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

Fri, May 18, 2018


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 in the Federal Register makes this a good time to get to know the Master List.

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Ace FESS Coding Updates With This Quick Terminology Quiz

Tue, May 15, 2018


CPT® 2018 introduced several changes for nasal/sinus endoscopy codes, sometimes referred to as FESS codes. Otolaryngology coders need some real anatomy-terminology skills to apply these codes correctly, so here’s your chance to sharpen your knowledge.

Look at the terms below. In some cases, you’ll see a related code tied to the term to help show how the term and coding connect. Match the term to the proper definition, and then check your answers at the end.

Ready, Set, Go Match These Terms!

1. Ethmoidectomy

Code example: 31253 (Nasal/sinus endoscopy, surgical with ethmoidectomy

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ICD-10-CM Coding for ‘Vomiting’ Is Simple, Except When It’s Not

Fri, May 11, 2018


Many coders have memorized R11.- (Nausea and vomiting). It’s a common complaint. But did you know that the diagnosis code for cyclical vomiting is in nervous system category G43.- (Migraine)? I was interested to see that when I read a recent Gastroenterology Coding Alert article. In a leap that perhaps only those in healthcare would understand, the discovery made me wonder where else ICD-10-CM puts codes related to the term vomiting. Here’s what I found.

For Cyclical Vomiting, Turn to the Nervous System Chapter

First is the subcategory that …

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

Mon, May 7, 2018


coding HCPCS for drugs and supplies

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 is a set of two related codes for Sublocade, which is indicated for the treatment of moderate to severe opioid-use disorder in adult patients. Note the difference in amount administered, shown at the end of each descriptor (bold added):

  • Q9991 (Injection, …
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Will ICD-11 Have a Code for ‘Struck by Turtle’?

Thu, May 3, 2018


Subcategory W59.22- (Struck by turtle) is an ICD-10-CM code that’s been in the blog a few times. So when I started playing with the WHO ICD-11 Coding Tool, I had to try “turtle” as a search term. No luck, but I did find PA71 (Unintentionally struck, kicked, or bumped by animal

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Get 1 Step Closer to 99285 Perfection With This HPI Primer

Thu, Apr 26, 2018


emergency medicine coding

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 this information applies beyond emergency coding, so it’s a good refresher for all coders who report E/M services.

See Where History Fits in the Descriptor

Here’s the …

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Thrombectomy, US, LHC: Did You Catch These Cardio CCI Manual Changes for 2018?

Mon, Apr 23, 2018


cardiology CCI manual updates

National Correct Coding Initiative (NCCI or CCI) is one of those hidden-depths areas of coding. If you cardiovascular coders know the major CCI edits that apply to you, you’ve got one layer down. But you need to know what’s in the policy manual (available here), too, if you truly want to code in compliance with CCI. Here is a helping hand: a look at what’s new for cardio in the 2018 CCI manual.

Think of 30000 and Thrombectomy First

Chapter V, section D, …

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

Fri, Apr 20, 2018


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 what I mean? Check out these bullet lists based on the code descriptors, and note the similarities in the first few bullets as well as differences:


  • bilateral total pelvic lymphadenectomy


  • bilateral total pelvic lymphadenectomy
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Podiatry Alert: Here’s What Caused $330 Million in Improper Payments for Part B and DMEPOS

Mon, Apr 16, 2018


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 Medicare Fee-for-Service Supplemental Improper Payment Data” report measures improper payments through the Comprehensive Error Tate Testing (CERT) program. The numbers are estimates based on a sampling of claims reviewed. The time period for …

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

Thu, Apr 12, 2018


quality measure cooperative agreements

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, updating, and expanding quality measures are all included. CMS indicates potential partnerships with clinical specialty societies and professional organizations, patient advocacy organizations, education and research organizations, and health systems.

The stated goal is to “leverage …

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