CPT codes for Evaluation & Management (E&M) services are principally included in the CPT code range 99202-99499. The codes describe the site of service (e.g., office, hospital, home, nursing facility, emergency department, critical care), the type of service (e.g., new or initial encounter, follow-up or subsequent encounter), and various miscellaneous services (e.g., prolonged physician service, […]
Basics of Cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. For medical billing purposes, cardioversion has been coded as an external and internal procedure. CPT codes 92960 (cardioversion, elective, electrical conversion of arrhythmia; external) and […]
Bilateral Surgeries Billing Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day. Medicare makes the payment for bilateral procedures based on the lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized […]
On 5th Jan 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. This increased coverage of interprofessional consultations allows direct payment to consulting practitioners, expanding access […]
Basics of Destinations for Ambulance Transportation Ambulance transport is covered to the nearest appropriate facility to obtain necessary diagnostic and/or therapeutic services such as a CT scan or cobalt therapy as well as the return transport. In addition to all other coverage requirements, this transport situation is covered only to the extent of the payment […]
Basics of Arthroscopy Coding Guidelines To share arthroscopy coding guidelines, we referred National Correct Coding Initiative (NCCI) policy manual. CMS developed the NCCI manual to promote national correct coding of Medicare Part B claims. The Medicare NCCI promotes correct coding methodologies and controls improper coding leading to improper payment. Before going into detail about arthroscopy […]
A physician or supplier often has a lot of doubts when it comes to ambulance transports and ABNs. Most suppliers consider ABNs a way to avoid Medicare’s medical necessity denials. So let’s dive deeper into a detailed understanding of ABNs, and their appropriate use. ABNs are only rarely appropriate for ambulance services. A physician or […]
Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requirements. While medical billing frauds are intentional where practices might through up-coding and unbundling try to receive more insurance reimbursements than allowed. For differentiating between improper payments and medical billing fraud, let’s […]
Strengthening Affordable Care Act (ACA) Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality healthcare options for millions of consumers. This proposed rule would increase […]
Non-physician providers are healthcare professionals who offer medical services and are not doctors. A non-physician provider (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly, rather than billing under a physician, in certain circumstances. Examples of […]
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