There is an appropriate use for modifier 59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 minutes, per hour).
Read more »Proper Use of Modifier 59 after NCCI Update
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Use the Medicare National Correct Coding Initiative (NCCI) Tools
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The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment.
Read more »Medicare Proposed Changes for 2020 Physician Fee Schedule
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The changes for CPT also change the medical decision-making process for the codes, while requiring the performance of history and exam only as medically appropriate. CPT code changes also allow clinicians to choose the E/M visit level based on either medical decision-making or time involved.
Read more »Patients over Paperwork – CMS’s Approach to improve Patient Care
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The Omnibus Burden Reduction (Conditions of Participation) Final Rule strengthens patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers.
Read more »AMA Announces 2021 E/M Changes
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Medicare has published the 2021 E/M changes they intend to make and now, so has the AMA. We’ve all seen that when Medicare and CPT do not agree on the way in which a specific service, or group of services, should be reported, Medicare may produce HCPCS code(s) with specific guidance for Medicare contracted providers to follow.
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Basic Guidelines for Accurate Diagnosis Coding
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Medical coders are responsible for ensuring proper diagnosis coding for each procedure billed to an insurance company. Although most claims billers do not actually code diagnosis, they are often responsible for choosing the correct code for each claim. This article provides tips for accurate coding as well as information regarding diagnosis codes on claims.
Read more »ICD-10-CM Guidelines | Coding | Reporting FY 2020 | Respiratory System
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When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies to whether the other acute condition is a respiratory or nonrespiratory condition.
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Diagnostic Coding and Reporting Guidelines for Outpatient Services
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These coding guidelines for outpatient diagnoses have been approved for use by hospitals/ providers in coding and reporting hospital-based outpatient services and provider-based office visits. The terms encounter and visit are often used interchangeably in describing outpatient service contacts and, therefore, appear together in these guidelines without distinguishing one from the other.
Read more »Quantifying Your Medical Decision-Making
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This is the most important of the three key components because the Medical Decision-Making (MDM) reflects the intensity of the cognitive labor performed by the physician. There are four levels of MDM of incrementally increasing complexity Straightforward; Low Complexity; Moderate Complexity; and High Complexity.
Read more »New Medicare Beneficiary Identifiers (MBI)
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MBIs are required for all claims and transactions starting Jan. 1, 2020 (with few exceptions). Out with the old Health Insurance Claim Numbers (HICNs) and in with the new Medicare Beneficiary Identifiers (MBIs) as beneficiaries receive updated cards in advance of a Jan. 1, 2020, transition.
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