Meet the Latest Modifier-Related RAC Topics

Thu, Nov 21, 2019


prepare for RAC audits related to medical coding modifiers

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 …

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See What’s New for HCPCS Level II J and Q Codes in 2020

Mon, Nov 18, 2019


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 …

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Which Medicare Diabetes Prevention Program Code Is Worth $168 in 2020?

Thu, Nov 14, 2019


Medicare Diabetes Prevention Program HCPCS code payment

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 …

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Highlight E/M, Opioid Use Treatment, PAs, and Single-Disease Care in 2020 MPFS Final Rule

Mon, Nov 11, 2019


Medicare Physician Fee Schedule 2020 final rule

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/…

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How Do You Code Sinuva Placement for NGS Medicare? Find Out Here

Mon, Nov 4, 2019


otolaryngology coding for Sinuva implant

A new HCPCS Level II code lets you report the SinuvaTM 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 & …

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Get the Latest Vaping Coding Guidance From ICD-10-CM Official Guidelines

Mon, Oct 28, 2019


You now have authoritative guidance on ICD-10-CM coding for e-cigarette, or vaping, product use associated lung injury (EVALI). One thing you’ll learn: There may be new codes on the way to provide additional detail.

Get the Scoop on the New Vaping Guidelines

The four Cooperating Parties for ICD-10-CM approved the new vaping coding guidance, with the posting date of Oct. 17, 2019. The Cooperating Parties are the National Center for Health Statistics (NCHS), the American Health Information Management Association (AHIMA), the American Hospital Association (AHA), and the Centers for Medicare & Medicaid Services (CMS).

The post states that the guidance is likely to change as new clinical …

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Here’s Where to Turn When Coding for Chest Pain

Thu, Oct 24, 2019


ICD-10-CM coding for chest pain

A lot of primary care physicians and specialists see patients presenting with chest pain. In many cases, the provider may not be able to confirm a more specific diagnosis for the encounter. To ensure you’re coding this symptom correctly, follow these pointers on ICD-10-CM coding for chest pain.

Use Both the Index and Tabular List for Accurate Coding

When you look up the entry for “pain/chest” in the ICD-10-CM Alphabetic Index, here’s what you’ll discover:

  • The default code for chest pain is R07.9 (Chest pain, unspecified), …
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Ob-Gyn Coders, Beware This Costly Modifier 24 Myth

Mon, Oct 21, 2019


E/M coding for doctor counseling patient

Suppose a Medicare patient presents to your ob-gyn practice for a visit scheduled as a follow-up after cervical lesion biopsy, but the doctor also spends time on counseling and coordination of care related to the malignant tumor the biopsy identified. Can you report an E/M with modifier 24 if the visit is during the biopsy’s global period? Below you’ll find helpful hints from TCI’s Ob-Gyn Coding Alert.

Don’t Get Too Hung Up on What the Schedule Says

It is a myth that you can’t report an E/M code for a visit just …

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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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