we know the anatomy of Aorta. As we know, most of the major arteries arise from Aorta for example, Inominate artery, Left common carotid artery, Left subclavian artery, celiac... July 29th, 2016 Subsequent hospital visitsBy Codapedia | Published July 29th, 2016 Hospital services are all defined by CPT® as per day codes, that is, all of the care provided to a hospitalized patient during the calendar day. If a physician (or that physician's covering partner of the same specialty) sees the patient a second time during the calendar day, a second... July 29th, 2016 Subsequent Observation ServicesBy Codapedia | Published July 29th, 2016 CPT® released three new E/M services in 2011, to be used for the second and subsequent days that a patient is in observation status in the hospital. The codes are 99224--99226 and they are out of sequence in the CPT® book. They require the same level of documentation as the... July 29th, 2016 Evaluation and Management ServicesBy Codapedia | Published July 29th, 2016 According to the CPT® book, E/M services are divided into categories and subcategories. Office services are divided into new and established patient visits. Consultations are divided into outpatient/office consults and inpatient consultations. The E/M services typically have three to five levels of services and these levels are not interchangeable from... July 29th, 2016 I had a wheezer in the office, can I bill a 99215?By Codapedia | Published July 29th, 2016 At a coding session at a recent Pri-Med conference a Pediatrician asked this question: "I had wheezer in the office, and he was in the office a long time. I examined him, we did pulxe oximetry measurements, which we never get paid for both before and after a nebulizer treatment.... July 29th, 2016 Sports PhysicalsBy Codapedia | Published July 29th, 2016 Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope. If the patient presents for a well child visit, and also needs their camp physical filled out,... July 29th, 2016 Anesthesia and E/M servicesBy Codapedia | Published July 29th, 2016 Anesthesia services are billed using CPT® codes 00100-01999. These CPT® codes are cross-walked to surgical codes. The crosswalk is available from the American Society of Anesthesiologists at www.asahq.org. Each anesthesia code has a base unit assigned to it. The anesthetist also bills the number of time units, with a single... July 28th, 2016 New PatientBy Codapedia | Published July 28th, 2016 According to the American Medical Association’s CPT® book, a new patient is a patient who “has never received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years. There is an excellent chart in the front... July 28th, 2016 OIG Work Plan to look at excessive patient billing, place of service errorsBy | Published July 28th, 2016 The 2014 OIG Work Plan has finally been released and, while it doesn’t have a lot of new issues for physician practices, there are definitely some areas worth your attention to avoid future compliance hassles. If you’ve been wondering where it’s been, the OIG decided to change the timing of... July 28th, 2016 Category of Code SelectionBy Codapedia | Published July 28th, 2016 Does anyone remember the good old days, when you didn't need to know the patient's insurance to select a category of code? Now, correct selection of an E/M category of code requires the clinician and coder to consider: Where the service was performed The status of the patient (Observation vs... July 28th, 2016 Using Modifer -59By Codapedia | Published July 28th, 2016 By Crystal Reeves, CPC, CMPE, Principal Modifier -59 is probably one of the most misunderstood, misused, and most-feared of all CPT® modifiers. Some practices avoid using it all together because they don’t want to be guilty of unbundling. Some practices do not use it because they are not at all... July 28th, 2016 E-prescribing pay cuts loom for some in 2014, 2015By Codapedia | Published July 28th, 2016 Some practices may find 2014 immediately off to the wrong foot when their Medicare payments are reduced by 2 percent for failing to participate successfully in Medicare’s E-prescribing Incentive Program. Unfortunately, at this point successfully claiming an exemption may be the only way to stave off the cut for non-reporters,... July 28th, 2016 Learn Exactly how to Code Twin PregnancyBy Codapedia | Published July 28th, 2016 - As we know there are OB CPT® codes using for coding Pregnancy procedures. The procedures are divided on weeks of gestation. There are separate CPT® codes for first and second trimesters. The first trimester of pregnancy is week 1 through week 12, or about 3 months. The second trimester... July 28th, 2016 Do you know New CPT® Code changes in 2016: Read thisBy Codapedia | Published July 28th, 2016 - With New year in 2016, we will be having new CPT® codes in diagnostic radiology. Since, we will be having CPT® codes which will replace old CPT® codes, some of the codes will be deleted. Diagnostic Radiology have the lot of changes which I hope will help medical coder... July 28th, 2016 99213 Established patient visitBy Codapedia | Published July 28th, 2016 There are sample audited notes in resource section. 99213 is an established patient visit which requires 2 of 3 of the following components: An expanded, problem focused history, which is 1-3 HPI elements and 1 system in ROS reviewed An expanded, problem focused exam, which is 6 bullets from 1997... July 22nd, 2016 Testing for InfluenzaBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 22nd, 2016 - Last Review/Update August 4th, 2017
There are several types of testing that distinguishes between influenza virus types A and B and several changes in codes in 2016.
For direct observation to detect an infectious agent by immunoassay use:
87804- Infectious agent antigen detection by immunoassay with direct optical observation; Influenza.
If the specimen is tested for both Type ... June 28th, 2016 Q&A: We Bill Hot/Cold Packs (97010) but are Rarely Reimbursed. Why is This?By Melissa Hall | Published June 28th, 2016 - Last Review/Update March 5th, 2019 97010 is a service that is commonly not covered by payers or if it is covered, reimbursement is very minimal. This is due to a few reasons: June 28th, 2016 NAMAS - Study the Rules Before Auditing E&M Services by Teaching PhysiciansBy Find-A-Code | Published June 28th, 2016
If you work for a facility that utilizes residents, then you will need to understand the requirements for reporting teaching physician services. The Office of Inspector General (OIG) has had hospital teaching physician activities on their work plan repeatedly, and therefore it should be on your radar as well to ... June 24th, 2016 Study the Rules Before Auditing E&M Services by Teaching PhysiciansBy Sara San Pedro, CPC, CEMC, CPMA | Published June 24th, 2016 - Last Review/Update August 17th, 2017
If you work for a facility that utilizes residents, then you will need to understand the requirements for reporting teaching physician services. The Office of Inspector General (OIG) has had hospital teaching physician activities on their work plan repeatedly, and therefore it should be on your radar as well to ... June 23rd, 2016 What Are Unproven, Investigational or Experimental Procedures?By Brandy Brimhall CPC CMCO CPCO CCCPC CPMA | Published June 23rd, 2016 Many specialties, including chiropractors, perform services that may be deemed "experimental, investigational and unproven." Individual payer coverage determinations, as well as state boards, generally offer specific information defining this type of procedure and any other notice or guideline that providers must be aware of and adhere to.The terms "unproven, experimental ... June 16th, 2016 Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?By ChiroCode | Published June 16th, 2016 - Last Review/Update March 5th, 2019 Q&A: If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes? June 9th, 2016 CMS Calculations for Average Sales Pricing ASPBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2016 - Last Review/Update August 2nd, 2017
Because Drugs are not a part of the Medicare fees schedule, Drug pricing by Medicare is done according to Average Sales pricing (ASP) and is used to pay Part B claims. Average Wholesale pricing was used for part B Medicare payments until 2005, then ASP pricing/payment structure was implemented.
How ASP ... June 9th, 2016 Pass-Through Payments, how they work and Device Category Codes ListBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2016 - Last Review/Update August 4th, 2017 If you want to know if a DRUG is a Pass through drug - Find-A-Code has that information on the code information page under FEES and APC Fee information
A pass through payment for a drug is Medicare reimbursement paid in addition to an ASC's facility fee, however, CMS limits the eligibility ... June 7th, 2016 A dental guide to cross-coding for oral cancer screeningBy Christine Taxin | Published June 7th, 2016 - Last Review/Update January 30th, 2017 It is possible to bill medical insurance in the dental office for oral cancer testing. This will show you how June 6th, 2016 Billing, Documentation and Billable UnitsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 6th, 2016 - Last Review/Update August 2nd, 2017
Most third-party payers (eg, commercial insurers, Medicare, Medicaid) cover REMICADE® (infliximab) for its approved U .S . Food and Drug Administration indications (see Indications on page 5 of this guide) . However, benefits may vary depending upon a patient’s insurer or specific insurance plan (or “product”) offered by a payer.
When third-party ... May 27th, 2016 Documentation Criteria: Medicare PhysicalsBy Jeanette Anderson, CPC, CPMA | Published May 27th, 2016 - Last Review/Update August 16th, 2017
When billing annual Medicare physicals, it's very important to know the status of the patient, determining when they became eligible, and/or if they've seen another provider for any of these services as the initial visit codes are once in a lifetime codes and will be denied if they have already ... May 25th, 2016 May be a Payable Code for Dental Procedures under Medical PolicyBy Christine Taxin | Published May 25th, 2016
The following list may be payable Codes for Dental Procedures under a patients Medical Policy. Be sure to verify with the payer for benefit coverage and exclusions.
ICD-10-CM Diagnosis Codes
B00.2 Herpesviral gingivostomatitis and pharyngotonsilitis
K00.0 Andontia
K00.1 Supernumerary Tooth
K00.2 Abnormalites of size and form of tooth
K00.3 Mottled Teeth
K00.4 Disturbances in tooth formation
K00.5 Hereditary ... May 9th, 2016 Billing Compound DrugsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 9th, 2016 - Last Review/Update August 4th, 2017
Unclassified HCPCS codes can only be used when there is not a specific HCPCS code available for the drug being billed.
Each NDC associated with an unclassified drug code should be submitted on a separate claim line following the instructions specified in the Manual for Physicians and Providers- Coding and Filing ... May 9th, 2016 NOC Drug and Biological CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 9th, 2016 - Last Review/Update August 4th, 2017
The following are tips to help you when billing NOC drugs and biologicals, such as J3490, J3590, and J9999. Providers submit NOC codes in the 2400/SV101-2 data element in the 5010 professional claim transaction (837P).
When billing an NOC code, providers are required to provide a description in the 2400/SV101-7 data element. The 5010 ... May 3rd, 2016 Using the SBIRTBy Wyn Staheli, Director of Content | Published May 3rd, 2016 Screening, Brief Intervention, and Referral to Treatment (SBIRT) services are an effective tool for healthcare providers to identify, reduce, and prevent problematic substance use disorders. Healthcare practices can help their patients and improve their integrated care standards with the proper use of the SBIRT. April 29th, 2016 Adaptive Behavior CodingBy Wyn Staheli, Director of Content | Published April 29th, 2016 - Last Review/Update April 9th, 2018 Information about Adaptive Behavior Coding for Members. April 25th, 2016 The Use of Modifier 50By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 25th, 2016 - Last Review/Update August 4th, 2017
Modifier Review: Modifier -50
Modifier 50 is used to report a procedure performed bilaterally.
Example: The patient underwent bilateral tympanostomy with insertion of ventilating tubes.
If you look up the CPT code 69433, you will see it is a unilateral procedure and there are instructions telling you to append modifier -50 if it is ... April 4th, 2016 Coverage Criteria and Medical Necessity with MedicareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 4th, 2016 - Last Review/Update August 3rd, 2017
Negative Pressure Wound Therapy (NPWT) is defined as the application of sub-atmospheric pressure to a wound to remove exudate and debris from wounds. NPWT is delivered through an integrated system of a suction pump, separate exudate collection chamber and dressing sets to a qualified wound. In these systems, exudate is ... April 4th, 2016 Written Order Prior to Delivery (WOPD) is Required for Payment by MedicareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 4th, 2016 - Last Review/Update August 3rd, 2017
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare ... March 28th, 2016 Q&A: Is There a Better Supply Code to Use Than 99070?By ChiroCode | Published March 28th, 2016 - Last Review/Update March 5th, 2019 Are there more specific codes for supplies rather than using 99070? March 25th, 2016 Auditing Smoking Cessation ServicesBy John Burns, CPC, CPC-I, CEMC, CPMA | Published March 25th, 2016 - Last Review/Update August 16th, 2017
Most payers do indeed recognize smoking and tobacco cessation services as a covered health insurance benefit. We have found that some providers perform these services without fully understanding the reimbursement opportunities, while others claim such services without adequately documenting to support them. Medicare, for example, will pay for two (2) ... March 23rd, 2016 Added Thoughts on Medical Necessity & Determining Appropriate Levels of CareBy Stephen R. Levinson, M.D., CHCA ASA, LLC | Published March 23rd, 2016 February’s Find-A-Code Newsletter provided a superb summary of the importance of Medical Necessity in determining the appropriate level of care warranted during a given Evaluation and Management service. The author also accurately identified the “Nature of the Presenting Problem(s)” as the E/M system’s measure of medical necessity, because it medically ... March 7th, 2016 Discarded Drugs and BiologicalsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2016 - Last Review/Update August 3rd, 2017
When a portion of a drug must be discarded, Medicare allows payment for amount administered as well as the discarded portion. Your Medicare carrier may require you to use modifier JW. The JW modifier is to be applied only to the portion discarded. Multi-use vials are not subject to payment for discarded amounts.
Take ... March 4th, 2016 Medicare Improper Payment Report for Behavioral Health Services (2014)By Wyn Staheli, Director of Content | Published March 4th, 2016 Medicare Improper Payment Report information regarding Behavioral Health Services February 26th, 2016 Clear the Smoke on Debridement and Active Wound Care CodesBy | Published February 26th, 2016 Confused about when to choose a debridement code and an active wound code? CPT® 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth. “Depth is... February 26th, 2016 Auditing for Cerumen Removal Codes 69209, 69210By Scott Kraft | Published February 26th, 2016 - Last Review/Update August 16th, 2017
2016 brings changes to how physician practices bill for the removal of impacted cerumen, including a new CPT code. The rules that apply to the two cerumen removal codes now available for use mean that auditors will need to scrutinize the documentation closely in order to ensure codes are being ... February 25th, 2016 Pricing is for a single shoe or individual insertsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 25th, 2016
If you are contracted with a payer be sure you recognize that the pricing is for a single shoe or insert.
When billing orthotics it seems to be less confusing to bill two line items, one for the Left - LT and one for the Right Rt.
... February 24th, 2016 Nebulizer Therapy Billing Reminders - Modifiers, Dispensing Fees, and OrdersBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 24th, 2016 - Last Review/Update August 3rd, 2017 The ICD-10-CM code describing the condition necessitating nebulizer therapy must be included on each claim for equipment, accessories, and/or drugs.
When ever a unit dose code is billed, it must have a KO, KP, or KQ modifier. (Exception: The KO, KP, and KQ modifiers should not be used with code J7620.)
