Drum Roll: What Does MPFS 2019 Final Rule Say About E/M?

Mon, Nov 5, 2018


Medicare released the CY 2019 Medicare Physician Fee Schedule (MPFS). One of the big questions from the proposed rule was whether E/M payment rules would change. Here are some highlights on what made it into the final rule for E/M and what didn’t.

The News You’ve Been Waiting for …

The proposal to combine payment rates for E/M levels two to five (meaning they would all pay the same) has been postponed and will likely look different when …

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Ask Yourself These Questions When Working Appeals

Mon, Oct 29, 2018


ask these questions for more successful appeals

Sometimes it’s the simple things that can help your appeal for a medical insurance claim. Work through these questions to be sure you’re giving a claim its best chance.

Did You Cite the Claim?

You may get your appeal back if you don’t make it clear which original claim you’re referencing. Plenty of coders and billers have learned this one the hard way.

Bonus tip: While we’re in the transition period to MBIs for Medicare, your MAC may accept either the MBI or HICN to identify …

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Know 3 Rule-Out Rules for Better ICD-10-CM Coding

Thu, Oct 25, 2018


If you come across documentation that refers to ruling out a diagnosis, it’s time to go on high alert. There are some specific rules you need to follow for ICD-10-CM coding. Here are tips straight from the 2019 ICD-10-CM Official Guidelines for Coding and Reporting (OGs).

1. Know When to Use Codes That Specify ‘Ruled Out’

ICD-10-CM includes some codes with the term “ruled out” in the descriptor. Look especially at these observation Z code categories:

  • Z03.- (Encounter for medical observation for suspected diseases and conditions ruled out)
  • Z04.- (Encounter for examination and observation for other …
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Time for a Halloween Coding Fright-Fest!

Tue, Oct 23, 2018


Happy Halloween, Coders!

We’ve had some fun in the past with Halloween-themed codes, but there are still a few left, especially if we throw some ICD-11 into the witchy brew. Here’s a quick quiz to get you in the spooky spirit.

How to Treat Problematic Arachnid Blood Vessels

Stephen Spider comes into the office complaining about some veins that have become a pest. How do you code the treatment?

Use code 36468 (Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk) for this one! You’ll want to review the coverage rules for this treatment, though. You and the patient don’t want to …

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On the Cutting Edge? Check Out These ‘Remote’ CPT® 2019 Additions With MPFS Tips

Wed, Oct 17, 2018


The CPT® 2019 code set is adding to your options for remote services. Here’s a rundown of the changes you can expect for certain remote monitoring services as well as EHR consultative time.

Turn to 9945X for Remote Physiologic Monitoring

The new code set will add codes for remote physiologic monitoring (like weight, BP, pulse oximetry):

  • Use 99453 for set-up and educating the patient
  • Use 99454 to represent each 30 days of device supply with recordings or alerts
  • Use 99457 for 20 minutes or more per month spent by the provider or clinical staff on treatment management, including communication with the patient or caregiver.


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Perfect Your Coding for Pressure Ulcer Diagnoses With These Documentation Tips

Mon, Oct 15, 2018


know who can document pressure ulcer stage

ICD-10-CM has a lot of codes (more than 150!) for pressure ulcers, and that means your clinicians’ documentation game has got to be on point for your to get the most accurate code for the case. These three steps should help you get the job done.

1. Know Where to Look for Pressure Ulcer Stage Documentation

For pressure ulcers, a nurse is often the one who documents stage. So it’s good news you can base code assignment for pressure ulcer stage on medical record documentation by someone other than the “physician or other qualified healthcare practitioner legally accountable for establishing …

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Smart Move: Know These Top Medicare Denial Reasons AND How to Avoid Them

Wed, Oct 10, 2018


Prevent avoidable Medicare denials!


Let’s put data to work to help prevent denials! CGS is one of the Medicare contractors that provides information on top claim denial reasons, and here we’ll take a look at some denial triggers from August 2018 and how you can prevent them.

Check Status Before Reporting Duplicate Service

Reporting the exact same service more than once leads to a duplicate service denial. For August 2018, CGS indicates there were more than 120,000 duplicate service denials for Part B in Kentucky and Ohio.

So how can you avoid this common problem? Here’s what CGS suggests:

  • Don’t resubmit a claim until you’…
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Don’t Let These Deleted CPT® Codes Sink Your 2019 Claims

Mon, Oct 8, 2018


For claims to succeed, you can’t use deleted CPT® codes. There’s no getting around it. So give your claims their best chance in 2019 by making sure these deleted codes don’t land on your claims.

And of course: You need to know the new codes (see blog post overviews Part 1, Part 2, Part 3) and revisions. Some of the deletions are covered there, as well, but it doesn’t hurt to discuss the changes from multiple angles. The codes below …

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Do You Know the Answers to These Medicare Disaster Relief Questions?

Wed, Oct 3, 2018


Medicare waiver for hurricane impact

Because of Hurricane Florence, CMS issued several waivers in North Carolina, South Carolina, and Virginia to help with access to healthcare. Even if you’re not in an affected area, this should be a reminder that disaster prep isn’t just about working in theory. You need to understand it well enough to apply it. Below you’ll find some questions based on the Medicare resources available. You can see if you need to study to ensure you know the rules when an emergency strikes.

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Last-Minute Tips to Catch Every ICD-10-CM 2019 Eyelid Code Change

Fri, Sep 28, 2018


ICD-10-CM 2019 adds specificity to eyelid diagnosis coding

It’s ICD-10-CM 2019-eve! A big chunk of the changes effective Oct. 1, 2018, make coding for many eyelid diagnoses more specific, requiring you to specify not only the eye but also the eyelid involved. To be sure you’re ready, here’s one last crash course in eyelid ICD-10-CM coding for 2019. (more…)

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