Category: Medical Coding

How to avoid medical necessity denials

How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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2022 care management services codes to know

2022 care management services codes to know

Question: Can you please tell us what the new codes are for principal care management and chronic care management? Answer: There are three new codes in the care management section of the CPT codebook. Care Management Services Principal Care Management Services New CPT codes have been added in 2022 to describe “Principal Care Management Services.” […]
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Hundreds of new inpatient procedure codes finalized for fy 2023

CMS finalized the fiscal year (FY) 2023 inpatient procedure code set along with accompanying guidelines. KEY TAKEAWAYS331 new procedure codes will become effective October 1.The middle revenue cycle will need to be updated on recent coding changes that will affect hospital reimbursement. The FY 2023 ICD-10-PCS procedure code set and the ICD-10-PCS Official Guidelines for […]
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Regulations Open Doors for Telehealth Services in FQHCs

Regulations Open Doors for Telehealth Services in FQHCs

Make sure your facility is aware of all the Medicare policy changes that permit payment for expanded services. Telehealth as a healthcare delivery platform has been in existence since the late 1960s. It was first introduced through projects initiated by the National Aeronautics and Space Administration (NASA) and the Nebraska Psychology Institute. The declaration of […]
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Preventive Medicine Versus E&M Codes

Preventive Medicine Versus E&M Codes

Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms, conditions, diagnoses and/or problems that need to […]
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Don’t Overlook These New PLA Codes

Don’t Overlook These New PLA Codes

A quarterly update for the Clinical Laboratory Fee Schedule (CLFS), issued May 4, includes nine new CPT® codes for proprietary laboratory analyses (PLAs). Medical coding and billing staff that process claims for lab testing should be aware of these codes and pricing. 9 New PLA Codes The following PLA (type of service 5) codes are […]
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