Category: Medical Coding

Booster-Codes-for-COVID-19-Vaccine

Updated Booster Codes for COVID-19 Vaccine Released

Age determines who qualifies for the bivalent formulations from Pfizer and Moderna. On Aug. 31, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 vaccines to include updated booster bivalent formulations. These latest formulations include messenger RNA components to help build immunity against both […]
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ICD-10 Codes for Work-Related Injuries 2022

‘Good labors are the great resource for the company’ Here are the ICD-10 CM codes for general injuries in the workplace.       ICD-10-CM – Z77. 29: Exposure to Harmful Substances or Environments Z77.29 is a specific/billable code for Exposure to Harmful Substances that is used to indicate a diagnosis for reimbursement purposes. W22. 8XXA […]
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Flu-Vaccination-Coding-and-Billing-2022-2023

Flu Vaccination Coding and Billing for 2022-2023

Has your billing department prepared for the upcoming 2022-2023 influenza season? As we approach the 2022-2023 influenza season, the Centers for Disease Control and Prevention (CDC) continues to recommend flu vaccination for everyone aged 6 months and older, with the ideal timing being by the end of October. This guidance remains consistent with previous years. […]
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New Coding Issues to Confront Coders

New Coding Issues Emerge To Confront Coders

  The new codes and subsequent issues will be effective Oct. 1, 2023. According to senior healthcare consultant Laurie Johnson, who presented the information during the series, three major issues emerged from her research and manifested themselves in her presentation —a presentation that was augmented with commentary from Erica Remer, MD, co-host for the long-running […]
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Medical-Necessity-Code-Changes-ICD-10-CM

NCDs Affected by ICD-10-CM Medical Necessity Code Changes

When ICD-10-CM is updated Oct. 1, so are these National Coverage Determinations. Are you wondering which National Coverage Determinations (NCDs) will be affected by the thousands of diagnosis code changes going into effect Oct. 1? Centers for Medicare & Medicaid Services (CMS) transmittal tells all. CMS Transmittal 11546, issued Aug. 4, is a one-time notification […]
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Clinical-Coding-Changes-ICD-10-CM-PCS

Clinical Coding Changes: ICD-10-CM/PCS C&M Committee

Throughout the years in the health information management field, we’ve always been deeply interested in clinical coding and even find clinical coding to be fun. With that comes learning about the annual coding changes: new, revised and deleted codes. That brings us to the ICD-10-CM/PCS Coordination and Maintenance (C&M) Committee, how they work and the […]
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95165-CPT-Coding-Conundrums

CPT® 95165 Coding Conundrums

Three tips are all you need to correctly bill allergen immunotherapy, single or multiple antigens. Allergy services, such as those reported with CPT® 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single or multiple antigens (specify number of doses), remain on the radar of third-party payer investigation units […]
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Coding-Guide-2022

How to Get Paid: Coding Guide for 2022

What you need to know to avoid claim denials and to maximize practice revenue Despite your best efforts to follow billing guidelines, payers still deny your claims. Or in some cases, they pay you and then take the money back. Experts say you can’t ever eliminate denials and post-payment recoupment entirely, but you can reduce […]
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Use-CPT-Modifiers-to-get-paid-correctly

CPT Modifiers for Physicians to Get Paid

During a typical office visit, physicians may provide evaluation and management (E/M) services, minor procedures and more. The question is: Can they bill for each one separately? In some cases, the answer is no. In others, though, the answer is yes — but they must know what current procedural terminology (CPT) modifier to append. Modifiers […]
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Rise-in-Inaccurate-Payments

Rise in Inaccurate Payments Due to New Reimbursement Method

When the Centers for Medicare & Medicaid Services (CMS) implemented the Patient Driven Payment Model (PDPM) as the new reimbursement method for skilled nursing facilities (SNF), some of us in the coding and auditing world thought it likely to result in inaccurate payments. The old model, the Resource Utilization Group—Version IV (RUGS-IV), calculated SNF reimbursement […]
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