Modifier 59 Misuse Cost 1 Health System Millions — Know Where to Go for the Rules

Mon, Jan 7, 2019


False Claims Act settlement modifier 59

Exploiting modifier 59 was a major factor in a recent $12.5 million settlement for False Claims Act allegations. How’s that for motivation to shore up your modifier 59 know-how? Here are some resources to get you on your way.

Read the Write-Up on the Recent False Claims Act Settlement

Find out some of the details that resulted in the $12.5 million settlement and five years of regular monitoring of billing practices for a hospital and health system in Pennsylvania by reading the brief DOJ release about the case. With modifier 59 (Distinct procedural service) in the mix, you can guess that intentional improper unbundling was a …

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HCPCS 2019: Update CROS/BiCROS Hearing Device Codes for a Better Clinical Match

Fri, Jan 4, 2019


For those of you who report contralateral routing hearing aid devices (CROS/BiCROS), here’s what you need to know about the big makeover these codes got for 2019.

Catch the Little Differences in Code Descriptors

As noted in a previous blog post about HCPCS 2019, the hearing aid codes will test your ability to spot tiny variations in code descriptors. (But as a coder, you are already all about the details, right?)

Pay particular attention to the ends of the descriptors for these new codes. To help …

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Get the Latest on Changes to Medicare’s 2019 History Documentation Requirements

Thu, Dec 20, 2018


We’ve been talking a lot about the 2019 Medicare Physician Fee Schedule final rule, but when there are changes to E/M rules, there can never be enough information, right? CMS recently released a response to a question that arose during a provider call about what parts of history ancillary staff or the beneficiary can document …

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HCPCS 2019: Get to Know New Code G2012 for Virtual Check-In

Mon, Dec 17, 2018


Payment for non-face-to-face communication with patients isn’t the most clear-cut topic. But with new 2019 HCPCS code G2012, you’ve got an intriguing option for virtual check-ins with Medicare patients. Ready to learn more?

Dig In to the Long Descriptor for G2012

The first place to learn about the code is the long code descriptor:

  • G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor …
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Obstetrics: Take the Confusion Out of Pre-Existing Hypertension ICD-10-CM Coding

Thu, Dec 13, 2018


ICD-10 coding for hypertension in pregnancy

Hypertension is a common diagnosis, so a lot of specialties have to understand the rules for coding this condition. Obstetrics coders have to go one step further for hypertension and learn the specific rules for coding pre-existing hypertension in pregnancy, which is our focus today.

Watch for Documentation of Pre-Existing or Gestational

You’ll find the obstetrics codes for hypertensive disorders in the O10-O16 range of ICD-10-CM. Categories O10.- (Pre-existing hypertension complicating pregnancy, childbirth and the puerperium) and O11.- (Pre-existing hypertension with pre-eclampsia) are both specific to pre-existing …

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Pop Quiz: Test Your Assumptions About QPP 2019 Payment Year

Mon, Dec 10, 2018


QPP pop quiz!

Understanding the Medicare Quality Payment Program (QPP) is tough. But the data Medicare released from the 2017 performance year shows you were up for the challenge. And that’s good news because the 2017 performance year affects 2019 Medicare payments and maybe has helped you prepare for the 2019 performance year, too. Let’s see how you do on a quick quiz about the 2017 QPP performance year.

Ready, Set, Go … to the QPP Questions

Q1: Which number reflects the percentage of MIPS eligible clinicians receiving a positive adjustment AND an adjustment for exceptional performance?

  • A. 2 percent
  • <...

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Do You Land in the Winner Column for MPFS 2019?

Thu, Dec 6, 2018


For the 2019 Medicare Physician Fee Schedule (MPFS), we’ve talked about E/M and a bit about remote monitoring. But now let’s take a general overview of the ups and downs expected for individual specialties.

Know Where to Find the Info and What It Means

Table 94 of the 2019 MPFS final rule is titled “CY 2019 PFS Estimated Impact on Total Allowed Charges by Specialty.” The table shows allowed charges by specialty; impact of changes to work, practice expense, and malpractice RVUs; and the combined impact of the changes.

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Language Lesson: Add These Terms to Your MIPS 2019 Glossary to Save Research Time

Tue, Dec 4, 2018


MIPS 2019 GlossaryWhen MACRA and MIPS come up, does it feel like speaking another language? For the 2019 performance year, there are even some new terms to learn. We’ve got the new language and tips on where you’ll see it used so you don’t have to spend time searching.

Collection Type: Apply to Sets of Similar Quality Measures

According to the Quality Payment Program Year 3: Final Rule Overview. the official definition of collection type is, “a set of quality measures with …

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ICD-10-CM: 3 Tips for More Accurate Hyperthyroidism Coding

Thu, Nov 29, 2018


ICD-10-CM includes a host of codes for hyperthyroidism, and that means your team’s documentation and coding skills need to be sharp. Here are some helpful hints to get you on your way.

Learn Your Terms and Prefixes to Locate Codes

Knowing medical anatomy and terminology is a must for coders, and that includes knowing that the thyroid is a gland located in the front of the neck. It has a sort of butterfly shape, and its job is to produce hormones that affect the speed of the metabolism.

For coding, it’s also important not to get tripped up by …

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ICD-10-CM: Know Which Terms Lead to Codes for Generalized Anxiety Disorder and Panic Disorder

Tue, Nov 27, 2018


diagnosis coding for generalized anxiety disorder

Generalized anxiety disorder and panic disorder rank among the most common mental health disorders in the U.S. population. A variety of health professionals may see patients with these conditions, including primary care providers and specialists. That means knowing the diagnosis coding terminology below is beneficial for a lot of us in the field.

Starting point: Both of our mental health diagnoses-in-focus are in the “other” category F41.- (Other anxiety disorders), but they have unique ICD-10-CM codes.

Use F41.0 for …

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