CPT® Coding - Articles

The Importance of Medical Necessity
July 9th, 2019 - Marge McQuade, CMSCS, CHCI, CPOM
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 ...
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
July 8th, 2019 - Wyn Staheli, Director of Research
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 ...
Q/A: Do I Really Need to Have an Interpreter?
July 1st, 2019 - Wyn Staheli, Director of Research
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 ...
Don't Let Your QPro Certification(s) Expire! Your Certifications Matter!
June 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Hello QPro Members, Just a friendly reminder!                                                                                        ...
How to Properly Report Monitoring Patients Taking Blood-thinning Medications
June 18th, 2019 - Wyn Staheli, Director of Research
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.
A United Approach
June 14th, 2019 - Namas
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 ...
Documentation of E/M services for Neurology (Don't Forget the Cardiology Element)
June 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Spotlight: Anatomy Images
June 13th, 2019 - Brittney Murdock, QCC, CMCS, CPC
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.
Spotlight: Printing Additional Code Information
June 13th, 2019 - Brittney Murdock, QCC, CMCS, CPC
Did you know you can print the information from Find-A-Code's code information pages? Click the Printer icon on any code information page. You can check/unckeck the boxes at the top to select what information you want to print: It's that easy!
How to Code Ophthalmologic Services Accurately
June 6th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
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 ...
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
May 29th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
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?
Your New Patient Exam Code Could Determine How Many Visits You Get
May 27th, 2019 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
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 ...
What to Look for When Auditing Smoking Cessation Services
May 24th, 2019 - NAMAS
What to Look for When Auditing Smoking Cessation Services
Q/A: I’m Being Audited? Is There a Documentation Template I can use?
April 29th, 2019 - Wyn Staheli, Director of Research
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 ...
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 ...
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 drgwil@gmail.com
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.
Auditing Ophthalmology and Optometry Exams
April 19th, 2019 - Namas
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 ...
Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?
April 1st, 2019 - Wyn Staheli, Director of Research
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 ...
Corrections and Updates
April 1st, 2019 - Wyn Staheli, Director of Research
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 ...
Spinal Cord Stimulator Used for Chronic Pain
April 1st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Prolonged Services
March 29th, 2019 - Namas
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) ...
How to Report Imaging (X-Rays) of the Thumb
March 18th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
Date of Service Reporting for Radiology Services
March 7th, 2019 - Wyn Staheli, Director of Research
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.
Spotlight: GLOBAL Periods
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
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...
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 ...
Separately Report a "Separate Procedure" with Confidence
February 22nd, 2019 - Namas
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 ...
Understanding NCCI Edits
February 20th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries
February 14th, 2019 - Aimee Wilcox
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 ...
Q/A: Do Digital X-rays Have Their Own Codes?
February 7th, 2019 - Wyn Staheli, Director of Research
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 ...
Clinical Staff vs Healthcare Professional
February 5th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
BC Advantage Now Offering Q-Pro CEUs!
February 5th, 2019 - Find-A-Code
We are excited to announce BC Advantage is now offering Q-Pro CEUs! It is now even easier to get your QPro CEUs and stay current with BC Advantage: offering news, CEUs, webinars and more. BC Advantage is the largest independent resource provider in the industry for Medical Coders, Medical Billers,...
Q/A: Can I Bill a Review of X-Rays?
February 1st, 2019 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
Physical Therapy Caps Q/A
February 1st, 2019 - Wyn Staheli, Director of Research
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 ...
Q/A: Which Code Should I Use for a Lab Interpretation Fee?
January 24th, 2019 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
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 ...
New Genetic Test for Severe Inherited Conditions
January 3rd, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
Welcome 2019 CPT Codes!
January 3rd, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...

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Flexion-Distraction Billing Clarification
December 20th, 2018 - Wyn Staheli, Director of Research
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 ...
The Diabetic Patient and Medical Manifestations
December 20th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Treating a diabetic patient with medical oral complications may be covered under the patient's medical plan. With the patient's oral health at risk, the medical portion may reimburse for certain procedures, since medical plans only pay from medical necessity the treatment must be considered...
Allergy Immunotherapy Coding Guidelines (CMS) Effective: 01/01/2006
November 26th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
CMT Fees in 2019
November 26th, 2018 - Wyn Staheli, Director of Research
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.
Billing 99211 Its not a freebie
November 9th, 2018 - BC Advantage
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...
