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Latest articles

Small Practices are Affected by MIPS Increased Thresholds
June 25th, 2018 - Wyn Staheli, Director of Research
We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part ...
How Does the Physician Compare Website Affect You?
June 25th, 2018 - Wyn Staheli, Director of Research
The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ...
VA Expands Telehealth
June 14th, 2018 - Wyn Staheli, Director of Research
On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ...
Will Medicare's Proposed Reformations Affect Your Practice?
June 12th, 2018 - Wyn Staheli, Director of Research
Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards more value based payment systems, innovation and new models are being sought to both reduce costs and increase quality. This article outlines the ideas presented in the ...
Inappropriate Use of Units Costs Practice Over $800,000
June 11th, 2018 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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?

Editors choice articles

Health Care Fraud - Don’t Do It!
July 31st, 2017 - Chris Woolstenhulme, CPC, CMRS
If you wonder if what you are doing is fraud, DON’T DO IT! The government takes this extremely serious. I don't need to tell you this.  I have often been apprehensive about making a mistake and I wonder, will it be fraud? Will I spend time in jail for accidentally sending in a duplicate ...
Pre-op visits: True or False?
December 29th, 2015 - Codapedia Editor
Are the following statements true or false? • The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules. • The surgeon can never be paid to do a pre-op visit if s/he is going to take the patient to surgery. • The...
Billing Incident to Services-Whose Number Should Be Used?
December 29th, 2015 - Seth Canterbury, CPC, ACS-EM
Should You Bill Incident to Services for a Medicare Patient Under The Number of the “Supervising Physician” or the “Ordering Physician”? This issue was first clarified in the preamble of the 11/1/01 Federal Register (available here on p. 23 of the file, p. 55267 of the...
Cloned E/M notes
December 29th, 2015 - Codapedia Editor
Have you ever read a physician office note and thought it was strangely familiar? Or, not just familiar but identical to another note? Well, Medicare contractors have noticed the same thing, and the Office of Inspector General has included this on their 2011 Work Plan. Medicare contractors have...
Cardiology Coding Unmasked - Part 2 Therapeutic Cardiology Procedures, CPT Codes (92980-92982; 92984; 92995-92996), Medical Necessity Issues (ICD-9-CM)
December 29th, 2015 - Nancy Maguire
92980 Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel 92981 Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional...

Latest questions/posts

Dexcom G5 CPT
   Jul 13th, 2018 - precod 10 

medical practice reimbursement issues
1st    Jul 11th, 2018 - johntimber

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

Rewording prior question on CPT 93000
   Jun 27th, 2018 - sschwartz 3 

Aetna denial on E/M codes
   Jun 27th, 2018 - gowri.tina

Pouchoscopy with dilation of anus with biopsy?
1st    Jun 25th, 2018 - mlh2000ku

VP tie off
   Jun 22nd, 2018 - lizzg

Axillary artery cutdown
1st    Jun 20th, 2018 - dll

Mesh removal in office
1st    Jun 13th, 2018 - Nikkibear

Initial patient eval with medical services
1st    Jun 12th, 2018 - Andrea58

CPT code for Colon hydrotherapy
1st    Jun 7th, 2018 - daltonl

ERCP Coding
   May 31st, 2018 - Roxanne W    1 

Office visit with Provider and Nurse Only lab, same DOS
   May 30th, 2018 - sschwartz 3 

DERMATOLOGY - Muscle, myocutaneous, or fasciocutaneous flap; CPT 15733
   May 30th, 2018 - gowri.tina

Ecg/ekg
   May 24th, 2018 - sschwartz 3 

Telehealth
1st    May 24th, 2018 - CoderRich

Not accepting insurance company at one site but not others?
1st    May 19th, 2018 - cbchun 1 

Arkansas Medicaid capitation CPT code
   May 16th, 2018 - anitac

ORIF radial head AND neck
1st    May 11th, 2018 - carsil864

Opertative Report
1st    May 8th, 2018 - stepyg


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