When billing miscellaneous equipment or accessories (E1399), the claim must ... February 23rd, 2016 ABN is required - (if you anticipate payer will deny or is not medically necessary)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2016 - Last Review/Update August 3rd, 2017
An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1st, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, ... February 23rd, 2016 PRESCRIPTION (ORDER) REQUIREMENTS (Confirm with your Local Payer)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2016 - Last Review/Update August 4th, 2017
All items billed to Medicare require a prescription. An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. Items dispensed and/or billed that do not meet these prescription requirements and those below must be ... February 23rd, 2016 Coverage Criteria and Medical Necessity for a Mobility DeviceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2016 - Last Review/Update August 4th, 2017
General Coverage Criteria for a Mobility DeviceAccording to CMS, all of the following basic criteria (A-C) must be met for a power mobility device (K0800-K0898) or a push-rim activated power assist device (E0986) to be covered. Additional coverage criteria for specific devices are listed below.
The beneficiary has a mobility limitation ... February 23rd, 2016 Billing Reminders - (POV - Power Operated Vehicles) Modifiers, Verification, Delivery time...By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2016 - Last Review/Update August 4th, 2017
According to CMS, delivery of the PMD must be within 120 days following completion of the F2F.
Exception: within 6 months from the date of an affirmed ADMC.
• The PMD will be denied if the underlying condition is reversible and length of need is < 3 months.
• The KX modifier ... February 17th, 2016 Getting Paid When Reporting Unlisted CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 17th, 2016 - Last Review/Update August 4th, 2017
Using unlisted codes can be quite labor intensive, but if you are prepared and understand ahead of time about using unlisted codes you will have a higher success rate of reimbursement.
Verify the payers guidelines - Be sure your code selection it is a payable code; if it is not a payable code ... February 17th, 2016 TeleMedicine Terms and Definitions and who can bill - Using ModifiersBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 17th, 2016 - Last Review/Update August 4th, 2017 Medical practitioners who can bill for a covered Telehealth service vary by state law, but they may include:
physician,
nurse practitioner,
physician assistant,
nurse midwife,
clinical nurse specialist,
clinical psychologist,
clinical social worker, and
registered dietician or nutrition professional
Distant or Hub site: Site at which the physician or other licensed practitioner delivering the service is located at the time the ... February 15th, 2016 Message to DME SuppliersBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2016 The Patient Access and Medicare Protection Act (PAMPA) was recently signed into law on December 28, 2015. Beginning January 1, 2016, the DME fee schedule rates are adjusted to reflect information from the DMEPOS competitive bidding program as required by section 1834(a)(1)(F)(ii) of the Social Security Act. These adjustments are ... February 15th, 2016 List of approved ICD-10 codes for Mental Health Providers - Washington State MedicaidBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2016
The agency covers the below outpatient services to treat conditions that fall within the ICD diagnosis code range for mental health. For billing purposes, providers are required to use the most specific code available.
The agency also covers preventative mental health care, if the most specific code is used.
See the agency’s ... February 12th, 2016 Behavioral Heath Treatment/Services - Documentation RequirementsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 12th, 2016 - Last Review/Update August 4th, 2017
Reason for referral.
Tests administered, scoring/interpretation, and time involved.
Present evaluation.
Diagnosis (or suspected diagnosis that was the basis for the testing if no mental/neurocognitive illness was found).
Recommendations for interventions, if necessary.
Identity of person performing service.
... February 12th, 2016 Patient Status: Hospital Inpatient vs. ObservationBy Jeanette Anderson, CPC, CPMA | Published February 12th, 2016 - Last Review/Update August 16th, 2017
As an auditor, we must ensure that the documentation supports the selected use of codes for reimbursement. When auditing hospital encounters, the patient status serves as the basis for the code selection and therefore must be clearly documented. This ensures that the hospital is able to collect appropriate reimbursement.
During an ... February 1st, 2016 Will Incident-To in Your Organization Pass a Compliance Audit?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 1st, 2016 Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits. February 1st, 2016 Documentation and Billing PracticesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 1st, 2016 - Last Review/Update August 7th, 2017
Prescribed to:
Reduce pain by restricting mobility of the trunk: OR
Facilitate healing following an injury to the spine or related tissue; OR
Otherwise support weak and/or deformed spinal muscles.
Documentation and billing practices be sure you are meeting all the requirements to bill a spinal orthoses.
Spinal Orthoses billed with HPCPCS L0450, L0454, L0621, L0625 and L0628 must be billed with ... February 1st, 2016 Elastic Garments - Medicare NoncoveredBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 1st, 2016 - Last Review/Update August 4th, 2017
According to Noridian, CMS has determined that elastic garments do not meet the statutory definition of a brace because they are not rigid or semi-rigid devices. Therefore, effective for claims with dates of service on or after April 1, 2009, these items will be denied as Medicare noncovered, no benefit category.
This ... January 29th, 2016 Announcing Find-A-Codes newest addition - Medical /Lab Test InformationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016 Announcing Find-A-Codes Newest product: Medical /Lab Test Information, available with your Find-A-Code subscription.Test information includes:
overview of the test
utility - when/why/how the test is used
diseases the test is often used to detect or monitor
specimen collection methods/procedures
testing methodology
usual turnaround time
interpretation of test results
reference ranges for test results (normal, abnormal, etc.)
diagnosis and billing ... January 29th, 2016 Wound Care & Debridement- Provided by Physician, NPP or as Incident-to ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016 Providers must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required ... January 29th, 2016 Certificate for Provider - Performed Microscopy ProceduresBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016
Effective January 19, 1993, a laboratory that holds a certificate for provider-performed microscopy procedures may perform only those tests specified as provider-performed microscopy procedures and waived tests, as described below, and no others.
HCPCS Code Test
Q0111
Wet mounts, including preparations of vaginal, cervical or skin
specimens
Q0112
All potassium hydroxide (KOH)
preparations
Q0113
Pinworm examinations
Q0114
Fern test
Q0115
Post-coital direct, qualitative ... January 6th, 2016 E/M service prior to a screening colonoscopyBy Codapedia | Published January 6th, 2016 CMS does not pay for an Evaluation and Management service prior to a screening colonoscopy. If a patient calls or is sent from another physician to schedule a screening colonoscopy, do not bill any type of E/M service prior to the procedure. Some commercial carriers also... January 6th, 2016 Don’t expect to see payment any time soon for ‘telephone consults’By Codapedia | Published January 6th, 2016 Four new CPT® codes that got some attention when the 2014 CPT® changes were released late last year were a new E/M code series, 99446-99449, designed to be reported when a consulting provider offered a telephone or Internet E/M service that included a verbal and written... January 6th, 2016 Preventive Medicine Services for Medicare PatientsBy | Published January 6th, 2016 The most widely known fact about Medicare and preventive medicine is that fee-for-service Medicare does not cover an annual physical exam. This is because in its beginning, Medicare was prohibited from paying for routine services. Over the years, Congress has mandated the payment of some screening... January 6th, 2016 Doing--and coding--for minor procedures in primary careBy Codapedia | Published January 6th, 2016 I asked a Family Physician recently if he did minor procedures in his practice. He said, “I send them all to my partner. Tim loves doing minor procedures, and he’s fast. I don’t bother with them myself.” His partner, by inclination or design, was the designated... January 6th, 2016 Modifiers in Postoperative PeriodsBy Codapedia | Published January 6th, 2016 Modifiers in Postoperative Periods Introduction Documenting the events of a patient visit is not always the simplest and most straightforward of processes. Many variables affect which information must be included in order to report a procedure or service accurately. Global periods are one of those... January 6th, 2016 Reporting Administration Codes with VaccinesBy Codapedia | Published January 6th, 2016 When it comes to billing for vaccines, the rules for reporting administration codes can be tricky. Reporting the right vaccine code alone is not enough to guarantee proper billing. Most billing scenarios allow providers to charge for both the vaccine product and the administration of the vaccine itself. However, there... January 6th, 2016 Coding Excisions and Wound RepairsBy Codapedia | Published January 6th, 2016 Chart audits frequently examine coding associated with lesion removals and wound repairs. In order to assign the appropriate procedure code, certain documentation must be included in the medical record, such as lesion type, excision size, wound repair, and location. Without these important details, providers... January 6th, 2016 Use of binocular microscopy in the officeBy Codapedia | Published January 6th, 2016 Binocular Microscopy Question: Our physicians want to report binocular microscopy in addition to minor ear procedures when they use the microscope in the office. For example, removing ear wax or placing tubes, and mastoid debridements. Can binocular microscopy be reported in addition to the minor procedure... December 21st, 2015 Screening barium enema examinations may be paid as an alternative to a screening colonoscopy (code G0105) examinationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 21st, 2015 - Last Review/Update August 4th, 2017
According to the Pub-100, screening barium enema examinations may be paid as an alternative to a screening colonoscopy (code G0105) examination. The same frequency parameters for screening colonoscopies (see those codes above) apply. In the case of an individual who is at high risk for colorectal cancer, payment may be made for ... December 21st, 2015 Colorectal Cancer Screening; Barium Enema; as an Alternative to G0104, Screening SigmoidoscopyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 21st, 2015 - Last Review/Update August 7th, 2017 G0106 - Colorectal Cancer Screening; Barium Enema; as an Alternative to G0104, Screening Sigmoidoscopy Screening barium enema examinations may be paid as an alternative to a screening sigmoidoscopy (code G0104). The same frequency parameters for screening sigmoidoscopies (see those codes above) apply.In the case of an individual aged 50 or over, payment may be ... December 21st, 2015 Characteristics of High Risk and How Often Test can be PerformedBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 21st, 2015 - Last Review/Update August 7th, 2017
According to Medicares Pub-100, 60 - Colorectal Cancer Screening Ref: AB-03-114;
Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month ... December 21st, 2015 Service is considered colorectal cancer screening services, age limit, every 48 monthsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 21st, 2015 - Last Review/Update August 7th, 2017
G0104 - Colorectal Cancer Screening; Flexible Sigmoidoscopy
Screening flexible sigmoidoscopies (code G0104) may be paid for beneficiaries who have attained age 50, when performed by a doctor of medicine or osteopathy at the frequencies noted below.For claims with dates of service on or after January 1, 2002, contractors or carriers pay for screening ... December 11th, 2015 Money In Your Pocket: Balance BillBy Codapedia | Published December 11th, 2015 The Comprehensive Error Rate Testing (CERT) program Medicare uses to assess the accuracy of provider billing has uncovered a big source for mistakes – documentation problems when a patient is receiving psychotherapy services on the same date as an E/M encounter, according to CMS. There are... December 11th, 2015 CMS: Lot of errors billing psychotherapy services when E/M visit is involvedBy Codapedia | Published December 11th, 2015 The Comprehensive Error Rate Testing (CERT) program Medicare uses to assess the accuracy of provider billing has uncovered a big source for mistakes – documentation problems when a patient is receiving psychotherapy services on the same date as an E/M encounter, according to CMS. There are... December 11th, 2015 CMS NCD drops clinical trial requirement for FDG PET scans for solid tumorsBy Codapedia | Published December 11th, 2015 Patients no longer need to be in a CMS-approved clinical trial for physician practices to get paid for doing as many as four FDG PET scans for solid tumors – one for an initial treatment strategy and three to guide subsequent treatments, according to CMS... December 11th, 2015 Hospital discharge, nursing facility admit billable on same day by same provider in most instancesBy | Published December 11th, 2015 Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple... December 11th, 2015 Who Qualifies for TCM Services?By Codapedia | Published December 11th, 2015 Any patient post-discharge whose medical and/or psychosocial problems are complex enough to require TCM services qualifies for these codes. Here are the specifics: 1. Location: “TCM is for higher-risk patients being discharged from an inpatient or observation status to their home, rest home, or assisted living... December 11th, 2015 How to bill for Well Woman Exams (WWE)By Codapedia | Published December 11th, 2015 Well Woman Exam CodingThere are options for billing pelvic exams and Pap smears for non-Medicare payers, albeit inconsistently by health plan. Some health plans will pay G0101, Q0091, S0610 and/or S0612. Some will pay one or another, some will pay a combination of two, others... December 3rd, 2015 Amazing tips for coding CPT® code for AngiogramBy Codapedia | Published December 3rd, 2015 Basics about CPT® code for Angiogram For percutaneous surgery, it is very important to code the angiography codes for studying the arteries or veins. In interventional radiology, we have many CPT® codes for angiograms that are specific are each artery or vein. These Angiogram procedure codes... December 2nd, 2015 99212--established patient visit - Sample audited notesBy | Published December 2nd, 2015 Established patient visits all require 2 out of 3 of history, exam, medical decision making 99212: History required is problem focused: 1-3 HPI elements Exam required is problem focused: 1 body area/organ system examined from the 1995 exam, or one bullet from the multi-specialty exam... December 2nd, 2015 Yet another new auditor looking at Part B claimsBy Codapedia | Published December 2nd, 2015 Recovery Audit Contractors (RACs) may be about to take a break while CMS awards new contracts, but don’t rest on your laurels. CMS has handed out yet another auditor contract for a single auditor, known as a Supplemental Medical Review Contractor (SMRC) to do nationwide claims... November 19th, 2015 Documentation Guidelines - E/M auditingBy | Published November 19th, 2015 What is the difference between the two sets of Guidelines?
There are two major differences. The first is in the history of the present illness (HPI). In the 1995 Guidelines, in order to document a history of the present illness at a detailed level, the clinician must document ... November 19th, 2015 Medical Necessity is not Medical Decision MakingBy | Published November 19th, 2015 I can count on two consistent issues in coding audits. Doctors report that their patients are, in general, sicker than patients in other practices. Coders report that their physicians are, in general, worse documenters than physicians in other practices and select codes that are too high based on ... November 19th, 2015 E/M service with no examBy Codapedia | Published November 19th, 2015 Does an E/M service require an exam? It depends on the category of service.
Established patients and subsequent hospital visits require two out of three of the key components, history, exam and medical decision making. Any two components at the level of documentation required determines the level of ... November 13th, 2015 Using ICD-10-CM Z-codesBy Evan M. Gwilliam DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA, Christine Woolstenhulme, CMRS | Published November 13th, 2015
Chapter 21 of ICD-10-CM is titled "Factors Influencing Health Status and Contact with Health Services". They cover codes in the categories from Z00 to Z99. This chapter is used for encounters with health care providers where the patients have no current illnesses or injury. For example, a patient may present at ... October 20th, 2015 Modifiers – Reimbursement or Informational? Modifier TrainingBy WPS Medicare | Published October 20th, 2015 October 19th, 2015 The JW Modifier is Only Applied to the Amount of Drug or Biological that is DiscardedBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 19th, 2015 - Last Review/Update August 4th, 2017 According to CMS, local contractors may require the use of the modifier JW to identify unused drug or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological.
