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Supplies and DME (Durable Medical)
News and Important Information
CGS- DME Documentation Checklists Updated 08/04/2023
New Modifier Required on all Single-Use Drugs Starting July 1, 2023
Effective April 17, 2023, Get the updated DMEPOS Required Face-to-Face Encounter & Written Order Prior to Delivery List, including 10 new items. Visit DMEPOS Order Requirements for more information. 2023-01-19
FINAL RULE: Medicare Program; End-Stage Renal Disease Prospective Payment System - DME Supplies 2022-01-13
Electrical Stimulation and Electromagnetic Therapy Devices
DME Documentation Requirements
Resources
Find-A-Code Tools and Resources
DME Information Forms (DIF)
CMS Form 484 - Certificate of Medical Necesssity - OxygenCMS Form 846 - Certificate of Medical Necessity - Pneumatic Compression Devices (No longer required after 01/01/2023)CMS Form 847 - Certificate of Medical Necessity - Osteogenesis StimulatorsCMS Form 848 - Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (TENS)CMS Form 849 - Certificate of Medical Necessity - Seat Lift MechanismsCMS Form 854 - Certificate of Medical Necessity - Continuation FormCMS Form 10125 - DME Information Form - External Infusion PumpsCMS Form 10126 - DME Information Form - Enteral and Parenteral Nutrition
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by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Preventive medicine services, initial preventive physical examinations (IPPE), and the annual wellness exam consist of many required performance and documentation criteria to ensure ample patient history is obtained and charted in an effort to reduce the risk of disease and disease progression. Although not planned, these encounters often include a problem-oriented visit as well, requiring the coder to know how to separate out the preventive service from the problem-oriented encounter for coding and billing.
Aug 15th, 2023
Reporting Drug Wastage with Modifier JW and NEW Modifier JZ
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Modifier JW has been around since 2003 with changes in Medicare policies to ensure standard utilization in 2017; however, because of a continued lack of reporting consistency, Medicare has created and implemented policy related to reporting a new modifier, JZ. How does this impact Medicare reimbursement and why is this modifier so important?
Feb 27th, 2023
CMS Announces Changes to DME Program
by Wyn Staheli, Director of Content - innoviHealth
CMS recently announced that there have been some changes made to the DMEPOS program. The Medicare Learning Network (MLN) “DMEPOS Quality Standards” lists several changes to the program. Read more about understanding these changes.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The Evaluation and Management (E/M) changes made in 2021 and again in 2023 brought about new CPT codes and guidelines for reporting prolonged services. Just as Medicare disagreed with CPT in the manner in which prolonged service times should be calculated, they did so again with the new 2023 changes. Here are three things you should know when reporting prolonged services for all E/M services.
Dec 27th, 2022
Compliance Billing: Power Mobility Devices
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.
Nov 23rd, 2022
2022-11-23-MLNC - Weekly Edition
Colorectal Cancer Screening Test: Reduced Coinsurance for Related Procedures Begins January 1 - - Ambulance Fee Schedule: CY 2023 Inflation Factor & Productivity Adjustment - - Medicare Ground Ambulance Data Collection System: Information to Help You Report - -...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The 2023 Evaluation and Management changes have been published and efforts are ongoing to educate coders and provider organizations on the guideline and code description changes that will impact professional coding in the facility setting. These changes required a significant revision to the guidelines and definitions of the various levels of complexity associated with the Number and Complexity of "Problems Addressed" during an encounter, which is the first element of medical decision making (MDM) and the following explanations and examples should provide a greater understanding of the changes headed our way in January.
by CMS - MLNConnects
Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.
Oct 20th, 2022
Billing for Incontinence and Urinary Products
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
We all understand anything covered under health insurance must be medically necessary. In other words, it must be essential in treating and managing a patient's condition or to evaluate, diagnose, or treat an illness, injury, disease, or its symptoms. In this article, we will address catheters, urological supplies, and disposable ...
Sep 15th, 2022
Emergency Department - APC Reimbursement Method
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...
Sep 8th, 2022
Are You Prepared to Avoid Repayments
by Raquel Shumway
Watchful care is needed when submitting claims.
The Office of the Inspector General (OIG), after completing an audit on a Medicare Advantage Plan in August 2022, is now demanding repayment of claims to the tune of $3,518,465. Although the payer is contesting that amount, it is possible that they may begin demanding repayments from the providers to cover their costs of repayment.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Over the past few years, at least 15 states have consistently pursued the goal of using social determinants of health (SDOH) in their overall healthcare analysis and treatment programs for patients, and CMS has taken notice. Data and outcomes obtained from these state programs have essentially provided an outline of how the government intends to pursue health equity through managed care contracts (MCOs) and Children's Health Insurance Program (CHIP). What is CMS seeing that they like so much and how might that affect future MCO contracts?
Aug 18th, 2022
CMS says Less Paperwork for DME Suppliers after Jan 2023!
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
Aug 4th, 2022
Billing and Coding: Bone Mass Measurement
by Amanda Ballif
Guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement.
by Amanda Ballif
The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.
Jul 21st, 2022
Addressing Trauma and Mass Violence
by Amanda Ballif
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.
Jul 20th, 2022
Accurate Coding Is The Key To Your Job - Here's Why
by Find-A-Code™
Medical billing codes dominate your day. They are the raw ingredients you use to do your job. But they are more than just numbers on an electronic form. They are also the life blood of the healthcare industry's billing capabilities.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.
by SAMSHA Newsroom
Today, agencies across the U.S. Department of Health and Human Services (HHS) issued a joint letter to states, tribes, and jurisdictions encouraging them to prioritize and maximize their efforts to strengthen children’s mental health and well-being. The letter, signed by leaders of the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL), outlines HHS’ plans to support and facilitate state-level coordination across federal funding streams to advance and expand mental health services for children.
