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Smash 3 Myths to Upgrade Your Mammography Coding and Coverage Knowledge

18. July 2019

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Mammography is a common service, but radiology coders need to learn some not-so-common rules. Take your know-how to the next level by getting to the truth about these myths. Myth 1: Mammography Is for Women Only Medicare’s National Coverage Determination (NCD) for Mammograms states that “diagnostic mammography is a radiologic procedure furnished to a man […]

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CCI Modifiers: July 1 Update to Modifier 59 Rule Is Now in Force … and More

16. July 2019

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Modifiers are the key to overriding Correct Coding Initiative (CCI) edits, so let’s give them the attention they deserve. We’ll start with a recent rule update and move on to helpful hints about CCI-associated modifiers in general. Which CCI edits? Our focus here will be Medicare CCI Procedure-to-Procedure (PTP) edits for physicians and practitioners. Do […]

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PDPM: Snap Up This ICD-10-CM Knowledge for Your SNF

17. June 2019

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The Patient Driven Payment Model is bringing new importance to the ICD-10-CM code set for SNFs. Here’s where the diagnosis codes will come into play. Get a Quick Overview of the PDPM The Patient Driven Payment Model (PDPM) is a new case-mix classification system that will replace the Resource Utilization Group, Version IV (RUG-IV), effective […]

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Modifier 51 Hints: Your Go-To Guide for the MPFS Multiple Procedure Column

13. June 2019

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There are nine different Multiple Procedure indicators on the Medicare Physician Fee Schedule (MPFS), meaning there are a lot of payment adjustment possibilities you need to know. Here’s each indicator, an example of a code with that indicator, and a quick look at where modifier 51 comes into play. What Is Modifier 51? The basic […]

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Modifier 25 Scavenger Hunt! Can You Find These Answers?

21. May 2019

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Keeping up with modifier 25 rules can be intimidating, so let’s add a little fun by seeing if you can unearth the answers to these questions at the locations provided. Ready, set, go! 1. Is This a Separate E/M? You may have the descriptor memorized for modifier 25 (Significant, separately identifiable evaluation and management service […]

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Clear Up Coverage Questions for Medicare’s Hepatitis B Screening

17. May 2019

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The percentage of people who have hepatitis B but don’t know it could be as high as 67 percent, and the opioid epidemic is fueling an increase in infections, according to the Department of Health and Human Services (HHS). That’s one reason screening is so important. Medicare’s coverage rules for hepatitis B screening are specific, […]

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Bulk Up Your Global Surgical Package Knowledge for Cleaner Claims

6. May 2019

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Let’s take Medicare’s list of services included in global surgery payment up a notch. If you remember each added tip below, you’ll be more likely to avoid reporting both too many and too few codes. Read This Booklet to Dive Deeper The source of the straight-from-Medicare bullet points quoted below is Medicare’s Global Surgery Booklet. […]

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Medicare Helper: Don’t Let DOS Be the Downfall for Your Claims

2. May 2019

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Determining date of service (DOS) can be harder than it seems. Once you dive into the world of professional/technical components, monitoring services, and other non-obvious DOS possibilities, things get complicated fast. You can use the Medicare rules below as a starting point. Apply Different Dates for Radiology Components For many radiology codes, the Medicare Physician […]

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$325 Million in Office Visit Underpayments! How Much Is Yours?

8. April 2019

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Audit discussions often focus on the fear of upcoding and having to hope that repaying the extra amount is the worst of the consequences. But downcoding is another problem area affecting your payments and more. Here’s why you should never purposely downcode your services. Start With a CERT Story Wondering about the $325 million in […]

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Simplify Cystocele Coding With These ICD-10-CM and CPT® Pointers

25. March 2019

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Urogynecology brings together urology and gynecology, specifically focusing on treating pelvic floor disorders. One diagnosis urogynecology coders need to be familiar with is cystocele, our topic for today. Tie Your Diagnosis to These ICD-10-CM Codes A cystocele occurs when the wall between the bladder and vagina weakens, causing a protrusion. You should report this condition […]

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