For example, ... October 13th, 2015 Pricing ModifierBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 13th, 2015 - Last Review/Update August 7th, 2017
Place the modifiers listed below (except modifiers with an *) to the right of the procedure code in Item 24D on the CMS 1500 claim form or for ANSI X12 4010 electronic claims submission use segment 2-370-SV101-3.
Processing delays can occur for claims submitted without the pricing modifier in the first modifier position. ... October 8th, 2015 Conditions or Exceptions that might justify coverage of foot careBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 8th, 2015 - Last Review/Update August 7th, 2017
When using G0127 keep in mind routine foot/nail care is generally excluded from coverage under Medicare, however there are some exceptions:
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Although not intended as a comprehensive list, the following metabolic, neurologic,and peripheral vascular diseases (with synonyms in parentheses) most commonly represent the underlying conditions that might ... October 5th, 2015 Reporting Laterality Still Requires ModifiersBy Wyn Staheli, Director of Content | Published October 5th, 2015 One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).
Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology ... September 25th, 2015 Bone Mass Measurements (BMMs)By Find-A-Code | Published September 25th, 2015 Listed is a summary of the revisions and additions to Chapter 13 of the Medicare Claims Processing Manual and Chapter 15 of the Medicare Benefit Policy Manual.
CHAPTER 13
Effective for dates of service on and after January 1, 2007, the CY 2007 Physician Fee Schedule final rule expanded the number of ... September 21st, 2015 Documentation and Medical Necessity - Ablative Treatment for Spinal Pain - UHC Medical PolicyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 21st, 2015 - Last Review/Update August 7th, 2017
According to UnitedHealthcares policy: For chronic cervical, thoracic and lumbar pain, Thermal radiofrequency ablation of facet joint nerves is proven and medically necessary when confirmed by the following:
Temperature 60 degrees Celsius or more;
Duration of ablation 40 - 90 seconds
Positive response to medial branch block injection at the side and level of the proposed ... September 21st, 2015 Documentation and Reimbursement for TestingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 21st, 2015 - Last Review/Update August 7th, 2017 The medical record must contain documentation that the testing is expected to influence treatment of the condition toward which the testing is directed. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition that warrants the test(s).
TC - Technical component Modifier may be ... September 11th, 2015 Medicare Makes Moderate Sedation PayableBy Find-A-Code | Published September 11th, 2015 Medicare Makes Moderate Sedation Payable
Christine Taxin
Should your primary care physicians ever find cause to perform moderate sedation, you’ll be interested in a new Medicare policy that may make it payable as of Oct. 1. Medicare Pub. 100-04 Transmittal 1324 finally makes Medicare policy consistent with the fee schedule pricing for ... August 20th, 2015 Covered Bariatric Surgery ProceduresBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 20th, 2015 Covered Bariatric Surgery Procedures
Effective for services on or after February 21, 2006, Medicare has determined that the following bariatric surgery procedures are reasonable and necessary under certain conditions for the treatment of morbid obesity.
The patient must have a body-mass index (BMI) 35, have at least one co-morbidity related to ... August 19th, 2015 Billing injections on the same day as an E/M serviceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 19th, 2015 But increasingly, payers are being just as reflexive when it comes to denying the E/M service, saying that it's bundled into the injection.
What's the truth? While there are many instances when the E/M service is bundled into the injection service, there are probably just as many instances when these denials ... August 19th, 2015 A Dental Guide to Cross-Coding for Oral Cancer ScreeningBy Christine Taxin Adjunct Professor, University of New York School of Dentistry - Links2Success.biz | Published August 19th, 2015 Dental professionals are a patient’s primary source of screening within the oral cavity; thus attention must be paid to the most common oral malignancy: squamous cell carcinoma. Historically such malignancies were attributed only to patients with a history of extensive alcohol and tobacco use. However, other risk factors such as ... August 10th, 2015 Manipulation Under Anesthesia in the OfficeBy | Published August 10th, 2015 - Last Review/Update January 27th, 2017 When manipulation under anesthesia is done in the office instead of a facility, code selection is different. August 10th, 2015 Documentation Requirements for Therapy ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015 Documentation Requirements for Therapy Services, indicates that the amount of time for each specific intervention/modality provided to the patient is not required to be documented in the Treatment Note. However, the total number of timed minutes must be documented. These examples indicate how to count the appropriate number of units ... August 10th, 2015 Orthognathic Surgery - Medical Policy Criteria - RegenceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015
Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury.
[1] Note: This policy does not address the surgical ... August 10th, 2015 Audit Fighting TacticsBy Tom Necela, DC, CPC, CPMA, CCP-P | Published August 10th, 2015 - Last Review/Update January 27th, 2017 Four Tactics or tips to help you fight back when you are audited or have your claims reviewed. They are effective and easy to use. August 10th, 2015 Can Chiropractors Bill 99211?By Melissa Hall | Published August 10th, 2015 - Last Review/Update January 27th, 2017 This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse’s code, is not really made for the physician to use. In fact, the AMA, CPT ... August 10th, 2015 Adjunctive (Add-On) CodesBy ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017 Stop losing hard-earned dollars. Too often, dollars are left on the table at billing time. Adjunctive codes for associated services should be added when they are appropriate. Here are a few examples of coding that are often overlooked.
97014 & 97032 Electrical Stimulation Supplies
According to the Relative Value Update Committee (RUC), ... August 7th, 2015 TMJ Medical Necesity and Documentation- AetnaBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2015 - Last Review/Update August 7th, 2017
Notes: Most Aetna HMO plans exclude coverage for treatment of temporomandibular disorders (TMD) and temporomandibular joint (TMJ) dysfunction
For plans that cover treatment of TMD and TMJ dysfunction, requests for TMJ surgery require review by Aetna's Oral and Maxillofacial Surgery patient management unit. Reviews must include submission of a problem-specific history ... August 7th, 2015 Reimbursed on a Daily Basis /ModifiersBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2015 - Last Review/Update August 7th, 2017 HCPCS codes E0935 (Continuous passive motion exercise device for use on knee only), and E0936 (Continuous passive motion exercise device for use other than knee) are reimbursed on a daily basis consistent with CMS guidelines.
The following HCPCS codes are also reimbursed on a daily basis:
E0193 -Powered air flotation bed (low air loss therapy)
E0194 -Air fluidized bed
E0277 –Powered ... August 7th, 2015 Orthognathic Surgery - Medical Policy Criteria - RegenceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2015 - Last Review/Update August 7th, 2017
Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury.
[1] Note: This policy does not address the surgical ... August 3rd, 2015 Method for Computing Fee Schedule Amount (Rev. 1, 10-01-03)By | Published August 3rd, 2015 B3-15006
The CMS continually updates, refines, and alters the methods used in computing the fee schedule amount. For example, input from the American Academy of Ophthalmology has led to alterations in the supplies and equipment used in the computation of the fee schedule for selected procedures. Likewise, new research has changed ... July 20th, 2015 Hospice Pre - Election Evaluation and Counseling Services (Rev. 2258)By Find-A-Code | Published July 20th, 2015
Effective January 1, 2005, Medicare allows payment to a hospice for specified hospice pre-election evaluation and counseling services when furnished by a physician who is either the medical director of or employee of the hospice.
Medicare covers a one-time only payment on behalf of a beneficiary who is terminally ill, (defined ... July 17th, 2015 Mandatory Assignment on Carrier Claims (Rev. 2487, Issued: 06-08-12)By Find-A-Code | Published July 17th, 2015 The following practitioners who provide services under the Medicare program are required to accept assignment for all Medicare claims for their services. This means that they must accept the Medicare allowed amount as payment in full for their practitioner services. The beneficiary’s liability is limited to any applicable deductible plus ... July 10th, 2015 Coding Requirements for Specimen Collection (Rev. 3056, 12-01-14)By Jared Staheli | Published July 10th, 2015
The following HCPCS codes and terminology must be used:
• 36415 – Collection of venous blood by venipuncture.
• G0471 – Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency ... July 10th, 2015 Certificate for Provider-Performed Microscopy Procedures (Rev. 865, 07-03-06)By Jared Staheli | Published July 10th, 2015
Effective January 19, 1993, a laboratory that holds a certificate for provider-performed microscopy procedures may perform only those tests specified as provider-performed microscopy procedures and waived tests, as described below, and no others.
HCPCS Code
Test
Q0111
Wet mounts, including preparations of vaginal, cervical or skin specimens
Q0112
All potassium hydroxide (KOH) preparations
Q0113
Pinworm examinations
Q0114
Fern test
Q0115
Post-coital direct, ... July 10th, 2015 Certificate of Waiver (Rev. 1652, 01-05-09) - CLIABy Jared Staheli | Published July 10th, 2015
Effective September 1, 1992, all laboratory testing sites (except as provided in 42 CFR 493.3(b)) must have either a CLIA certificate of waiver, certificate for providerperformed microscopy procedures, certificate of registration, certificate of compliance, or certificate of accreditation to legally perform clinical laboratory testing on specimens from individuals in the ... July 10th, 2015 HCPCS Subject To and Excluded From CLIA Edits (Rev. 865, 07-03-06)By Jared Staheli | Published July 10th, 2015 At this time, all claims submitted for laboratory tests subject to CLIA are edited at the CLIA certificate level. However, the HCPCS codes that are considered a laboratory test under CLIA change each year. The CMS identifies the new HCPCS (non-waived, nonprovider-performed procedure) codes, including any modifiers that are subject ... July 10th, 2015 Anatomic Pathology Services (Rev. 1, 10-01-03)By Jared Staheli | Published July 10th, 2015
Clinical laboratory tests include some services described as anatomic pathology services in CPT (i.e., certain cervical, vaginal, or peripheral blood smears). The CPT code 85060 is used only when a physician interprets an abnormal peripheral blood smear for a hospital inpatient or a hospital outpatient, and the hospital is responsible ... July 10th, 2015 National Minimum Payment Amounts for Cervical or Vaginal Smear Clinical Laboratory Tests (Rev. 1, 10-01-03)By Jared Staheli | Published July 10th, 2015
For cervical or vaginal smear clinical laboratory tests, payment is the lesser of the local fee or the national limitation amount, but not less than the national minimum payment amount (NMPA). However, in no case may payment for these tests exceed actual charges. The Part B deductible and coinsurance do ... July 10th, 2015 Organ or Disease Oriented Panels (Rev. 1451, 07-07-08)By Jared Staheli | Published July 10th, 2015
Organ or disease panels must be paid at the lower of the billed charge, the fee amount for the panel, or the sum of the fee amounts for all components. When panels contain one or more automated tests, the contractor determines the correct price for the panel by comparing the ... July 10th, 2015 CPT Codes Subject to and Not Subject to the Clinical Laboratory Fee Schedule (Rev. 1, 10-01-03)By Jared Staheli | Published July 10th, 2015
For fee schedule purposes, clinical laboratory services include most laboratory tests listed in codes 80048-89399 of CPT-1996. The CMS issues an update to the laboratory fee schedule each year, with information about whether prices have been determined by CMS or whether the individual carrier must determine the allowable charge.
Codes not ... July 10th, 2015 Procedures Not Subject to Fee Schedule When Billed With Blood Products (Rev. 1, 10-01-03)By Find-A-Code | Published July 10th, 2015 The following codes are not subject to fee schedule limitations when submitted for payment on the same bill with charges for blood products. Rather, assume they are to be used for blood matching and not for diagnostic purposes.
Codes: 86901, 86905, 86930-86932, 86920-86922, 86890, 86870, 86891, 86880-86886, 86971, and 86930.
If no ... July 10th, 2015 Not Otherwise Classified Clinical Laboratory Tests (Rev. 1, 10-01-03)By Find-A-Code | Published July 10th, 2015 The following codes for unlisted or not otherwise classified (NOC) clinical laboratory tests are not subject to the NLA:
81099 87999 84999 88299 85999 89399 86999
The NOC codes shall suspend for review and the carrier shall determine a price for them.
... July 9th, 2015 Hospital Outpatient Payment Under OPPS for New, Unclassified Drugs and Biologicals After FDA Approval But Before Assignment of a Product-Specific Drug or Biological HCPCS Code (Rev. 3085)By Jared Staheli | Published July 9th, 2015
Section 621(a) of the MMA amends Section 1833(t) of the Social Security Act by adding paragraph (15), Payment for New Drugs and Biologicals Until HCPCS Code Assigned. Under this provision, payment for an outpatient drug or biological that is furnished as part of covered outpatient department services for which a ... July 9th, 2015 Automated Multi-Channel Chemistry (AMCC) Tests for ESRD Beneficiaries (Rev. 3116, 04-06-15)By Jared Staheli | Published July 9th, 2015
Instructions for Services Provided on and After January 1, 2011
Section 153b of the MIPPA requires that all ESRD-related laboratory tests must be reported by the ESRD facility whether provided directly or under arrangements with an independent laboratory. When laboratory services are billed by providers other than the ESRD facility and ... July 9th, 2015 A Local B/MAC/Carrier Receives a Claim for an RRB Beneficiary (Rev. 2474, Issued: 05-18-12)By Find-A-Code | Published July 9th, 2015 When a local contractor (Part B MAC or carrier) receives a Form CMS-1500 or electronic claim that is identified as a RRB claim for Medicare payment that should be processed by the RRB contractor, the claim shall be returned as unprocessable. Use the following messages:
CARC 109 – Claim not covered ... July 9th, 2015 Pharmacy Supplying Fee and Inhalation Drug Dispensing Fee (Rev. 754, 01-03-06)By Jared Staheli | Published July 9th, 2015 Section 303(e) (2) of the MMA implements a supplying fee for immunosuppressive drugs, oral anti-cancer chemotherapeutic drugs, and oral anti-emetic drugs used as part of an anti-cancer chemotherapeutic regimen. Effective January 1, 2005, Medicare paid a separately billable supplying fee of $24.00 to a pharmacy, dialysis facility in the State ... July 9th, 2015 Reporting of Hematocrit and/or Hemoglobin Levels (Rev. 1412, 04-07-08)By Jared Staheli | Published July 9th, 2015
Effective January 1, 2008, the following claims must report the most recent hematocrit or hemoglobin reading:
1. All claims billing for the administration of an ESA (HCPCS J0881, J0882, J0885, J0886 and Q4081).
2. All claims for the administration of a Part B anti-anemia drug (other than ESAs) used in the treatment ... July 9th, 2015 Required Modifiers for ESAs Administered to Non-ESRD Patients (Rev. 1412, 04-07-08)By Jared Staheli | Published July 9th, 2015
Effective January 1, 2008, all non-ESRD claims billing HCPCS J0881 and J0885 must begin reporting one of the following modifiers:
EA: ESA, anemia, chemo-induced
EB: ESA, anemia, radio-induced
EC: ESA, anemia, non-chemo/radio
Institutional claims that do not report one of the above modifiers will be returned to the provider.
