HCPCS Coding - Articles

Healthcare Common Procedure Coding System (HCPCS)
August 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?
August 13th, 2019 - Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA
Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...
CMS Proposes to Reverse E/M Stance to Align with AMA Revisions
August 6th, 2019 - Wyn Staheli, Director of Research
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...
Denial Management is Key to Profitability
July 15th, 2019 - Wyn Staheli, Director of Research
A recent article by Modern Medicine cited a report by Becker’s Hospital Review which stated that it costs approximately $118 per claim to resolve a claim denial. Granted, these were hospital claims, but the process is essentially the same for outpatient services. In fact, you could say it is...
When Can You Bill Orthosis Components Separately?
July 9th, 2019 - Wyn Staheli, Director of Research
Othoses often have extra components. When can you bill those components separately? For example, can you bill for a suspension sleeve (L2397) with a knee orthosis (e.g., L1810)?
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 ...
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.
Medicare Now Reimburses for Remote Monitoring Services (G2010)
June 13th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare's 2019 Final Rule approved HCPCS code G2010 for reimbursement, which allows providers to be paid for remote evaluation of images or recorded video submitted to the provider (also known as "store and forward") to establish whether or not a visit is required. This allows providers to get paid for ...
Facts on Procedure Codes
May 8th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are two levels of codes used for services and procedures: Level I Codes are used for Services and Procedures provided by physicians. 5 digit numerical code, example, 99213 - Office or other outpatient visits Level II Codes are used to bill Medical equipment supplies and transport services. 4 digit Alpha/Numerical code example, ...
Biofeedback - Is it Medically Necessary?
April 24th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational. The majority of payers will list Biofeedback on an exclusions list. Others such as BC ...
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 ...
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 ...
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,...
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 ...
Q/A: Is G8730 Still Required? Are G Codes Required at all?
January 14th, 2019 - Wyn Staheli, Director of Research
G8730, when is it required. Many G codes are still active and are required for non-quality reporting.

Prior years:  (click bar to view 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...
Keys to Successful Claims Filing
August 30th, 2018 - Noridian Medicare
There are many factors that can contribute to your success in filing claims and getting reimbursed. The information below is from the CMS website. Completing Item 12, Patient's or Authorized Person's Signature, on the CMS-1500 form for a non-assigned claim A signature on file (SOF) indicates the supplier has obtained the beneficiary's one-time authorization on ...
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?
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 ...
Documentation: Face to Face for Home Health Certification
July 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 ...
Home Oxygen Therapy -- CMN for Oxygen
June 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.
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?
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?
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: Breastfeeding Supplies
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...
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: 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 Self-Management Training
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Diabetes Self-Management Training Procedure Codes G0108: DSMT, individual, per 30 minutes G0109: GDSMT, group (2 or more), per 30 minutes ICD-10-CM G0108-G0109: Contact payer for more specific guidelines Frequency G0108-G0109 Initial year: Up to 10 hours of initial training within a continuous 12-month period Subsequent years: Up to 2 ...
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: Glaucoma Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Glaucoma Screening Procedure Codes G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist ICD-10-CM G0117-G0118: Z13.5 Frequency G0117-G0118: Once a year Additional information G0117-G0118 Coverage as is indicated with ...
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: 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: Initial Preventive Physical Examination
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Initial Preventive Physical Examination (Medicare Only) Procedure Codes G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation ...
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: Prostate Cancer Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Prostate Cancer Screening Procedure Codes G0102: Prostate cancer screening; digital rectal examination G0103: Prostate cancer screening; prostate specific antigen test (PSA) ICD-10-CM G0102-G0103: Z12.5 Frequency G0102-G0103: Once annually Additional Information G0102-G0103 Only for males aged 50 and older G0102 Copayment and deductible may apply, consult your payer Find-A-Code™ - Preventive Services - ...
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 Gynecological Examination
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Screening Gynecological Examination Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...
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 ...
Coverage Criteria for Nonwearable Automatic Defibrillators
April 19th, 2018 - Find-A-Code
According to Noridian and CGS Administrators LCD L33690, a nonwearable automatic defibrillator (E0617) is covered for beneficiaries in two circumstances. They meet either (1) both criteria A and B or (2) criteria C, described below: The beneficiary has one of the following conditions (1-8):A documented episode of cardiac arrest due to ventricular fibrillation, not due to a ...
Indications for Serotypes A and B Botulinum Toxins
April 16th, 2018 - Find-A-Code
According to Novitas LCD L27476, the following indications apply: 1. Blepharospasm and strabismus2. Spastic dystonia or focal dystonias to relieve pain, to assist posturing and walking, to increase range of motion, to assist in the outcome of physical therapy, and/or to reduce spasm thus allowing adequate perineal hygiene.3. Spasmodic dysphonia4. Achalasia and cardiospasm when ...
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 ...
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 ...
Documentation for Surgical Dressings
March 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for surgical dressings.
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 ...
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 ...
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. ...
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's Integrated Behavioral Healthcare Services and Collaborative Care Program
January 18th, 2018 - Wyn Staheli, Director of Research
Over the last several years, primary care has begun to integrate behavioral health services to better address shortfalls in patient quality of care. Some of the first codes were the Health and Behavior Assessment/Intervention (96152-96155) codes, which were added in 2002. Since then, many different models have been experimented with and have ...
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?
Preventative Services: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
January 11th, 2018 - Find-A-Code
The following information from the Medicare Learning Network provides guidance on Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
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 ...
Coverage and/or Medical Necessity for the Use of Hyaluronan or Derivitive
January 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 ...
Diagnosis billing with J0888
January 9th, 2018 - Find-A-Code
The following information is from LCD L36276. The diagnosis codes listed below require the use of the EC modifier (ESA administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy) when submitting claims for J0888. In addition, these diagnosis codes are marked with an * indicating they require a dual diagnosis. The ...
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, ...
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.
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 ...
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 ...
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 ...
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 ...
Abuse, Neglect, or Maltreatment
January 3rd, 2018 - Wyn Staheli
According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence: An appropriate code from category T74- (confirmed) or T76- (suspected) Any accompanying mental ...
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
HCPCS CODES FOR WHICH ASP REPORTING IS DONE IN UNITS OF MEASURE OTHER THAN AN NDC Updated November 14, 2016 A9587 GALLIUM GA-68, DOTATATE, DIAGNOSTIC, 0.1 MILLICURIE 0.1 millicurie A9588FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE 1 millicurie A9606 RADIUM RA-223 DICHLORIDE, THERAPEUTIC, PER MICROCURIE 1 microcurie C9132 PROTHROMBIN COMPLEX CONCENTRATE (HUMAN), KCENTRA, PER I.U. OF FACTOR IX ACTIVITY 1 IU C9140 INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (AFSTYLA), 1 I.U. 1 IU J0256 INJECTION, ALPHA 1 PROTEINASE INHIBITOR ...
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...

Article categories




About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association