Barbara’s News – Page 10 – CRN Healthcare Solutions

Coverage Expands as Six Health Systems Combine

April 17, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Borrowing a page from the plan announced by Amazon, JP Morgan Chase, and Berkshire Hathaway, six healthcare systems in New Jersey are joining their work forces to expand coverage to 50,000 employees and dependents under a single self-insured health … For more, read here: AAPC Blog

Blue Cross of Mich. Reverses Decision

April 12, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Blue Cross Blue Shield (BCBS) of Michigan is delaying their planned non-coverage of hyaluronic acid injections for knees, slated for April 1. BCBS Pulls Up BCBS giving themselves time to study if hyaluronic acid has the true medical benefit that it c… For more, read here: AAPC Blog

OIG: Many Outpatient PT Claims Fail to Comply

April 5, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

The Office of Inspector General (OIG) did a study of physical therapy claims and documentation for Medicare patients and issued a report this month in March. Their findings are of great concern for the PT and rehabilitation specialty. The OIG reviewed… For more, read here: AAPC Blog

E/M Update Opinions Shared at Listening Session

April 5, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

A representative from the Hospital and Ambulatory Policy Group at the Centers for Medicare & Medicaid Services (CMS) held a listening session regarding proposed updates to the documentation guidelines for evaluation and management (E/M) services o… For more, read here: AAPC Blog

Medical Coding Tissue Transfer or Rearrangement

March 26, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

I often see incorrect medical coding for “flaps”, which were adjacent tissue transfers, 14000-14350. Coders do not always understand that you can only code for the closure of the primary and secondary defect, but not for each flap that is created. Sur… For more, read here: AAPC Blog

Post-Operative Complications in the Global Period

March 1, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Is the caring for, and treatment of post-operative complications in the global period coded and billable? To answer this question, You first must know who the third-party payer is because different payers have different rules. What’s the Globa… For more, read here: AAPC Blog

Anthem Rescinds Modifier 25 Payment Reductions

March 1, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Anthem has sent a letter to the AMA to announce they are rescinding the policy reducing payment for physicians when billing an E/M with a modifier 25 and a procedure that has zero or 10 global days. Anthem was planning on taking a 25 percent reductio… For more, read here: AAPC Blog

Modifier 58 Versus 78; Which Should You Use?

February 21, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Sometimes coders are confused when they should apply modifier 58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period and modifier 78 Unplanned Return to the Operating… For more, read here: AAPC Blog

How to Code Flu – from Prevention to Care

February 6, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

Flu season is here, prompting a great deal of confusion about how to code. I decided to spend some time on the Centers for Disease Control and Prevention (CDC) website and other resources to try to clarify the murky in this very sick flu season. Car… For more, read here: AAPC Blog

Case Studies: Modifier 59 and X[ESPU] Use

January 29, 2018August 28, 2018Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCONo Comments

When I last wrote “Modifier 59 – To Use or Not to Use”, I promised to follow it up with some real-life examples of when we should be using the 59 or the new Medicare X[ESPU] modifiers. Let’s look at some clinical examples and first determine if the … For more, read here: AAPC Blog