Medicare – Page 4

Critical Care Coding FAQ: Become a Master of Time

Beware: CPT, CMS differ on ‘family discussion’ parameters.
When the physician treats a patient with a critical illness or injury, you need to know when to start and stop the critical care clock in order to avoid miscoding. Check out this FAQ to find out what’s part of critical care, what’s not, and how to correctly […]

Maximize 99291 Coding with This Critical Care FAQ Physician ‘preventing further deterioration’ keys valid critical care claims….
Critical Care Coding Checklist Certain patient conditions could indicate 99291 service. Given the…
Bust 4 Myths About Pediatric Critical Care Services MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric…

Oncology Coding: Update Your PET Claims With This New Guidance

Here are the requirements the exam must meet, according to Medicare.
If your PET claim meets certain requirements, you don’t need to append modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study), according to MLN Matters article MM6753.
Effective for dates of service on or after Nov. […]

Which PET Code Is Best for Brain Images? Question: Which CPT code is appropriate for PET performed…
Oncology Coding 2010 Update: 3 New Lab Services CodesWatch for your chance to replace 86316 with more specific…
ICD-9 Update: Take Your Oncology Coding Specificity Up a Notch With 7 2010 Changes Tumor lysis syndrome is getting its own code —…

CMS Will Cover HIV Screening As Preventive Care Service

Bonus: Effective immediately!
You’re probably accustomed to CMS taking away coverage for certain services, but in an early holiday gift to practices, CMS has actually added a preventive care service to its roster of covered screenings, effective immediately.
CMS issued a final decision on Dec. 8 declaring that HIV testing will now be covered for Medicare beneficiaries […]

Show Us the Money for Primary CareAlmost everyone agrees that federal and private insurers should reimburse…
Colorectal Cancer Screening: A Medicare Coding & Billing FAQ Steer clear of G0121 denials with these tips. If…
Good-Bye Fee-For-Service, Hello ‘Episodes of Care’It’s not like we’re going to go back to capitation…

AMA Symposium Report: Low-Level Consult Reporting in 2010

Hey, Coding News readers! It’s your turn to weigh in on the consult controversy.
Question: What should you do for Medicare 2010 coding if an inpatient consult on a patient’s initial hospital day does not support 99221?
Answer: Kenneth Simon, MD, MBA, FACS, CMS, senior medical officer at the CPT symposium was very adamant that you […]

Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report…
CMS at AMA Chicago: We’re Reducing Consult Request RequirementCMS auditors will look for 1 less thing in consult…
OK to Code Debridement With Consult?Question: Can you charge for an inpatient consult and a bedside…

CMS at AMA Chicago: We’re Reducing Consult Request Requirement

CMS auditors will look for 1 less thing in consult documentation.
With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.
Separate ICD-9 codes will help substantiate the medical necessity for providing consultative […]

Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report…
Medicare Changes to 2010 CPT Inpatient Consultation Codes Prevent 99251-99245 denials in 2010 with this checklist. Multiple…
Medicare 2010 CPT Consultation Code ChangesNew rules for consult coding straight from the AMA Meeting…

Medicare Changes to 2010 CPT Inpatient Consultation Codes

Prevent 99251-99245 denials in 2010 with this checklist.
Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.
Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles […]

Medicare 2010 CPT Consultation Code ChangesNew rules for consult coding straight from the AMA Meeting…
Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report…
Proposed 2010 MPFS: $26 More for ‘Welcome to Medicare’ ExamCMS welcomed health care providers to an July 9 open…

Medicare 2010 CPT Consultation Code Changes

New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement.
If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone.
Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian […]

Medicare Changes to 2010 CPT Inpatient Consultation Codes Prevent 99251-99245 denials in 2010 with this checklist. Multiple…
CMS at AMA Chicago: We’re Reducing Consult Request RequirementCMS auditors will look for 1 less thing in consult…
Consultation 5 R’s Miss 1 element, and invite auditors to check out…

Coder’s Navigation Tool: 2010 Medicare Physician Fee Schedule

It’s that time of year coders — yes, time to comb through pages and pages and pages of the final 2010 Medicare Physician Fee Schedule. We’ve got a handy place to start.
If you want a quick overview of fee schedule’s financial impact on your physician practice’s specialty, go here and scroll to page 1171. There, […]

Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding…
How Obama’s Medicare Cuts Hit Physician Reimbursement The budget released Thursday suggests we cut $300 billion from…
CMS Issues Corrections to 2009 Physician Fee Schedule Final RuleIt’s that time of year again — time to get…

Nonphysician Providers and Incident-To: Your Coding Questions Answered

Here’s why you should keep your physicians’ work schedules on file.
Correctly billing your nonphysician practitioners (NPPs) incident-to services means the difference between 85 and 100 percent reimbursement. But if you bill incident-to haphazardly, you’re just waving a red flag at auditors.
And those auditors are jonesin’ to find incident to billing problems. Just check out this […]

Nonphysician Providers & Incident To ChecklistCheck state laws PLUS this crucial document. In last week’s…
Steer Your Incident-To Coding Using These 4 Questions 100 percent pay possible if NPP follows internist’s care…
Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill…

Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?

Question: I heard that Medicare made some changes about diabetic patients’ eligibility for bariatric surgery. Do we have to pay more attention to the patient’s BMI?
Answer: A few months ago, Medicare did implement some new regulations for bariatric procedures for diabetic patients.
The rule: If your physicians perform bariatric surgery procedures on diabetic patients you need to take […]

Medical Necessity for Teen Obesity Surgery? New study indicates that bariatric surgery reverses Type 2…
5 Steps to Medicare Opt-Out Have you decided to just say no? If your…
CMS: Apnea is Key for Sleep Testing Coverage Medicare benes who suffer from obstructive sleep apnea (OSA)…

Critical Care Coding FAQ: Become a Master of Time

Oncology Coding: Update Your PET Claims With This New Guidance

CMS Will Cover HIV Screening As Preventive Care Service

CMS at AMA Chicago: We’re Reducing Consult Request Requirement

Medicare Changes to 2010 CPT Inpatient Consultation Codes

Medicare 2010 CPT Consultation Code Changes

Nonphysician Providers and Incident-To: Your Coding Questions Answered

Medicare Coverage for Bariatric Surgery: Do You Know These BMI Guidelines?

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