Tag: HCPCS Codes

the-challenges-of-billing-observation-correctly

The Challenges of Billing Observation Correctly

Observation, outpatient outlier payments, and the Inpatient-only List: Getting it right is not always easy. On this week’s Monitor Mondays we had a robust discussion about Condition Code 44. And on June 9, I will be presenting a webinar on the nebulous concept of “outpatient” service in a bed. Both of these have one thing […]
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preventive-medicine-versus-em-codes-the-same-day-coding-dilemma

Preventive Medicine Versus E&M Codes

Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms, conditions, diagnoses and/or problems that need to […]
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Confirm Dosage for New COVID-19 Booster

NDCs will help you determine when to use 0094A and 91309. If you’ve been waiting for news on Moderna’s booster dose-specific COVID-19 vaccine for adults, check this out: The Food and Drug Association (FDA) revised the emergency use authorization (EUA) to include this booster as of March 29, 2022. Assign 0094A, 91309 for Booster Dose […]
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new-codes-in-2022-for-principal-care-and-chronic-care-management-services

New codes in 2022 for principal care and chronic care management services

There are three new codes in the care management section of the CPT codebook, covering principal care management and chronic care management services. Here’s what physicians need to know about them. Principal Care Management Services New CPT codes have been added in 2022 to describe “Principal Care Management Services.” These codes are like chronic care […]
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cms-repeals-final-rule-digital-therapeutics-year-shifting-guidance

CMS Repeals Final Rule on Digital Therapeutics in A Year of Shifting Guidance

  The absence of an established, repeatable, and scalable path to commercialization and prescription of DTx has bottlenecked broader uptake, says one physician leader. Key Takeaways The Centers for Medicare & Medicaid Services has repealed its Medicare Coverage of Innovative Technology final rule. The action leaves multiple unanswered questions for digital therapeutic reimbursement, with payers […]
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early-warning-hospital-billing-errors-portend-bleakness

Early Warning: Hospital Billing Errors Portend Bleakness

Hospitals across the nation are seeing lower profits, and it’s all because of a sudden tsunami of Medicare and Medicaid provider audits. Whether it be by Recovery Audit Contractor (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or otherwise, hospital audits are rampant. Billing errors, especially “supposed bundling,” are causing a high rate […]
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many-final-ipps-rules-are-released

Many Final IPPS Rules Are Released

While much attention has been focused on the release of the IPPS Final Rule, other final rules might have gone unnoticed. The Centers for Medicare & Medicaid Services (CMS) were very busy the first week of August, with the release of final rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs), and inpatient […]
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Prolonged Services in CPT versus Medicare

  The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from […]
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cms-updates-medicare-part-b-drug-prices

CMS Updates Medicare Part B Drug Prices

Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
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