SuperCoder Blog

If you report HCPCS Level II C codes for drugs, there are a handful of changes coming Jan. 1, 2020, that you’ll want to know. Here’s what’s being added and deleted for lefamulin, brexanolone, levoleucovorin, and iodine I-131 iobenguane.

Reminder: HCPCS Level II C codes, meaning codes that start with the letter C, were originally developed by Medicare for use by Outpatient Prospective Payment System (OPPS) hospitals. A short list of non-OPPS hospitals may also use C codes. But physician and other pro-fee claims should not use these codes. Instead, pro-fee claims …

Category III CPT^® codes are separate from the more commonly used Category I codes, making it all too easy to overlook these important codes. Follow the five tips below to help ensure your coding is accurate for Category III codes.

1. Update Cat. III Codes Twice a Year

Consider this question: When are CPT^® codes updated? January 1 is the answer a lot of medical coders automatically reply with. But the CPT^® update calendar is not that simple, and Category III is one of the complications.

The American Medical Association (AMA) implements new CPT^® Category III codes July 1 and January 1. Category III codes are temporary codes …

“Other” tissue graft code 20926 turned into a sort of catch-all code over the years, but that will change with the CPT^® 2020 code set. On Jan. 1, 2020, you’ll have five new medical codes to use in place of 20926. Be ready with these helpful pointers.

Look at 15769-15774 Instead of 20926

In the CPT^® 2019 code set, you look in the musculoskeletal system codes for 20926 (Tissue grafts, other (eg, paratenon, fat, dermis)). In 2020, 20926 will be deleted, and you will move your search for the replacement codes to the integumentary system section.

Other Soft Tissue

• 15769 (Grafting of autologous …
  

Risk adjustment models often focus on chronic conditions, like cancer, when determining risk scores for patients. But limiting your medical coding to a single diagnosis isn’t the best approach for these increasingly important payment models. Oncology and hematology coders can get their reporting in line with risk adjustment models, including Hierarchical Condition Categories (HCCs), by following these tips.

Take A Quick Look at HCCs and Risk Adjustment

If you’re unfamiliar with HCCs, here are the basics. Medicare uses HCCs for Medicare Advantage and a couple of other programs. Other third-party payers also may use HCCs or a similar construct in …

Many of the CPT^® 2020 changes that affect gastroenterology medical coders relate to radiological services. Don’t let these imaging updates slow you down when the codes change Jan. 1, 2020.

Which Hemorrhoidectomy Code Is Moving From Cat. III to Cat. I?

The first series of gastro code changes are for internal hemorrhoidectomy by ligation other than rubber band. In 2020, codes 46945 (single hemorrhoid column/group) and 46946 (2 or more hemorrhoid columns/groups) will add this phrase: “without imaging guidance.”

New CPT^® notes for these codes will tell you not to report 46945 and 46946 with ultrasound …

You may know that medical coding modifiers can affect payment and bundling rules for your claims, but did you know modifiers are on the radar for Recovery Audit Contractors (RACs), too? Here are some of the recently added audit issues that have links to modifier use.

Quick background: Medicare’s RAC program is used to identify and correct improper Medicare payments. RACs review Medicare claims after payment, checking the claims for approved RAC topics.

Prevent This Endomyocardial …

You’re using ICD-10-CM 2020, and you’ve had some time to prepare for CPT^® 2020. But now the HCPCS Level II 2020 code set is out for medical coders to review, too! Let’s take a look at some J and Q code changes coming your way Jan. 1, 2020.

The Os Have It! Ophthalmology and Oncology Get New Codes

We’ll start with three new J codes. A J code is a HCPCS Level II code that starts with the letter J and represents the supply …

The 2020 payment rates are now available for the Medicare Diabetes Prevention Program (MDPP). Here’s a quick look at the codes, rates, and program resources.

Compare 2019 and 2020 MDPP Payments

The goal of the MDPP Expanded Model is to prevent Medicare beneficiaries who have an indication of prediabetes from developing diabetes. Below you’ll find MDPP HCPCS Level II codes and their 2019 and 2020 payment rates. For full descriptors, see MLN Matters MM11455.

G9873 (First Medicare Diabetes Prevention Program (MDPP) core session …

Medicare has released the Medicare Physician Fee Schedule (MPFS) for 2020. Let’s see how it stacks up against some of the proposals from Medicare that we looked at back in August.

Expect Separate Payment for E/M Office Levels in 2021

Even though we’re still in 2019, a lot of us have 2021 E/M coding changes on our mind. In the MPFS 2020 final rule, Medicare confirms that they won’t be moving forward with a previous plan to blend payment rates for certain office/…

A new HCPCS Level II code lets you report the Sinuva^TM implant for nasal polyps, but coding for placement may vary based on the encounter. Medicare Administrative Contractor (MAC) National Government Services has some advice for its providers. Here’s what you need to know if you perform coding for otolaryngology.

Update HCPCS Coding for Oct. 1, 2019, and Later

Sinuva is an in-office drug treatment for recurrent nasal polyps, according to Intersect ENT, as reported in the May 15, 2018, Centers for Medicare & …