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HCPCS Coding - Articles

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...
CMS Proposed New E/M Codes for Podiatry
July 16th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
According to CMS changes are coming for E/M codes.  A recent proposal from CMS stated: "The E/M visit code set is outdated and needs to be revised and revalued." Since podiatry tends to furnish a lower level of E/M visits, CMS is proposing new G-codes to report E/M office/outpatient visits. The proposed ...
Inappropriate Use of Units Costs Practice Over $800,000
June 11th, 2018 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?
Documentation for Surgical Dressings
March 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for surgical dressings.
No HCPCS Code Available? Now What?
February 21st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes. There are several types of HCPCS level II codes such as: Permanent National Codes Dental Codes Miscellaneous Codes Temporary National ...
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 ...
Patients Undergoing a Bone Marrow Transplant (BMT)
February 1st, 2018 - Find-A-Code
Accoring to Wisconsin Physicians Service Insurance Corporation L34699, when using J2820 for patients undergoing a bone marrow transplant (BMT), 2 diagnosis codes are required:1) Z76.82 Awaiting organ transplant status2) Pick a code from one of these categories: C81- Hodgkin Lymphoma C82- Follicular Lymphoma Non-follicular Lymphoma C83.1- Mantle cell lymphoma C83.3- Diffuse large B-cell lymphoma C83.7- Burkitt lymphoma C83.8- Other (Intravascular large B-cell lymphoma, Primary effusion B-cell lymphoma, or Lymphoid granulomatosis) Mature T/NK-cell lymphomas C84.4- Peripheral T-cell ...
Reporting Tooth Numbers and Oral Cavity Areas
February 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
When billing for dental procedures you need to identify the exact tooth and/or location in the oral cavity. Qualifiers are used to report the location and tooth number. When billing procedures on teeth and the oral cavity, the JP qualifier is used to identify the tooth number(s) and the JO ...
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 ...
Medicare Reimburses for Discarded/Wasted Drugs
January 5th, 2018 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
Your organization may be leaking revenue without realizing the leak can be stopped. If your organization purchases single-use packets or single dose vials for individual patient use and ends up discarding some of the drug, Medicare has now authorized payment for the discarded or wasted portion. Stop leaking revenue today by reading this article and implementing the guidance provided here.

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List of Common Unclassified Injectable drugs (this list in not all-inclusive)
August 4th, 2017 - Chris Woolstenhulme, CPC, CMRS
This is a list of some of the most common Injectable unclassified drugs used with J3490 Antilirium – 1 mg/ml Ascorbic Acid – 500 mg/ml Ascorbic Acid – 250 mg/ml Bacitracin, Intramuscular – 50,000 unit vials Bacitracin, Intramuscular – 10,000 unit vials Brevital Sodium – 500 mg/5 ml Caffeine and Sodium Benzoate – 250 mg/ml Capastat Sulfate – 1 ...
HCPCS Codes - ASP Reporting is done in Units not NDC
July 26th, 2017 - Chris Woolstenhulme, CPC, CMRS
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.
Treating Diabetic Patients in Your Office?
June 30th, 2017 - Shannon DeConda
CMS will be rolling out an Expanded Diabetes Prevention Plan January 1, 2018 as well as new Durable Medical Equipment (DME) supply codes for Continuous Glucose Monitors (CGM) July 1, 2017. These services will offer your practice the opportunity to better assist your diabetic patient's needs. Remember that prior to providing ...
Changes with DME
June 20th, 2017 - Chris Woolstenhulme, CPC, CMRS
Due to the cost and refills that is required with portable oxygen systems separate payment classes were added in 2007 for oxygen generating portable equipment. Each year, Payment Classes for Oxygen Generating Portable Equipment, Stationary Oxygen Contents, and Portable Oxygen Contents, are adjusted to make additional payment classes for oxygen ...
High Compression Bandage System Clarification
March 1st, 2017 - Chris Woolstenhulme, CPC, CMRS
Multi-layered, sustained, graduated, high compression bandage systems are used primarily to treat lymphedema and venous or stasis leg ulcers. A number of graduated, high-compression bandage systems products have been developed, including Profore®, Dyna-Flex®, Surepress®, Setopress®, and other similar product systems.Providers should note that the treatment of lymphedema with the application ...
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 ...
G-Codes eff Jan 01,2017 for additional payment for Psych - Collaborative Care
January 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Medicare has agreed to make separate payments to physicians and non-physicians for Behavioral Health Integration (BHI) services beginning Jan. 01, 2017. Any condition new or pre-existing behavioral health or substance use disorders are eligible. Beneficiaries may have comorbid, chronic, or other medical conditions they are being treated for as well. Using the ...
Covered colonoscopy is attempted but cannot be completed due to extenuating circumstances
December 21st, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Medicare will pay for the interrupted colonoscopy as long as the coverage conditions are met for the incomplete procedure. However, the frequency standards associated with screening colonoscopies will not be applied by CWF. When a covered colonoscopy is next attempted and completed, Medicare will pay for that colonoscopy according to ...
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 ...
Medicare Inpatient only list - online search tool
April 30th, 2014 - Mike Todai
CMS provides Medicare Inpatient list. There are several links Dr. Hirsch has provided to clarify the topic so I will not spend much time to save reader's time. Our recommendation is that hospitals should ask for CPT® / Procedure codes from the physician / physician office. We have built an...
Medicare Inpatient only list - online search tool
April 30th, 2014 - Mike Todai
CMS provides Medicare Inpatient list. There are several links Dr. Hirsch has provided to clarify the topic so I will not spend much time to save reader's time. Our recommendation is that hospitals should ask for CPT® / Procedure codes from the physician / physician office. We have built an...
Wellness visits for Medicare patients
November 18th, 2013 - Codapedia Editor
Dec 20, 2010 Added Medicare's MLN Matters article as a resource. Hold the champagne--it's true that Health Care Reform added an annual "wellness"visit for every beneficiary, but it's not what you or your doctors think of as an annual exam. In fact, it's has more in common with the...
Unna Boot Application
September 2nd, 2009 - Codapedia Editor
Physicians bill for Unna Boot application using code 29580. The supply code is A6456, Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard. Notice that the code unit is 1 for one yard. Bill for both on the same...
Certification of Home Health Agency Services for Medicare
February 25th, 2009 - Codapedia Editor
In 2001, Medicare added two new HCPCS codes to describe certification and recertification of home health services performed by a physician. A qualified NPP may not provide this service because only a physician may order home health services for a patient. There are two codes, G0179 and G0180,...
Care Plan Oversight for Medicare Patients
February 25th, 2009 - Codapedia Editor
Medicare has developed two HCPCS codes for providing Care Plan Oversight (CPO) to their patients. There are also CPO codes in the CPT® book for non-Medicare patients. See the article in Codapedia related to the CPO codes for non-Medicare patients. For Medicare patients, the service is...
Healthcare Common Procedure Coding System
February 12th, 2009 - Codapedia Editor
Healthcare Common Procedure Coding System (HCPCS) are a set of standardized codes which health care providers use to report services to insurance companies. The first set, CPT® (Level I HCPCS codes,) are owned, developed and copyrighted by the American Medical Association. These codes are...

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