Coding

CMS to Implement Street Medicine Code - 10/25/2023

Following advocacy from the Texas Medical Association and medical student members, the Centers for Medicare & Medicaid Services (CMS) created a place of service code for street medicine, making it possible for physicians to get paid for services provided to people who are currently unhoused effective Oct. 1.


Code Carefully for Bilateral Procedures - 10/04/2023

Coding for bilateral procedures can be confusing. Many payers accept CPT modifier 50 as an indicator of a bilateral procedure, but they differ in how they apply it to their coding and payment policies.


Billing Errors to Avoid: Pulmonary, Mohs Procedures - 08/21/2023

Medicare audits have revealed recurring errors in billing for pulmonary procedures and Mohs surgery. Here are some guidelines for correct billing.


Medicare Coding Errors to Avoid: Add-on, Place of Service, and Modifiers - 08/21/2023

Medicare audits have revealed recurring errors in billing with add-on and place-of-service codes as well as claims that appear to be duplicate because they lack an appropriate modifier. Here are some guidelines for correct billing.


Use Modifiers to Override Correct Coding Initiative Edits - 08/21/2023

Correct Coding Initiative Edits Now Free on Internet


More Medicare Payment Updates for 2015 - 08/21/2023

Find out changes affecting pneumococcal vaccine, preventive and screening services, and new waived tests, plus a revalidation tip and how to learn more about Physician Compare.


Payers Axe Consultation Codes - 07/25/2023

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.


E&M Coding — Are You Under, Over, or on Target? - 07/20/2023

E&M Coding — Are You Under,Over,or on Target?


Document Time for Psychotherapy Services - 07/20/2023

Year-old changes in psychiatry and psychotherapy CPT codes are still tripping up physicians. According to Medicare, distinguishing between evaluation and management services and psychotherapy is the key.


Practice e-Tips on Coding - 07/20/2023

Get practice tips on all things coding. Learn about coding methods, correct coding, resources, coding related to Workers' Comp and more.


Quality of Life: Pay-for-Quality Programs Increasingly Address Nonmedical Drivers of Health - 07/10/2023

Insurance payers seldom give physicians incentives to address nonmedical drivers of health, especially in traditional fee-for-service payer contracts. Those incentives remain rare even in pay-for-quality programs that emphasize value-based care, but they are gaining traction.


CMS To Deny Incomplete Claims on Discarded Drugs Starting in October - 06/22/2023

Starting Oct. 2, the Centers for Medicare & Medicaid Services (CMS) will kick back certain claims involving discarded or unused drugs if practices fail to implement a new billing and coding policy the payer has been phased in since the beginning of the year.


Cigna Delays Problematic Modifier 25 Policy - 05/31/2023

Cigna will delay its demanding requirement for physicians to submit additional documentation for routine, minor procedure claims after the Texas Medical Association, American Medical Association, and dozens of other medical organizations urged the payer to immediately rescind the policy in April.


Medicine Urges Cigna to Withdraw Far-Reaching Modifier 25 Policy - 05/03/2023

Demonstrating the far-reaching impact of a new Cigna policy, the Texas Medical Association joined organized medicine and other health professionals in collectively and vociferously calling on the payer to “immediately rescind” an onerous requirement for additional documentation for routine, minor procedure claims starting in June.


Update: New Cigna Policy Requires Additional Documentation for Same-Day Procedures - 04/03/2023

Despite medicine’s pushback, Cigna plans to move forward with burdensome billing policy requiring additional documentation for routine, minor procedure claims starting in June.


Prevent Improper Code Bundling With New Medicare Tool - 02/15/2023

Physicians can take advantage of a new Medicare tool to sort through the thousands upon thousands of service codes that can be bundled together for claims payment – and avoid improper billing.


Check Claims Dates for Drug Administration as Coding Updates Loom - 12/02/2022

With annual updates to billing codes for medications set for Jan. 1, physicians are reminded to use the most current National Drug Code (NDC) and Healthcare Common Procedure Coding System (HCPCS) combinations when filing claims for drug administration.


E/M Revisions in 2023 CPT Code Set Aim to Simplify Documentation - 11/02/2022

In an effort to continue to tamp down physicians’ administrative burden, the American Medical Association has revised the codes and guidelines for most evaluation and management services in its 2023 Current Procedural Terminology code set.


Does Your Documentation Support Modifier 25? - 07/26/2022

Are your claims with evaluation and management (E&M) codes being denied when billed with modifier 25? TMA receives many inquiries from practices about such denials. Not only are some insurance carriers now requiring practices to submit medical records with a modifier 25, but also they often then deny the claim, saying documentation doesn’t support the use of modifier 25.


About Nurses as Assistants at Surgery - 06/22/2022

Learn what a first assistant nurse is, and how to bill when they assist during surgery.


Health Plans Not All Recognizing New Telehealth Code - 04/05/2022

A new telehealth code and a series of coding modifier descriptors have already taken effect in 2022 or will take effect soon. But not all health plans are recognizing the new coding elements, according to Texas Medical Association staff monitoring their status.


CMS Debuts Coding Changes for Telehealth - 03/10/2022

The Centers for Medicare & Medicaid Services (CMS) will implement a new place of service (POS) code related to telehealth and update an existing one on April 4. POS codes refer to where medical services are provided. These changes will affect Texas physicians caring for Medicare patients.


The X{EPSU} Modifiers Further Define Modifier 59 - 12/27/2021

Modifier 59, the distinct procedural service modifier associated with Medicare National Correct Coding Initiative edits, is one you might find confusing (many practices do). Follow these guidelines


New Patient Visit: Three Years Is a Key - 12/03/2021

Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.


Correct Code for Billing a Routine Venipuncture - 11/17/2021

Learn the correct code for billing a routine venipuncture.