Results of a recent coding and clinical documentation pilot study indicate that the ICD-10-CM coding classification changes made for diabetes mellitus have significantly improved coding for this disease. The results of the study noted that although a few ICD-10-CM “unspecified” diabetes codes were assigned, the majority of the diabetes codes sufficiently captured the diagnoses as […]
The most awaited time of the year is here! It is December, the time to celebrate and indulge in treats and sweets, family time, and loads of gifts. With so much to be done, from baking and cooking to decoration and cleaning of the snow and a host of other things that accompany a […]
One of the most frequent errors can result from using the wrong modifiers. In addition to the accurate coding of treatment, medical claims must be billed in combination with codes for additional services performed in the office, the corresponding modifiers, if necessary, and ICD-10 or diagnosis codes. In this article, we will be discussing wrong […]
One of the most frequent errors can result from the submission of invalid modifier combinations. In addition to the accurate coding of treatment, medical claims must be billed in combination with codes for additional services performed in the office, the corresponding modifiers, if necessary, and ICD-10 or diagnosis codes. The most commonly used wrong modifier […]
Beneficiaries who are dually eligible for Medicare and Medicaid often experience difficulties accessing durable medical equipment (DME), such as wheelchairs, in a timely manner. Whether Medicare or Medicaid covers a specific item may be unclear. Medicaid usually is the “payer of last resort,” which means that DME suppliers generally must obtain a Medicare denial before […]
One of the most frequent errors can result from the submission of invalid modifier combinations. In addition to the accurate coding of treatment, medical claims must be billed in combination with codes for additional services performed in the office, the corresponding modifiers, if necessary, and ICD-10 or diagnosis codes. In this article, we will be […]
Reference (Outside) Laboratory: When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding Modifier 90 to the usual procedure number. For the Medicare program, this modifier is used by independent clinical laboratories when referring tests to a reference laboratory for analysis. Modifier 90 […]
The Medicare National Correct Coding Initiative (NCCI) includes Procedure-to-Procedure (PTP) edits that define when HCPCS)/ Current Procedural Terminology (CPT) codes should not be reported together either in all situations or in most situations. For PTP edits that have a Correct Coding Modifier Indicator (CCMI) of “0,” the codes should never be reported together by the […]
(This article talks only about the Medicare Fee-For-Service Program / Original Medicare) What is NCCI? The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. NCCI Procedure-to-Procedure (PTP) code pair edits are automated prepayment edits that prevent […]
The Centers for Medicare and Medicaid Services (CMS) is seeking to change its approach to paying clinicians for many office visits, incorporating recommendations and ideas from research done by the American Medical Association. Medicare also is pressing for greater disclosure to consumers about hospital prices and for the creation of incentives for dialysis centers to […]
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