Category: Medical Coding

Medicare Payment Rates for COVID-19 Test CPT Codes

CMS Releases Medicare Payment Rates for COVID-19 Test CPT Codes

Medicare payment rates for CPT codes 87635, 86769, and 86328 range from $42.13 to $51.31, CMS recently announced. CMS recently revealed how much it will pay for new Current Procedural Terminology (CPT) codes developed by the American Medical Association (AMA) for COVID-19 diagnostic tests. The guidance previously detailed Medicare payment rates for Healthcare Common Procedure […]
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COVID-19 Reimbursement

Safeguarding COVID-19 Reimbursement

Waivers, modifiers, lab tests, multiple diagnosis codes…the layers and specifics of COVID-19 coding cannot be overlooked when ensuring appropriate reimbursement and safeguarding claims against third-party payer audits. As hospitals and healthcare organizations begin to assess the required steps necessary to prepare for the transition back to a pre-COVID-19 operating environment, apart from timelines and state […]
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IPPS Proposed Rule_ Proposes Increased Payment Rates

2021 IPPS Proposed Rule: CMS Proposes Increased Payment Rates

According to the proposed rule, CMS projects total Medicare spending on inpatient hospital services, including capital, will increase by about $2.07 billion in FY 2021. CMS’ fiscal year (FY) 2021 Inpatient Prospective Payment System (IPPS) proposed rule, released May 11, includes a proposed increase to hospital payment rates, the creation of a new Medicare-Severity Diagnosis-Related Group […]
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IPPS Proposed Rule_ Proposes Increased Payment Rates

Medicare Telehealth Coding as of April 30

Healthcare providers are granted even more latitude for use of telehealth services during the COVID-19 public health emergency. On a Friday, at month-end, the Centers for Medicare & Medicaid Services (CMS) kindly dropped another bomb on us: more temporary policy changes during the public health emergency for COVID-19. We may have this all sorted out just […]
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Coding in Age of COVID-19_ Deciphering Coding Nuances, Best Practices

Coding in Age of COVID-19: Deciphering Coding Nuances, Best Practices

  Without much warning, the novel Coronavirus, or COVID-19, has taken over our healthcare system. It has taxed our healthcare workers, our national stockpiles of PPE, and affected millions of Americans nationwide. In addition to healthcare workers on the front lines, the pandemic has also impacted the healthcare revenue cycle, causing major confusion, questions, and inconsistencies as […]
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Radiology and Imaging CPT Change

2020 Radiology and Imaging CPT Change

  Become a coding superhero with X-ray vision. When is imaging separately reported, and how? The relative value units (RVUs) for some codes include the provider’s use of imaging to accurately visualize the specimen or problem the code is meant to address. The most notable changes with regards to radiology for 2020 can be found […]
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Coronavirus_ Antibody Testing Guidance

Coronavirus: FDA Updates Antibody Testing Guidance

  The U.S. Food and Drug Administration (FDA) has updated COVID-19 antibody testing guidance. According to a news release, the revised rule allows laboratories and commercial manufacturers to help accelerate the use of tests they develop to expand rapid testing capacity. The rule allows companies to develop and distribute serological, antibody, tests after validation while an […]
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New Billing Basics for Telemedicine

New Billing Basics for Telemedicine

Betsy Nicoletti, MS, a nationally recognized coding expert, will take your coding questions via email and provide guidance on how to code properly to maximize reimbursement. Have a question about coding? Send it here. In this column, Nicoletti outlines some key guidance for using telemedicine. These rules would apply during the Centers for Medicare & Medicaid […]
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Know About COVID-19 Coding and Billing

What Providers Need to Know About COVID-19 Coding and Billing

  The healthcare system is facing an unprecedented crisis, but accurate COVID-19 coding and billing can help providers weather the storm and prepare for future outbreaks. The COVID-19 pandemic is putting strain on the healthcare system, but accurately capturing data and documenting cases of the novel coronavirus can help ease the burden on providers. COVID-19 […]
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Coding High-Throughput COVID-19 Testing

Coding High-Throughput COVID-19 Testing

The Centers for Medicare & Medicaid Services (CMS) created two new HCPCS Level II codes for lab tests that use high-throughput technologies to detect SARS-CoV-2, the virus that causes COVID-19. The rate for these codes is $100, roughly twice the rate of similar tests that don’t use high-throughput technologies. Consider New Codes in Place of […]
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