Jul 7th, 2022
New Audio-Only Telehealth Guidance to Meet HIPAA Rules
by U.S. Department of Health & Human Services
Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.
by CMS - MLNConnects
News - Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 - Men’s Health: Talk to Your Patients About Preventive Services - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes - ICD-10-CM Diagnosis Codes: Fiscal...
by CMS - MLNConnects
News - COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose - - Biosimilars: Interchangeable Products May Increase Patient Access - - Critical Care Evaluation & Management Services: Comparative Billing Report in May - -...
by Chelsea Richwine and Christian Johnson
New ONC data show that, as of 2021, nearly all non-federal acute care hospitals were enabled to electronically prescribe controlled substances (EPCS). According to the American Hospital Association (AHA) Information Technology (IT) Supplement Survey, the proportion of non-federal acute care hospitals enabled for EPCS increased from 67% in...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Have you already implemented a care management services program in your provider organization? If not, now may be the time to seriously consider doing so. Significant 2022 changes to the codes and increases in RVUs and reimbursement rates creates an opportunity not only to improve patient care for chronic conditions but will also help your practice increase revenues if done correctly.
May 26th, 2022
Care Management Billing
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Chronic Care Management (CCM) is taking off, and with new codes and rules, it can get confusing. According to CMS, here are a few guidelines to help you with concurrent billing of CCM services.
You can’t report complex CCM and non-complex CCM for the same patient in a calendar month
Don‘t report ...
May 19th, 2022
Methadone Take-Home Flexibilities Extension Guidance
by SAMSHA Newsroom
On March 16, 2020, SAMHSA issued an exemption to Opioid Treatment Programs (OTPs) whereby a state could request “a blanket exception for all stable patients in an OTP to receive 28 days of Take-Home doses of the patient’s medication for opioid use disorder.” States could also “request up to 14 days of Take-Home medication for those patients who are less stable but who the OTP believes can safely handle this level of Take-Home medication.”
The exemption will carry on effective upon the expiration of the COVID-19 Public Health Emergency, subject to conditions listed in this article.
May 17th, 2022
Understanding the Basics of Reporting Mammography Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
How familiar are you with the coding and documentation requirements for screening and diagnostic mammography? What is diagnostic digital breast tomosynthesis and can you bill for it? This article review the basics of reporting screening, diagnostic, and digital breast tomosynthesis.
by SAMSHA Newsroom
New Resources to Help People Seeking Care to Understand and Access Protections Offered Under the Parity Law for Mental Health and Substance Use Disorder Benefits
May 2nd, 2022
Continuous Glucose Monitors (CGMs) -- New Codes
by Wyn Staheli, Director of Content - innoviHealth
New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing.
On December 28, 2021, we published the Medicare DMEPOS final rule in the Federal Register. This addressed the ...
Apr 27th, 2022
How to Reduce the Risk of Copy and Paste
by Erica E. Remer, MD CCDS
Providers should never C&P (copy and paste) material they have not read nor vetted for accuracy. A young Jeopardy! champion died from bilateral pulmonary emboli following a colectomy in January 2021. Following his surgery, it was reported that the surgeon referred to “DVT/VTE Prophylaxis/Anticoagulation” and another note read, “already ordered.” “DVT...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare made changes to the rules governing concurrently reporting transitional care management services and chronic care management services during the same calendar month. How might this help providers identify chronic conditions that risk adjust?
Apr 26th, 2022
Preventive Services
by Shannon O. DeConda, CPC CPC-I CEMC CEMA CPMA CRTT
In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding...
Apr 25th, 2022
CMS Creates New Code for Over-the-Counter COVID-19 Test
by Raquel Shumway
COVID-19 testing coverage is expanding with a new code which became effective on April 4, 2022. From that date until the end of the COVID-19 public health emergency (PHE), Medicare is conducting a COVID-19 Test demonstration “to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements.”
Apr 25th, 2022
The Impact of Coding on Maternal Outcomes
by Kristi Pollard, RHIT CCS CPC CIRCC AHIMA-Approved ICD-10-CM/PCS Trainer
This area of coding is not so easy. While most maternal deaths are preventable, the rate has been increasing in the United States since 2000. As a matter of fact, the U.S. has twice as many maternal deaths than other high-income countries. To reverse this trend, The Joint...
by Raquel Shumway
DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. DynamiCare Health Inc. has developed a contingency management program for those dealing with substance use disorders. CM “addresses the brain’s reward response in ways that conventional counseling and medications often cannot.” Over a course of 50 years, it has shown that this program is effective. The OIG, upon analysis, has determined that there is low risk for fraud and abuse and has offered their opinion at the request of DynamiCare Health, Inc.
Apr 21st, 2022
2022-03-03-MLNC - 2022 Payment, Quality, & Policy Changes
by CMS - MLNConnects
News - Ambulance Prior Authorization Model Expands April 1 - Nutrition-related Health Conditions: Recommend Medicare Preventive Services - Claims, Pricers, & Codes - HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals - Events - ICD-10 Coordination & Maintenance Committee Meeting — March...
Apr 12th, 2022
Monitoring Changes to Telehealth in 2022
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
SUMMARY: Did you realize telehealth services increased by 11,000% between 2019-2020? Once again the newest CPT and HCPCS updates address telehealth changes for 2022 with new modifiers and guidelines for reporting. With such an increase in usage, the OIG has also identified significant fraud.
by CMS - MLNConnects
News - COVID-19 Monoclonal Antibodies: Revised Emergency Use Authorization for EVUSHELD - Program for Evaluating Payment Patterns Electronic Reports for Short-term Acute Care Hospitals - Quality Payment Program: 2020 Performance Information on Care Compare - Skilled Nursing Facilities: Submit Technical Expert Panel Nominations by March 16 ...
Feb 24th, 2022
Prolonged Services Billed As a Split/Shared Visit
by Raquel Shumway
According to the new Medicare’s 2022 Medicare Physician Fee Schedule Final Rule (MPFS) in some cases, Prolonged Services can now be billed as a split/shared visit.
