HCPCS Level II Update: Make Room for New Monoclonal Antibody Codes

Thu, Sep 19, 2019


HCPCS Level II updates for monoclonal antibodies

The Oct. 1, 2019, update for HCPCS Level II codes is bringing more than 50 changes for J and Q codes, and several of them are for monoclonal antibodies. We’ve already covered updates to trastuzumab coding; now let’s look at some more changes effective soon.

J0593: Add Code for Angioedema Treatment

Read the full descriptor for J0593 (Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)). You’ll need to follow the warning to not report the code to …

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Part 3: Master Medicine Code Updates for CPT® 2020

Mon, Sep 16, 2019


EEG updates in CPT 2020

A lot of specialties will find relevant updates in the Medicine section of CPT® 2020, and we’ve pulled together the can’t-miss news for you here. Tip: If you report EEG, you will certainly want to read on.

Don’t forget: You’ll find the E/M and Surgery section updates in Part 1 and the Radiology and Path/Lab section updates in Part 2.

Look for Flu Code in Vaccines, Toxoids

The January CPT® update includes 90694 (Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL …

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Part 2: Know What’s New in CPT® 2020 for Radiology and Path/Lab

Thu, Sep 12, 2019


radiology CPT 2020 updates

You’ve gotten a glimpse at the new E/M and Surgery codes in Part 1 of our CPT® 2020 series. Now let’s dive in to the updates for the Radiology section and the Pathology and Laboratory section.

Focus on 4 Areas for Radiology Updates

Abdomen X-rays, GI imaging, myocardial imaging, and radiopharmaceutical tumor localization are the headliners for the radiology code updates.

Abdomen X-ray: In 2019, you have 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). In 2020, the descriptor will change to specify the …

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Part 1: Prepare for CPT® 2020 for E/M and Surgery Codes

Mon, Sep 9, 2019


The 2020 CPT® code set includes 394 code changes, with 248 new codes, 71 deletions, and 75 revisions, according to the AMA. Let’s start learning those changes by going over what’s new in Category I for E/M and Surgery section codes.

Expect Remote and Online to Dominate E/M Changes

You probably know there will be big changes for 2021 office/outpatient visit E/M code descriptors. But there’s some E/M news for 2020, too.

First, you’ll have new online digital E/M codes 99421-99423 in place of …

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What’s Proposed for MIPS in 2020 and What Are MVPs?

Thu, Aug 29, 2019


The Quality Payment Program (QPP) proposed rule for 2020 adds some insights into what we may see in 2021, as well. One possibility is a new MIPS Value Pathways (MVPs) framework. Here is a look at the highlights for these MACRA-related updates.

Prepare for Performance Threshold Points to Go Up

First up, the QPP 2020 proposed rule includes changes for the performance threshold, the lowest number of points required to avoid a negative Medicare payment adjustment. We’ve included current numbers to help demonstrate the change from the 2019 performance year:

  • 2019: 30 points
  • 2020: 45 points
  • 2021: 60 points.

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Anesthesia Coders: Know How to Report for Multiple Procedures During Obstetric Cases

Mon, Aug 26, 2019

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Obstetrical cases don’t always go as planned, so make sure you’re ready to report the correct anesthesia CPT® codes for these labor and delivery variations.

Handle Labor, C-Section, and Tubal Ligation Coding

Question: What is the proper coding when a patient has anesthesia for labor that results in a cesarean section with tubal ligation at the same operative session?

Answer: For multiple procedures at the same anesthetic session, you should code for the most complex anesthetic, according to the October 2014 CPT® Assistant. In the case described, you should report 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any …

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Learn Coronary Artery Anatomy According to CPT® and CCI

Thu, Aug 22, 2019


coding for coronary interventions

When your job is converting medical documentation into codes, your knowledge of medical anatomy has to be shipshape. But you’ve got the added complication that the code set you’re using may have its own definitions for specific terms. Case in point: CPT® guidelines set out five major coronary arteries with coronary artery branches for only three. Use this quick refresher to improve your coronary revascularization coding.

What Are the Major Coronary Arteries?

Codes 92920-92944 represent percutaneous revascularization services for coronary vessels. Also called cardiac catheterization and percutaneous coronary intervention (PCI), the services you’ll see include angioplasty, atherectomy, and stenting.

AMA CPT® guidelines with the PCI codes list …

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Top 10 ICD-10-CM Official Guideline Updates for 2020

Mon, Aug 19, 2019


The FY2020 ICD-10-CM Official Guidelines for Coding and Reporting (OGs) are available now so you can prepare for the 2020 diagnosis code changes and rule changes at the same time.

Some revisions involved adding a missing word that was already obvious from context, so we won’t cover every change here. But this overview will give you a good idea of the significant changes to come, effective Oct. 1, 2019.

1. Watch for Swap From ‘Physician’ to ‘Provider’

In a few places, the OGs replace “physician” with “provider.” All of the quotes below show the 2020 wording. The bold word shows where the 2019 OGs used the term physician instead of …

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Catch Radiation and Home Visit Changes Coming Soon to Medicare Manual

Thu, Aug 15, 2019


Medicare has announced two updates to the Medicare Claims Processing Manual (MCPM). The implementation date is set for Aug. 27, 2019, but they’re effective all the way back to Jan. 1, 2019. If your physician performs home visits or superficial radiation treatment, you’ll want to be sure your knowledge is up to date.

1. Eliminate Home Visit Documentation Requirement

If you’ve been keeping up with E/M documentation requirement changes, you know that Medicare removed the requirement for the medical record to include medical necessity for a home visit in place of an office or outpatient E/M in 2019. Now the MCPM is …

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Add These AUC-Related Modifiers to Your Imaging Claims in 2020

Mon, Aug 12, 2019


At the end of July, Medicare released a set of modifiers that you need to know if you’re involved in ordering or coding for imaging. The modifiers, effective Jan. 1, 2020, are part of Medicare’s changes related to Appropriate Use Criteria (AUC) for advanced diagnostic imaging services. Check out the AUC-related modifiers below and then read on to brush up on this program.

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