Professional claims that are billed without ... July 9th, 2015 Hospitals Billing for Epoetin Alfa (EPO) and Darbepoetin Alfa (Aranesp) for Non-ESRD Patients (Rev. 1412, 04-07-08)By Jared Staheli | Published July 9th, 2015
NOTE: For EPO and Aranesp billing instructions for beneficiaries with ESRD, see the Claims Processing Manual, Chapter 8, sections 60.4 and 60.7.
For patients with chronic renal failure who are not yet on a regular course of dialysis, EPO and Aranesp administered in a hospital and billed as an outpatient service ... July 9th, 2015 Claims Processing Rules for ESAs Administered to Cancer Patients for Anti-Anemia Therapy (Rev. 3085, Effective: Upon Implementation of ICD-10)By Jared Staheli | Published July 9th, 2015
The national coverage determination (NCD) titled, “The Use of ESAs in Cancer and Other Neoplastic Conditions” lists coverage criteria for the use of ESAs in patients who have cancer and experience anemia as a result of chemotherapy or as a result of the cancer itself. The full NCD can be ... July 9th, 2015 Claims Processing Rules for Hospital Outpatient Billing and Payment - Drugs, Biologicals, and Radiopharmaceuticals (Rev. 2903, 04-07-14)By Jared Staheli | Published July 9th, 2015
A. General Billing and Coding for Hospital Outpatient Drugs, Biologicals, and Radiopharmaceuticals
Hospitals should report charges for all drugs, biologicals, and radiopharmaceuticals, regardless of whether the items are paid separately or packaged, using the correct HCPCS codes for the items used. It is also of great importance that hospitals billing ... July 9th, 2015 Claims Processing Rules for Hospital Outpatient Billing and Payment - HCPCS Codes Replacements (Rev. 2903, 04-07-14)By Jared Staheli | Published July 9th, 2015
The HCPCS code list of retired codes and new HCPCS codes reported under the hospital OPPS is published quarterly via Recurring Update Notification. The latest payment rates associated with each APC number may be found in the OPPS PRICER file available on the CMS Web site, as well as in ... July 8th, 2015 DMEPOS - Repair Labor Billing and Payment PolicyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 8th, 2015 The following table contains repair units of service allowances for commonly repaired items billed under HCPCS code K0739 (Repair or Non-routine Service for Durable Medical Equipment Other than Oxygen Equipment Requiring the Skill of a Technician, Labor Component, Per 15 Minutes). This applies to non-rented and out-of-warranty items.
When billing for ... July 8th, 2015 Single Drug Pricer (SDP) (Rev. 397, 01-03-05)By Jared Staheli | Published July 8th, 2015 Effective January 1, 2003, contractors pay drug claims on the basis of the prices shown on the SDP files, if present.
On a quarterly basis, CMS furnishes three SDP files to all FIs, carriers, and ROs except regional home health intermediaries (RHHIs) and durable medical equipment regional carriers (DMERCs), as follows:
1. ... July 8th, 2015 Assignment Required for Drugs and Biologicals (Rev. 1, 10-01-03)By Jared Staheli | Published July 8th, 2015
A. Local Carriers
Under §114 of the Benefits Improvement Act of 2000, effective for claims with dates of service on or after February 1, 2001, payment for any drug or biological covered under Part B of Medicare may be made only on an assignment-related basis. Therefore, no charge or bill may ... July 8th, 2015 Claims Processing Requirements - General (Rev. 3085, Implementation: Upon Implementation of ICD- 10)By Jared Staheli | Published July 8th, 2015
A/B MACs (B) are billed with the ASC X12 837 professional claim format or, if approved, with the paper form CMS-1500. A/B MACs (A) are billed with the ASC X12 837 institutional claim format or, if approved, with the paper Form CMS-1450.
See Chapters 24, 25 and 26 for detailed claims ... July 8th, 2015 HCPCS Service Coding for Oral Cancer Drugs (Rev. 1, 10-01-03)By Jared Staheli | Published July 8th, 2015 The following codes may be used for drugs other than Prodrugs, when covered:
Generic/Chemical Name
How Supplied
HCPCS
Busulfan
2 mg/ORAL
J8510
Capecitabine
150mg/ORAL
J8520
Capecitabine
500mg/ORAL
J8521
Methotrexate
2.5 mg/ORAL
J8610
Cyclophosphamide *
25 mg/ORAL
J8530
Cyclophosphamide *
(Treat 50 mg. as 2 units
50 mg/ORAL
J8530
Etoposide
50 mg/ORAL
J8560
Melphalan
2 mg/ORAL
J8600
Prescription Drug chemotherapeutic NOC
ORAL
J8999
Each tablet or capsule is equal to one unit, except for 50 mg./ORAL of cyclophosphamide (J8530), which is shown as ... July 8th, 2015 HCPCS and NDC Reporting for Prodrugs (Rev. 136, 04-09-04)By Jared Staheli | Published July 8th, 2015 FI claims
For oral anti-cancer Prodrugs HCPCS code J8999 is reported with revenue code 0636.
DMERC claims
The supplier reports the NDC code on the claim. The DMERC converts the NDC code to a “WW” HCPCS code for CWF. As new “WW” codes are established for oral anticancer drugs they will be ... July 8th, 2015 Oral Anti-Emetic Drugs Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen (Rev. 2931, 07-07-14)By Jared Staheli | Published July 8th, 2015
See the Medicare Benefit Policy Manual, Chapter 15, and the National Coverage Determination (NCD) Manual, Section 110.18, for detailed coverage requirements.
Effective for dates of service on or after January 1, 1998, Medicare Part B (including (institutional claims processed by Part A Medicare Administrative Contractors (MACs) and physician/supplier claims processed by ... July 8th, 2015 HCPCS Codes for Oral Anti-Emetic Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10)By Jared Staheli | Published July 8th, 2015
The physician/supplier bills for these drugs with the ASC X12 837 professional claim format, or if approved, with the paper form CMS-1500. The facility bills with the ASC X12 837 institutional claim format, or if approved, with the paper Form CMS-1450. The following HCPCS codes are assigned:
Code
Description
J8501
APREPITANT, oral, 5 mg ... July 8th, 2015 Claims Processing Jurisdiction for Oral Anti-Emetic Drugs (Rev. 2931, 07-07-14)By Jared Staheli | Published July 8th, 2015
The following chart shows which drugs are billed to the A/B MAC, or carrier and which drugs are billed to the DME MAC.
Per the Balanced Budget Act of 1997, effective for claims with dates of service on or after January 1, 1998, the claims processing jurisdiction rules in Chart 1 ... July 8th, 2015 Requirements for Billing A/B MAC (A) for Immunosuppressive Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10)By Jared Staheli | Published July 8th, 2015
Hospitals not subject to OPPS bill on ASC X12 837 institutional format or paper Form CMS-1450 (if approved) with bill type 12x (hospital inpatient Part B) or l3x (hospital outpatient) as appropriate.
For claims with dates of service prior to April 1, 2000, providers report the following entries:
• Occurrence code 36 ... July 7th, 2015 When to Report 70332 For TMJ Imaging ProceduresBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 7th, 2015 - Last Review/Update August 7th, 2017
Question: When going through radiology codes for TMJ, I saw different codes for imaging studies of the TMJ. Can you please tell me the difference between 70328, 70330 and 70332?
Michigan Subscriber
Answer: If the documentation indicates a TMJ x-ray in two projections of one side, one film with the mouth open, and one with the mouth ... July 7th, 2015 Policy for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11)By Jared Staheli | Published July 7th, 2015
Claims with dates of service on and after October 14, 2011, the Centers for Medicare & Medicaid Services (CMS) will cover annual alcohol misuse screening (HCPCS code G0442) consisting of 1 screening session, and for those that screen positive, up to 4 brief, face-to-face behavioral counseling sessions (HCPCS code G0443) ... July 7th, 2015 Institutional Billing Requirements for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11)By Jared Staheli | Published July 7th, 2015
For claims with dates of service on and after October 14, 2011, Medicare will allow coverage for annual alcohol misuse screening, 15 minutes, G0442, and brief, face-to-face behavioral counseling for alcohol misuse, 15 minutes, G0443 for:
• Rural Health Clinics (RHCs) - type of bill (TOB) 71X only – based on ... July 7th, 2015 Professional Billing Requirements for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11,By Jared Staheli | Published July 7th, 2015 - Last Review/Update February 5th, 2018 For claims with dates of service on and after October 14, 2011, CMS will allow coverage for annual alcohol misuse screening, 15 minutes, G0442, and behavioral counseling for alcohol misuse, 15 minutes, G0443, only when services are submitted by the following provider specialties found on the provider’s enrollment record:
01 - ... July 7th, 2015 Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages for Alcohol Screening and Behavioral Counseling Interventions (Rev. 2433, 10-14-11)By Jared Staheli | Published July 7th, 2015
Contractors shall use the appropriate claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare summary notice (MSN) messages when denying payment for alcohol misuse screening and alcohol misuse behavioral counseling sessions:
• For RHC and FQHC claims that contain screening for alcohol misuse HCPCS code G0442 ... July 7th, 2015 Professional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11)By Jared Staheli | Published July 7th, 2015
Contractors shall use the following claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare Summary Notice (MSN) messages when denying payment for G0444 when reported more than once in a 12- month period.
o CARC 119 – “Benefit maximum for this time period or occurrence has ... July 7th, 2015 Institutional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11)By Jared Staheli | Published July 7th, 2015
For claims with dates of service on and after October 14, 2011, Medicare will allow coverage for annual screening depression in adults, HCPCS G0444 for:
• Rural Health Clinics (RHCs) type of bill (TOB) 71X only – based on the all-inclusive payment rate.
• Federally Qualified Health Centers (FQHCs) TOB 77X only ... July 7th, 2015 CARCs, RARCs, Group Codes, and MSN Messages for Screening for Depression in Adults (Rev. 2431, 10-14-11)By Jared Staheli | Published July 7th, 2015
Contractors shall use the appropriate CARC, RARC, group codes, or MSN messages when denying payment for annual depression screening in adults:
• For RHCs and FQHCs when screening for depression, HCPCS code G0444, with another encounter/visit with the same line-item date of service, use group code CO and :
o CARC 97 ... July 7th, 2015 Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15)By Jared Staheli | Published July 7th, 2015
For services furnished on or after November 29, 2011, Medicare will cover Intensive Behavioral Therapy for Obesity. Medicare beneficiaries with obesity (BMI ≥30 kg/m2 ) who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other ... July 7th, 2015 Institutional Billing Requirements for Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15)By Jared Staheli | Published July 7th, 2015
Effective for claims with dates of service on and after November 29, 2011, providers may use the following types of bill (TOB) when submitting HCPCS code G0447: 13x, 71X, 77X, or 85X. Service line items on other TOBs shall be denied.
Effective for claims with dates of service on and after ... July 7th, 2015 Professional Billing Requirements for Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15)By Jared Staheli | Published July 7th, 2015
CMS will allow coverage for Face-to-Face Behavioral Counseling for Obesity, 15 minutes, (G0447), Face-to-face behavioral counseling for obesity, group (2-10), 30 minute(s) (G0473), along with 1 of the ICD-9 codes for BMI 30.0-BMI 70 (V85.30- V85.39 and V85.41-V85.45), only when services are submitted by the following provider specialties found on ... July 7th, 2015 Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages for Policy for Intensive Behavioral Therapy (Rev. 3232, 01-05-15)By Jared Staheli | Published July 7th, 2015
Contractors shall use the appropriate claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare summary notice (MSN) messages when denying payment for obesity counseling sessions:
• Denying services submitted on a TOB other than 13X and 85X:
CARC 171 – Payment is denied when performed by this ... July 7th, 2015 Screening for Hepatitis C Virus (HCV) (Rev. 3215, 06-02-14)By Jared Staheli | Published July 7th, 2015
Effective for services furnished on or after June 2, 2014, Medicare covers screening for hepatitis C Virus (HCV) with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act regulations, when ordered by the beneficiary’s ... July 7th, 2015 Institutional Billing Requirements for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15)By Jared Staheli | Published July 7th, 2015
Effective for claims with dates of service on and after June 2, 2014, providers may use the following types of bill (TOBs) when submitting claims for screening for HCV screening, HCPCS G0472: 13X, 71X, 77X, and 85X. Service line-items on other TOBs shall be denied.
The service shall be paid on ... July 7th, 2015 Professional Billing Requirements for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15)By Jared Staheli | Published July 7th, 2015
For claims with dates of service on or after June 2, 2014, Medicare will allow coverage for HCV screening, HCPCS G0472, only when services are ordered by the following provider specialties found on the provider’s enrollment record:
01 - General Practice
08 - Family Practice
11 - Internal Medicine
16 - Obstetrics/Gynecology
37 - Pediatric ... July 7th, 2015 Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15)By Jared Staheli | Published July 7th, 2015
Contractors shall use the appropriate claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare summary notice (MSN) messages when denying payment for HCV screening, HCPCS G0472:
• Denying services submitted on a TOB other than 13X, 71X, 77X, or 85X:
CARC 170 - Payment is denied when ... July 7th, 2015 Payment Allowance Limit for Drugs and Biologicals Not Paid on a Cost or Prospective Payment Basis (Rev. 131, 03-26-04)By Jared Staheli | Published July 7th, 2015 Prior to January 1, 2004, drugs and biologicals not paid on cost or prospective payment are paid based on the lower of the billed charge or 95 percent of the average wholesale price (AWP) as reflected in published sources (e.g., Red Book, Price Alert, etc.). Examples of drugs that are ... July 6th, 2015 Healthcare Common Procedure Coding System (HCPCS) Coding for the IPPE (Rev. 2159, 04-04-11)By Jared Staheli | Published July 6th, 2015
The HCPCS codes listed below were developed for the IPPE benefit effective January 1, 2005, for individuals whose initial enrollment is on or after January 1, 2005.
G0344: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 6 months of Medicare enrollment
Short Descriptor: Initial ... July 6th, 2015 A/B Medicare Administrative Contractor (MAC) and Contractor Billing Requirements for the IPPE (Rev. 2159, 04-04-11)By Jared Staheli | Published July 6th, 2015
Effective for dates of service on and after January 1, 2005, through December 31, 2008, contractors shall recognize the HCPCS codes G0344, G0366, G0367, and G0368 shown above in §80.1 for an IPPE. The type of service (TOS) for each of these codes is as follows:
G0344: TOS = 1
G0366: TOS ... July 6th, 2015 Coinsurance and Deductible for the IPPE (Rev. 2159, 04-04-11)By Jared Staheli | Published July 6th, 2015 The Medicare deductible and coinsurance apply for the IPPE provided before January 1, 2009.