Feb 10th, 2022
SDoH Improves Reimbursement and Risk Scores
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The new guidelines for evaluation and management (E/M) services 99202-99215 refer to social determinants of health (SDoH) on the new or revised Table of Risk. Healthcare professionals have long hoped for the ability to score these problematic patient conditions in a meaningful way, not only for reimbursement, but also for quality of care and treatment options. SDoH codes recently added to the ICD-10-CM codeset continue to impress upon us the importance of identifying and reporting these patient issues and when combined with the new table of risk for scoring the E/M service, can impact reimbursement and care.
by Wyn Staheli, Director of Content - innoviHealth
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Jul 29th, 2021
Medicare's ABN Booklet Revised
by Wyn Staheli, Director of Content - innoviHealth
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.
Jun 1st, 2021
Chronic Care Management Services
by Wyn Staheli, Director of Content - innoviHealth
This article discusses some of the different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death.
May 4th, 2021
Comparison of Add-On Code Guidelines
by Wyn Staheli, Director of Content - innoviHealth
Add-on codes are codes that are not intended to be reported alone. They are reported with another primary procedure to identify that additional services have been provided in conjunction with that primary procedure. Generally, they include the words “List separately in addition to code.” Interestingly, there are some differences in the instructions/guidelines regarding the use of these codes in the CPT® codebook, the NCCI Policy Manual, and on the CMS website. This article outlines the differences between each of these.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...
Mar 10th, 2021
COVID-19 Vaccines
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...
by Wyn Staheli, Director of Content - innoviHealth
This article discusses WHY CMS decided to create code G2212 to be used with prolonged office Evaluation and Management (E/M) services instead of code 99417 as of January 1, 2021. The proposed Medicare Physician Fee Schedule stated that code 99417 would be used so it is essential to understand why they made this change to avoid potential problems with billing these services.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215. While Medicare has agreed to accept the AMA's CPT E/M coding changes, they have formulated an opinion contrary to how CPT calculates time specific ...
Jan 5th, 2021
CMS Final Rule Changes E/M Reporting Guidelines
by Wyn Staheli, Director of Content - innoviHealth
Just when we thought we had figured out Evaluation and Management (E/M) reporting for 2021, CMS released their final rule and now we will need to make some adjustments. While CMS stated that they were adopting the AMA guidelines for E/M office or other outpatient services, they did make a few changes.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...
Sep 1st, 2020
Not Following the Rules Costs Chiropractor $5 Million
by Wyn Staheli, Director of Content - innoviHealth
Every healthcare office needs to know and understand the rules that apply to billing services and supplies. What lessons can we learn from the mistakes of others? What if we have made the same mistake?
Aug 10th, 2020
Coding Injections for Pain Management
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management. Trigger Point Injections Trigger point injections are reported by how many muscles are treated using an ...
Jun 29th, 2020
HCPCS Codes Were NOT all Created for the Same Purpose
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...
May 18th, 2020
Packaging and Units for Billing Drugs
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number.
Take a look at the following
J1071 - Injection, testosterone cypionate, 1mg
For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL
(100 mg/mL = 1 mL and there are ...
Apr 21st, 2020
Special COVID Laboratory Specimen Coding Information
by Wyn Staheli, Director of Content - innoviHealth
With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies.
Apr 20th, 2020
Emergency Room and Ancillary Services
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Billing for an Emergency department is not the same as billing for a hospital or in the provider's office; there are several differences and requirements. For example. the hospital will report a stay with Diagnosis Related Groups (DRG's), which include hospital resources used during the patient's stay, while office visits ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Apr 2nd, 2020
More Telehealth Changes Announced by CMS
by Wyn Staheli, Director of Content - innoviHealth
On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information
Mar 30th, 2020
Providing Telehealth Services During COVID-19 Crisis
by Wyn Staheli, Director of Content - innoviHealth
The rules for providing telehealth services during this pandemic have changed and some requirements have been waived. Please keep in mind that “waiving requirements” does not mean that anything goes. Another important consideration is that Medicare and private payers may likely have different rules so you need to make sure that you know individual payer requirements during this time.
by NAMAS
Healthcare providers and the population at large are concerned about safe access to care considering the COVID-19 pandemic. As a result, we have received many inquiries this week about how to bill for “telehealth” services.
Let’s first address that true telehealth services have some pretty stringent requirements from CMS, including that ...
by Aubrie Rowley
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
Mar 20th, 2020
Implementing Telehealth Visits
by NAMAS
The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection.
Step ...
Mar 17th, 2020
Additional Coronavirus Testing Code Announced
by Wyn Staheli, Director of Content - innoviHealth
On March 13, 2020, a new CPT code was announced by the American Medical Association (AMA) who maintains the CPT code set. This early release of a CPT code is rare and is effective immediately.
Feb 20th, 2020
New HCPCS Code for Coronavirus Testing Announced
by Wyn Staheli, Director of Content - innoviHealth
Currently, healthcare providers testing patients for Coronavirus must use an unspecified code. To provide better tracking, on February 13, 2020, CMS announced the creation of a new HCPCS code.
by Wyn Staheli, Director of Content - innoviHealth
DME suppliers must bill bilateral supplies with modifiers RT and LT on separate claim lines or they are being rejected.
Dec 3rd, 2019
Q/A: Can I Order a TENS unit for a Medicare Patient?
by Wyn Staheli, Director of Content - innoviHealth
Question
Can a chiropractor order a TENS unit for a Medicare patient? We cannot order X-rays for a Medicare patient so I assume we cannot order a TENS unit either.
Answer
It’s not that you can’t order the TENS unit, it’s just that when it comes to doctors of chiropractic, Medicare only covers ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...
Aug 13th, 2019
Healthcare Common Procedure Coding System (HCPCS)
by Christine Woolstenhulme, QMC 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, ...
Aug 13th, 2019
Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?
by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
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 ...
by Wyn Staheli, Director of Content - innoviHealth
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., ...
Jul 15th, 2019
Denial Management is Key to Profitability
by Wyn Staheli, Director of Content - innoviHealth
Jul 9th, 2019
When Can You Bill Orthosis Components Separately?
by Wyn Staheli, Director of Content - innoviHealth
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)?
