Midland Memorial Hospital agreed to pay over $555,000 for a medical coding error that resulted in claims being sent out for reimbursement from the government even though patients did not have a primary COVID-19 diagnosis. The Texas hospital told local news source News West9 that it miscoded 87 claims last November and sent those claims […]
The updates include unique CPT codes for a new formulation of the COVID-19 vaccine developed by Pfizer and new codes for booster doses expected to roll out later this month. The American Medical Association (AMA) has announced updates to the Current Procedural Terminology (CPT) code set to account for changes to COVID-19 vaccines, including booster […]
Telehealth advocates are submitting recommendations to CMS to improve coverage for remote patient monitoring services in the proposed 2022 Physician Fee Schedule. With remote patient monitoring projects surging in popularity as a result of the pandemic, telehealth advocates are lobbying the Centers for Medicare & Medicaid Services to improve proposed coverage plans in the 2022 […]
Reducing denials starts with understanding osteopathic manipulation as well as coding and coverage guidelines for this therapy. Is it appropriate to bill an evaluation and management (E/M) service when osteopathic manipulative treatment (OMT) is performed at the same visit? We must address a few key principles to adequately answer this question. I learned quickly, having […]
What are the latest code changes? Get the facts, fast. This month, there’s new billing guidance for a COVID-19 vaccine; there are three new HCPCS Level II codes for COVID-19 therapeutic injections; and Medicare payment allowances for the 2021-22 influenza vaccine codes have been released. FDA Approves COVID-19 Vaccine Pfizer’s COVID-19 vaccine received the green […]
AMA announced that the CPT codes for the third doses of the Moderna and Pfizer COVID-19 vaccines are finalized and ready for the upcoming booster shot administrations. The American Medical Association (AMA) announced that the Current Procedural Terminology (CPT) codes for the third doses of the Moderna and Pfizer COVID-19 vaccines are effective for immediate […]
CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
It is critical to submit comments on proposed rule on critical care. As I said last week, the Physician Fee Schedule Proposed Rule for the 2022 calendar year (CY) came out July 23, and the Centers for Medicare & Medicaid Services (CMS) is soliciting comments by Sept. 13 I’m going to review the proposed changes […]
C9076 is the newest addition to the list of HCPCS Level II codes for CAR-T therapies, effective July 1. Learn the latest changes to reporting products and procedures related to Chimeric Antigen Receptor (CAR) T-cell therapy to ensure proper medical coding and billing of CAR-T services furnished to Medicare patients. Review the Basics CAR-T is […]
Deciding which code to use starts with determining each payer’s policy. The Healthcare Common Procedure Coding System (HCPCS) has two principal subsystems, referred to as Level I and Level II. Knowing when to use HCPCS Level I codes versus HCPCS Level II codes can be confusing, mainly because many services are described by both code […]