The HHS Office of Inspector General’s (OIG) announced on April 25th that after nearly 23 years, the compliance guidelines for individual and small group physician practices will undergo a major overhaul. The first round of the upgrades could be rolled out by the end of 2023, according to the Federal Register notice “Modernization of Compliance…
The place of service (POS) code set provides location information necessary to pay claims correctly. There are times when the health care industry requires a greater need for specificity than Medicare. While Medicare may not require this greater specificity to process and pay claims, it will adjudicate claims with the new codes in order to…
There are often questions and confusion on what is included and acceptable when choosing “Drug therapy requiring intensive monitoring for toxicity” in the Medical Decision-Making Risk category for Evaluation and Management coding. This article reviews the definition and guidelines as provided by CMS and their Medicare Administrative Contractors (MACs). Risk: High MDM – Drug therapy…
Global OB Care Coding and Billing Guidelines By: Sheila Haynes – Coding and Compliance Manager The total obstetric care package, commonly referred to as “Global OB Care”, includes the provision of antepartum care, delivery services and postpartum care. When the same group physician and/or other healthcare professional provides all components of the OB package, the…
By: Sheila Haynes – Coding and Compliance Manager Correct coding and code definitions apply in all circumstances and to all provider types. Whenever a code is billed which includes another service or supply, whether by code definition or by coding guidelines, the included service or supply is not eligible for separate reimbursement. Supplies For Professional…
Medical billers, coders, compliance officers, practice managers, and other healthcare business professionals joined AAPC on Dec. 9 for the first day of ELEVATE. The two-day leadership conference is dedicated to career development and helping healthcare business professionals learn what they can do to enhance their skill sets and advance their careers. The virtual event features…
The report below describes spinal injection procedures in detail, noting how many of these procedures are bundled into one code. Continue reading below to learn more! Do you have a complicated surgery case that needs help with coding? RT Welter would love to help! Please upload the operative note by clicking on the link below.…
By: Sheila Haynes, Manager Coding & Compliance Defining Interactive Complexity +90785: Interactive Complexity (+90785) is an add-on code utilized for office visits with a psychologist or other mental health professional that are complicated by language, behavior, emotions, mandated reporting requirements or trauma. +90785 is utilized in addition to one of the following primary service codes…
By: Sheila Haynes, CPC Coding and Compliance Manager Take notice and prepare for changes to the guidelines for billing split/shared services if your practice’s physicians and qualified health care professionals (QHP) regularly team up for hospital visits. The new guidelines go into effect on Jan. 1, 2022. What is a Split/Shared Visit? Definition of split…
Modifier 25 is an important Evaluation and Management service medical professionals need to understand. It is used for same-day procedures when services beyond usual pre and post-operation are necessary. Continue reading below for a breakdown and examples of modifier 25! By: Sheila Haynes, CPC Coding and Compliance Manager Pay close attention to billing E/M (office…