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Jul 1st, 2019
Q/A: Do I Really Need to Have an Interpreter?
by Wyn Staheli, Director of Content - innoviHealth
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 ...
by Wyn Staheli, Director of Content - innoviHealth
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.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
May 8th, 2019
Facts on Procedure Codes
by Christine Woolstenhulme, QMC 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, ...
Apr 24th, 2019
Biofeedback - Is it Medically Necessary?
by Christine Woolstenhulme, QMC 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 ...
Apr 1st, 2019
Corrections and Updates
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Apr 1st, 2019
Spinal Cord Stimulator Used for Chronic Pain
by Christine Woolstenhulme, QMC 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 ...
Mar 4th, 2019
Billing Guidelines for Repositioning
by Wyn Staheli, Director of Content - innoviHealth
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 ...
by Wyn Staheli, Director of Content - innoviHealth
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).
Feb 12th, 2019
Coding Medicare Initial Preventive Physical Exams (IPPE)
by Aubrie Rowley
The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...
Feb 1st, 2019
Physical Therapy Caps Q/A
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Jan 24th, 2019
Q/A: Which Code Should I Use for a Lab Interpretation Fee?
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
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 ...
Jan 23rd, 2019
Everything You need to Know about Drugs
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
We have it all! Search our WK Drug Database for drugs and pharmaceuticals. When it comes to support and guidance the WK Drug Database offers a paramount search and is conveniently presented in one place.
Pricing
GPIs
NDCs
Billing Codes
Indications/Diseases
Packaging Information
Active and Inactive
and more...
Additionally, learn more about drugs and pharmaceuticals that can be used to detect, treat, or monitor ...
Jan 22nd, 2019
Home Oxygen Therapy
Jan 14th, 2019
Q/A: Is G8730 Still Required? Are G Codes Required at all?
by Wyn Staheli, Director of Content - innoviHealth
G8730, when is it required. Many G codes are still active and are required for non-quality reporting.
Jan 14th, 2019
What is Virtual Communication (G0071)?
by NAMAS
Beginning January 1st, 2019 all of our RHC and FQHC organizations have a new CPT code to
consider implementing for their Medicare populous (check per Advantage Plan Administration for coverage). In its current form, this code is not reportable by organizations not meeting the RHC/FQHC designation.
The code isG0071 and is termed ...
Jan 3rd, 2019
2019 Coding Changes for Chiropractic
by Wyn Staheli, Director of Content - innoviHealth
The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...
by Wyn Staheli, Director of Content - innoviHealth
The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...
Oct 26th, 2018
Capped Rental Items
by Kristy Ritchie
CMS Gives guidance on Capped Rental Items:
Items in this category are paid on a monthly rental basis not to exceed a period of continuous use of 13 months.
Based on Supplier Standard 5, suppliers are required to advise beneficiaries of the rent/purchase option for capped rentals and inexpensive or routinely purchased items. ...
Aug 30th, 2018
Keys to Successful Claims Filing
by 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 ...
Aug 16th, 2018
Importance of Depression Screenings
by Wyn Staheli, Director of Content - innoviHealth
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
Aug 16th, 2018
Using Modifiers 96 and 97
by Wyn Staheli, Director of Content - innoviHealth
The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...
Jul 25th, 2018
Q/A: Can I Bill Spinal Decompression Table to Insurance?
by Wyn Staheli, Director of Content - innoviHealth
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
by Christine Woolstenhulme, QMC 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 ...
Jun 14th, 2018
Home Oxygen Therapy -- CMN for Oxygen
by 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.
Jun 11th, 2018
Inappropriate Use of Units Costs Practice Over $800,000
by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, 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?
Jun 4th, 2018
How Many Modalities Are Too Many?
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
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?
by 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 ...
May 9th, 2018
Preventive Medicine: Annual Wellness Visit
by 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 ...
May 9th, 2018
Preventive Medicine: Breastfeeding Supplies
by 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 ...
May 9th, 2018
Preventive Medicine: Colorectal Cancer Screening
by 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 ...
May 9th, 2018
Preventive Medicine: Contraceptive Methods
by 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: ...
May 9th, 2018
Preventive Medicine: Counseling to Prevent Tobacco Use
by 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, ...
May 9th, 2018
Preventive Medicine: Depression Screening
by 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 ...
May 9th, 2018
Preventive Medicine: Diabetes Self-Management Training
by 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 ...
May 9th, 2018
Preventive Medicine: Glaucoma Screening
by 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 ...
by 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 ...
May 9th, 2018
Preventive Medicine: Hepatitis C Virus (HCV) Screening
by 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, ...
by Brandon Herman, QMC QMCC QMBHC QMPM QMPoC
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 ...
by 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 ...
by 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 ...
May 9th, 2018
Preventive Medicine: Lung Cancer Screening
by 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 ...
by 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, ...
May 9th, 2018
Preventive Medicine: Newborn Screenings/Tests
by 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 ...
May 9th, 2018
Preventive Medicine: Prostate Cancer Screening
by 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 - ...
by 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 ...
May 9th, 2018
Preventive Medicine: Screening Gynecological Examination
by 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, ...
May 9th, 2018
Preventive Medicine: Screening Pap Tests
by 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 ...
Apr 19th, 2018
Coverage Criteria for Nonwearable Automatic Defibrillators
by 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 ...
Apr 16th, 2018
Indications for Serotypes A and B Botulinum Toxins
by 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 ...
Apr 12th, 2018
Billing Nutrition Counseling
by Wyn Staheli, Director of Content - innoviHealth
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 who may report evaluation and management ...
Apr 12th, 2018
Billing Nutrition Counseling in a Chiropractic Setting
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Mar 29th, 2018
Medicare Telemedicine Changes for 2018
by Aimee L. Wilcox, CPMA, CCS-P, 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 ...