The Medicare deductible is waived effective for the IPPE provided on or after January 1, 2009. Coinsurance continues to apply for the IPPE provided on or after January 1, 2009.
As a result of the Affordable Care Act, ... July 6th, 2015 Medicare Summary Notices (MSNs) for the IPPE (Rev. 1615, 01-05-09)By Jared Staheli | Published July 6th, 2015
When denying additional claims for G0344, G0366, G0367 and G0368, contractors shall use MSN 18.22 - This service was denied because Medicare only covers the one-time initial preventive physical exam with an electrocardiogram within the first 6 months that you have Part B coverage, and only if that coverage begins ... July 6th, 2015 HCPCS Coding for Diabetes Screening (Rev. 457, 04-04-05)By Jared Staheli | Published July 6th, 2015
The following HCPCS codes are to be billed for diabetes screening:
82947 – Glucose, quantitative, blood (except reagent strip)
82950 – post-glucose dose (includes glucose)
82951 – tolerance test (GTT), three specimens (includes glucose)
... July 6th, 2015 Carrier Billing Requirements for Diabetes Screening (Rev. 457, 04-04-05)By Jared Staheli | Published July 6th, 2015
Effective for dates of service January 1, 2005 and later, carriers shall recognize the above HCPCS codes for diabetes screening.
Carriers shall pay for diabetes screening once every 12 months for a beneficiary that is not pre-diabetic. Carriers shall pay for diabetes screening at a frequency of once every 6 months ... July 6th, 2015 Modifier Requirements for Pre-diabetes (Rev. 457, 04-04-05)By Jared Staheli | Published July 6th, 2015
A claim that is submitted for diabetes screening and the beneficiary meets the definition of pre-diabetes shall be submitted in the following manner:
The line item shall contain 82497, 82950 or 82951 with a diagnosis code of V77.1 reported in the header. In addition, modifier “TS” (follow-up service) – shall be ... July 6th, 2015 Fiscal Intermediary (FI) Billing Requirements for Diabetes Screening (Rev. 457, 04-04-05)By Jared Staheli | Published July 6th, 2015
Effective for dates of service January 1, 2005 and later, FIs shall recognize the above HCPCS codes for diabetes screening.
FIs shall pay for diabetes screening once every 12 months for a beneficiary that is not pre-diabetic. FIs shall pay for diabetes screening at a frequency of once every 6 months ... July 6th, 2015 HCPCS Coding for Cardiovascular Disease Screening for Diabetes Screening (Rev. 408, 01-03-05)By Jared Staheli | Published July 6th, 2015
The following HCPCS codes are to be billed for Cardiovascular Disease Screening:
80061 – Lipid Panel
82465 – Cholesterol, serum or whole blood, total
83718 – Lipoprotein, direct measurement, high density cholesterol
84478 – Triglycerides
... July 6th, 2015 Carrier Billing Requirements for Diabetes Screening (Rev. 408, 01-03-05)By Jared Staheli | Published July 6th, 2015
Effective for dates of service, January 1, 2005, and later, carriers shall recognize the above HCPCS codes for Cardiovascular Disease Screening.
Carriers shall pay for Cardiovascular Disease Screening once every 60 months.
A claim that is submitted for Cardiovascular Disease Screening shall be submitted in the following manner:
The line item shall contain ... July 6th, 2015 Fiscal Intermediary (FI) Billing Requirements for Diabetes Screening (Rev. 408, 01-03-05)By Jared Staheli | Published July 6th, 2015
Effective for dates of service, January 1, 2005, and later, intermediaries shall recognize the above HCPCS codes for Cardiovascular Disease Screening.
FIs shall pay for Cardiovascular Disease Screening once every 60 months.
A claim that is submitted for Cardiovascular Disease Screening shall be submitted in the following manner:
The line item shall contain ... July 6th, 2015 HCPCS Code for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07)By Jared Staheli | Published July 6th, 2015
Effective for services furnished on or after January 1, 2007, the following code, modifiers, and type of service (TOS) are used for AAA screening services:
G0389: Ultrasound, B-scan and or real time with image documentation; for abdominal aortic aneurysm (AAA) screening
Short Descriptor: Ultrasound exam AAA screen
Modifiers: TC, 26
TOS: 4
... July 6th, 2015 Advance Beneficiary Notice for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07)By Jared Staheli | Published July 6th, 2015
Medicare contractors will deny an AAA screening service billed more than once in a beneficiary’s lifetime.
If a second G0389 is billed for AAA for the same beneficiary or if any of the other statutory criteria for coverage listed in section 1861(s)(2)(AA) of the Social Security Act are not met, the ... July 6th, 2015 Coding and Payment of DSMT Services (Rev. 1255, 07-02-07)By Jared Staheli | Published July 6th, 2015 The following HCPCS codes are used to report DSMT:
• G0108 - Diabetes outpatient self-management training services, individual, per 30 minutes.
• G0109 - Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.
The type of service for these codes is 1.
Payment to physicians and providers for outpatient DSMT ... July 6th, 2015 Healthcare Common Procedure Coding System (HCPCS) for HIV Screening Tests (Rev. 2199, 07-06-10)By Jared Staheli | Published July 6th, 2015
Effective for claims with dates of service on and after December 8, 2009, implemented with the April 5, 2010, IOCE, the following HCPCS codes are to be billed for HIV screening:
• G0432- Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening,
• G0433 - Infectious agent antibody ... July 6th, 2015 Billing Requirements for HIV Screening Tests (Rev. 2199, 07-06-10)By Jared Staheli | Published July 6th, 2015
Effective for dates of service December 8, 2009, and later, contractors shall recognize the above HCPCS codes for HIV screening.
Medicare contractors shall pay for voluntary HIV screening as follows in accordance with Pub. 100-03, Medicare National Coverage Determinations Manual, sections 190.14 and 210.7:
• A maximum of once annually for beneficiaries ... July 6th, 2015 Payment Method for HIV Screening Tests (Rev. 2199, 07-06-10)By Jared Staheli | Published July 6th, 2015 Payment for HIV screening is under the Medicare Clinical Laboratory Fee Schedule for TOBs 12X, 13X, 14X, 22X, and 23X beginning January 1, 2011. For TOB 85X payment is based on reasonable cost. Deductible and coinsurance do not apply. Between December 8, 2009, and April 4, 2010, these services can ... July 6th, 2015 Healthcare Common Procedure Coding System (HCPCS) Coding for the AWV (Rev. 2159, 04-04-11)By Jared Staheli | Published July 6th, 2015
The HCPCS codes listed below were developed for the AWV benefit effective January 1, 2011, for individuals whose initial enrollment is on or after January 1, 2011.
G0438 - Annual wellness visit; includes a personalized prevention plan of service (PPPS); first visit
G0439 – Annual wellness visit; includes a personalized prevention plan ... July 6th, 2015 A/B Medicare Administrative Contractor (MAC) and Carrier Billing Requirements for the AWV (Rev. 2159, 04-04-11)By Jared Staheli | Published July 6th, 2015
Effective for dates of service on and after January 1, 2011, contractors shall recognize HCPCS codes G0438 and G0439 shown above in section 140.1 for billing AWVs. The type of service (TOS) for each of the new codes is 1. AWV services are paid under the Medicare Physician Fee Schedule ... July 6th, 2015 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Advance Beneficiary Notices (ABNs) for the AWV (Rev. 2159, 04-04-11)By Jared Staheli | Published July 6th, 2015
Messages for Carriers, FIs, and A/B MACs:
When paying claims for an AWV, contractors shall use the following Medicare Summary Notices (MSNs):
MSN: 18.25: “Your Annual Wellness Visit has been approved. You will qualify for another Annual Wellness Visit 12 months after the date of this visit.”
Spanish Version “Su Visita Anual de ... July 6th, 2015 Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)By Jared Staheli | Published July 6th, 2015
The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for those individuals who use tobacco but do not have signs or symptoms of tobacco-related disease. These are in addition to the two CPT codes 99406 and 99407 that currently are ... July 6th, 2015 Carrier Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)By Jared Staheli | Published July 6th, 2015
Carriers shall pay for counseling to prevent tobacco use services billed with code G0436 or G0437 for dates of service on or after January 1, 2011. Carriers shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010 through December 31, ... July 6th, 2015 Fiscal Intermediary (FI) Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)By Jared Staheli | Published July 6th, 2015
The FIs shall pay for counseling to prevent tobacco use services with codes G0436 and G0437 for dates of service on or after January 1, 2011. FIs shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010, through December 31, ... July 6th, 2015 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)By Jared Staheli | Published July 6th, 2015
When denying claims for counseling to prevent tobacco use services submitted without diagnosis codes 305.1 or V15.82, contractors shall use the following messages:
MSN 15.4: The information provided does not support the need for this service or item.
MSN Spanish Version: La informaciónproporcionada no confirma la necesidadparaesteservicio o artículo
RARC M64 - Missing/incomplete/invalid ... July 6th, 2015 Coding Requirements for IBT for CVD Furnished on or After November 8, 2011 (Rev. 2432, 11-08-11)By Jared Staheli | Published July 6th, 2015
The following is the applicable Healthcare Procedural Coding System (HCPCS) code for IBT for CVD:
G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
Contractors shall not apply deductibles or coinsurance to claim lines containing HCPCS code G0446.
... July 6th, 2015 Correct Place of Service (POS) Codes for IBT for CVD on Professional Claims (Rev. 2432, 11-08-11)By Jared Staheli | Published July 6th, 2015
Contractors shall pay for IBT CVD, G0446 only when services are provided at the following POS:
11- Physician’s Office
22-Outpatient Hospital
49- Independent Clinic
72-Rural Health Clinic
Claims not submitted with one of the POS codes above will be denied.
The following messages shall be used when Medicare contractors deny professional claims for incorrect POS:
Claim Adjustment ... July 6th, 2015 Provider Specialty Edits for IBT for CVD on Professional Claims (Rev. 2432, 11-08-11)By Jared Staheli | Published July 6th, 2015
Contractors shall pay claims for HCPCS code G0446 only when services are submitted by the following provider specialty types found on the provider’s enrollment record:
01= General Practice
08 = Family Practice
11= Internal Medicine
16 = Obstetrics/Gynecology
37= Pediatric Medicine
38 = Geriatric Medicine
42= Certified Nurse Midwife
50 = Nurse Practitioner
89 = Certified Clinical Nurse Specialist
97= ... July 6th, 2015 Correct Types of Bill (TOB) for IBT for CVD on Institutional Claims (Rev. 2432, 11-08-11)By Jared Staheli | Published July 6th, 2015
Effective for claims with dates of service on and after November 8, 2011, the following types of bill (TOB) may be used for IBT for CVD: 13X, 71X, 77X, or 85X. All other TOB codes shall be denied.
The following messages shall be used when Medicare contractors deny claims for G0446 ... July 6th, 2015 Frequency Edits for IBT for CVD Claims (Rev. 2432, 11-08-11)By Jared Staheli | Published July 6th, 2015
Contractors shall allow claims for G0446 no more than once in a 12-month period.
NOTE: 11 full months must elapse following the month in which the last G0446 IBT for CVD took place.
Contractors shall deny claims IBT for CVD claims that exceed one (1) visit every 12 months.
Contractors shall allow one ... July 6th, 2015 Healthcare Common Procedure Coding System (HCPCS) Codes for Screening for STIs and HIBC to Prevent STIs (Rev. 2476, 02-27-12)By Jared Staheli | Published July 6th, 2015
Effective for claims with dates of service on and after November 8, 2011, the claims processing instructions for payment of screening tests for STI will apply to the following HCPCS codes:
• Chlamydia: 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800 (used for combined chlamydia and gonorrhea testing)
• Gonorrhea: 87590, ... July 6th, 2015 Billing Requirements for Screening for STIs and HIBC to Prevent STIs (Rev. 2476, 02-27-12)By Jared Staheli | Published July 6th, 2015
Effective for dates of service November 8, 2011, and later, contractors shall recognize HCPCS code G0445 for HIBC. Medicare shall cover up to two occurrences of G0445 when billed for HIBC to prevent STIs. A claim that is submitted with HCPCS code G0445 for HIBC shall be submitted with ICD-9 ... July 5th, 2015 Payment for Colorectal Cancer Screening (Rev. 3232, 01-05-15)By Jared Staheli | Published July 5th, 2015
Payment is under the MPFS except as follows:
• Fecal occult blood tests (82270* (G0107*) and G0328) are paid under the clinical diagnostic lab fee schedule except reasonable cost is paid to all non-OPPS hospitals, including CAHs, but not IHS hospitals billing on TOB 83x. IHS hospitals billing on TOB 83x ... July 5th, 2015 Deductible and Coinsurance for Colorectal Cancer Screening (Rev. 3232, 01-05-15)By Jared Staheli | Published July 5th, 2015
There is no deductible and no coinsurance or copayment for the fecal occult blood tests (G0107 and G0328), flexible sigmoidoscopy (G0104), colonoscopy on individual at high risk (G0105), and colonoscopy on individual not meeting criteria of high risk (G0121). When a screening colonoscopy becomes a diagnostic colonoscopy anesthesia code 00810 ... July 5th, 2015 HCPCS Codes, Frequency Requirements, and Age Requirements (If Applicable) - Colorectal Cancer Screening (Rev. 3096, 11-18-14)By Jared Staheli | Published July 5th, 2015
Effective for services furnished on or after January 1, 1998, the following codes are used for colorectal cancer screening services:
• 82270* (G0107*) - Colorectal cancer screening; fecal-occult blood tests, 1-3 simultaneous determinations;
• G0104 - Colorectal cancer screening; flexible sigmoidoscopy;
• G0105 - Colorectal cancer screening; colonoscopy on individual at high risk;
• ... July 5th, 2015 Common Working Files (CWF) Edits for Colorectal Cancer Screening (Rev. 1062, 01-02-07)By Jared Staheli | Published July 5th, 2015
Effective for dates of service January 1, 1998, and later, CWF will edit all colorectal screening claims for age and frequency standards. The CWF will also edit FI claims for valid procedure codes (G0104, G0105, G0106, 82270* (G0107*), G0120, G0121, G0122, and G0328) and for valid bill types. The CWF ... July 5th, 2015 Ambulatory Surgical Center (ASC) Facility Fee for Colorectal Cancer Screening (Rev. 1160, 07-02-07)By Jared Staheli | Published July 5th, 2015
CPT code 45378, which is used to code a diagnostic colonoscopy, is on the list of procedures approved by Medicare for payment of an ambulatory surgical center facility under §1833(I) of the Act. CPT code 45378 is currently assigned to ASC payment group 2. Code G0105, colorectal cancer screening; colonoscopy ... July 5th, 2015 Billing Requirements for Claims Submitted to FIs for Colorectal Cancer Screening (Rev. 1953, 10-04-10)By Jared Staheli | Published July 5th, 2015
Follow the general bill review instructions in Chapter 25. Hospitals use the ANSI X12N 837I to bill the FI or on the hardcopy Form CMS-1450. Hospitals bill revenue codes and HCPCS codes as follows:
Screening Test/Procedure
Revenue Code
HCPCS Code
TOB
Fecal Occult blood test
030X
82270***
(G0107***),
G0328
12X, 13X,
14X**, 22X, 23X,
83X, 85X
Barium enema
032X
G0106,
G0120,
G0122
12X, 13X,
22X, 23X,
85X****
Flexible Sigmoidoscopy
*
G0104
12X, 13X,
22X, 23X,
83X, ... July 5th, 2015 MSN Messages for Colorectal Cancer Screening (Rev. 1062, 01-02-07)By Jared Staheli | Published July 5th, 2015
The following MSN messages are used (See Chapter 21 for the Spanish versions of these messages):
A. If a claim for a screening fecal-occult blood test, a screening flexible sigmoidoscopy, or a barium enema is being denied because of the age of the beneficiary, MSN message 18.13 is used.