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 ...
Common Allergy CPT Codes and MUEs
October 30th, 2018 - Find-A-Code™
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 ...
Documentation Requirements for Allergy Testing 10/29/2018
October 30th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Allergy Testing 10/29/2018
October 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Q/A: What Codes do I use for CLIA-Waived Tests?
October 16th, 2018 - Wyn Staheli, Director of Research
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 ...
Pelvic Floor Dysfunction Treatment Coverage
October 16th, 2018 - Wyn Staheli, Director of Research
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 ...
Prolonged Services Its Not Just About Time
October 5th, 2018 - BC Advantage
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 ...
Is cox-flexion distraction billable as 97012
October 4th, 2018 - ChiroCode
Is cox-flexion distraction billable as 97012? Can you use 97140 and 98941 on the same day?
Tools and Resources for Life Care Planners
October 2nd, 2018 - Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS
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...
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...
Rhizotomy Procedures
September 26th, 2018 - BC Advantage
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...
2019 Code Changes are Just Around the Corner - Are You Ready?
September 24th, 2018 - Wyn Staheli, Director of Research
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 ...
Medicare Timed Codes Guidelines
August 16th, 2018 - Wyn Staheli, Director of Research
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 ...
Q/A: Can I Bill Mechanical Massage?
August 16th, 2018 - Wyn Staheli, Director of Research
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.
BREAKING NEWS: CMS Proposes to Change E&M Coding
August 15th, 2018 - Christine Taxin
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 ...
Are incident to services worth the risk
August 13th, 2018 - BC Advantage
Incident-to services allow non-physician practitioners (NPPs) such as nurse practitioners and physician assistants to bill under a supervising physician if they perform services that are incidental to a physician-created plan of care. Incident-to billing offers two key benefits: First, the physician is reimbursed at 100% of the contracted rate with...
When Medical Necessity and Medical Decision Making Don't Match
August 3rd, 2018 - BC Advantage
As coders and auditors, we are taught the documentation guidelines on how to determine medical decision making. However, Medicare is clear that medical necessity is what determines the overall payment. In order to know what to do when medical necessity and medical decision making do not line up, you must...
Q/A: Can I Bill Spinal Decompression Table to Insurance?
July 25th, 2018 - Wyn Staheli, Director of Research
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
Provider-Based Facilities and Split Billing: Is Your Facility Being Reimbursed for All Work Performed?
July 18th, 2018 - NAMAS
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 ...
Dual Medicare-Medicaid Billing Problems
July 12th, 2018 - Wyn Staheli, Director of Research
It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...
Q/A: Can You Swap Out 97140 with 97530?
July 12th, 2018 - Wyn Staheli, Director of Research
Codes 97140 and 97530 are not interchangeable. See why.
Q/A: Should I Bill Massage as 97124 or 97140?
June 20th, 2018 - ChiroCode
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 ...
Q/A: Coding for ECG/EKG’s
June 13th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS & Marge McQuade
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 ...
Provider-Based Facilities and Split Billing Is Your Facility Being Reimbursed for All Work Performed?
June 8th, 2018 - Sharon Hoglund, CPC, CPMA, CEMC, CEMA
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...
The Range of Motion Conundrum
June 7th, 2018 - Gregg Friedman, DC, CCSP
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 ...
Q/A: Coding for Lesion Removal and Repair
June 5th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that...
Auditing Therapy Evaluation Codes - Not So Quick!
June 4th, 2018 - Nancy J Beckley, MS, MBA, CHC
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...
How Many Modalities Are Too Many?
June 4th, 2018 - Dr Evan Gwilliam, Clinical Director for PayDC chiropractic EHR software
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?
AMA vs Medicare rules and the use of the PT modifier
May 22nd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Preventive Medicine: Alcohol Misuse Screening & Counseling
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Annual Wellness Visit
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Bone Mass Measurements
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Breast Cancer Genetic Screening
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Cardiovascular Disease Screening Tests
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Cervical Dysplasia Screening
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Colorectal Cancer Screening
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Contraceptive Methods
May 9th, 2018 - Find-A-Code™
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: ...
Preventive Medicine: Counseling to Prevent Tobacco Use
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Dental Caries in Children
May 9th, 2018 - Find-A-Code
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 ...