Mar 27th, 2018
Home Oxygen Therapy -- A Face-to-Face Encounter
by Raquel Shumway
What is required for a Home Oxygen Therapy, Face-to-Face Encounter.
Mar 8th, 2018
Documentation for Home Blood Glucose Monitors (BGM)
by Medicare Learning Network
The Medicare Learning Network provides guidance on how to Prevent Denials for Home Blood Glucose Monitors (BGM)...
Feb 28th, 2018
Telemedicine Billing and Reimbursement
by Jared Staheli, MPP
The opportunities for providers who want to provide telemedicine continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding ...
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Feb 21st, 2018
No HCPCS Code Available? Now What?
by Christine Woolstenhulme, QMC 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 ...
by Wyn Staheli, Director of Content - innoviHealth
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following (emphasis added):
Services furnished under the Outpatient ...
Feb 1st, 2018
Multiple Diagnostic Imaging Payment Reduction
by Wyn Staheli, Director of Content - innoviHealth
CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...
Jan 25th, 2018
Psychiatric Partial Hospitalization Programs
by Wyn Staheli, Director of Content - innoviHealth
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 ...
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Jan 15th, 2018
Billing with a GP Modifier
by Wyn Staheli, Director of Content - innoviHealth
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?
Jan 15th, 2018
Medicare Requiring Specific Modifiers on Therapy Services
by Wyn Staheli, Director of Content - innoviHealth
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
Services furnished under the Outpatient ...
Jan 11th, 2018
Intensive Outpatient Treatment (IOP)
by Wyn Staheli, Director of Content - innoviHealth
Intensive Outpatient Programs (IOPs) are considered to be an intermediate level of care which is commonly considered after the patient has been discharged from inpatient care. For some patients and/or conditions they can also provide an effective level of care when hospitalization is not clinically indicated or preferred. The following ...
by Find-A-Code™
The following information from the Medicare Learning Network provides guidance on Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
Jan 9th, 2018
Billing Electrotherapy with AcuKnee
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
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 ...
by 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 ...
Jan 9th, 2018
Diagnosis billing with J0888
by 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 ...
Jan 9th, 2018
Outpatient Rehabilitation Modifiers
by Jared Staheli, MPP
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, ...
Jan 5th, 2018
Medicare Reimburses for Discarded/Wasted Drugs
by Aimee L. 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.
by 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 ...
by Christine Woolstenhulme, QMC 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 ...
Jan 4th, 2018
General Physical Therapy Modality Guidelines
by 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 ...
Jan 4th, 2018
Hydrotherapy Guidelines
by 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 ...
Jan 4th, 2018
Proper Usage of Electrical Stimulation
by 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 ...
Jan 3rd, 2018
Abuse, Neglect, or Maltreatment
by Wyn Staheli, Director of Content - innoviHealth
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 ...
Dec 28th, 2017
DME Documentation Requirements
by Wyn Staheli, Director of Content - innoviHealth
Properly documenting DME orders is crucial for reimbursement. It should be noted that without meeting the payer requirements, the claim will be denied. For Medicare, the beneficiary will not be responsible for paying for the item if the provider and/or supplier do not meet requirements. Commercial payers have similar policies so carefully ...
Oct 31st, 2017
Modifier NU
by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
Is it necessary to use the modifier NU for all supplies? or is NU part of the code itself? Where should the NU be noted on the 1500 form?
by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
Do we need to charge for non-covered services performed under a maintenance visit if we use the S8990 code when billing Medicare?
Sep 30th, 2017
Annual Wellness Visit & Health Risk Assessment
by Find-A-Code™
Coding tips regarding Annual Wellness Visit and Health Risk Assessments
by Find-A-Code™
The following information from the Medicare Learning Network provides guidance on Diabetes Self-Management Training....
Sep 1st, 2017
Preventive Services: Hepatitis C Virus (HCV) Screening
by Find-A-Code™
The following information from the Medicare Learning Network provides guidance on Hepatitis C Virus (HCV) Screening....
Aug 29th, 2017
Quality Measures for Chiropractic - 2017
by Wyn Staheli, Director of Content - innoviHealth
Performance Measurement Codes for Chiropractic:
Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year.
Pain Assessment and Follow-Up
131
ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...
Aug 24th, 2017
Q/A: MIPS and G Codes
by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good?
Aug 4th, 2017
Proposed Telehealth Changes for 2018
by Wyn Staheli, Director of Content - innoviHealth
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements from other third-party payers.
Proposed Codes
HCPCS code G0296 ...
Aug 1st, 2017
Annual Wellness Visit (AWV)
by Wyn Staheli, Director of Content - innoviHealth
Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays.
Jun 27th, 2017
Modifier JW With Drug Codes
by Find-A-Code™
Modifier JW
In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers ...
May 12th, 2017
When Using Code 99050 (After Hours)
by Wyn Staheli, Director of Content - innoviHealth
Question: When using code 99050 (after hours), do I just add a amount, example $25.00, to our normal total charges for that patients visit?
Feb 10th, 2017
Q/A: What is the Proper Code for "Lumbar Decompression?
Dec 30th, 2016
How APC Payment Rates Are Set
by Brittney Murdock, QCC CMCS CPC
The payment rates for most separately payable medical and surgical services are determined by multiplying the prospectively established scaled relative weight for the service’s clinical APC by a conversion factor (CF) to arrive at a national unadjusted payment rate for the APC.
Nov 21st, 2016
Best Diagnosis Codes for E-stim
Sep 30th, 2016
Medicare Condition Code 44
by Jeanette Anderson, CPC CPMA
Medicare Condition Code 44 is used when an inpatient admission needs to be changed to outpatient status. There are some instances where a Medicare patient was admitted to the hospital with an inpatient status, but upon review it is deemed more appropriate for the entire encounter to be an outpatient ...
by Find-A-Code™
If you work for a facility that utilizes residents, then you will need to understand the requirements for reporting teaching physician services. The Office of Inspector General (OIG) has had hospital teaching physician activities on their work plan repeatedly, and therefore it should be on your radar as well to ...
by Sara San Pedro, CPC CEMC CPMA
If you work for a facility that utilizes residents, then you will need to understand the requirements for reporting teaching physician services. The Office of Inspector General (OIG) has had hospital teaching physician activities on their work plan repeatedly, and therefore it should be on your radar as well to ...