This service is ... July 5th, 2015 Remittance Advice Notices for Colorectal Cancer Screening (Rev. 1, 10-01-03)By Jared Staheli | Published July 5th, 2015
All messages refer to ANSI X12N 835 coding.
A. If the claim for a screening fecal-occult blood test, a screening flexible sigmoidoscopy, or a screening barium enema is being denied because the patient is less than 50 years of age, use:
• Claim adjustment reason code 6 “the procedure code is inconsistent ... July 5th, 2015 HCPCS and Diagnosis Coding for Glaucoma Screening Services (Rev. 1, 10-01-03)By Jared Staheli | Published July 5th, 2015
The following HCPCS codes should be reported when billing for screening glaucoma services:
G0117 - Glaucoma screening for high-risk patients furnished by an optometrist (physician for carrier) or ophthalmologist.
G0118 - Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist (physician for carrier) or ophthalmologist.
The carrier claims type ... July 5th, 2015 Special Billing Instructions for RHCs and FQHCs for Glaucoma Screening Services (Rev. 371, 04-04-05)By Jared Staheli | Published July 5th, 2015
Screening glaucoma services are considered RHC/FQHC services. For claims with dates of service before April 1, 2005, RHCs and FQHCs bill the FI under bill type 71X or 73X along with revenue code 0770 and HCPCS codes G0117 or G0118 and RHC/FQHC revenue code 0520 or 0521 to report the ... June 25th, 2015 Table of Preventive and Screening Services (Rev. 3232, 01-05-15)By Jared Staheli | Published June 25th, 2015 Service
CPT/HCPCS Code
Long Descriptor
USPSTF Rating
Coins./ Deductible
Initial Preventive Physical Examination, IPPE
G0402
Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment
*Not Rated
WAIVED
Initial Preventive Physical Examination, IPPE
G0403
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with ... June 25th, 2015 Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes (Rev. 2824, 04-07-14)By Jared Staheli | Published June 25th, 2015
Vaccines and their administration are reported using separate codes. The following codes are for reporting the vaccines only.
HCPCS
Definition
90653
Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90654
Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18 – 64;
90655
Influenza virus vaccine, split virus, preservative free, for children 6- 35 ... June 25th, 2015 CWF A/B Crossover Edits for FI/AB MAC and Carrier/AB MAC Claims (Rev. 2824, 04-07-14)By Jared Staheli | Published June 25th, 2015 When CWF receives a claim from the carrier/AB MAC, it will review Part B outpatient claims history to verify that a duplicate claim has not already been posted.
CWF will edit on the beneficiary HIC number; the date of service; the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, ... June 25th, 2015 HCPCS and Diagnosis Codes for Mammography Services (Rev. 3232, 01-05-15)By Jared Staheli | Published June 25th, 2015
The following HCPCS codes are used to bill for mammography services.
HCPCS Code
Definition
77051*(76082*)
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, diagnostic mammography (list separately in addition to code for primary procedure). Code ... June 19th, 2015 Dental and Oral Surgical Procedures - UNITEDHEALTHCARE CoverageBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 19th, 2015 - Last Review/Update August 8th, 2017 The following is found in Oxfords Dental policy.
Oxford's Dental Department will review requests for dental services rendered:
for the following services when delivered in conjunction with dental services:
Dental services
Oral surgical services
Anesthesia services delivered in conjunction with dental services.
by practitioners of the following specialties: oral/maxillofacial surgery
pediatric dentistry
endodontics
orthodontices
NOTE: All other specialties require Medical Director ... June 18th, 2015 Completion of Certificate of Medical Necessity Forms (Rev. 2993, Upon Implementation of ICD- 10)By Jared Staheli | Published June 18th, 2015 1. SECTION A: (This may be completed by supplier.)
a. Certification Type/Date - If this is an initial certification for this patient, the date (MM/DD/YY) is indicated in the space marked "INITIAL". If this is a revised certification (to be completed when the physician changes the order, based on the patient's ... June 18th, 2015 Completion of the Elements of PEN CMN (Rev. 1, 10-01-03)By Jared Staheli | Published June 18th, 2015 The patient's name, address, and HICN and the nature of the certification (i.e., initial, renewed, or revised) must be entered on all certifications by the supplier, physician, or physician's designated employees. The supplier identifying information is required on all PEN certifications.
All medical and prescription information must be completed from the ... June 18th, 2015 Application of DMEPOS Fee Schedule (Rev. 1, 10-01-03)By Jared Staheli | Published June 18th, 2015 Services that are paid under the DME fee schedule are identified in the DMEPOS fee schedule file available free on the CMS Web Site at: http://www.cms.hhs.gov/providers/pufdownload/default.asp
The DMEPOS fee schedule applies to claims to FIs as follows.
BILL TYPE/ DEFINITION
ORTHOTICS/ PROSTHETICS
DME/ OXYGEN
12X (Hospital inpatient Part B)
Subject to fee schedule
Not covered, therefore, ... June 18th, 2015 Provider Billing for Prosthetic and Orthotic Devices (Rev. 2629, 02-05-13)By Jared Staheli | Published June 18th, 2015 See § 01 for definition of provider.
These items consist of all prosthetic and orthotic devices excluding parenteral/enteral nutritional supplies and equipment and intraocular lenses.
Prosthetics and orthotic devices are included in the Part A PPS rate unless specified as being outside the rate. For SNFs, customized prosthetic devices that are not ... June 18th, 2015 Billing for Inexpensive or Other Routinely Purchased DME (Rev. 1, 10-01-03)By Jared Staheli | Published June 18th, 2015 This is equipment with a purchase price not exceeding $150, or equipment that the Secretary determines is acquired by purchase at least 75 percent of the time, or equipment that is an accessory used in conjunction with a nebulizer, aspirator, or ventilators that are either continuous airway pressure devices or ... June 18th, 2015 Billing for Certain Customized Items (Rev. 1, 10-01-03)By Jared Staheli | Published June 18th, 2015 Due to their unique nature (custom fabrication, etc.), certain customized DME cannot be grouped together for profiling purposes. Claims for customized items that do not have specific HCPCS codes are coded as E1399 (miscellaneous DME). This includes circumstances where an item that has a HCPCS code is modified to the ... June 18th, 2015 Oxygen Equipment and Contents Billing Chart (Rev. 1, 10-01-03)By Jared Staheli | Published June 18th, 2015 The following chart indicates what oxygen fee schedule component is billable/payable under various transaction scenarios for providers and suppliers:
1. Situation: Beneficiary Uses a Stationary System Only
a. Rental Cases (Beneficiary Uses a Stationary System Only)
Type of System
Stationary Monthly Payment
Oxygen Content Fee
Portable Add-On
Portable Contents Fee
Concentrator
Yes
No
No
No
E1377 E1378 E1379 E1380 E1381 E1382 E1383 E1384 ... June 18th, 2015 Billing for Maintenance and Servicing (Providers and Suppliers) (Rev. 1, 10-01-03)By Jared Staheli | Published June 18th, 2015 General
Payment is not made for maintenance and servicing if the beneficiary rents the equipment since payment for maintenance and servicing are included in the rental payments. An exception to this is the 6-month service fee for capped rental items that the beneficiary has elected not to purchase (see §40.2 and ... June 18th, 2015 Billing for Supplies and Drugs Related to the Effective Use of DME (Rev. 2993, Upon Implementation of ICD- 10)By Jared Staheli | Published June 18th, 2015 Suppliers and providers bill supplies that are necessary for the effective use of DME, including drugs, with the appropriate HCPCS code identifying the supply. HHAs must also report revenue code 0294, "Supplies/Drugs for DME Effectiveness."
Suppliers and providers, other than HHAs, bill supplies and drugs (not including drugs that are necessary ... June 18th, 2015 Institutional Provider Reporting of Service Units for DME and Supplies (Rev. 2993, Upon Implementation of ICD- 10)By Jared Staheli | Published June 18th, 2015 Provider outpatient departments report service units using the ASC X12 837 institutional claim format or on the Form CMS 1450 the number of items being billed for orthotic and prosthetic devices.
For purchased DMEPOS items (excluding items requiring frequent and substantial servicing, capped rental items, and oxygen which cannot be purchased) ... June 18th, 2015 Special Considerations for SNF Billing for TPN and EN Under Part B (Rev. 2993, Upon Implementation of ICD- 10)By Jared Staheli | Published June 18th, 2015 The HCPCS code and any appropriate modifiers are required. SNFs bill the A/B MAC (B) for TPN and EN under Part B, using the ASC X12 837 professional claim format, or the Form CMS-1500 paper claim if applicable.
The following HCPCS codes apply.
B4034 B4035 B4036 B4081 B4082 B4083 B4084 B4085 B4150 ... June 17th, 2015 Elimination of "Kit" Codes and Pricing of Replacement Codes (Rev. 1, 10-01-03)By Jared Staheli | Published June 17th, 2015 Prior to 2002, most suppliers billed for dialysis supplies using codes describing "kits" of supplies. The use of kit codes allowed suppliers to bill for supply items without separately identifying the supplies that are being furnished to the patient. Effective January 1, 2002, these kit codes were deleted and suppliers ... June 17th, 2015 Daily Payment for Continuous Passive Motion (CPM) Devices (Rev. 1, 10-01-03)By Jared Staheli | Published June 17th, 2015 The CPM devices (HCPCS code E0935) are classified as items requiring frequent and substantial servicing and are covered as DME as follows (see the Medicare National Coverage Determinations Manual.):
• Continuous passive motion devices are covered for patients who have received a total knee replacement. To qualify for coverage, use of ... June 17th, 2015 Payment of DMEPOS Items Based on Modifiers (Rev. 489, 07-05-05)By Jared Staheli | Published June 17th, 2015 The following modifiers were added to the HCPCS to identify supplies and equipment that may be covered under more than one DMEPOS benefit category:
• AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply;
• AV Item furnished in conjunction with a prosthetic device, prosthetic or orthotic; and
• AW ... June 15th, 2015 Billing for Unlisted Drug Codes J3490 J9999 and C9399By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2015 - Last Review/Update August 17th, 2017
When billing for unlisted drug codes J3490 and J9999 you must indicate the name, strength, and dosage of the drug in block 19 on the CMS-1500 claim form (or in 2400.SV101-7 in theANSI 837 claim file). It is extremely important to review the complete long descriptors in the HCPCS code, for the applicable HCPCS codes ... June 15th, 2015 Billing for Unlisted Drug Codes J3490 J9999 and C9399By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2015 - Last Review/Update August 8th, 2017
When billing for unlisted drug codes J3490 and J9999 you must indicate the name, strength, and dosage of the drug in block 19 on the CMS-1500 claim form (or in 2400.SV101-7 in theANSI 837 claim file). It is extremely important to review the complete long descriptors in the HCPCS code, for the applicable HCPCS codes you can ... June 9th, 2015 Covered Codes for Bariatric SurgeryBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2015 - Last Review/Update August 17th, 2017
CMS has determined that the following procedures will be covered for beneficiaries who have a body-mass index (BMI) ≥ 35, have at least one co-morbidity related to obesity, have been previously unsuccessful with medical treatment of obesity, and this medical information must be documented in the patient's medical record.
Submitted claims ... June 9th, 2015 Covered Codes for Bariatric SurgeryBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2015 - Last Review/Update August 8th, 2017
CMS has determined that the following procedures will be covered for beneficiaries who have a body-mass index (BMI) ≥ 35, have at least one co-morbidity related to obesity, have been previously unsuccessful with medical treatment of obesity, and this medical information must be documented in the patient's medical record.
Submitted claims ... May 11th, 2015 Isodose Planning CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 11th, 2015 - Last Review/Update February 18th, 2016 Teletherapy isodose planning codes 77305-77315 and brachytherapy isodose planning codes 77326-77328, which are frequently reported with the basic radiation dosimetry calculation code 77300, were identified in the codes inherently performed together 75 percent of the time or greater, as the planning codes now universally require performance of dosimetry calculation as ... April 23rd, 2015 Alcohol Screening to Reduce MisuseBy Wyn Staheli, Director of Content | Published April 23rd, 2015 - Last Review/Update June 9th, 2016 April is Alcohol Awareness Month and April 9 is National Alcohol Screening Day. Because alcohol misuse contributes to a variety of both social and medical problems, this day was set aside as a way to reach out, educate and increase awareness in communities. By screenings and other initiatives, at-risk individuals ... April 17th, 2015 2015 Guidelines, Diagnosis Pregnancy and AntepartumBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 17th, 2015 - Last Review/Update February 3rd, 2017 Services provided to diagnose pregnancy are to be reported separately and not considered a part of antepartum care given to the patient. Be sure to report the E/M visits separately as of the 2015 revised guidelines.
The services normally provided in uncomplicated maternity cases include antepartum care, delivery as well as ... April 15th, 2015 Medicare Updates Preventive Exam and Wellness Visit InformationBy Wyn Staheli, Director of Content | Published April 15th, 2015 - Last Review/Update June 9th, 2016 Medicare has updated their provider educational tools for the Initial Preventive Physical Examination (IPPE) and the Annual Wellness Visit (AWV). These tools were designed to help providers gain a greater understanding of these services. Learn what the required elements for these services as well as important coverage and coding information.
CLICK ... April 9th, 2015 G0105 - Colorectal Cancer Screening; Colonoscopy on Individual at High RiskBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 9th, 2015 - Last Review/Update August 8th, 2017 Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was performed). ... March 16th, 2015 Plantar Fasciitis: Medical Necessity and Cross CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2015 - Last Review/Update August 9th, 2017 Prior to treatment you must determine Medical Necessity.
