Zip Through the New Definitive vs. Presumptive Designation for Drug Testing With the Latest CPT® Assistant

Posted on 12. Jun, 2015 by in Hot Coding Topics.

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The April 2015 CPT® Assistant ends your confusion about new drug identification and testing codes updated in the 2015 CPT® code set. Find out how the new reporting mechanism distinguishes testing procedures based on presumptive, definitive, and therapeutic drug assay categories instead of the old qualitative or quantitative methodology.

Reviewing the latest issue will also improve your understanding of how to report optical coherence tomography of the breast and total disc arthroplasty. Plus, solve an ICD-10-CM coding dilemma with an immunization coding scenario. To get spot-on guidance, simply type a code or keyword into SuperCoder.com’sCode Connect to see the April article that suits your needs.

  • Drug Identification and Testing: 80100-80104, 80150-80299, 80320-80377, 82491-82492, 82541-82544, 83992
  • ICD-10-CM Case Scenario: 90460-90461, 90471-90474, 90654, G0008
  • Optical Coherence Tomography During Breast Surgery: 0351T-0354T
  • Sacroplasty: 22511, 0200T, 0201T
  • Total Disc Arthroplasty: 22554, 22845, 22851, 22856, 22858, 63075, 0375T, 0092T.

The latest selection

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ICD-10: Be Ready for 2 GERD K Codes in October

Posted on 12. Jun, 2015 by in ICD-10.

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Rely on the note to get information you need to choose either K21.0 or K21.9.Rely on the note to get information you need to choose either K21.0 or K21.9.

If your office sees patients who complain of acid reflux and heartburn frequently, you will want to get comfortable with the new coding changes with ICD-10 in October.

ICD-9: You currently use ICD-9 530.81 (Esophageal reflux) on your gastroesophageal reflux disease (GERD) claims.

ICD-10:

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Reader Question: Look to State Guidelines for 90-Day Supplies

Posted on 12. Jun, 2015 by in Coding Challenge.

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Question: We have patients who have instructions from their employers to get a 90-day drug supply to save the employer and the patient money. My pediatricians want to help our patients in this regard, but we aren’t sure if there are restrictions against giving out more than a 30-day supply of ADHD medications. Can you advise?

Supercoder.com Subscriber

Answer:

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Don’t Relax Your HIPAA Standards

Posted on 12. Jun, 2015 by in Provider News.

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Audit delay doesn’t mean you can forget about privacy.

Ignore the HHS Office for Civil Rights’ upcoming HIPAA audits at your peril, experts warn.

Disregarding Phase 2 audits is no longer an option, Jared Festner, HIPAA specialist for Irvine, Calif.-based Medical Information Technology Group said in a statement. “If you think for one minute your [organization] won’t be under the microscope for everything from device encryption, essaywritingservices.com.au to making sure that every policy and procedure is completely filled out and updated on a yearly basis, you’ll be kicking yourself once you receive fines of up to $1.5 million per offense.”

The delay in Phase 2 OCR audits doesn’t mean that you can relax your efforts to make sure you’re in compliance with all HIPAA regulations, said Charlotte, N.C.-based attorney Chara O’Neale in a blog post for law firm Parker Poe.

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Physician Fee Schedule: Follow Changing Payment Trail for Your Lab

Posted on 12. Jun, 2015 by in Hot Coding Topics.

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The RVUs aren’t all you need to observe.

As it turns out, things weren’t settled when CMS published the Medicare Physician Fee Schedule Final Rule in November last year.

Now you’ll need to pay attention to changes in payment and claims processing if you don’t want to face confusion as you bill for your lab services in 2015.

Do this: Just read the following updates, and you’ll have everything you need to understand your Medicare pay — for now.

Your Claims Should Be Moving Again

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ICD-10: Associations Fear ICD-10 Transfer Might Trigger Massive Denials

Posted on 27. May, 2015 by in ICD-10.

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End-to-end testing reveals potential problems.

If you have questions about the ICD-10 transition, you’re not alone. Specialty societies, including the American Medical Association (AMA), are waiting for answers, too.

The AMA was among 100 medical groups that wrote to the Centers for Medicare & Medicaid Services (CMS) on March 4 seeking responses to ICD-10 issues that they believe have not been appropriately addressed. Although the groups didn’t go so far as to request a delay to the Oct. 1 implementation date, they did express strong concerns about the transition in the 7-page letter to Acting CMS Administrator Andrew Slavitt.

Chief among the issues were the results of CMS’s end-to-end testing periods, which revealed claim acceptance rates in the 76 to 89 percent range.

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Reader Question: Appeal for Payment if LCD Support Spirometry Diagnosis

Posted on 27. May, 2015 by in Coding Challenge.

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Question:My records indicate that spirometry is a coverable CMS expense, but we cannot get Medicare to reimburse for it. The denials state that COPD/pulmonary dysfunction and chronic bronchitis are not coverable. My CMS sheet states that is exactly what the test is covered for. What should we do? 

Colorado Subscriber

Answer:

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Billing: 5 Tips You Need to Know for Clean 2015 Claims

Posted on 27. May, 2015 by in Provider News.

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This MAC illuminates several of the most challenging coding issues.

Your MAC has been processing claims based on the “new” 2015 rules for a few weeks now, but your head may still be spinning over the changes. Sit back and get the scoop on proper claims submissions thanks to the following five tips provided by NGS Medicare’s Nathan L. Kennedy, Jr., CPC, CHC, CPPM, CPC-I during the MAC’s Jan. 27 online conference, “J6 January Quarterly Release Webinar.”

1. Update Your Interventional Cardiology Specialty Code. “CMS established a new specialty code for interventional cardiology, and that specialty code is C3,” Kennedy said. “In the past, interventional cardiology was not an acceptable Medicare specialty and you had to go with cardiology, but now you can submit an application for that specialty if the specialist is new best essay writers uk, or you can request a change for someone…

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Compliance: Do You Know How to Avoid These 5 Types of Medicaid Fraud?

Posted on 27. May, 2015 by in Hot Coding Topics.

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Medicaid auditors could be reviewing your files—make sure you aren’t violating any of these common issues.

If you’re worrying about whether your state Medicaid provider might head your way for an audit, keep in mind that you only have to stress if you’re doing something you shouldn’t be—and one way to find out if that’s the case is to check in on the most common types of Medicaid fraud.

Fortunately, the Arkansas Medicaid Fraud Control Unit recently published five examples of common Medicaid fraud types essayswriters.biz. Read on for the list, as well as examples to help you steer clear of these issues.

1. Billing for Services Not Rendered: This type of fraud occurs when “a provider bills for treatments or procedures which are not actually performed,” the Arkansas Medicaid Fraud Control Unit says on its website.

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ICD-10: CMS Accepts 81 Percent of ICD-10 Test Claims

Posted on 14. May, 2015 by in ICD-10.

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Biggest denial reason had nothing to do with diagnosis coding.

It appears that ICD-10 really will be implemented this year, with a recent Congressional hearing confirming that the government doesn’t plan to push back the new diagnosis coding system any further than it already has been—and with those plans full steam ahead, CMS revealed that its recent end-to-end testing period returned positive results.

The agency processed 14,929 test claims during the Jan. 26 to Feb. 3 testing period, from 661 participating providers. An overwhelming majority of claims—81 percent—were accepted through the system, and the remaining claims were rejected for three main reasons custom-papers-online.com, as follows, according to the most recent statistics released by CMS:

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