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Latest articles

Muscle Testing and Range of Motion Information
November 8th, 2018 - Wyn Staheli, Director of Research
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
Medi-Cal Coverage Criteria for Hospital Beds and Accessories
November 7th, 2018 - Raquel Shumway
Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.
Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?
November 7th, 2018 - Wyn Staheli, Director of Research
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 ...
How to Use Modifier Indicators with NCCI Edits (2018-10-31)
October 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator.  Medicare may have restrictions on the use of a modifier used to bypass an edit.  This important part of coding can alert a payer or ...
Anesthesia and Pain Management
October 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Anesthesia and Pain management is under close watch from the OIG according to a report from Anesthesia Business consultants, they stated, "The Health and Human Services Office of Inspector General (HHS OIG) reports in its most recent Semi-annual Report to Congress that in FY 2017 it brought criminal actions against 881 individuals or organizations ...

Editors choice articles

Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?
November 7th, 2018 - Wyn Staheli, Director of Research
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 ...
We've Always Done It This Way and Other Challenges in Education
October 19th, 2018 - BC Advantage
As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into...
HCC - Acceptable Provider Interpretation for Diagnostic Testing
October 1st, 2018 - Wyn Staheli, Director of Research
The following table is taken from the Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance dated 2017-09-27 (see References). It is a listing of acceptable provider interpretation of diagnostic testing. Acceptable Examples include: Cardiology and Vascular Surgeons Echocardiogram (including Doppler, Duplex, Color flow of the heart vessels) EKG (electrocardiogram) – Stress test, Cardiac ...
The Potential Impacts of a Flat Rate EM Reimbursement on our Industry
September 26th, 2018 - BC Advantage
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...
Pricing for ASC’s and APC’s
August 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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...

Latest questions/posts

Attempted ERCP
1st    Nov 16th, 2018 - Emmi

Z code
   Nov 16th, 2018 - rdinaso    12 

Cannabis oil as an alternative medicine
1st    Oct 31st, 2018 - Kirsti090

Chopart Amputation Revision
1st    Oct 30th, 2018 - Hgorby

J0171 - Epinephrine Epi Pen - Help please
   Oct 19th, 2018 - Mand0984 11 

CPT code for nephrology capitation billing to arkansas Medicaid
   Oct 17th, 2018 - anitac

Outcome Assessment Tools
1st    Sep 14th, 2018 - DrEd

NHP-RI CPT 64450-XS denied as non coverd
   Sep 11th, 2018 - austin

Diabetic Foot Care
   Aug 28th, 2018 - alleegator13

Hiv - 2
1st    Aug 21st, 2018 - Jstew

MDM credit in Table B
   Aug 17th, 2018 - damills 1 

Grouping of mutually exclusive CPt4 in IR DRG
1st    Aug 17th, 2018 - Hhiba

Denial in question
   Aug 15th, 2018 - alleegator13

Incident To Billing
   Aug 14th, 2018 - dlstoner512 1 

Reimbursement Question for J2785 - Injection, regadenoson, 0.1 mg
1st    Aug 13th, 2018 - Jaywalkz

CPT 61510 and 61518- multiple tumors
   Aug 12th, 2018 - LBAROGIANIS 250 

ICD-10 - Help
   Aug 7th, 2018 - precod 10 

Repair Code vs Flap Code
   Aug 2nd, 2018 - sharris

Dexcom G5 CPT
   Jul 13th, 2018 - precod 10 

I need codes for private lab tests to report to Medicare and AARP
1st    Jun 28th, 2018 - maryaloftus


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