For any case of pregnancy in which a woman uses opioids during the pregnancy or postpartum period, codes from subcategory O99.32, Drug use complicating pregnancy, childbirth, and the puerperium, should be assigned. A secondary code from category F11, Opioid-related disorders, should also be assigned to identify the manifestation of Opioid Use and Counseling. Opioid Use […]
Billing and Coding Guidelines (continued…) Treatment devices, designs, and construction may be charged during a course of therapy when documentation substantiates multiple volumes of interest/ports, the use of custom-made devices, and/or the necessity of replacement devices. Providers should bill for devices at the beginning of the treatment course and then may bill again later in […]
Major Reasons for Denial Services performed for diagnoses not listed as covered in this policy or for excessive frequency will be denied as not medically necessary. Frequency is considered excessive when services are performed more frequently than generally accepted by peers and the reason for additional services is not justified by documentation. Indications not listed […]
ASCs vs HOPDs: When performing outpatient procedures, many orthopedic surgeons operate in ASCs or hospital-based outpatient departments (HOPDs). Although some of the workflows and services offered may appear similar between the two, the background operations are substantially different from a business and regulatory perspective. An HOPD is owned by and typically attached to a hospital, […]
The American Medical Association (AMA) announced the release of the 2021 Current Procedural Terminology (CPT®) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic service available to patients. Trusted since 1966 as the health system’s common language, the CPT code set enables accurate reporting, measurement, analysis, and benchmarking of medical services […]
CPT Code 99214 is commonly used for billing office or outpatient visits involving established patients with moderate to high complexity in medical decision-making. To meet the criteria for this level of Evaluation and Management (E/M) service, proper documentation is critical. It requires a detailed history, detailed examination, and medical decision-making of moderate to high complexity. […]
Coders are the backbone of an organization’s fiscal health. Timely coding contributes to timely hospital revenue and cash flow, both of which are essential for a hospital to function. However, coders must be willing to look beyond their traditional roles and examine how they can help ensure the continued financial viability and financial success of […]
Reimbursement analysis provides an accurate picture of the reimbursement environment, which is important to ensure your practice will be able to provide new, innovative services. A comprehensive reimbursement analysis should be conducted with adequate lead time to include an in-depth understanding of payer-mix, the delivery cost of the new service, and the anticipated reimbursement by […]
According to some sources, patients are now the third-largest payer group in the US behind Medicare and Medicaid. So, now is not the time to let those amounts due slide! One of the best ways to capture those amounts due is by avoiding surprises on the part of the patient by letting them know right […]
Non-covered services do not require an ABN since the services are never covered under Medicare. While not required, the ABN provides an opportunity to communicate with the patient that Medicare does not cover the service and the patient will be responsible for paying for the service. Pre-emptive communication through a voluntary ABN can prevent negative […]
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