Coding

Establishing Medical Necessity for E&M Services(1) - 06/28/2022

With few exceptions, Medicare — and private health plans — pay only for medically reasonable and necessary services. Be sure that your documentation supports the E&M

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.

Practice e-Tips on Coding - 12/03/2021

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

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.

Coding and Documentation Check-Ups - 08/25/2021

An abbreviated review of claims coding and medical record documentation is performed by a professional coder and auditor to provide a glimpse into a physician’s coding techniques.

Coding and Documentation Training - 08/25/2021

Training can provide an in depth understanding of federal guidelines and establish criteria for appropriate charge capture. Accurate coding and documentation can reduce your liability exposure and your risk for audits.

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.

New Code Accounts for Certain Additional Expenses During Public Health Emergencies - 09/10/2020

The American Medical Association has released a Current Procedural Terminology (CPT) code for reporting additional practice expenses incurred during a public health emergency, including the COVID-19 pandemic.

E&M Coding Changes Among Major CPT Revisions for 2021 - 09/08/2020

The American Medical Association last week released its 2021 Current Procedural Terminology (CPT) code set, which includes major revisions to office and other outpatient evaluation and management (E&M) services designed to decrease physician documentation requirements.

Live Webinar to Help You Prepare for 2021 E&M Coding Changes - 09/01/2020

If you want to learn more about evaluation and management (E&M) coding changes that go into effect Jan. 1, tune in to a live Texas Medical Association webinar: 2021 E/M: Ready Set Go!

E&M Coding About to Change - 08/03/2020

First, the bad news: Physicians need to take some serious time between now and Jan 1, 2021, to study changes that are coming to Medicare outpatient evaluation and management (E&M) codes – changes most private insurers likely will follow. Now the good news: The changes should reduce the amount of documentation needed with each patient.