Original Medicare Coverage and Payment Related to COVID-19

Diagnostic Tests Medicare Part B, which includes a variety of outpatient services, covers medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. Medicare Part B also covers medically necessary imaging tests, such as computed tomography (CT) […]

Understanding ASC Billing and Coding

Starting January 1, 2008, the Centers for Medicare & Medicaid Services (CMS) revised the procedures eligible for ASC payment annually. Furthermore, CMS issued quarterly updates to the lists of covered surgical procedures and ancillary services to set payment indicators and rates for newly introduced Level II HCPCS and Category III CPT Codes regarding ASC billing […]

Medical Coding Update for Telehealth

There is three options Medical Coding Update for Telehealth and other communications-based technology services i.e. Telephone calls, Internet consultations, and Telemedicine exams. This information is based on guidelines from the Centers for Medicare & Medicaid Services. 2020 Medical Coding Update for Telehealth 1. Telephone Calls HCPCS code G2012 Description: Brief communication technology-based service, e.g. virtual […]

Medicare Advantage Plan Coverage and Payment Related to COVID-19

Medicare Advantage plan (also known as “Part C”) is an “all in one” alternative to Original Medicare. Medicare Advantage plans cover Medicare Part A and Part B services, and usually prescription drugs covered under Medicare Part D. These plans also may offer extra benefits Original Medicare doesn’t cover. Medicare Part D also called the Medicare […]

Correct Use of Modifier 50 in ASC Billing

Modifiers are two-digit symbols added to CPT procedure codes to signify that the procedure has been altered in some way. Medicare and most other payers accept modifiers; however, using modifiers correctly can be confusing, since not all payers want modifiers used the same way. Medicare defines the ASC facility’s Global Period as 24 hours from […]

Are you correctly Using 99291 and 99292 codes?

Critical care is the direct delivery by a physician(s) of medical care for a critically ill or injured patient. The care of such patients involves decision making of high complexity to assess, manipulate, and support central nervous system failure, circulatory failure, shock-like conditions, renal, hepatic, metabolic, or respiratory failure, postoperative complications, overwhelming infection, or other […]

How to code correctly for laceration repairs?

Answering a few questions will help you code correctly for laceration repairs (such as staples, sutures, or similar closure materials): Was the repair limited to the epidermis, dermis, and subcutaneous tissue, or did you need to probe more deeply?Use simple repair codes for superficial wounds (epidermis and dermis) that need only a single-layer closure. If […]

Key Points for Billing and Coding Critical Care Services

Critical care medicine specialists diagnose and treat a wide variety of diseases. A multidisciplinary team approach is needed to care for critically ill patients. Though there are only two codes for critical care services, reporting critical care presents a challenge because of the rules and regulations involved. In fact, Medicare and commercial payers scrutinize the […]

Coding for Opioid Use and Counseling

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 for Radiation Oncology (Part 2)

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 […]

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