Coding News – CRN Healthcare Solutions

CMS Proposes Payment Changes to Endoscopic Sinus Codes

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Aug 12, 2019

The Centers for Medicare & Medicaid Services (CMS) is proposing major payment changes to sinus endoscopy services. The 2020 Physician Fee Schedule (PFS) proposed rule includes the following excerpt: We are proposing to apply the special rule for m… For...

Anthem Changes Timely-Filing Deadlines

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Aug 5, 2019

Anthem has sent out a notice to all providers who have signed non-Medicare or Medicare Advantage contracts with them, stating: “Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, … For more, read...

ICD-10 Guidelines: Sometimes You Have to Break the Rules

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Aug 1, 2019

Rik Salomon, CPC, CRC, CEDC, CEMA, CMCS, and I recently got into a rather spirited debate with a group of Certified Professional Coders (CPCs®) on coding guidelines and how they govern our medical coding. CPT® and ICD-10 guidelines are the primary det… For more,...

Reporting Bilateral Services: Conflicting Information Causes Confusion

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 29, 2019

Payer-specific rules — especially rules that vary for every claim — not only make collecting revenue difficult, but also add to the cost of collection of monies earned by the physicians. A blog clarifies Novitas’ instructions for reporting modifier … For more,...

Michigan Surgeon Accused of $60M Billing Fraud

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 23, 2019

Bay City, Michigan surgeon Vasso Godiali, MD, was indicted on July 10, 2019, for allegedly orchestrating a $60 million healthcare fraud scheme. He is also charged with money laundering for financial transactions involving almost $50 million in proceed… For more,...

Getting Inspire Therapy for Sleep Apnea Covered

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 17, 2019

Obstructive sleep apnea causes those who suffer from it to sleep poorly and always feel tired. Obstructive sleep apnea is also indicative for heart Inspire® therapy is a promising alternative to traditional treatment options for sleep apnea, but getting it covered...

Billing 95165 Is Nothing to Sneeze At

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 11, 2019

The professional service of preparation and provision of antigens for allergen immunotherapy — reported using CPT® 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple … For more,...

Differentiate Separate Procedures with Modifiers 59 and X[ESPU]

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jul 8, 2019

When you have distinct, separate procedures, know which modifiers will get the claim paid in full. Modifier 59 Distinct procedural service acts as a “universal unbundling” modifier for procedures that are normally included as part of another procedur… For more,...

Cyber Threats to Physician Practices Are Growing

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jun 24, 2019

Here’s how to fight back. Most of us are concerned about being personally attacked by cybercriminals, and we must have that same increased awareness within our medical practices. Cybercriminals consider medical practices ripe for the picking. Security For more, read...

AMA on Evaluation and Management Guidelines

by Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO | Jun 18, 2019

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management (… For more,...