How to Document E/M with Counseling and Coordinating Care
The only case when time may be used as the overriding factor in determining an evaluation and management (E/M) level is when counseling and/or coordinating care dominates the encounter, which means that the time expended on counseling and/or coordinat… For more,...
Understand Clearing Houses
Clearing houses affect revenue flow through denials. Understanding them and their processes helps you speed your re-submissions. After a claim file is sent to the clearinghouse, an edit report is sent back to the practice, indicating claims and charg… For more,...
Modifiers 52 and 53 vs. 73 and 74
Modifier 52, Reduced Services and Modifier 53, Discontinued Procedure apply to physician services while Modifiers 73 and 74, Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia and Disc… For more,...
E/M Documentation by Med Students Rules Clarified
The Centers for Medicare & Medicaid Services (CMS) issued a MLN Matters article ( MM10412 Revised) on May 31 with a retroactive effective date of January 1, 2018 clarifying documentation requirements when performed by Medical Students in a teac… For more,...
Audiology Technician Billing
Medicare stipulates precise requirements for billing audiology technicians’ services. As outlined in the Centers for Medicare & Medicaid Services’ (CMS) Transmittal 84 in February 2008, these requirements are distinct from those governing audiolog… For...
Coding 3 or 4 Sinuses Using FESS Codes
A lot of people have been asking questions about how to code FESS surgeries with the new combination codes when three or four sinuses are operated on. Sinus and FESS We have been expecting an AMA CPT® Assistant article with guidance this year, but no … For more,...
Denials Management for the Medical Coder
Managing denials is more difficult in 2018 than it was in 2005, 2000, or 1998. Not because practices are necessarily receiving more denials from payers but because unlike the early to mid-2000s and 1990s, we are now posting payments via auto remit pro… For more,...
Advocacy to Change 31241’s Pay to Outpatient
Advocates are seeking to convince the Centers for Medicare & Medicaid Services (CMS) to pay for outpatient care of patients receiving 31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery. The new code for 2018 was assigned… For...
Coverage Expands as Six Health Systems Combine
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,...
Blue Cross of Mich. Reverses Decision
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,...
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