Jun 6th, 2016
Billing, Documentation and Billable Units
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Most third-party payers (eg, commercial insurers, Medicare, Medicaid) cover REMICADE® (infliximab) for its approved U .S . Food and Drug Administration indications (see Indications on page 5 of this guide) . However, benefits may vary depending upon a patient’s insurer or specific insurance plan (or “product”) offered by a payer.
When third-party ...
May 27th, 2016
Documentation Criteria: Medicare Physicals
by Jeanette Anderson, CPC CPMA
When billing annual Medicare physicals, it's very important to know the status of the patient, determining when they became eligible, and/or if they've seen another provider for any of these services as the initial visit codes are once in a lifetime codes and will be denied if they have already ...
May 9th, 2016
Billing Compound Drugs
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Unclassified HCPCS codes can only be used when there is not a specific HCPCS code available for the drug being billed.
Each NDC associated with an unclassified drug code should be submitted on a separate claim line following the instructions specified in the Manual for Physicians and Providers- Coding and Filing ...
May 9th, 2016
NOC Drug and Biological Codes
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The following are tips to help you when billing NOC drugs and biologicals, such as J3490, J3590, and J9999. Providers submit NOC codes in the 2400/SV101-2 data element in the 5010 professional claim transaction (837P).
When billing an NOC code, providers are required to provide a description in the 2400/SV101-7 data element. The 5010 ...
May 3rd, 2016
Using the SBIRT
by Wyn Staheli, Director of Content - innoviHealth
Screening, Brief Intervention, and Referral to Treatment (SBIRT) services are an effective tool for healthcare providers to identify, reduce, and prevent problematic substance use disorders. Healthcare practices can help their patients and improve their integrated care standards with the proper use of the SBIRT.
Apr 29th, 2016
Adaptive Behavior Coding
by Wyn Staheli, Director of Content - innoviHealth
Information about Adaptive Behavior Coding for Members.
Apr 4th, 2016
Coverage Criteria and Medical Necessity with Medicare
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Negative Pressure Wound Therapy (NPWT) is defined as the application of sub-atmospheric pressure to a wound to remove exudate and debris from wounds. NPWT is delivered through an integrated system of a suction pump, separate exudate collection chamber and dressing sets to a qualified wound. In these systems, exudate is ...
Mar 28th, 2016
Q&A: Is There a Better Supply Code to Use Than 99070?
by ChiroCode™
Are there more specific codes for supplies rather than using 99070?
Mar 25th, 2016
Auditing Smoking Cessation Services
by John Burns, CPC CPC-I CEMC CPMA
Most payers do indeed recognize smoking and tobacco cessation services as a covered health insurance benefit. We have found that some providers perform these services without fully understanding the reimbursement opportunities, while others claim such services without adequately documenting to support them. Medicare, for example, will pay for two (2) ...
by Wyn Staheli, Director of Content - innoviHealth
Medicare Improper Payment Report information regarding Behavioral Health Services
Feb 1st, 2016
Documentation and Billing Practices
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Prescribed to:
Reduce pain by restricting mobility of the trunk: OR
Facilitate healing following an injury to the spine or related tissue; OR
Otherwise support weak and/or deformed spinal muscles.
Documentation and billing practices be sure you are meeting all the requirements to bill a spinal orthoses.
Spinal Orthoses billed with HPCPCS L0450, L0454, L0621, L0625 and L0628 must be billed with ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
According to Medicares Pub-100, 60 - Colorectal Cancer Screening Ref: AB-03-114;
Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
G0106 - Colorectal Cancer Screening; Barium Enema; as an Alternative to G0104, Screening Sigmoidoscopy Screening barium enema examinations may be paid as an alternative to a screening sigmoidoscopy (code G0104). The same frequency parameters for screening sigmoidoscopies (see those codes above) apply.In the case of an individual aged 50 or over, payment may be ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
G0104 - Colorectal Cancer Screening; Flexible Sigmoidoscopy
Screening flexible sigmoidoscopies (code G0104) may be paid for beneficiaries who have attained age 50, when performed by a doctor of medicine or osteopathy at the frequencies noted below.For claims with dates of service on or after January 1, 2002, contractors or carriers pay for screening ...
Oct 13th, 2015
Pricing Modifier
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Place the modifiers listed below (except modifiers with an *) to the right of the procedure code in Item 24D on the CMS 1500 claim form or for ANSI X12 4010 electronic claims submission use segment 2-370-SV101-3.
Processing delays can occur for claims submitted without the pricing modifier in the first modifier position. ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
When using G0127 keep in mind routine foot/nail care is generally excluded from coverage under Medicare, however there are some exceptions:
Click here to read the entire article
Although not intended as a comprehensive list, the following metabolic, neurologic,and peripheral vascular diseases (with synonyms in parentheses) most commonly represent the underlying conditions that might ...
Sep 21st, 2015
Documentation and Reimbursement for Testing
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The medical record must contain documentation that the testing is expected to influence treatment of the condition toward which the testing is directed. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition that warrants the test(s).
TC - Technical component Modifier may be ...
Aug 7th, 2015
Reimbursed on a Daily Basis /Modifiers
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
HCPCS codes E0935 (Continuous passive motion exercise device for use on knee only), and E0936 (Continuous passive motion exercise device for use other than knee) are reimbursed on a daily basis consistent with CMS guidelines.
The following HCPCS codes are also reimbursed on a daily basis:
E0193 -Powered air flotation bed (low air loss therapy)
E0194 -Air fluidized bed
E0277 –Powered ...
