Coding

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.

Practice e-Tips on Coding - 10/19/2022

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

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.

Code Carefully for Bilateral Procedures - 10/27/2021

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.

Know When to Use Modifier 26 in Medicare Claims - 04/01/2021

When Medicare procedures have both professional and technical components, modifiers 26 and TC may come into play. Don’t delay payment by forgetting to add modifier 26 when needed.

Use Modifier AT With Tetanus Vaccine - 03/24/2021

For Medicare claims, to report the tetanus vaccine administered for  treating an injury or direct exposure to a disease or condition, append modifier AT to the code for the vaccine.

Need Billing and Coding Help? Visit TMA’s New Educational Quick Tips Website - 03/18/2021

The Texas Medical Association’s reimbursement specialists understand how quickly information changes, and are here to help you stay stay up to date with a new webpage that features educational quick tips on a variety of practice help topics.

Use Transitional Care Management CPT Codes - 03/18/2021

Two new CPT codes for transitional care management services are in effect, and Medicare accepts them. But read the Medicare rules carefully because they vary from the CPT guide.

Low-Level Code May Have High Misuse - 02/26/2021

It’s been called the “nurse visit” code, and also “the most abused code in the CPT book.” Do you use 99211 correctly?

List Cost on Medicare Radiopharma Claims - 02/05/2021

When billing Medicare for radiopharmaceutical procedure codes, you must list the total acquisition cost on the claim.

Timing for Annual Medicare Mammograms - 11/20/2020

Medicare counts 11 full months after the month in which the patient received her screening

AMA Creates CPT Codes for Combination COVID-19/Flu Tests - 10/15/2020

The American Medical Association (AMA) has created two new Current Procedural Terminology (CPT) codes for multi-virus testing to detect COVID-19 and influenza.

How Health Plans Are Covering COVID-19 Testing and Treatment - 10/09/2020

Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.

Aim for Accuracy in Claims - 09/22/2020

Did you make one of the nearly 1.7 million annual requests to correct minor errors or omissions on a Medicare claim? Novitas Solutions has a new initiative to help you avoid the time and hassle of making corrections.