Find Flu Vaccine Codes Fast for Cleaner Medicare Claims

Thu, Oct 17, 2019


In early October 2019, flu activity was low, according to the Centers for Disease Control and Prevention (CDC). But hopefully vaccinations will land in the “widespread” category for this flu season. A high volume of services means a high volume of coding, though, so protect your Medicare reimbursement with this guidance on flu vaccination coding.

Scan This Table for Vaccine Coding and Payment Information

Medicare post the codes and payment allowances for influenza virus vaccinations (the supply) on the Seasonal Influenza Vaccines Pricing page. There can be updates, but as of Oct. 17, 2019, the page shows the codes, drugs (2019/2020 …

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Get the Facts About Reporting Glaucoma Screening to Medicare

Mon, Oct 14, 2019


coding for glaucoma screening

Before you report glaucoma screenings to Medicare, go through this quick Q&A to be sure you’ve got all the bases covered. The Medicare Benefit Policy Manual, Chapter 15, Section 280.1, is your source for information about glaucoma screenings that you report to Medicare, and we’ve put together the major points for reporting to Part B right here.

Get started: These are the HCPCS codes that apply. You should report only one on the patient’s claim:

  • G0117 (Glaucoma screening for high risk patients furnished by an optometrist or …
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Get the Scoop on Proposed Medicare Codes for Managing 1 Chronic Condition

Thu, Oct 10, 2019


code for principal care management

You’ve got Chronic Care Management (CCM) codes when a patient has multiple chronic conditions to manage, but what about when there’s just one? To help solve the problem, Medicare wants to introduce new codes for Principal Care Management (PCM). Here’s more on that from the 2020 Medicare Physician Fee Schedule (MPFS) proposed rule.

Start With the Proposed Principal Care Management Codes

The proposed codes do not have final characters or descriptors yet, but they are temporarily identified as follows. The only difference in the …

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6 Tips to Ace CPT® 2020’s New Long-Term EEG Codes

Mon, Oct 7, 2019


CPT coding for EEG 2020 updates


CPT® 2020 is overhauling long-term electroencephalography (EEG) coding, as Part 3 of our CPT® update series reported. Read on for more helpful hints to prepare you for the new EEG codes and guidelines, effective Jan. 1, 2020.

Tip 1: Replace Resources Featuring These 9595x Codes

The 2020 CPT® code set will delete EEG monitoring codes 95950, 95951, 95953, and 95956. The first code applies to identification and lateralization of cerebral seizure focus, and the final three apply to localization. Payers will not accept these deleted codes for services on or after Jan. 1, 2020.

Code 95827 for all-night recording also will be obsolete, …

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Welcome ICD-10-CM 2020! Do You Know the Code Set’s Secret Language?

Thu, Oct 3, 2019


know ICD-10-CM Official Guidelines terminology

As of Oct. 1, we are officially applying the 2020 ICD-10-CM code set. Get your diagnosis coding year off to a good start by refreshing your knowledge of some of the not-always-obvious terms essential to accurate claims: NEC, NOS, and, with.

If you want full details, check Section I. A of the FY2020 “ICD-10-CM Official Guidelines for Coding and Reporting.” And if you want to know more about ICD-10-CM 2020 changes, read our series with update highlights:

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Your Guide to CCI Trends for the End of the Year

Mon, Sep 30, 2019


On Oct. 1, 2019, there will be 118 new National Correct Coding Initiative (NCCI or CCI) edits for physicians reporting to Medicare. Keep your coding up to date and in compliance with the edits with this quick overview featuring path/lab, allografts, venous procedures, and radiation oncology.

Keep in mind: The edits we’re talking about here are Medicare practitioner procedure to procedure (PTP) edits. Medicare updates these edits each quarter.

Look Before You Lab (See What I Did There?)

Most of the CCI edit additions for this quarter are related to

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ICD-10-CM: 3 Official Tips for More Accurate COPD Coding

Thu, Sep 26, 2019


ICD-10-CM coding for COPD

ICD-10-CM 2020 is bringing a small change to chronic obstructive pulmonary disease (COPD) code J44.0, making it a good time to refresh your knowledge of the guidelines that apply to coding for this disease (or group of diseases, if you want to be precise!).

1. Understand the Change to J44.0

To start, let’s take a quick look at the code change effective Oct. 1, 2019. Code J44.0 will add parentheses around the word acute, so the descriptor will look like this: (Chronic obstructive pulmonary disease with (acute) lower respiratory infection).

As explained in our

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Get Pro/Tech Component Refresher From October MPFS Update

Mon, Sep 23, 2019


dermatology coding and payment

When you think of professional component and technical component, Medicare’s division of a single code may spring to mind. But the October 2019 update to the Medicare Physician Fee Schedule (MPFS) has a dermatology example that shows there’s more than one way to think about PC/TC. Here are the details.

RVUs for PC + TC = Global

The October MPFS update will change the relative value units (RVUs) for two global dermatology codes, which apply to services used in the detection of skin cancer. The RVUs for the codes, 96931 and 96934, will change so that the global code RVUs equal the values of the professional and technical component …

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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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