Category: Medical Coding

Billing and coding for coronavirus

Billing and Coding for Coronavirus: 7 things to know

CMS has released several fact sheets in recent weeks on billing and coding to provide guidance to healthcare organizations testing and treating patients for COVID-19, the disease caused by the novel coronavirus. Seven things to know: CMS developed Healthcare Common Procedure Coding System code U0001 to allow laboratories and healthcare providers to bill for using the CDC’s […]
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Coronavirus

Coronavirus: What Every Medical Coder Needs to Know

On Dec. 31, 2019, as many of us here in the U.S. were celebrating New Year’s Eve, a pandemic quietly began in the Chinese province of Hubei. First identified in Wuhan, the provincial capital, coronavirus (more accurately known as COVID-19 or 2019-nCoV) has spread rapidly in the two ensuing months, resulting in infections, and even […]
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Modifier 59 vs. X[ESPU] Modifiers

Modifier 59 Is Over-Used and Abused, MAC Says

Failure to adopt the X[ESPU] modifiers may be putting your practice at risk for Medicare fraud. Modifier 59 Distinct procedural service continues to be the most-used modifier among Medicare Part B providers, according to Novitas, and it is sending up red flags for possible Medicare fraud and abuse. Representatives from the Medicare Administrative Contractor (MAC) […]
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chiropractic manipulative therapy code denial

E&M Denials When Billed With Chiropractic Manipulative Therapy: What to Do

Question: Why do my Evaluation & Management (E&M) codes keep getting denied when I bill them in conjunction with spinal manipulation? I have been receiving increasing inquiries regarding the denial of Evaluation and Management (E&M) codes 99201-99215 when billed with chiropractic manipulation. It appears to be happening on a wide scale, so I want to address […]
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2020 MIPS Changes

What You Need to Know About 2020 MIPS Changes

In November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of changes, please review the 2020 MIPS Final Rule or CMS’ Quality Payment Program Resource […]
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Emergency Department Coding

Differentiating Between Professional and Facility Emergency Department Coding

ED professional codes are typically assigned by professional coders with specialized training in emergency medicine coding. The CPT® code set, including ED code descriptors and applicable rules, guide this choice based on the documented history, physical exam, and medical decision-making, as indicated by the chief complaint and the nature of the presenting problem. In addition, […]
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E/M Coding Guidelines

How 2021 E/M Coding Guidelines Could Ease Physicians’ Documentation Burdens

Physicians will potentially have a lighter documentation burden and more time to spend with patients in 2021 thanks to an overhaul of Medicare Coding guidelines for outpatient evaluation and management (E/M) services. “The whole point was to have people not document stuff that was not necessary, not relevant to the clinical management of the patient,” […]
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Coding for Coronavirus

Coding for Coronavirus: 6 Things To Know

As the U.S. responds to a growing threat of the 2019 novel coronavirus, CMS and other organizations are clarifying how to code for testing and treatment of the disease. Six things to know: 1. CMS created a new Healthcare Common Procedure Coding System code for providers and labs testing patients for SARS-CoV-2, or severe acute respiratory syndrome […]
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