CPT® guidelines offer clues for what payers and auditors are looking for in op notes. When reading notes or auditing documentation associated with the performance of diagnostic endoscopies performed by otolaryngologists (e.g., 31231, 31575, 31525, … For more, read here: AAPC Blog
Continue ReadingModifier 59 Is Over-Used and Abused, MAC Says
Failure to adopt the X[ESPU] modifiers may be putting your practice at risk for Medicare fraud. Modifier 59 Distinct procedural service continues to be the most-used modifier among Medicare Part B providers, according to Novitas, and it is sending up … For more, read here: AAPC Blog
Continue ReadingMedicare Telehealth Coding as of April 30
Healthcare providers are granted even more latitude for use of telehealth services during the COVID-19 public health emergency. On a Friday, at month-end, the Centers for Medicare & Medicaid Services (CMS) kindly dropped another bomb on us: more t… For more, read here: AAPC Blog
Continue ReadingUsing Modifier 95 for Telehealth Makes Cents
Capture full payment for remote visits during the PHE for COVID-19. An interim final rule published in the April 6, 2020, Federal Register explains how to bill telehealth services during the COVID-19 public health emergency (PHE). The final rule goes … For more, read here: AAPC Blog
Continue ReadingCheck Your FESS Claims for Improper Payment Adjustments
MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endosco… For more, read here: AAPC Blog
Continue ReadingNew Medicare Cards Initiate Phishing Scam
Medicare patients are receiving calls from telephone solicitors who are phishing for private identification information for nefarious purposes. The ruse is facilitated by the issuance of new Medicare cards. Here’s How the Scam Goes Down The callers c… For more, read here: AAPC Blog
Continue ReadingNew Patient E/M Denials: Mystery Solved
New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in t… For more, read here: AAPC Blog
Continue ReadingMultiple Endoscopy Rule Examples
In my last blog “Special Rules Apply to Endoscopic Sinus Surgeries,” I discussed the change to the Multiple Endoscopy Rule for multiple surgeries when performed within the family of endoscopic sinus codes. How Does the Multiple Endoscopy Rule Affect … For more, read here: AAPC Blog
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Special Rules Apply to Endoscopic Sinus Surgeries
The multiple surgery calculation for nasal endoscopy codes is changed when multiple nasal endoscopies are performed in the same session on the same day. For Calendar Year 2020, instead of paying the multiple surgeries at 50 percent, surgeons will be … For more, read here: AAPC Blog
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Helping Substance Abusers Via Telemedicine
The U.S. Drug Enforcement Administration (DEA) missed its deadline for creating regulations for a special registration process for prescribing controlled substances via telemedicine. What Is the Ryan Haight Online Pharmacy Consumer Protection Act? T… For more, read here: AAPC Blog
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