Aug 7th, 2015
TMJ Medical Necesity and Documentation- Aetna
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Notes: Most Aetna HMO plans exclude coverage for treatment of temporomandibular disorders (TMD) and temporomandibular joint (TMJ) dysfunction
For plans that cover treatment of TMD and TMJ dysfunction, requests for TMJ surgery require review by Aetna's Oral and Maxillofacial Surgery patient management unit. Reviews must include submission of a problem-specific history ...
by Jared Staheli, MPP
When CWF receives a claim from the carrier/AB MAC, it will review Part B outpatient claims history to verify that a duplicate claim has not already been posted.
CWF will edit on the beneficiary HIC number; the date of service; the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, ...
by Jared Staheli, MPP
In order to bill drugs to the DME MACs, the supplier must be a pharmacy. States may not regulate the qualifications of Federal employees who are carrying out their authorized Federal activities within the scope of their employment. However, IHS employees are not subject to state licensure laws and IHS ...
by Jared Staheli, MPP
To enable direct billing of DMEPOS, an IHS supplier must enroll with the NSC as a “DME Supplier”, secure a Medicare supplier billing number and comply with the supplier standards specified in 42 CFR §424.57, and submit all DME claims to the appropriate DME MAC based on current DME jurisdiction ...
Jun 18th, 2015
Application of DMEPOS Fee Schedule (Rev. 1, 10-01-03)
by Jared Staheli, MPP
Services that are paid under the DME fee schedule are identified in the DMEPOS fee schedule file available free on the CMS Web Site at: http://www.cms.hhs.gov/providers/pufdownload/default.asp
The DMEPOS fee schedule applies to claims to FIs as follows.
BILL TYPE/ DEFINITION
ORTHOTICS/ PROSTHETICS
DME/ OXYGEN
12X (Hospital inpatient Part B)
Subject to fee schedule
Not covered, therefore, ...
Jun 18th, 2015
Completion of the Elements of PEN CMN (Rev. 1, 10-01-03)
by Jared Staheli, MPP
The patient's name, address, and HICN and the nature of the certification (i.e., initial, renewed, or revised) must be entered on all certifications by the supplier, physician, or physician's designated employees. The supplier identifying information is required on all PEN certifications.
All medical and prescription information must be completed from the ...
by Jared Staheli, MPP
Section 1834(a)(5) of the Act requires patients who receive home oxygen therapy and who at the time such services are initiated have an initial arterial blood gas value of 56 or higher or an initial oxygen saturation at or above 89 percent to be retested between 60 and 90 days ...
by Jared Staheli, MPP
The following modifiers were added to the HCPCS to identify supplies and equipment that may be covered under more than one DMEPOS benefit category: • AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply; • AV Item furnished in conjunction with a prosthetic device, prosthetic or orthotic; and • AW ...
Jun 15th, 2015
Billing for Unlisted Drug Codes J3490 J9999 and C9399
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
When billing for unlisted drug codes J3490 and J9999 you must indicate the name, strength, and dosage of the drug in block 19 on the CMS-1500 claim form (or in 2400.SV101-7 in theANSI 837 claim file). It is extremely important to review the complete long descriptors in the HCPCS code, for the applicable HCPCS codes you can ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was performed). ...
Mar 16th, 2015
Plantar Fasciitis: Medical Necessity and Cross Codes
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Prior to treatment you must determine Medical Necessity.
Be sure conservative therapy/treatment was previously done and documented for at least 6 months and proven to be unsuccessful.
NSAIDS - at least 4 weeks ineffective or contraindicated
Physical Therapy such as taping and stretching
Activity modification
Splints used at night for more that 4 weeks
Corticosteroid injection
Arch Supports, ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The current diagnosis pointer for, Influenza, Pneumococcal or Hepatitis B vaccines is ICD-10-CM code Z23. Listed are tips for coding, and also the diagnosis pointers used for claims previous to 10/01/15:
Influenza: G0008
Procedure codes:
90630
90653-90662
90672-90674
90685-90688
Medicare codes:
Q2034-Q2039
Expired diagnosis code:
V04.81
Pneumococcal: G0009
Procedure codes:
90670
90732
Expired diagnosis code:
V03.82
Hepatitis B: G0010
Procedure codes
90739-90747
Expired diagnosis code
V05.3
Both Influenza and Pneumococcal Vaccines received in same visit: G0008 with G0009
Procedure codes:
(See previous)
Expired diagnosis code:
V06.6 (effective 10/01/06 - 09/30/15)
Extra Tips:
Be sure ...
Feb 9th, 2015
Coding And Billing For JETREA - Physician Office
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is ...
Dec 4th, 2014
Correct Coding - Cefaly®
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The Cefaly® device (Cefaly Technology) is a transcutaneous electrical nerve stimulator (TENS) that is applied to the forehead using a self-adhesive electrode positioned bilaterally over the upper branches of the trigeminal nerve. The Cefaly® device is intended to stimulate the upper branches of the trigeminal nerve and has received Food ...
Dec 4th, 2014
Correct Coding and Coverage of Ventilators
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Joint DME MAC Publication
Ventilator technology has evolved to the point where it is possible to have a single device capable of operating in numerous modes, from basic continuous positive pressure (CPAP and bi-level PAP) to traditional pressure and volume ventilator modes. This creates the possibility that one piece of equipment ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Joint DME MAC and PDAC Publication
Recently, claims for braces attached to wheelchairs have been submitted using HCPCS code K0108 - WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED. K0108 is not the correct HCPCS code to use for these items.
CMS has clarified the distinction between braces (orthoses) and durable medical equipment (DME) under Medicare Part ...
Dec 4th, 2014
Correct Coding: Lithium Batteries
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The DME MACs have recently noted confusion on the part of DMEPOS suppliers regarding the proper billing of lithium batteries. There are two types of lithium batteries Lithium batteries and Lithium Ion batteries. Lithium ion batteries are commonly used in consumer electronic devices and are rechargeable. Standard lithium batteries are disposable, non-rechargeable batteries. ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Joint DME MAC Publication
Continuous glucose monitoring (CGM) devices measure glucose in the interstitial fluid, not capillary blood, providing interstitial glucose readings every few minutes. CGM systems are composed of several components — disposable sensors that are inserted in the subcutaneous tissue, a transmitter that relays information to the receiver, and a ...