Be sure conservative therapy/treatment was previously done and documented for at least 6 months and proven to be unsuccessful.
NSAIDS - at least 4 weeks ineffective or contraindicated
Physical Therapy such as taping and stretching
Activity modification
Splints used at night for more that 4 weeks
Corticosteroid injection
Arch Supports, ... March 9th, 2015 Billing Imminuzation for Pneumococcal, Influenza, and Hepatitis B with MedicareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
The current diagnosis pointer for, Influenza, Pneumococcal or Hepatitis B vaccines is ICD-10-CM code Z23. Listed are tips for coding, and also the diagnosis pointers used for claims previous to 10/01/15:
Influenza: G0008
Procedure codes:
90630
90653-90662
90672-90674
90685-90688
Medicare codes:
Q2034-Q2039
Expired diagnosis code:
V04.81
Pneumococcal: G0009
Procedure codes:
90670
90732
Expired diagnosis code:
V03.82
Hepatitis B: G0010
Procedure codes
90739-90747
Expired diagnosis code
V05.3
Both Influenza and Pneumococcal Vaccines received in same visit: G0008 with G0009
Procedure codes:
(See previous)
Expired diagnosis code:
V06.6 (effective 10/01/06 - 09/30/15)
Extra Tips:
Be sure ... March 9th, 2015 Wound Care - Are you Using the Most Appropriate Codes?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017 If you often use 11042-11047, be sure you are using the correct codes. If you are preparing the site for surgery, these would not be the correct codes to use. In addition, when using codes 11042-11047, be sure to document the size of the wound; use this set of codes only if ... February 26th, 2015 Levels of Supervision Required by MedicareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 26th, 2015 - Last Review/Update March 2nd, 2016 Be sure you know and understand the levels of supervision required so as not to result in non-compliance audits, possible fines and take-backs. Supervision requirements may also affect your documentation requirements; be sure to document the presence during the procedure or performance if it requires personal supervision.
Find-A-Code has levels of supervision ... February 25th, 2015 Aetna Policy on Bathroom and Toilet Equipment and Supplies - CoverageBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 25th, 2015 - Last Review/Update February 18th, 2016 Clinical Policy Bulletin:Bathroom and Toilet Equipment and Supplies
Number: 0429
Policy Aetna's HMO-based and health network plans (HMO, QPOS, Health Network Only, Health Network Option, Golden Medicare, and U.S. Access) generally follow Medicare's criteria for durable medical equipment (DME) items that are used in the bathroom. Most DME items used in the bathroom are ... February 21st, 2015 Coding for Vaccine AdministrationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update March 1st, 2016 Information on Medicare Vaccine Coverage
Medicare Part B Vaccine Coverage
Medicare Part D Vaccine Coverage
Vaccine Coding
Vaccines Administered at Well-child Visits
When vaccines are provided as part of a well-child encounter, the ICD-9 guidelines instruct that code V20.2 (routine infant or child health check) includes immunizations appropriate to the patient's age. A code from ... February 21st, 2015 UnitedHealthcare to Require Functional Limitation ReportingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update March 1st, 2016 Effective August 1, 2014, the UnitedHealthcare Medicare Advantage Plans from UnitedHealthcare will implement the new Medicare Outpatient Therapy Functional Limitation Reporting requirement. The reporting scenarios will be similar to Medicare functional limitation reporting.
Announced in the UnitedHealthcare May 2014 Bulletin, contracted physical, occupational, and speech therapist claims with dates of service ... February 21st, 2015 Implementation of a Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update March 1st, 2016 CMS is establishing five specific payment codes to be used by FQHCs submitting claims under the PPS:
1. G0466 – FQHC visit, new patient A medically-necessary, face to face encounter (one-on-one) between a new patient and a FQHC practitioner during which time one or more FQHC services are rendered and includes ... February 21st, 2015 Billing Requirements for G0466, G0467, G0468, G0469 or G0470 - MLNBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update February 18th, 2016 Basic Billing Requirements
When reporting an encounter/visit for payment, the claim (77X TOB) must contain a FQHC specific payment code (G0466, G0467, G0468, G0469 or G0470) that corresponds to the type of visit.
FQHC specific payment specific codes G0466, G0467 and G0468 must be reported under revenue code 052X or under ... February 13th, 2015 Chiropractic Services - Aetna Clinical Policy BulletinBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 2015 - Last Review/Update March 1st, 2016 AETNA
Clinical Policy Bulletin: Chiropractic Services
Number: 0107
http://www.aetna.com/cpb/medical/data/100_199/0107.html
Policy
Note: Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details.
Aetna considers chiropractic services medically necessary when all of the following criteria are met:
The member has a neuromusculoskeletal disorder; and
The medical necessity for treatment is clearly documented; and
Improvement is ... February 9th, 2015 Coding And Billing For JETREA - Physician OfficeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 9th, 2015 - Last Review/Update August 9th, 2017
The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is ... February 9th, 2015 Coding And Billing For JETREA® - Hospital Outpatient DepartmentBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 9th, 2015 - Last Review/Update August 9th, 2017
The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is ... February 5th, 2015 Medicare ResourcesBy | Published February 5th, 2015 - Last Review/Update April 5th, 2018 For detailed information on this government program, as it relates to Chiropractic services, see Section C-Medicare in theChiroCode DeskBook.
You need to understand the following concepts:
Enrollment/Revalidation
How Medicare Payment Works
Medicare as Secondary Payer (MSP) - resource 218 and 219
MAC Jurisdictions
Medicare Coverage of Chiropractic Services
Maintenance Care vs Active Care - resource
Medicare Appeals
Physician Quality Reporting System (PQRS) - resource 317
Advance ... January 29th, 2015 Claims Processing ResourcesBy | Published January 29th, 2015 - Last Review/Update February 1st, 2017 A clean claim is vital to the processing and payment of your claims. The "cleaner" the claim, the faster you will receive payment. It is the responsibility of the provider to understand what is needed and required by the carrier; then provide that information.
You need to understand the following concepts:
Claim Followup ... January 28th, 2015 Modifier XU Fact SheetBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 8th, 2017
Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the service was not part of the usual components of the main service
Use Modifier ... January 28th, 2015 Modifier XS Fact SheetBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 9th, 2017
Separate Structure, A Service That Is Distinct Because It Was Performed on A Separate Organ/Structure
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided on different organs/structures
Use Modifier XS with the Column 2 procedure code in the NCCI files
Use Modifier XS only when there ... January 28th, 2015 Modifier XP Fact SheetBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 9th, 2017
Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided by different practitioners in the same group practice
Use Modifier XP with the Column 2 procedure code in the ... January 28th, 2015 Modifier XE Fact SheetBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 28th, 2015 - Last Review/Update August 9th, 2017
Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided during separate patient/provider encounter
Use Modifier XE with the Column 2 procedure code in the NCCI files
Use Modifier XE only when there ... January 17th, 2015 Diagnosis Coding ResourcesBy | Published January 17th, 2015 - Last Review/Update January 30th, 2017 Proper documentation of a patient's condition(s) is essential to the reimburement process. Section G-Diagnosis Coding of the ChiroCode Deskbook contains a more thorough discussion of diagnosis coding. ICD-9-CM is the HIPAA required code set for diagnosis coding until October 1, 2015 when ICD-10-CM becomes the new standard. We recommend the ... January 16th, 2015 Billing for Split Unit of BloodBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 16th, 2015 - Last Review/Update March 1st, 2016 Billing for Split Unit of Blood
(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, implementation: 04-07-08)
HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split, and some portion of the unit is transfused to one patient while the other portions are transfused to other patients ... December 23rd, 2014 CMS Announces New HCPCS Modifiers to be Implemented January 2015By | Published December 23rd, 2014 - Last Review/Update January 30th, 2017 Beginning January 5, 2015 CMS (Centers for Medicare and Medicaid Services) requires new HCPCS modifiers to be used in place of modifier 59 for all Medicare claims.
These new subset modifiers are known as -X{ESPU} and are defined as follows:• XE - separate encounter, a service that is distinct because it ... December 4th, 2014 New G-Codes Released by CMS for FQHC PPS (Federally Qualified Health Centers)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016 Medicare has established 5 new codes for reporting FQHC (Federally Qualified Health Center) services effective Oct 01, 2014. Very specific guidelines are to be followed for proper reimbursement.
G0466 — A medically-necessary, face to face encounter (one-on-one) between a new patient and a FQHC practitioner during which time one or more FQHC services ... December 4th, 2014 Vacuum Erection Devices (VED)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016 Vacuum pumps coded L7900 must demonstrate a capability to generate a negative pressure in the range of greater than 3.9 and less than 17 inches of mercury (100 and 432 mmHg, respectively). All devices coded L7900 for reimbursement by Medicare must include a vacuum limiter such that a maximum vacuum ... December 4th, 2014 Collagen Surgical Dressings - Coding Verification Review RequirementBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016 In the case of collagen dressings coded A6021, A6022, A6023 and A6024, the predominate component must be collagen.
Effective for claims with dates of service on or after June 1, 2013, the only products which may be billed to Medicare using code A6021, A6022, A6023 and A6024 are those for which ... December 4th, 2014 Correct Coding MyoPro® (Myomo, Inc.) Assist DeviceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016 The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have evaluated the MyoPro® upper extremity assist device and determined that it falls within the Durable Medical Equipment (DME) benefit category. Claims for MyoPro® should be submitted using the DME miscellaneous code E1399.
Suppliers are reminded that when submitting claims for items ... December 4th, 2014 Correct Coding and Coverage of VentilatorsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017 Joint DME MAC Publication
Ventilator technology has evolved to the point where it is possible to have a single device capable of operating in numerous modes, from basic continuous positive pressure (CPAP and bi-level PAP) to traditional pressure and volume ventilator modes. This creates the possibility that one piece of equipment ... December 4th, 2014 Correct Coding: Lithium BatteriesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017
The DME MACs have recently noted confusion on the part of DMEPOS suppliers regarding the proper billing of lithium batteries. There are two types of lithium batteries Lithium batteries and Lithium Ion batteries. Lithium ion batteries are commonly used in consumer electronic devices and are rechargeable. Standard lithium batteries are disposable, non-rechargeable batteries. ... December 4th, 2014 Coverage and Correct Coding of Continuous Glucose Monitoring DevicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017 Joint DME MAC Publication
Continuous glucose monitoring (CGM) devices measure glucose in the interstitial fluid, not capillary blood, providing interstitial glucose readings every few minutes. CGM systems are composed of several components — disposable sensors that are inserted in the subcutaneous tissue, a transmitter that relays information to the receiver, and a ... December 4th, 2014 Off the Shelf - OTS Orthotics New CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017 In February 2012, The Center for Medicare and Medicaid Services (CMS) issued guidance that initially identified specific Healthcare Common Procedure Coding System (HCPCS) codes that were considered Off-the-Shelf (OTS) orthoses. The list of HCPCS codes that were finalized as part of this review as OTS orthotics, effective January 1, 2014, ... December 4th, 2014 Correct Coding - Cefaly®By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017 The Cefaly® device (Cefaly Technology) is a transcutaneous electrical nerve stimulator (TENS) that is applied to the forehead using a self-adhesive electrode positioned bilaterally over the upper branches of the trigeminal nerve. The Cefaly® device is intended to stimulate the upper branches of the trigeminal nerve and has received Food ... December 4th, 2014 Correct Coding: Braces (Orthoses) Attached to WheelchairsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017 Joint DME MAC and PDAC Publication
Recently, claims for braces attached to wheelchairs have been submitted using HCPCS code K0108 - WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED. K0108 is not the correct HCPCS code to use for these items.
CMS has clarified the distinction between braces (orthoses) and durable medical equipment (DME) under Medicare Part ... December 3rd, 2014 Coding for Laser TherapyBy | Published December 3rd, 2014 - Last Review/Update January 30th, 2017 The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnosis code.
Coverage for laser, as with any other service, is strictly dependent upon the ... November 24th, 2014 Billable HCPCS Codes vs. Payable HCPCS CodesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 24th, 2014 - Last Review/Update August 9th, 2017 The PDAC (Medicares - Pricing, Data Analysis and Coding) receives frequent inquiries regarding a billable HCPCS code and a payable HCPCS code. One may think the two are the same; however, this is not the case.
A billable HCPCS code is one that is submitted on a claim to the DME ... November 21st, 2014 Modifier 50By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published November 21st, 2014 - Last Review/Update January 30th, 2017 Modifier Review: Modifier -50
Modifier 50 is used to report a procedure performed bilaterally.
Example: The patient underwent bilateral tympanostomy with insertion of ventilating tubes.
If you look up the CPT code 69433, you will see it is a unilateral procedure and there are instructions telling you to append modifier -50 if ... November 21st, 2014 Coding for Laser TherapyBy | Published November 21st, 2014 - Last Review/Update January 30th, 2017 The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the ... November 7th, 2014 Q & A: 97022 and Dry HydromassageBy | Published November 7th, 2014 - Last Review/Update January 30th, 2017 Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do not select a ... November 5th, 2014 Is Modifier -59 going away?By | Published November 5th, 2014 - Last Review/Update January 30th, 2017 Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that "CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” The new codes are: October 22nd, 2014 Q & A: 97022 and Dry HydromassageBy | Published October 22nd, 2014 - Last Review/Update January 27th, 2017 Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do ... October 16th, 2014 Piriformis InjectionsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published October 16th, 2014 - Last Review/Update January 30th, 2017 Piriformis Injections
The piriformis muscle is a small muscle that attaches at the sacrum, travels across the pelvis and attaches to the top of the femur. It is an external rotator of the hip and leg, which allows the leg and hip to move outward. The sciatic nerve is comprised of ... October 16th, 2014 CT (Computed Tomography) EnterographyBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published October 16th, 2014 - Last Review/Update January 30th, 2017 Computed Tomography (CT) Enterography
CT enterography is not a specific procedure but rather a protocol used with CT abdomen, CT pelvis or CT abdomen and pelvis. It uses CT imaging and two types of contrast to better visualize the anatomy of the interior small intestines.
For years endoscopic techniques were the ... October 16th, 2014 Evaluation and Management (EM) in the Skilled Nursing FacilityBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published October 16th, 2014 - Last Review/Update January 30th, 2017 Evaluation and Management (EM) in the Skilled Nursing Facility
The first time I remember visiting a skilled nursing facility was after my grandmother's stroke. She was rehabilitating there, trying to learn to speak again. Once she was back to her normal activities, she returned to our home where she was taken ... October 16th, 2014 ABN FAQ for Chiropractic CareBy | Published October 16th, 2014 - Last Review/Update November 29th, 2017 What is the ABN form used for?
