What you need to know to avoid claim denials and to maximize practice revenue Despite your best efforts to follow billing guidelines, payers still deny your claims. Or in some cases, they pay you and then take the money back. Experts say you can’t ever eliminate denials and post-payment recoupment entirely, but you can reduce […]
During a typical office visit, physicians may provide evaluation and management (E/M) services, minor procedures and more. The question is: Can they bill for each one separately? In some cases, the answer is no. In others, though, the answer is yes — but they must know what current procedural terminology (CPT) modifier to append. Modifiers […]
When the Centers for Medicare & Medicaid Services (CMS) implemented the Patient Driven Payment Model (PDPM) as the new reimbursement method for skilled nursing facilities (SNF), some of us in the coding and auditing world thought it likely to result in inaccurate payments. The old model, the Resource Utilization Group—Version IV (RUGS-IV), calculated SNF reimbursement […]
Effective from discharges/visits on October 1, 2022, the 2023 Official Coding and Reporting Guidelines for ICD-10-CM have been established. On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) issued MLN Connects, featuring an article focusing on long COVID. This article imparts guidance on coding practices for both long COVID and ongoing COVID […]
The effective date for 0081A-0083A and 91308 is June 17, 2022. The Food and Drug Administration (FDA) granted emergency use authorization (EUA) to the Pfizer-BioNTech COVID-19 vaccine for patients ages 6 months to 4 years. The new CPT® codes for reporting this vaccine are: 0081A Immunization administration by intramuscular injection of severe acute respiratory syndrome […]
Medicare updates its policy for these services to align with CPT®. The Centers for Medicare & Medicaid Services (CMS) revised its Part B benefit policy for critical care services, effective Jan. 1, 2022. Policy changes finalized in the 2022 Medicare Physician Fee Schedule (MPFS) final rule include a new definition of critical care services, who […]
Implement a compliance process in your practice for querying providers for outpatient services. Querying providers about their documentation may seem inappropriate, but it is an important part of the medical coding process. A physician query allows a medical coder to formally ask a healthcare provider a question about something they wrote (or didn’t write) in […]
Medical Coding Updates and Insights Unveiled Effective April 1, 2022, the HCPCS Level II code set, which is employed to record medical services and provisions, will encompass the integration of 37 novel codes. Furthermore, the second quarter revision encompasses the elimination of five codes and a refinement of the description for one modifier. Lay Terms […]
The ability to rapidly and accurately report such granular detail requires a robust data infrastructure. Instrumental to this infrastructure are the specific AMA Current Procedural Terminology (CPT®) product and administrative codes related to COVID-19 vaccines. Long described as the “common language of medicine,” the CPT code set is kept current through the work of the CPT Editorial […]
AMA updated the CPT code for the third dose of Pfizer’s pediatric COVID-19 vaccine on the heels of the FDA’s recently expanded emergency use authorization. The American Medical Association (AMA) announced a Current Procedural Terminology (CPT) code set update to include a code for administering a third dose of Pfizer’s COVID-19 vaccine in children 5 […]