Keeping Up to DateDecember 7th, 2018 - NAMAS
Keeping up to date on coding and documentation changes, is critical for medical coders, billers, auditors, and compliance personnel. Every year American Medical Association (AMA) creates, revises, and deletes CPT codes on January 1st. Same thing occurs with the ICD-10 codes in October. For CPT codes, the intention of the...Auditing looking between the linesNovember 30th, 2018 - BC Advantage
When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not...Billing 99211 Its not a freebieNovember 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 InformationNovember 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 AccessoriesNovember 7th, 2018 - Raquel Shumway
Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.Documentation Requirements for Allergy Testing 10/29/2018October 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 ...We've Always Done It This Way and Other Challenges in EducationOctober 19th, 2018 - BC Advantage
As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into...Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?October 16th, 2018 - Wyn Staheli, Director of Research
We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...Chiropractic OIG Audit Recommendations - Lessons LearnedSeptember 28th, 2018 - Wyn Staheli, Director of Research
The OIG recently concluded an audit on a chiropractic office located in Florida and had some significant findings. They recommended the following:
Refund to the Federal Government the portion of the estimated $169,737 overpayment for claims for chiropractic services that did not comply with Medicare requirements and are within the 4-year ...Join QPro Today and Get CertifiedSeptember 12th, 2018 - Find a Code
Join QPro Today and Get Certified!
To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards.
Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...Importance of Depression ScreeningsAugust 16th, 2018 - Wyn Staheli, Director of Research
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...Attention Providers - Please Make Time to Read this LetterJuly 17th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
In an effort to show CMS is committed to changing the rules to accommodate their providers CMS released a letter to Doctors of Medicare Beneficiaries. The letter offers encouragement and a promise to reduce the burden of unnecessary rules and requirements. The letter states “President Trump has made it clear that ...Documentation: Face to Face for Home Health CertificationJuly 9th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...WHO Said ICD-11 is Coming SoonJune 26th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...Home Oxygen Therapy -- CMN for OxygenJune 14th, 2018 - Raquel Shumway
The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.Brooklyn Chiropractor OIG Report - Lessons LearnedApril 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.Documentation for Evaluation and Management (E/M) ServicesMarch 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: 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.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.Documentation for Enteral NutritionMarch 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ...Documentation for Negative Pressure Wound TherapyMarch 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy.Documentation for Ordering Oxygen Supplies and EquipmentMarch 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for Ordering Oxygen Supplies and Equipment.Documentation for Surgical DressingsMarch 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for surgical dressings.Documentation for Urological SuppliesMarch 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for urological supplies.Delivering Bacterial Culture Lab OrdersMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests...Coverage for Power Tilt/Recline Seating Systems for WheelchairsMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems...Documentation Tips for Ostomy SuppliesMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies....Preventing Denials for Lower Limb ProsthesisMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on denials for lower leg prostheses and how to prevent them:
For the 2017 report period, most of the improper payments for lower leg prostheses were due to insufficient documentation.
For Medicare to cover a lower limb prosthesis claim, the medical record must support the beneficiary’s ...Preventing Denials for Therapeutic CGMs and Related SuppliesMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related SuppliesDocumentation and Orders for Laboratory TestsMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for ordering laboratory tests.Documentation and Orders for Respiratory Assistive DeviceMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines.Documentation for Skilled Nursing FacilitiesMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF).Documentation for Inpatient Rehabilitation FacilitiesMarch 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).Documentation for Home Health Services (Part A non DRG)March 8th, 2018 - Medicare Learning Network
The Medical Learning Network provides coverage guidance, which should be documented, for home health services.Q and A: Coding Mixed Cardiogenic and Septic ShockFebruary 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,...Insufficient Documentation ErrorsJanuary 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
According to CMS ICN 909160, claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed, meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.
Claims ...Antiresorptive Osteonecrosis of the JawsJanuary 9th, 2018 - Find-A-Code
Osteonecrosis is a serious bone disease caused when the bone is starved of its normal blood supply. Because bone is living tissue, without a good supply of oxygenated blood, it becomes weakened and then dies. Scientists have not been able to identify the exact cause of osteonecrosis of the jaws, but they have ...Coverage and/or Medical Necessity for the Use of Hyaluronan or DerivitiveJanuary 9th, 2018 - Find-A-Code
According to Palmetto GBA, Medicare will cover the cost of the injection and the injected hyaluronate polymer for patients who meet the following clinical criteria:
Knee pain associated with radiographic evidence of osteophytes in the knee joint, sclerosis in bone adjacent to the knee, or joint space narrowing.
Morning stiffness of less than 30 minutes in duration or crepitus on motion of the ...GeneSight Psychotropic Testing and DocumentationJanuary 9th, 2018 - Find-A-Code
According to Wisconsin Physicians Service Insurance Corporation, there is limited coverage for the GeneSight® Psychotropic (AssureRx Health, Inc, Mason, OH) gene panel. GeneSight® testing may only be ordered by licensed psychiatrists or neuropsychiatrists contemplating an alteration in neuropsychiatric medication for patients diagnosed with major depressive disorder (MDD) (in accordance with DSM IV/V criteria) who are suffering with refractory moderate to ...Diathermy eg Microwave Use and DocumentationJanuary 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 GuidelinesJanuary 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 GuidelinesJanuary 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'sJanuary 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 ...Modifiers 54-55, split surgical and postoperative careJanuary 4th, 2018 - Find-A-Code
54 -Surgical care only; Surgeon is performing only the preoperative and intra-operative care
55 - Postoperative management only; Physician, other than surgeon, assumes all or part of postoperative care
Modifiers should be placed on the surgical code
Used on 10 day and 90 day surgical procedures
Both the surgeon and the physician providing the postoperative ...Proper Usage of Electrical StimulationJanuary 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 CodingJanuary 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 ...Reimbursement for Therapy StudentsJanuary 4th, 2018 - Find-A-Code
According to CGS Administrators, qualified professionals may serve as clinical instructors for therapy students within their scope of practice. Physical therapist assistants and occupational therapy assistants may only serve as clinical instructors for physical therapist assistant students and occupational therapy assistant students, respectively, when performed under the direction and supervision ...Skilled Therapy, When it's Appropriate and BillableJanuary 4th, 2018 - Find-A-Code
According to CGS Administrators,
"A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ...Ultrasound TherapyJanuary 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 ...