The Centers for Medicare & Medicaid Services (CMS) has announced it is revising the method for calculating payment for incomplete colonoscopies billed with modifier -53. Effective January 1, 2016, the new payment rates will apply when modifier -53 (discontinued procedure) is appended to Current Procedural Terminology (CPT) codes 44388, 45378, G0105 and G0121. As CMS […]
CMS Issues 2016 HCPCS Update
The Centers for Medicare & Medicaid Services (CMS) has posted its final Level II HCPCS application determinations for 2016. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, […]
2016 CPT Gastroenterology Coding Sheets: Colonoscopy and ERCP
The American Society for Gastrointestinal Endoscopy (ASGE) has published two new coding sheets in order to assist practices in understanding and implementing GI-specific coding. As ASGE notes, the purpose of the coding sheet is to “provide a high level overview to support practices as they prepare for 2016.” Coding sheets are available for: Colonoscopy (CPT […]
Chiropractors: Check Out These ICD-10 Myths and Facts
The American Chiropractic Association has published a new infographic focused in ICD-10 myths. The infographic, which can be viewed by clicking here, shares several myths, including: Doctors should not waste time on ICD-10 implementation. A bill, if passed, would allow for a transition period of “dual reporting,” allowing organizations to bill both ICD-9 and ICD-10 […]
Medicare Identifies Improper Payments Associated With Extracorporeal Shock Wave Lithotripsy
Medicare has disclosed the primary cause for improper payments associated with extracorporeal shock wave lithotripsy (ESWL). This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors and other governmental organizations, such as […]
CMS Discusses Payment Errors Associated With Co-Surgeon Modifier -62
The Centers for Medicare and Medicaid Services (CMS) recently released a Medicare Learning Network podcast intended to clarify CMS’s existing policy regarding payments errors because of a failure to apply properly the co-surgeon modifier -62, when two or more surgeons of different specialties participate in one operative session and each separately submit claims to Medicare. […]
CMS Provides Clarification on the Use of Modifiers When Billing “Wrong Surgery on a Patient”
The Centers for Medicare and Medicaid Services (CMS) recently released a Medicare Learning Network podcast which was intended to clarify the correct use of certain HCPCS modifiers, specifically when billing for wrong surgery on a patient. CMS discussed the HCPCS modifier -PC (Wrong Surgery on Patient), which was established in CR6405 (pdf), along with two […]
FAQs About CPT Coding and Reimbursement for Psychiatrists
Following substantial changes to the current procedural terminology (CPT) psychiatry codes, the American Psychiatric Association updated its frequently asked questions (FAQs) about coding and reimbursement for psychiatrists. The update occurred in March. If your organization performs mental health billing and coding, these FAQs may be a valuable resource to review. The following are the questions […]
ICD-10 Allergy and Immunology Coding Resources
The American Academy of Allergy, Asthma & Immunology (AAAAI) offers a robust collection of information and resources to designed to help practicing allergists/immunologists properly follow ICD-10 rules. As the AAAAI notes, if your practice performs allergy billing and coding, the conversion from ICD-9 to ICD-10 was rather seamless for some diagnoses but more complicated for […]
17 FAQs About Billing Medicare for Chronic Care Management Services
The Centers for Medicare & Medicaid Services (CMS) has released a new, special MLN Matters article (pdf) on chronic care management (CCM) services frequently asked questions. Here are the 17 FAQs — and their answers provided by CMS — regarding billing CCM services to the physician fee schedule (PFS) under CPT code 99490. 1. CPT […]