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Latest articles

No HCPCS Code Available? Now What?
February 21st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
New Modifiers Released in 2018
February 13th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Payment Rates Increase for Behavioral Health Office Services
February 13th, 2018 - Wyn Staheli, Director of Research
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 ...
Scoring & Reporting Your Audit Findings
February 2nd, 2018 - Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT
This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week.
Medicare Requiring Modifier GP on Physical Therapy Services
February 1st, 2018 - Wyn Staheli, Director of Research
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 (emphasis added): Services furnished under the Outpatient ...

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

   Feb 22nd, 2018 - rdinaso    12 

ABN protocol
   Feb 20th, 2018 - alleegator13

   Feb 14th, 2018 - m.payson

SNF discharges
1st    Feb 14th, 2018 - m.payson

Anesthesiologist Billing for E/M visits
1st    Feb 6th, 2018 - kjenk

Post op Rechecks/new trama
   Jan 31st, 2018 - alleegator13

99496- billable if patient passes during 30 day period
   Jan 30th, 2018 - smilsdo 1 

gangilon cysts
   Jan 29th, 2018 - alleegator13

Inclusive denials
   Jan 27th, 2018 - bsrinivasarao777     3 

Inclusive denials
   Jan 27th, 2018 - bsrinivasarao777     3 

Diagnosis Overweight
   Jan 24th, 2018 - rphelps 615 

Anesthesia billing for gastroenterology
   Jan 24th, 2018 - rphelps 615 

Hereditary cancer testing ICD10 codes
1st    Jan 22nd, 2018 - DCM

Lower extremity angioplasty with thrombolysis infusion.
1st    Jan 17th, 2018 - kwesner

1st    Jan 17th, 2018 - Kwatson

Modifier 25 with New patient visit codes and procedure on same day
   Jan 16th, 2018 - daystarjj 4 

CPT 94664
1st    Jan 10th, 2018 - KarS

6 month repeat colonoscopy
1st    Jan 3rd, 2018 - halifax gastro

vaccine admin billing
1st    Dec 18th, 2017 - Maha 2 

Procedure code 99222
1st    Dec 14th, 2017 - sghant01


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