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No new conversion factor and PQRS requirements addressed in proposed fee...

Payments set until AprilThe “doc fix” implemented April 1 had a 0% update through March 31, 2015, leaving the conversion factor at $35.8228. CMS didn’t include a new conversion factor in the proposed...

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Pay for chronic care management easier in proposed fee schedule

A program to pay for chronic care management (CCM) that CMS proposed last year has undergone changes in the proposed 2015 Medicare physician fee schedule: While the new rules make it easier to fulfill...

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CMS sketches out ICD-10 testing schedule, finalizes Oct. 1, 2015 start date

Practices will have expanded access to ICD-10 testing next year, including three opportunities each for acknowledgement and end-to-end testing, CMS said. You’ll be able to test whether a claim with...

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Make sure PCI is documented during myocardial infarction to report 92941

Answer: Your doctor was correct not to report 92941 for this case, confirms coding consultant Terry Fletcher, BS, CPC, CCC, CEMC, CCS-P, CCS, CMSCS, CMC in Laguna Beach, Calif.If you read the code...

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Pay for chronic care management easier in proposed fee schedule, part 2

More good news for practices who offer transitional care management (TCM) services: CMS proposed similarly amending the direct-supervision requirements for those codes (99495-99496). But the E/M...

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CMS sketches out ICD-10 testing schedule, finalizes Oct. 1, 2015 start date,...

Timely, detailed test results are key End-to-end testing is where providers will find out whether their claims will be paid or denied with ICD-10 codes, says consultant and former CMS official Stanley...

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Read payer policies closely when doing radiofrequency for knee OA

Question: One of our doctors is looking into performing minimally invasive genicular nerve ablation procedures and wants me to research the CPT codes and Medicare reimbursement. The procedure uses a...

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Code encounter type, placeholders for ear or nose foreign body

When treating a patient with a foreign body in the ear or nose, your clinicians will need to document laterality for ears and whether the visit is an initial, follow-up or late effect for accurate...

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Don’t bet on payment for epithelial ingrowth, a complication of LASIK

Question:  My ophthalmologist is planning surgery to correct a case of epithelial ingrowth using the following procedure: “The procedures is flap lift, removal of epithelial ingrowth and suturing of...

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PQRS: Prepare for more requirements, cuts to claims-based measures

The quality reporting changes in the proposed 2015 physician fee schedule are so drastic that medical practices should start working on their quality reporting game plan now, a health care consultant...

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Code each lesion shaved separately when reporting series 11300-11313

Question: My physician did a shaving of two separate epidermal lesions on a patient’s chest and abdomen. One lesion measured 0.8 cm and the other was 1.4 cm. Would we add lesion sizes together to...

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Follow these 5 tips on modifier 25 to correctly bill separate E/M services

When a patient in for a procedure requires additional services, you’ll want to make sure same-day E/M services are distinct and documented comprehensively to avoid a modifier 25 denial, which accounts...

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Get to know ‘sequelae’ to code late effects in ICD-10

Coders must learn some new terminology as part of their understanding of ICD-10-CM. In some cases, the concept in ICD-10 is similar to ICD-9, but the term used is different. For example, in ICD-9-CM,...

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Submit additional documentation to support dry needling services

When a provider indicates he performed a trigger point but did not inject drugs, prepare to submit his procedure report with the claim because you’ll use an unlisted code to report the visit. Dry...

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Code intersection syndrome as tenosynovitis of the wrist in I-9, I-10

Question: What diagnosis code would you use for intersection syndrome of the wrist? Answer: Intersection syndrome is another term for tenosynovitis of the radial wrist extensors, according to Medscape....

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Document key elements during initial contact with patient to get paid for TCM...

Question: I’m confused about the initial point of contact with the patient when using the transitional care management (TCM) codes 99495 and 99496. Is documentation of the details of the call required...

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Ensure that doctors note specific tobacco products for ICD-10

Submitting the tobacco-cessation counseling codes in ICD-9 means selecting between two tobacco-use diagnosis codes. In ICD-10, you’ll have nine to choose from. In ICD-9, you use diagnosis code 305.1...

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Drug screen FAQ – 5 answers for presumptive tests, immunoassay definition

Clear up your confusion about how to report the new drug screen codes to private payers that use the CPT codes. The new presumptive codes don’t crosswalk to the qualitative codes providers used in...

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ICD-10 tip: Master migraine coding

Take note of the number and duration of a patient’s migraines to properly code them in ICD-10. Here’s a scenario to illustrate the point: A 32-year-old female presents to the pain management clinic for...

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3 ways ICD-10-CM crosswalks can cause problems with your diagnosis coding

Be careful if you plan to rely on mapping tools to select the correct ICD-10-CM codes as part of your transition to the new code set. Not only do these tools, such as General Equivalency Mappings...

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