Preventive Medicine: Depression Screening
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Diabetes Screening
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: General Procedures
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and Administration
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Hepatitis C Virus (HCV) Screening
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Human Immunodeficiency Virus (HIV) Screening
May 9th, 2018 - Brandon Herman, QCC
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 ...
Preventive Medicine: Human Papilomavirus (HPV) Vaccine and Screening
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Influenza Virus Vaccine and Administration
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Lung Cancer Screening
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Newborn Screenings/Tests
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Pneumococcal Vaccine and Administration
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Screening Children for Visual Acuity
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Screening for Anemia
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Screening for STIs & HIBC to Prevent STIs
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Screening Mammography
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Screening Pap Tests
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Therapy for Fall Prevention
May 9th, 2018 - Find-A-Code™
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, ...
Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
May 9th, 2018 - Find-A-Code™
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 ...
Preventive Medicine: Use of Modifier 33
May 9th, 2018 - Find-A-Code™
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. ...
Brooklyn Chiropractor OIG Report - Lessons Learned
April 23rd, 2018 - Wyn Staheli, ChiroCode Director of Research & Dr. Evan Gwilliam, Clinical Director PayDC Software
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.
Q/A: Modifiers for Injections
April 17th, 2018 - Nicole Olsen QCC
I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit....
Billing Nutrition Counseling in a Chiropractic Setting
April 12th, 2018 - Wyn Staheli, Director of Research
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 ...
Using Pulmonary Stress Tests
April 9th, 2018 - Find-A-Code
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 • ...
Medicare Telemedicine Changes for 2018
March 29th, 2018 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
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 ...
Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together
March 26th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
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?
Documentation for Evaluation and Management (E/M) Services
March 26th, 2018 - Nicole, QCC
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 ...
Q/A: Billing for GI Anesthesia
March 21st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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.
Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?
March 21st, 2018 - Wyn Staheli, Director of Research
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.
CPT Code for DOT exams
March 13th, 2018 - Wyn Staheli, Director of Research
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?
When is 97112 Neuromuscular Re-education Billable?
March 13th, 2018 - Dr. Evan Gwilliam, VP for PayDC
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.
Increased Therapy Denials Create Administrative Burden
March 5th, 2018 - Wyn Staheli, Director of Research
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 ...
Medicare Changes Requirements for Implantable Cardioverter Defibrillators (ICDs)
February 26th, 2018 - Wyn Staheli, Director of Research
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 ...
The Comprehensive Error Rate Testing Program
February 23rd, 2018 - Frank Cohen, MBA, MPA
With nearly a million physicians in this country, how do auditing organizations determine whom to audit?
Consultation Codes Q/A
February 20th, 2018 - ChiroCode
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?
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 ...
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 ...
Multiple Diagnostic Imaging Payment Reduction
February 1st, 2018 - Wyn Staheli, Director of Research
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 ...
Strapping and Kinesio Taping Coding Differences
February 1st, 2018 - Wyn Staheli, Director of Research
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: ...
Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes
February 1st, 2018 - Find-A-Code
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, ...
Q and A: Coding Mixed Cardiogenic and Septic Shock
February 1st, 2018 - BC Advantage
Q: If the attending documented, "likely mixed cardiogenic and septic shock," can I assign codes R57.0 and R65.21? A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember,...
Influenza, Are You Billing Correctly?
January 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Comprehensive Searches with Find-A-Code
January 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Find-A-Code is an exhaustive library of knowledge, the key to being successful while using this incredible tool is understanding how to find the information you need and what is available to you. Check out a few of our Comprehensive search tools. ...
Q/A: Can I Perform 2 Untimed Codes at the Same Time?
January 31st, 2018 - Wyn Staheli, Director of Research
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)?
Non-Coronary Vascular Stents: Mesenteric Vessels
January 29th, 2018 - Find-A-Code
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 ...
Paravertebral Joint/Nerve Blocks - Diagnostic and Therapeutic
January 29th, 2018 - Find-A-Code
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 ...
Psychiatric Partial Hospitalization Programs
January 25th, 2018 - Wyn Staheli, Director of Research
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 ...
How do I Find Out How Much I Can Charge for a 98941 for a Medicare Beneficiary?
January 25th, 2018 - Wyn Staheli, Director of Research
What can I charge for a 98941 for a Medicare Beneficiary? Read Here to find out more.
2018 Revisions to Prolonged Services
January 18th, 2018 - Wyn Staheli, Director of Research
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 ...
