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Latest articles

Coverage for Hearing Aids and Auditory Implants
April 23rd, 2019 - Brandon Dee Leavitt QCC, CMCS, CPC, EMT
For hearing impairment, Medicare is firm in its stance on when it will and will not cover hearing correction. In the PUB 100-02 Medicare Benefit Policy Manual, Chapter 16, Medicare cites the Social Security Act by explaining:  "..."hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids" ...
What is Medical Necessity and How Does Documentation Support It?
April 23rd, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
CPT Announces 2021 E/M Changes
April 23rd, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
OIG Announces - New Review For Medicare Part B Payments for Podiatry and Ancillary Services
April 23rd, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020.  The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.   Part of the ...
Auditing Chiropractic Services
April 22nd, 2019 - 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
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.

Editors choice articles

Voluntary Repayments
March 8th, 2019 - Namas
Should you volunteer to repay money from Medicare or other federal healthcare programs if you believe they were the result of errors on your end? The penalties for not doing so could be severe. Under the Federal False Claims Act, if retained overpayments can be shown to be to false ...
Q/A: Can you Help me Understand the New Medicare Insurance Cards?
March 7th, 2019 - Wyn Staheli, Director of Research
As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.
Medicare Physician Fee Schedule Indicators
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
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...
UnitedHealthcare to Discontinue Coverage of Consultations
March 4th, 2019 - Wyn Staheli, Director of Research
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).
Billing Guidelines for Repositioning
March 4th, 2019 - Wyn Staheli, Director of Research
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 ...

Latest questions/posts

Coding for respiratory tract infections and other conditions during pregnancy
1st    Apr 25th, 2019 - Paramesh

Medicare Annual Wellness Visit in the Nursing Home Setting
1st    Apr 22nd, 2019 - staracres

96372 Billing
   Apr 18th, 2019 - dlstoner512 1 

Appropriate Modifier for 83615 @ 2 Units for CMS?
1st    Apr 11th, 2019 - RNokes

43249 with 43236
   Apr 2nd, 2019 - AMat    2 

Synagis Injection
   Mar 28th, 2019 - Hgorby

nurse practitioner/hospital charges
   Mar 19th, 2019 - anitac

1st    Mar 14th, 2019 - AMat    2 

Codes effective 4/12019
1st    Mar 12th, 2019 - Haley33TK

Diagnostic Angiograms prior to Intervention
1st    Feb 28th, 2019 - Jodi

P59.9 (Neonatal jaundice)
1st    Feb 27th, 2019 - olerip

Brand new to ENT and I have a question
   Feb 17th, 2019 - rdinaso    12  1 

nephrology capitation codes
   Feb 11th, 2019 - anitac

27369 subsequent visit.
1st    Feb 8th, 2019 - StevenH

20610 & 27369 on the same day
   Feb 8th, 2019 - ranawaheed321 4 

MRI without contrast on Monday followed by an MRI with contrast on Tuesday.
   Jan 25th, 2019 - rdinaso    12  1 

PCS code
1st    Jan 18th, 2019 - Csara19

Neo coding
1st    Jan 17th, 2019 - Telle

Critical Care vs. Split Shared Services
   Jan 15th, 2019 - Andrea58

leuprolide acetate Lupron/Eligard J1950 versus J9217
   Jan 14th, 2019 - bets14687    1 


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