Coding

Payers Axe Consultation Codes - 08/07/2019

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.

Get Dates of Service Right on Medicare Claims - 05/30/2019

When you a perform a Medicare service that is global, has both a professional and a technical component, or spans days or months, you need to know what date Medicare considers to be the official date of service when you file your claim. Here is some guidance from the Centers for Medicare & Medicaid Services (CMS) about coding and billing dates of service on professional claims.

Use Modifiers to Override Correct Coding Initiative Edits - 05/28/2019

Correct Coding Initiative Edits Now Free on Internet

Medicare X{EPSU} Modifiers Further Define Modifier 59 - 05/24/2019

The Centers for Medicare & Medicaid Services has established four new modifiers to define subsets of the commonly — but often mistakenly — used modifier 59.

Medicare Critical Care and Initial Hospital Services E and M Slated for Review - 05/17/2019

If you’ve been “probed and educated” twice by Novitas Solutions Inc. for high rate of claims errors regarding certain evaluation and management (E&M) services, you may receive more such review and education this summer.

Code Carefully for Bilateral Procedures - 05/02/2019

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.

Use New G Codes for Medicare Therapy Claims - 03/04/2019

Starting with services dated Jan. 1, 2013, physicians have to report new, nonpayable G codes and related modifiers on Medicare claims for outpatient physical, speech, and occupational therapy.

Coding Changes Affect UnitedHealthcare Prior Authorization Lists - 02/22/2019

UnitedHealthcare (UHC) has replaced and added procedure codes on its notification and prior authorization (PA) lists.

Cornered: Proposed Medicare Fee Overhaul Could Box In Doctors - 02/05/2019

Proposed overhaul to Medicare payments for complex patient care visits and same-day office-based procedures could box in Texas physicians.

Use Transitional Care Management CPT Codes - 01/10/2019

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.

Coding and Documentation Review - 12/19/2018

An in-depth review of medical record documentation and claims coding that identifies deficiencies and areas of risk. This review will help streamline coding and documentation processes and decrease the risk of external audits.

United to Add Lab, Change Lab and Other Policies - 10/04/2018

Starting Jan. 1, 2019, UnitedHealthcare will use Quest Diagnostics, in addition to LabCorp, as in-network laboratories for all UHC members (excluding existing lab capitation agreements).

Responsibility for Coding - 09/18/2018

Remember, physicians ultimately are responsible for choosing which code s the practice bills to insurance carriers.

TMA to Feds: EHRs Must Talk to Each Other - 06/27/2018

The Texas Medical Association is pushing the Centers for Medicare & Medicaid Services to make sharing patient information through electronic health records safer, faster, and cheaper.

Practice e-Tips on Coding - 06/01/2018

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

Guidelines for Medicaid Radiology Prior Authorization - 05/03/2018

Texas Medicaid requires prior authorization for outpatient diagnostic radiology services. Follow these guidelines to help you sail through the process.

Zika Virus Testing — New Medicaid Instructions for Laboratories and Ordering Physicians - 05/03/2018

Laboratories must use a U4 modifier when submitting Medicaid claims for Zika virus testing, the Texas Medicaid and Healthcare Partnership announced on May 5.

Use Modifier AT With Tetanus Vaccine - 04/26/2018

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.

Blue Cross Targeting Modifier 50 Misuse - 04/19/2018

Beginning April 1, 2012, Blue Cross and Blue Shield of Texas (BCBSTX) will pursue overpayments it made for claims wrongly billed with modifier 50.

E&M Coding — Are You Under, Over, or on Target? - 04/17/2018

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

How to Increase Your Income by Thousands - 01/26/2018

This investment may be the most cost-effective way to raise your practice’s income.

Establishing Medical Necessity for E&M Services - 10/20/2017

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

E&M Coding Advice - 10/20/2017

Try this highly simplified but very useful “bottom-line” evaluation and management coding advice.

E&M Coding and Billing Still Trip Up Practices - 08/31/2017

Would your Medicare evaluation and management (E&M) coding and “incident to” billing stand up to close scrutiny? Here’s why you should start paying closer attention to these types of claims to avoid denials.

Medicine Fights Proposed Medicaid Specialty Care Cuts - 06/01/2017

As it does every two years, the Texas Health and Human Services Commission’s (HHSC's) Rate Analysis Department is reviewing CPT codes and making adjustments to the payments for those services. This time, the HHSC is proposing cuts in Medicaid payments for cardiovascular, gastroenterology, and robotic prostate surgery services. The problem is, practice costs are expected to increase in the coming years.