Non-Coronary Vascular Stents: Brachiocephalic arteries
January 16th, 2018 - Find-A-Code
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 - ...
Non-Coronary Vascular Stents: Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infropoliteal arteries)
January 16th, 2018 - Find-A-Code
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 ...
Non-Coronary Vascular Stents: Renal artery
January 16th, 2018 - Find-A-Code
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 ...
Medicare Requiring Specific Modifiers on Therapy Services
January 15th, 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: Services furnished under the Outpatient ...
Billing with a GP Modifier
January 15th, 2018 - Wyn Staheli, Director of Research
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?
Paravertebral Joint/Nerve Denervation
January 10th, 2018 - Find-A-Code
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 ...
Billing Electrotherapy with AcuKnee
January 9th, 2018 - Christine Woolstenhulme
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 ...
Conscious (Moderate) Sedation
January 9th, 2018 - Find-A-Code
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. Prior to 2017, ...
Non-Coronary Vascular Stents: Inferior vena cava and iliofemoral veins
January 9th, 2018 - Find-A-Code
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 ...
Outpatient Rehabilitation Modifiers
January 9th, 2018 - Jared Staheli
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, ...
Preventive Medicine with a New Patient
January 9th, 2018 - Find-A-Code
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 ...
2017-2018 Influenza (Flu) Resources for Health Care Professionals
January 4th, 2018 - Find-A-Code
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 ...
99024 for Subsequent Visits Within Global Period
January 4th, 2018 - Find-A-Code
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 ...
Acute Post-Operative Pain Management
January 4th, 2018 - Find-A-Code
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 ...
Beware of Limitations When Using Electrical Stimulation - Ultrasound
January 4th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Billing Negative Pressure Wound Therapy (NPWT) (disposable device)
January 4th, 2018 - Find-A-Code
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 ...
Diathermy eg Microwave Use and Documentation
January 4th, 2018 - Find-A-Code
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 ...
General Physical Therapy Modality Guidelines
January 4th, 2018 - Find-A-Code
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 ...
Hydrotherapy Guidelines
January 4th, 2018 - Find-A-Code
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 ...
Initial Evaluation Codes for PT's and OT's
January 4th, 2018 - Find-A-Code
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 ...
Mechanical Traction Therapy
January 4th, 2018 - Find-A-Code
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 ...
Proper Usage of Electrical Stimulation
January 4th, 2018 - Find-A-Code
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 ...
PT and OT Reevaluation Coding
January 4th, 2018 - Find-A-Code
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 ...
Ultrasound Therapy
January 4th, 2018 - Find-A-Code
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 ...
Understanding ASC Pricing
November 22nd, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
ASCs (Ambulatory Surgical Centers) have a separate fee schedule with a base allowed amount that is adjusted for each state using Core Based Statistical Areas (CBSA). Under the ASC payment system, Medicare pays facilities for specific ASC covered surgical procedures, however, there are only certain types of procedures that are eligible for payment ...
So, How Do You Decide if a Service was Provided?
October 13th, 2017 - David Glaser, JD
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.....
E&M Guidelines with NGS is Not Mandatory
September 20th, 2017 - Chris Woolstenhulme, CPC, CMRS
Changes with the 1995 Documentation Guidelines for Evaluation and Management services, is not considered mandatory. NGS had originally planned a change in examination requirements for Expanded Problem Focused and Detailed levels of service. The decision to not mandate the changes was due to feedback and multiple provider queries from NGS providers. All medical records that are reviewed will be ...
Global Surgical Package: When to Bill and When Not to Bill, that is the Question
September 8th, 2017 - Stephanie Allard, CPC, CEMA, RHIT
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.....
The Incredible Disappearing Consultation
August 18th, 2017 - J. Paul Spencer, CPC, COC
In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255 for inpatient).
How to Bill a Dressing Change
August 1st, 2017 - Chris Woolstenhulme, CPC, CMRS
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, ...
Auditing Vaccines
July 28th, 2017 - Paul Chandler
Auditing vaccines can be difficult, as precise attention needs to be paid to the documentation to extract all variables needed for proper coding.
Telemedicine: The Next Frontier in Care Delivery
July 7th, 2017 - Valora Gurganious, MBA, CHBA
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.
Auditing Incident-to Services
June 16th, 2017 - Michael Miscoe, Esq.
