Watch April MPFS Update for NGACO Code Changes With a January Twist

Mon, Mar 18, 2019

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NGACO home visit HCPCS code updates

Ready for some retroactive MPFS changes? The next Medicare Physician Fee Schedule update may have an April 1, 2019, implementation date, but the effective date is Jan. 1, 2019. The theme for the HCPCS codes involved is Next Generation Accountable Care Organization (NGACO) Model Post Discharge Home Visits.

Remember: “MACs will not search their files to retract payment for claims already paid or to retroactively pay claims. However, MACs will adjust claims that you bring to their attention,” MLN Matters Continue reading...

3 Can’t-Miss Reasons to Read the Radiology CPT® Coding Guidelines

Fri, Mar 15, 2019

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CPT guidelines for radiology coding

Supervision and interpretation, contrast, and images — these are all terms you need to know for radiology CPT® coding. The 70000 Radiology section guidelines are a good place to start for authoritative information.

Helpful: If you use a paper CPT® manual, you are likely to find the Radiology section guidelines directly preceding the first 70000 section code. If you use a TCI SuperCoder online coding package, you’ll find a Radiology Guidelines link on the details page for each code in the 70000 section.

Now let’s look at what you’ve been missing if you haven’t read the guidelines for …

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Keep Your Finger on the OIG Pulse by Knowing Where to Find Audit Targets

Tue, Mar 12, 2019

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Keep your finger on the OIG pulse

OIG audit targets can feel like moving targets with the website updated each month. Find out where you can go to keep tabs on the Office of Inspector General’s Work Plan items, and see an example of a recently added area to watch. (Tip: For more OIG information, you also can check out this free TCI SuperCoder webinar.)

Bookmark These OIG Pages to Stay on Top of What’s New

You can get started on the OIG Work Plan page for an overview about how OIG works. There are also …

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6 Ways to Put Medical Office Biller to Work for You

Mon, Mar 11, 2019

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Medical Office Biller

Sifting through all the options for online coding and billing software can be a slog, so we put together an at-a-glance breakdown of the top points you need to know for Medical Office Biller! You may have expected MPFS tools, but did you know you get coding Survival Guides and a monthly practice management newsletter from TCI, too? That means you have access to the data you need for accurate billing and you can develop your professional knowledge and skills when you choose Medical Office Biller.

 

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Look Ahead to These 3 Trends for April 2019 CCI Updates

Mon, Mar 4, 2019

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prepare the team for April CCI updates

Think Medicare’s April CCI updates are small potatoes? You may reevaluate that stance when you learn there are more than 11,000 additions planned for April 1, 2019. To help make it manageable, watch the three areas below.

Our focus: The topic here is Medicare practitioner procedure-to-procedure (PTP) Correct Coding Initiative (CCI) edits that will be added April 1, 2019.

First, Some CCI July News About Modifier Placement

Because we’re talking about CCI, it’s a good time to mention a recent announcement from Medicare about bypassing CCI edits.

Currently when you use modifier 59, XE, XS, XP, or XU to override an edit, Medicare’…

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Here’s Why the MPFS Should Be at the Top of Your Modifier Checklist

Mon, Feb 25, 2019

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Add MPFS to your modifier checklist

When you think of the Medicare Physician Fee Schedule (MPFS), fees might be the first word that comes to mind. But modifiers should be a close second. Here’s how you can use the MPFS to improve your modifier accuracy for Medicare claims.

Start here: To read about the MPFS bilateral indicator and modifier 50, read our blog post on bringing in correct bilateral pay.

See If Payment for More Than One Surgeon Is Allowed

If you open the MPFS file with RVUs from the Medicare site, you’ll see columns for …

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ICD-10-CM OGs: Get Team In Sync on Coding Based on Provider’s Statement

Thu, Feb 21, 2019

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team discussion improves medical documentation and coding

ICD-10-CM Official Guidelines state that your choice of diagnosis code is based on the provider’s diagnostic statement, but that’s not always as clear-cut as it sounds. Let’s dig in to this guideline.

Work From the Official Guideline Wording

The 2019 ICD-10-CM Official Guideline (OG) we’re discussing here is I.A.19:

Code assignment and Clinical Criteria

The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition …

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ICD-10-CM: Don’t Give Up Too Soon When Coding Flank Pain

Mon, Feb 18, 2019

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Flank pain is a complaint a lot of general practices and specialties see. Here are some pointers on how to code correctly for this common condition.

Find Flank Under Abdominal in the Index

The flank is the side area of the torso below the ribs. To code for flank pain, start by looking at the ICD-10-CM index. Under the entry for “Pain, flank,” the ICD-10-CM index points you to “Pain, abdominal.” And that instruction opens up a lot of possibilities.

Next to the entry for “Pain, abdominal,” there is the code R10.9 (Unspecified abdominal pain). If “flank pain” is all you have to work with from the …

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Do You Know About Medicare Add-On Code Edits? You Should!

Mon, Feb 11, 2019

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Medicare add-on code edits

Pairing an add-on code with an appropriate primary code is a key factor in bringing in that extra add-on reimbursement. The CPT® manual often provides a listing of appropriate primary codes for an add-on code, but not always. In those cases, you may find answers in Medicare’s Add-On Code Edits, our topic for today.

Know Where to Find Add-On Code Edits

When you see the term National Correct Coding Initiative edits, you probably think of column 2 codes getting bundled into column 1 codes. But if you want to be specific (and as a coder of course you do), those column 1/column 2 edits are Procedure to Procedure (PTP) …

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Bring in Correct Bilateral Procedure Pay With These Pro Pointers

Thu, Feb 7, 2019

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report bilateral surgeries using codes and modifiers

Choosing medical codes and modifiers for bilateral services can be confusing. Here are a few questions you can ask to help ensure accurate coding and reimbursement for physician claims.

Does the Code Descriptor Specify Bilateral?

“Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day,” states the Medicare Claims Processing Manual (MCPM), chapter 12, section 40.7.

One of the first steps in deciding how to report a bilateral service is to see whether the code itself represents a bilateral service. The …

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