The Advanced Beneficiary Notice of Non-Coverage (ABN) is the Notice of Liability that is required to be provided to Medicare patients in the event that the service(s) rendered to them are expected to not be covered. For chiropractic, reason for non-coverage is generally due ... October 9th, 2014 Modifier 24By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published October 9th, 2014 - Last Review/Update January 30th, 2017 Modifier -24
When a patient is seen during a global (postoperative) period for something unrelated to the surgery for which the global period applies, modifier -24 is appended to the evaluation and management (EM) service.
The insurance may deny payment for the EM service; however, if the notes for that service ... September 15th, 2014 Medicare Definition of Timed CodesBy Wyn Staheli, Director of Content | Published September 15th, 2014 - Last Review/Update July 12th, 2016 Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. Medicare Claims Processing Manual, Chapter 5 clarification included here. September 15th, 2014 Can Chiropractors Bill 99211?By | Published September 15th, 2014 - Last Review/Update January 30th, 2017 This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse's code, is not really made for the physician to use. In fact, the AMA, ... August 26th, 2014 Q & A: What is the Definition of "New Patient" for Billing Evaluation and Management (E/M) Services?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 26th, 2014 - Last Review/Update August 9th, 2017
Q: What is the definition of "new patient" for billing evaluation and management (E/M) services?
A: Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice ... August 12th, 2014 How do I find a HCPCS code for a laxative given to a patient in our office?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 12th, 2014 - Last Review/Update August 9th, 2017 A Laxative is considered a “Self Administered Drug” (SAD). Insurance will usually pay for the care you provide but will only cover certain drugs in the outpatient setting such as drugs administered through an IV. Therefore it would not be appropriate to report this under the Outpatient Prospective Payment System ... August 7th, 2014 Durable Medical Equipment, Prosthetics, Orthotics and SuppliesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017 Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.  We have given you some basic information to get you started including modifiers and how CMS views DMEPOS, please ... August 6th, 2014 The Proper Use of Evaluation and Management CPT Code 99211By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published August 6th, 2014 - Last Review/Update January 25th, 2017 The Proper Use of Evaluation and Management CPT Code 99211 When properly used and reported, evaluation and management service code 99211 can be useful, time saving and profitable. The description for code 99211 reads, “Office or other outpatient visit for the evaluation and management of an established patient, that may ... July 31st, 2014 Sphenopalatine Ganglion BlocksBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 31st, 2014 - Last Review/Update January 25th, 2017 The sphenoplatatine ganglion, more often referred to as the pterygopalatine ganglion (also Meckel’s ganglion or nasal ganglion) is located within the pterygopalatine fossa. You can locate that place by putting your fingers at the temporomandibular joint in front of your ears and then slightly moving your fingers up until ... July 31st, 2014 Fill In Doctor: Locum TenensBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017 It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ... July 31st, 2014 Can Chiropractors Bill 99211?By | Published July 31st, 2014 - Last Review/Update January 25th, 2017 This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged. The 99211 code, also known as the nurse's code, is not really made for the physician to use. ... July 31st, 2014 GP Modifier for Physio Therapy ServicesBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017 The -GP modifier needs to be appended to physio-therapy codes when submitting Medicare claims. However, be aware of differing policies for different types of payers. Chiropractors typically use the following Physical Medicine codes from the CPT book: 97010 thru 97799 (except for 97597-97610 for active wound care management). The current ... July 31st, 2014 Question & Answer on CPT code 37765 documentation requirements & preauthorizationBy Michelle Herbert, CPC | Published July 31st, 2014 - Last Review/Update January 25th, 2017 Question: is there a sample note to code 37765, our surgeon does Answer: Most third party payers are requiring a pre authorization on these vein codes. Provider documentation must include the failed conservative treatment. The following is the documentation and authorization requirements 1. A 3â€month trial of conservative therapy such ... July 31st, 2014 Microphlebectomy for the Treatment of Varicose VeinsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 31st, 2014 - Last Review/Update January 27th, 2017 Varicose veins can be troubling for the many people who suffer from them. Pain, itching, heavy and tired legs and swelling can make varicosities next to intolerable. Fortunately, there are several treatment options available. Microphlebectomy, sometimes referred to as "stab phlebectomy," is often performed on varicosities that are too small to ... July 31st, 2014 How Do You Report a CT of the Renals?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 31st, 2014 - Last Review/Update January 25th, 2017 People with kidney stones may suffer from severe abdominal pain, low back pain, painful urination, hematuria, nausea and vomiting while others with kidney stones, small enough to pass on their own, may have no symptoms at all. There are several tools used to diagnose kidney stones: Urinalysis can show the ... July 31st, 2014 Repeat Procedures on the Same Day - When to Report Modifiers -76 and -77By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 31st, 2014 - Last Review/Update January 25th, 2017 Have you ever had a claim deny as a ‘duplicate service’ only to find out upon further review that it was actually performed twice on the same day? This occurs more often than you realize and it is fairly easy to correct the error and get the claim paid. Modifiers ... July 31st, 2014 When It's Appropriate to Document a Comprehensive Patient HistoryBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 31st, 2014 - Last Review/Update January 25th, 2017 When It’s Appropriate to Document a Comprehensive Patient History by Aimee Wilcox, MA, CST, CCS-P Have you ever wondered when it is appropriate to document a comprehensive past medical, family and social history (PFSH) or if the necessity of doing so will be questioned during an audit? Well, providers ... July 24th, 2014 Are Medicare fees going up? Or down?By | Published July 24th, 2014 - Last Review/Update January 29th, 2016 Are Medicare fees going up? Or down? Results for the following:
Sequestration
Chiropractic Demonstration Project
Electronic Health Record/Meaningful Use
Physician Quality Reporting System - PQRS
Value-Based Modifier July 24th, 2014 Are Medicare fees going up? Or down?By | Published July 24th, 2014 - Last Review/Update January 25th, 2017 PAMA (up 0.5%)
On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014 (PAMA). Within this law, Congress instituted changes that went into effect on July 1, 2014. The law provided for a 0.5% update for claims with dates of service on or after ... July 16th, 2014 The Impact of ICD-10 Coding System on Medical BillingBy David Berky | Published July 16th, 2014 - Last Review/Update January 25th, 2017 Learn how the introduction of ICD-10 will impact the coding and billing of medical diagnosis and procedure. July 16th, 2014 Coding Facet Joint InjectionsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 16th, 2014 - Last Review/Update January 25th, 2017 If you work in pain management, anesthesia or interventional radiology, you are probably keenly aware of the changes that have occurred over the past three years with facet joint injection coding and its effect on your bottom line. A facet joint injection is a diagnostic procedure used to determine if ... July 16th, 2014 Coding Screening MammogramsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 16th, 2014 - Last Review/Update January 25th, 2017 Mammography is a method of taking x-ray images of the breasts to identify tumors or abnormalities in the tissues that may indicate breast cancer. Screening Mammography: Screenings are performed on otherwise healthy individuals to look for cancer or precursors to cancer of the breasts. Early detection of breast cancer ... July 16th, 2014 Computed Tomography (CT) EnterographyBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published July 16th, 2014 - Last Review/Update January 27th, 2017 CT enterography is not a specific procedure but rather a protocol used with CT abdomen, CT pelvis or CT abdomen and pelvis. It uses CT imaging and two types of contrast to better visualize the anatomy of the interior small intestines. For years endoscopic techniques were the only tools available ... July 16th, 2014 G0402: Medicare Preventive VisitBy | Published July 16th, 2014 - Last Review/Update January 25th, 2017 Medicare covers a one-time Initial Preventive Physical Examination (IPPE), also referred to as the “Welcome to Medicare†visit.  IPPE is a unique benefit available only to patients newly enrolled in the Medicare Program and must be received within the first 12 months of the effective date of their Medicare Part ... January 1st, 2014 Testing & Screening ToolsBy Wyn Staheli, Director of Content | Published January 1st, 2014 - Last Review/Update October 4th, 2017 There are numerous types of behavioral health screening tools for healthcare providers. Some, like the AUDIT and SBIRT are especially applicable to primary care providers caring for Medicare beneficiaries.
This page includes some general information and resources for some of these screening tools. Let us know if you would like others included ... November 8th, 2013 Modifiers –Reimbursement or Informational?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 8th, 2013 - Last Review/Update November 3rd, 2017 Modifiers are used to help describe the encounter, and used to further explain the procedure to the payer. Modifiers will be used if the procedure does not fit or clearly explain the entire encounter.
There are two types of modifiers:
Informational modifiers that do not impact reimbursement
Pricing or Payment modifiers that ... July 25th, 2013 Medicare Considering Paying DCs for E/M ServicesBy | Published July 25th, 2013 - Last Review/Update January 27th, 2017 A notice in the July 19, 2013 Federal Register, has a VERY important clause for all Doctors of Chiropractic! The Centers for Medicare and Medicaid Services (CMS) has asked for comment on whether or not Doctors of Chiropractic should be paid for Evaluation and Management (E/M) services. Keep in mind ... July 8th, 2013 Denials for 97140 (Manual Therapy)? Here's the story.By | Published July 8th, 2013 - Last Review/Update January 27th, 2017 The ChiroCode Institute has received several inquiries over the last few months regarding a denial for 97140 (Manual therapy—such as myofascial release or trigger point therapy) when billed with 98940-98942 (Chiropractic Manipulative Treatment - CMT) on the same visit. Most payers follow Medicare’s guidelines for the use of this code, ... December 31st, 2001 Commonly Asked Chiropractic Coding QuestionsBy ChiroCode | Published December 31st, 2001 - Last Review/Update August 19th, 2015 Commonly Asked Questions:
1. Retention of Records
2. 97140 Denials
3. Exercise Equipment
4. Coding for BioFreeze
5. 97014 or G0283
6. Billing for additional insurance forms
7. Report of Findings
8. Laser therapy
9. Spinal Decompression
10. Diagnosis Coding – 4th and 5th digit
11. Re-Reading X-rays
12. Outcomes Assessment Questionnaires
13. Accounts Receivable
14. 15-Minute Units
15. E/M and CMT There are more articles. View all articles... View articles for the current subject by subtopic:
Select the webinar title to view a summary and link to the webinar video. June 2nd, 2022 June 2, 2022 : Coding 2022 Care Management ServicesMay 5th, 2022 May 5, 2022 : Do Minor Procedures Feel like Major Work?April 14th, 2022 April 14 2022 : Reporting Telemedicine Services by Aimee WilcoxMarch 3rd, 2022 March 3, 2022 - Split/Shared & Incident-to Evaluation and Management Changes for 2022February 8th, 2022 February 8, 2022 - Medicare Audit, Do-it-yourselfApril 20th, 2021 Are your ICD-10 and CPT codes competing?April 7th, 2021 AMA Announced New E/M Guideline Changes on March 9, 2021 Retroactively Effective to January 1, 2021February 25th, 2021 How to Select an E/M Service Based on Time & Prolonged ServicesJuly 30th, 2020 Evaluation & Management Coding Rules are Changing in January - Is Your Organization Ready?November 21st, 2019 CPT Changes for 2020Are you aware of the code changes that will affect your organization on January 1, 2020? Join us for a review of the upcoming 2020 changes and how to locate important guidance for them using the Find-A-Code tools. May 14th, 2019 Confusing Codes for Chiropractors - 97110 versus 97112 versus 97530In 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. January 8th, 2019 Chiropractic Manipulative Treatment and Medicare - Part 2In 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.
December 18th, 2018 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.
September 25th, 2018 Neuromuscular Reeducation, Massage Therapy - Proper Use, Documentation and CodingIn 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.
August 23rd, 2018 Coding and Auditing for Upper Extremity ProceduresIn 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. June 19th, 2018 Billing Other Services with CMTPresented 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? ... May 29th, 2018 The Most Expensive Documentation Mistakes Chiropractors MakeNotes 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. May 22nd, 2018 Coding and Documenting Physical Therapy Treatment ModalitiesPresented 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 ... May 16th, 2018 All About Knee Coding & AuditingTotal knee replacement now acceptable ASC procedure also, not auditing for a year.
Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers. May 15th, 2018 How X-rays Help Create an Evidence Based PracticeLearn:
- 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. April 26th, 2018 Anatomy of the KneeCoders 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. April 17th, 2018 Documenting Diagnoses Like a Peer Reviewer, Take 2In 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! April 12th, 2018 Evaluation and Management Coding and AuditingAre 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). March 29th, 2018 Coding and Auditing TeleHealth ServicesDo 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. February 13th, 2018 How to Add Acupuncture to a Chiropractic OfficeIn 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. January 25th, 2018 Surgical Coding and AuditingEver 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. January 4th, 2018 Proper Coding and Billing for Drugs, Biologicals and InjectionsProper Coding and Billing for Drugs, Biologicals and Injections December 21st, 2017 What is RBRVS and How Can It Benefit Your OrganizationWhat is RBRVS and How Can It Benefit Your Organization October 10th, 2017 Which is the Most Profitable E/M Code for PI: 99203 or 99204?There is a lot of myth surrounding the use of the E/M codes. Dr. Grant will discuss how to best use these codes in a PI case to avoid the potential for a fraud claim by an insurer or a malpractice action by your patient. February 2nd, 2017 How to Check NCCI Edits Using FindACodeHow to Check NCCI Edits Using FindACode December 1st, 2016 Chapter 5.2 - Part 1 Modalities & Therapeutic Procedure Coding: OverviewLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 2 of 7.
... December 1st, 2016 Chapter 5.2 - Part 2 Modality Coding (97014, 97012)Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 3 of 7.
... December 1st, 2016 Chapter 5.2 - Part 3 Modality Coding ( 97035, 97010, 97032, 97039)Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 4 of 7.
... December 1st, 2016 Chapter 5.2 - Part 4 Therapeutic Procedure Coding (97140)Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 5 of 7.
... December 1st, 2016 Chapter 5.2 - Part 5 Therapeutic Procedure Coding (97110, 97124, 97112)Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 6 of 7.
... December 1st, 2016 Chapter 5.2 - Part 6 Therapeutic Procedure Coding (97530, 97510, 97139)Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 7 of 7.
... April 19th, 2016 DeskBook 101: Evaluation and Management Self AuditChapter 5.3 of the 2016 ChiroCode DeskBook is all new, with tables and examples to help you become an expert on E/M coding for chiropractic. E/M codes are a top target by auditors because many providers use them incorrectly, or trust their EHR system templates to do the work for them. In this webinar, find out how to audit your own E/M codes so you don't have to fear the auditors. March 8th, 2016 Q&A with ChiroCode's ExpertsPresented by Dr. Evan Gwilliam, ChiroCode's VP, and Brandy Brimhall, ChiroCode's Director of Education
There are more webinars. View all webinars... View webinars for the current subject by subtopic: 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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