To effectively audit incident-to services under Medicare, the auditor must first have an operational understanding of the rule. Unfortunately, this is not as easy as it sounds. Auditors must also understand that the incident-to rule is a Medicare only rule. This is one area where the maxim "if you are ...
Excluded from the Global OB Package
April 6th, 2017 - Chris Woolstenhulme, CPC, CMRS
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 ...
E/M Table of Risk
March 29th, 2017 - Wyn Staheli
The final sub-component of Medical Decision Making is the Risk of Significant Complications, Morbidity and/or Mortality. The following is the official Evaluation and Management Table of Risk. The level is selected by choosing one element from three criteria (Presenting Problem, Diagnostic Procedures Ordered, and Management Options), with the highest level selected ...
2014 brings big volume of changes to CCI edits
March 29th, 2017 - Find-A-Code
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....
Acute Postoperative Pain Management
March 20th, 2017 - Wyn Stahel
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 ...
Endocervical Curettage and Colposcopy
March 7th, 2017 - Chris Woolstenhulme, CPC, CMRS
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 ...
Menstrual Migraine Coding
March 7th, 2017 - Chris Woolstenhulme, CPC, CMRS
When coding chronic migraines related to menstrual cramps, you must document that the patient has menstrual migraines. With ICD-10 there are a variety of migraines, including those that are neurologic, abdominal, and ophthalmologic based. You must also document whether the menstrual migraine (G43.82- and G43.83-) is intractable or not intractable, including ...
Using Add-On Codes
March 3rd, 2017 - Chris Woolstenhulme, CPC, CMRS
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 ...
Using Modifier EY
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Some Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items require a detailed Written Order Prior to Dispensing (WOPD), while others require a Detailed Written Order (DWO) prior to billing. The specific requirements for an order are specified in the Medical Policy (Local Coverage Determination and/or Policy Article) for the ...
Care Plan Oversight Services
March 1st, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
Using Time Span Codes
February 24th, 2017 - Find-A-Code
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 ...
Coverage and/or Medical Necessity for the Use of Hyaluronan or Derivitive
February 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
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 ...
Anesthesia Code Changes in 2017- Epidural Steroid Injections (ESI)
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
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 ...
New and Deleted Angioplasty Codes for 2017
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
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; ...
New and Deleted Drug Screen codes for 2017
January 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
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 ...
Sleep Studies: Billing with Reduced Hours
January 12th, 2017 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
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 ...
NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy
December 16th, 2016 - Find-A-Code
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...
Billing for Prosthesis Designed and Prepared by the Dentist
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For maxillofacial services, if a prosthesis is provided, and is designed and prepared by the dentist, the Medicare Part B carrier may be billed with CPT codes 21076 through 21089. If the prosthesis is prepared by an outside laboratory, the laboratory bill goes to the Durable Medical Equipment Regional Carrier (DMERC), with Level ...
E/M 101
November 29th, 2016 - BC Advantage
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 ...
You can charge for Advanced Care Planning (ACP)
October 5th, 2016 - Chris Woolstenhulme, CPC, CMRS
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 ...
Visual Field Examination
August 10th, 2016 - Chris Woolstenhulme, CPC, CMRS
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 ...
How do I tell if a code is defined as unilateral or bilateral
August 3rd, 2016 - Codapedia
There are some procedures which are defined as unilateral procedures, and some defined as bilateral procedures. If the procedure is defined as unilateral but performedbilaterally, then the physician is paid 150% of the fee schedule amount when performed on both sides. If the code is defined as bilateral, there is...
Coding Selective and Non Selective Catheter Placement of Lower Extremity
July 29th, 2016 - Codapedia
- 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...
Modifier 52 vs. 53
December 29th, 2015 - Seth Canterbury, CPC, ACS-EM
So you’ve read the descriptions for both Modifiers 52 and 53, but you’re still on the fence as to which one is appropriate for a certain surgical case. This brief article will try to better differentiate between these two often-confused modifiers. Modifier 53 is appropriate when a...
Doing--and coding--for minor procedures in primary care
December 29th, 2015 - Codapedia Editor
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What Does It Mean To Scrub An Insurance Claim?
December 29th, 2015 - David Greene, MD
During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It’s unfortunately a necessary evil, as surgeons who contract with insurance companies rely on that reimbursement as the...
Reporting Administration Codes with Vaccines
December 29th, 2015 - Allison Singer, CPC
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...
