New Billing Codes for Coronavirus (COVID-19) Lab Tests

Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19). On 5th March 2020, CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 […]

Coding Guidelines for Coronavirus for Medicare Beneficiaries

In the 2nd week of March 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. The legislation will allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency. What is happening in the private health insurance sector remains unclear […]

Under Coding: Avoid At Any Cost

You may be asking: “What’s the problem with under coding? Aren’t I saving Medicare program dollars by billing lower levels of service?” CERT is a measure of improper payments. The goal of CMS is to pay claims that meet Medicare’s requirements and pay them at the proper level of service. When there is an underpayment […]

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 […]

Billing and Coding Guidelines for Radiation Oncology (Part 1)

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 – Understanding Payment Difference

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, […]

Deciphering 2021 CPT Code Changes for ASC

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 […]

How to use CPT CODE 99214 Correctly?

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. […]

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