Category: Medical Coding

Billing Codes for Coronavirus lab tests

CMS Develops New Billing Codes for Coronavirus Lab Tests

Two HCPCS billing codes will allow clinical laboratories and other providers to bill for certain coronavirus lab tests and support testing and tracking of new cases. CMS recently announced the development of new billing codes for coronavirus lab tests that will enable clinical laboratories and other providers to receive reimbursement for supporting patients during the outbreak and […]
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new influenza virus vaccine code

Code Change for Influenza Season 2020-2021

The 2019-2020 influenza season is winding down, so now is a good time to start preparing for the 2020-2021 influenza season. Let’s start with a new CPT® code for the flu vaccine. Flu Activity Report The Centers for Disease Control and Prevention (CDC) reports that viral activity is decreasing in the United States. According to […]
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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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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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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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