Dec 4th, 2014
Off the Shelf - OTS Orthotics New Codes
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
In February 2012, The Center for Medicare and Medicaid Services (CMS) issued guidance that initially identified specific Healthcare Common Procedure Coding System (HCPCS) codes that were considered Off-the-Shelf (OTS) orthoses. The list of HCPCS codes that were finalized as part of this review as OTS orthotics, effective January 1, 2014, ...
Nov 24th, 2014
Billable HCPCS Codes vs. Payable HCPCS Codes
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The PDAC (Medicares - Pricing, Data Analysis and Coding) receives frequent inquiries regarding a billable HCPCS code and a payable HCPCS code. One may think the two are the same; however, this is not the case.
A billable HCPCS code is one that is submitted on a claim to the DME ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
A Laxative is considered a “Self Administered Drug” (SAD). Insurance will usually pay for the care you provide but will only cover certain drugs in the outpatient setting such as drugs administered through an IV. Therefore it would not be appropriate to report this under the Outpatient Prospective Payment System ...
Jan 1st, 2014
Testing & Screening Tools
by Wyn Staheli, Director of Content - innoviHealth
There are numerous types of behavioral health screening tools for healthcare providers. Some, like the AUDIT and SBIRT are especially applicable to primary care providers caring for Medicare beneficiaries.
This page includes some general information and resources for some of these screening tools. Let us know if you would like others included ...
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Sep 5th, 2023
Modalities Used in Your Chiropractic Office
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Electrical stimulation, ultrasound, and mechanical traction are modalities commonly used in chiropractic offices. And they are commonly documented incorrectly or billed improperly. Learn the right (and wrong) ways to get paid for these kinds of services. Join Dr. Evan Gwilliam, certified coder, and all-around nice guy, as he answers your most burning questions about the CPT codes 97012, 97014/G0283, 97032, and 97035.Feb 14th, 2023
Use the Right Modifiers for Chiropractic Billing
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Do you really know when to use the 59 modifier? What about the AT? There are relatively few modifiers to consider when it comes to chiropractic billing and coding, but some payers have their own rules and it can be tricky to know when to use one modifier and not another. In this exciting webinar, Dr. Evan Gwilliam, a certified coder, will clear up all the questions you have about the modifiers you need to consider.Jul 7th, 2022
Dealing with the Little Coding Conundrums
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 14th, 2022
Reporting Telemedicine Services by Aimee Wilcox
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Mar 29th, 2018
Coding and Auditing TeleHealth Services
by Find-A-Code™
Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.by Find-A-Code™
Proper Coding and Billing for Drugs, Biologicals and InjectionsLinks and resources by topic.
Assessment Tools
Billing
CDT (Dental) Codes
CPT Coding
Code Updates
Coding
Annual Wellness Visit (AWV) by CMSCare Plan Oversight (CPO) services information by CGS MedicareCDT 2023 Updates - Delta DentalHCPCS General Information - by CMSInitial Preventive Physical Examination (IPPE)Search ICD-9, ICD-10 and HCPCS Codes by FindACode.comSupplies Topics PageThe Coders Handbook by PMIC
DME
AWP, WAC, ASP, APC ExplainedCompliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supply IndustryDME - Durable Medical Equipment & Supply CodesDME Billing guideanceDMEPOS Competitive Bidding Program - Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists Fact SheetDMEPOS Product SearchDurable Medical Equipment (DME) Medicare Administrative Contractor (MAC) JurisdictionsDurable Medical Equipment Center (DME) - by CMSHCPCS - (DMEPOS), DME (Durable Medical Equipment), Prosthectics, Orthotics, Supplies, Medical Products - Medical CodesMedicare Manual - Chapter 5 – Items and Services Having Special DME Review ConsiderationsNoridian Documentation ChecklistsNoridian Review of A5500 (Therapeutic Shoes)Supplies Topics Page
Diagnosis Coding
Documentation
HCPCS Coding
Annual Wellness Visit (AWV) by CMSBehavioral Health Integration Services Fact Sheet by CMSCanesCare Plan Oversight (CPO) services information by CGS MedicareCDT 2023 Updates - Delta DentalCertificate of Medical Necessity CMS-848 — Transcutaneous Electrical Nerve Stimulator (TENS)CMS - pment, Prosthetics/Orthotics, and Supplies Fee Schedule > Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule Durable Medical Equipment, Prosthetics/Orthotics, and SupplieCMS Clinical Decision Support MechanismsCMS' Connected Care ToolkitDMEPOS Competitive Bidding Program - Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists Fact SheetFederal Opioid Treatment StandardsHCPCS Code Change Request ApplicationHCPCS General Information - by CMSHome Oxygen Therapy BookletHospice Medicare Billing Codes Sheet by CGS Medicare (2018)Initial Preventive Physical Examination (IPPE)MLN: Medicare Vision Services Fact SheetNoridian Review of A5500 (Therapeutic Shoes)Quick Reference Chart by CMS: G-codes and Modifiers for Therapy Functional ReportingScreening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol MisuseScreening Pap Tests and Pelvic ExaminationsScreening, Brief Intervention, and Referral to Treatment (SBIRT) Services (non-dependent substance use)Search ICD-9, ICD-10 and HCPCS Codes by FindACode.comThe Coders Handbook by PMIC
ICD10CM Coding
Integration
Medicare
Practice Management
Preventive Medicine
Procedure Coding
Reimbursement
Supply Coding
ACA: Face-to-Face and Detailed Written OrderCertificate of Medical Necessity CMS-848 — Transcutaneous Electrical Nerve Stimulator (TENS)Documentation Checklist Transcutaneous Electrical Nerve Stimulators (TENS) by NoridianMedication and Counseling Treatment Insurance and Payments by SAMHSAMLN Matters Number: MM3927Opioid Treatment Programs
UB04 Form and Coding
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