Archive | Medicare RSS feed for this section

Find Out Which 4 Codes Are Off the DMEPOS 2018 Prior Authorization Master List

18. May 2018

0 Comments

DMEPOS had a 44 percent improper payment rate according to CERT’s 2017 Medicare FFS report. That’s high. Really high. So anyone submitting claims that fall under DMEPOS needs to be up on all the rules. One important area to watch is Medicare’s Master List of which codes require prior authorization. The recent annual update posted […]

Continue reading...

After July HCPCS Updates, Match These Meds to Correct Codes Faster

7. May 2018

0 Comments

Thinking about summer? You aren’t the only one! CMS has posted a file with five Q codes that will be effective July 1, 2018. If you code for any of these supplies, plan ahead so you’re ready to change your coding when July comes. Watch mg to Separate SublocadeTM Codes for Opioid Use Disorder First […]

Continue reading...

Get 1 Step Closer to 99285 Perfection With This HPI Primer

26. April 2018

0 Comments

Emergency medicine code 99285 seems to be popping up a lot lately because of potential overuse. To help give you your best chance at coding correctly, it helps to take a close look at each element involved. Today, let’s look at the history of present illness (HPI) requirement. The good news is that most of […]

Continue reading...

Compare 38571-38573 Lymphadenectomy Codes At-a-Glance to Avoid Cutting Reimbursement in Half

20. April 2018

0 Comments

If you’re already familiar with laparoscopic bilateral total pelvic lymphadenectomy codes 38571 and 38572, you know the pattern. The second code descriptor builds on the first. When the CPT® 2018 code set added 38573, the new code descriptor followed that pattern, adding quite a few more requirements before you use the new code. Not sure […]

Continue reading...

Podiatry Alert: Here’s What Caused $330 Million in Improper Payments for Part B and DMEPOS

16. April 2018

0 Comments

We’ve talked about CERT 2017 report results before in this blog, but that’s mostly been Part B. Podiatry coders need to be thinking about DMEPOS, too. And based on the 70.5 percent error rate estimated for podiatry under DMEPOS, practices need to put that on their priority lists. Review the CERT Report Stats The “2017 […]

Continue reading...

$30 Million in Funding for QPP Measure Development With CMS Cooperative Agreement

12. April 2018

0 Comments

Have you heard about the CMS program to partner with stakeholders to improve quality measures in the MACRA Quality Payment Program (QPP)? Up to $30 million in funding and assistance is involved over three years. Here Are the Target Groups and Goals A blog post from CMS describes this measure development funding opportunity. Developing, improving, […]

Continue reading...

OIG and CMS Are Both Watching Drug Specimen Validity Testing … Are You?

6. April 2018

0 Comments

Coding for drug testing and specimen validity testing was the focus of recently released MLN Matters SE18001. At the end of the MLN article, there’s a link to an OIG report on the topic revealing millions in improper payments. If CMS and the OIG consider something you code worthy of focus, you really should read […]

Continue reading...

Emergency Medicine Coders: Don’t Miss These 3 Trending Areas!

28. March 2018

0 Comments

There have been some hot topics in recent issues of TCI’s Emergency Department Coding & Reimbursement Alert that are just too good not to share. Here’s a quick summary with links to the articles for you lucky readers with access to the online newsletter or to Emergency Medicine Coder. 1. Streamline With This Change to […]

Continue reading...

Know When CCI Manual Says to Use Bone Marrow Code 38222

19. March 2018

0 Comments

The addition of diagnostic bone marrow and biopsy code 38222 in the CPT® 2018 code set simplified coding in some ways (multiple procedures in one code), but there are still questions to be answered about how to handle specific scenarios. In case you missed it, the 2018 Correct Coding Initiative (CCI) manual answered some of […]

Continue reading...

Understand Screening vs. Diagnostic With This Mammography Coding Snapshot

12. March 2018

0 Comments

When the CPT® 2017 code set introduced 77065-77067 for mammography, CMS hung on to HCPCS options G0202, G0204, and G0206 a while longer. But now Medicare accepts the CPT® codes, and the HCPCS options have been sent to the discontinued-code pile. Here’s helpful information on screening vs. diagnostic mammography to help you use the CPT® […]

Continue reading...