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COVID-19 Coding Q&A: CPT®, HCPCS, and ICD-10-CM News for Coronavirus Coding

12. March 2020

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A lot of information is appearing very fast about COVID-19 (coronavirus disease 2019), and medical coders have the extra challenge of sorting through the onslaught to find the bits relevant to coding claims related to testing and treatment. This Q&A brings together the latest authoritative news about coding for COVID-19.   Term tip: COVID-19, a […]

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GI Coding: Why Is Modifier 53 on the Medicare Physician Fee Schedule?

30. January 2020

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The Medicare Physician Fee Schedule (MPFS) includes special pricing for four colonoscopy codes when you append modifier 53 (Discontinued procedure). Here’s what you need to know about appending modifier 53 to these codes and the payment you can expect. Compare Rates for Total and Discontinued Colonoscopies Below are the four codes on the 2020 first […]

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99473 and 99474: Focus on 2020’s New Self-Measured BP Monitoring Codes

9. January 2020

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The clinical setting may not be the best place to get an accurate blood pressure reading, and two new CPT® 2020 codes are here to help. Medical codes 99473 and 99474 apply to self-measured blood pressure services. Here’s what you need to know. 1. Review the Codes and Descriptors Getting to know any new codes […]

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Know What’s New in the 2020 Medicare NCCI Manual

6. January 2020

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Medicare has posted the 2020 National Correct Coding Initiative (NCCI) manual, with the updates helpfully marked in red, as usual. Here are some hints on what you’ll find in the latest version. Review Radiology Section’s SPECT/Planar and Oncology Updates First up are changes in the radiology services section of the NCCI manual, which you’ll find […]

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Knock Out Medical Claim Denials With This 1-2-3 Prevention Plan

19. December 2019

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If denial prevention is one of your New Year’s resolutions, we’ve got some ideas to help you achieve your goal. Make 2020 your best year yet by watching the little details that matter for your medical claims, including changes for Appropriate Use Criteria, Medicare Beneficiary Identifiers, and global billing address requirements. 1. Remember That Code […]

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What Does the 2020 MPFS Say About Nasal/Sinus Endoscopy Payment?

16. December 2019

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The 2020 Medicare Physician Fee Schedule (MPFS) final rule states Medicare will apply the special rule for multiple endoscopic procedures to nasal/sinus endoscopy medical codes 31231-31298. In case you don’t have time to wade through the whole long rule, here are the major pointers on this change for otolaryngology coders. The change will be effective […]

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Oncology and Hematology Coders: Get Tips on HCCs and Risk Adjustment

2. December 2019

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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 […]

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Meet the Latest Modifier-Related RAC Topics

21. November 2019

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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 […]

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

14. November 2019

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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 […]

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

11. November 2019

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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 […]

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