Coding Excisions and Wound Repairs
October 15th, 2015 - Allison Singer, CPC, CPMA
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,...
Subsequent Observation Services
October 15th, 2015 - Codapedia Editor
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 three...
How to research coding questions
June 1st, 2015 - Christina Benjamin
How to Research Answers to Coding Questions Perform a search of the discussion board or listserv website prior to posting a new question. For your search terms, include specific words such as the diagnostic statement or procedure statement or the specific code number or ...
Category of Code Selection
March 17th, 2015 - Codapedia Editor
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...
Don’t expect to see payment any time soon for ‘telephone consults’
October 15th, 2014 - Scott Kraft
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 report back to the...
Who Qualifies for TCM Services?
April 22nd, 2013 - Lacy Gaskins
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,...
Clear the Smoke on Debridement and Active Wound Care Codes
January 5th, 2011 - Jennifer Schmutz
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 the...
CPT® Consult Rule Changes for 2010
November 2nd, 2009 - Codapedia Editor
By now you've heard the news that starting January 1, 2010, Medicare will no longer reimburse consultation services billed with codes 99241--99245, 99251--99255. But, the consult codes remain in the CPT® book for 2010. However, there is quite a bit of new editorial material related to...
Prolonged Services in an inpatient setting
July 31st, 2009 - Codapedia Editor
This article will describe the coding for using prolonged services in an inpatient setting. The codes are 99356: Prolonged physician service in the inpatient setting, first hour and 99357 each additional 30 minutes. See the CPT® book for the complete descriptions. These codes are used as add...
What is an Incomplete Colonoscopy?
June 12th, 2009 - Alyce Kalb
A complete colonoscopy according to Current Procedural Terminology published by the AMA is: “Colonoscopy, flexible, proximal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate...
Laparoscopic procedure without a code
May 11th, 2009 - Codapedia Editor
Do not use the open code for procedure when performing the service laparoscopically. Use an unlisted code if none exists. Contact your medical society and the CPT® committee to describe the service and advocate for a code. Here is Nancy Maguire's response to this question on the Q&A...
ROS Checklist
April 22nd, 2009 - Rikki Runyon
Review of Systems CHECKLIST: -General- ? Weight loss or gain ? Fatigue ? Fever or chills ? Weakness ? Trouble sleeping ----------------------------------------------------------------------------------- -Skin- ? Rashes ...
How do I submit a question to CPT® Assistant/AMA?
April 10th, 2009 - Christina Benjamin
I contacted AMA when they first started promoting their CPT® Network and offering a 30-day free trial access to it and they gave me the following information: 1. As a CPT® Assistant subscriber, if I have a question that is directly related to CPT® Assistant, they will answer...
How to submit a question to CPT® Assistant/AMA?
April 3rd, 2009 - Christina Benjamin
1. As a CPT® Assistant subscriber, if you have a question that is directly related to CPT® Assistant, they will answer it. Questions can be e-mailed to cptassistant@ama-assn.org with subject - call for letters and to attention of Gloria Green per the CPT® Assistant. They ask that...
Using Modifer -59
March 31st, 2009 - Crystal Reeves
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...
Modifier 79
March 18th, 2009 - Codapedia Editor
Modifier 79 is used to indicate that the physician performed a surgical service that required a return trip to the OR for an unrelated problem during the global post op period. Modifier 79 is appended to procedures. See the CPT® book for the complete definition. It is appended when: A...
Visual Acuity Screening
March 12th, 2009 - Codapedia Editor
Many physician practices are denied by third party payers when billing for a visual acuity test with a well child visit. The code for visual acuity testing is 99173. See the CPT® book for a complete definition of this code. This is a screening test of visual acuity, quantitative, bilateral,...
Modifier 21
March 4th, 2009 - Codapedia Editor
Modifier 21 was deleted from the 2009 CPT® book. It was a modifier that was not recognized by many payers, and did not give the practice any additional payment. See the add on, prolonged services codes 99354--99357 to report prolonged services. See the Codapedia articles about this topic.
Nurse visit and flu shots
February 18th, 2009 - Codapedia Editor
Both CPT® and CMS (Medicare) has made it clear that it is not appropriate to report a nurse visit when giving a flu shot. That is: do not bill a nurse visit when the patient presents to the office for a flu shot. Bill only for the administration of the vaccine and for the serum, if the...

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