Health Information Management Articles by Topic: CPT Coding
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APC Payment Insider, Issue 12, December 1, 2009
In this issue examine how to properly bill for supplies to eliminate lost revenue.
Inside...
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Briefings on APCs, Issue 12, December 1, 2009
If you thought you understood CMS’ policy when it comes to physician orders for clinical...
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Briefings on APCs, Issue 12, December 1, 2009
Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...
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Briefings on APCs, Issue 12, December 1, 2009
Understand how to sift through detailed OB/GYN operative notes to ensure accurate code assignment.
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Briefings on APCs, Issue 12, December 1, 2009
In this issue, we examine outpatient coding challenges that facilities are still facing. We unravel...
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APCs Weekly Monitor, Issue 46, November 20, 2009
When coding OB/GYN procedures, remember that ICD-9 codes 630–679 in Chapter 11 (Complications...
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APCs Weekly Monitor, Issue 46, November 20, 2009
Q: Can our hospital code and bill telemetry daily monitoring in conjunction with a chest pain...
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HIM Connection, Issue 46, November 17, 2009
Clinical knowledge is an essential element for capturing severity and MS-DRG assignment, according...
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APCs Weekly Monitor, Issue 45, November 13, 2009
Q: A surgeon excises a lesion on a patient’s back, but fails to document its size or the...
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APCs Weekly Monitor, Issue 45, November 13, 2009
When considering ways to reduce revenue loss at your facility, don’t look just for big-dollar...
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HIM Connection, Issue 45, November 10, 2009
The 2010 OPPS final rule released on October 30 contains few surprises, but does finalize two...
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APCs Weekly Monitor, Issue 44, November 6, 2009
Q. Several of our facilities that include hospital-based outpatient wound care clinics have...
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APCs Weekly Monitor, Issue 44, November 6, 2009
If you perform a level IV surgical pathology (88305) on more than one specimen from the same...
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APC Payment Insider, Issue 11, November 1, 2009
Learn how to correctly use modifier -59 and when to avoid it.
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APC Payment Insider, Issue 11, November 1, 2009
Given the continuing confusion, what can facilities do to handle MUEs?
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APC Payment Insider, Issue 11, November 1, 2009
In this issue we unravel the mysteries surrounding medically unlikely edits.
Inside:
&bull...
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Briefings on APCs, Issue 11, November 1, 2009
Our experts answer questions about the appropriate use of modifier -59.
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Briefings on APCs, Issue 11, November 1, 2009
Condition code 44, billing for radiopharmaceuticals highlight I/OCE changes
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Briefings on APCs, Issue 11, November 1, 2009
This issue features the second part of our series on physician supervision requirements for...
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APCs Weekly Monitor, Issue 43, October 30, 2009
Q. A patient who has undergone a kidney transplant and has plasmapheresis intravenously receives IV...
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APCs Weekly Monitor, Issue 42, October 23, 2009
Q: A patient with multiple wounds at different sites receives active wound management at one wound...
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APCs Weekly Monitor, Issue 42, October 23, 2009
Facilities need to have a clear understanding of when a procedure is diagnostic and when it is...
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APCs Weekly Monitor, Issue 41, October 16, 2009
Q: We don’t have the usual written orders for several tests. However, physicians dictate or...
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APCs Weekly Monitor, Issue 41, October 16, 2009
In FAQ 8736, CMS instructs hospitals how to report units in excess of the medically unlikely edits...
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APCs Weekly Monitor, Issue 40, October 9, 2009
Coding a screening colonoscopy should be relatively straightforward. However, the interpretation of...
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APCs Weekly Monitor, Issue 39, October 2, 2009
Q: How should we assign CPT codes for an infusion of desferal at the same time as blood products...
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APCs Weekly Monitor, Issue 39, October 2, 2009
How can your facility ensure compliance with the physician supervision requirements for diagnostic...
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APC Payment Insider, Issue 10, October 1, 2009
Does CPT 36592 pertain to a pre-existing catheter (such as a PICC line) that is available for use...
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APC Payment Insider, Issue 10, October 1, 2009
CMS proposes new methodology to calculate drug APC payment rates.
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APC Payment Insider, Issue 10, October 1, 2009
Proposed changes to outpatient supervision could be a huge boon.
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Briefings on APCs, Issue 10, October 1, 2009
Coders must understand what constitutes a ‘screening’ colonoscopy.
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Briefings on APCs, Issue 10, October 1, 2009
Given the continuing confusion, what can facilities do to handle MUEs?
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Briefings on APCs, Issue 10, October 1, 2009
This issue features the first part of our series on physician supervision requirements for...
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APCs Weekly Monitor, Issue 38, September 25, 2009
CMS created medically unlikely edits (MUEs) to ensure that providers don’t report excessive...
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APCs Weekly Monitor, Issue 38, September 25, 2009
Q: Is elective cardioversion code 92960 billable in the ED? For example, a patient presents in the...
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APCs Weekly Monitor, Issue 37, September 18, 2009
Q: We understand that we cannot charge for the use of equipment, but can we charge for the soft...
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APCs Weekly Monitor, Issue 37, September 18, 2009
Under the 2009 OPPS final rule, bundling is now subdivided into status indicators Q1, Q2, and Q3.
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JustCoding News: Inpatient, Issue 38, September 16, 2009
Recovery audit contractors are scrutinizing coding accuracy, and the transition to ICD-10 is only a...
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JustCoding News: Inpatient, Issue 38, September 16, 2009
Physicians perform observation services when they monitor patients’ conditions. A patient...
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JustCoding News: Inpatient, Issue 38, September 16, 2009
On September 10, Connolly, the RAC for Region C, approved the following issues for review for...
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APCs Weekly Monitor, Issue 36, September 11, 2009
Q: Can we bill for supplies or implants that we opened but did not use? If so, how do we report...
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APCs Weekly Monitor, Issue 36, September 11, 2009
To distinguish between bundled and packaged services, remember that bundling applies to coding and...
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APCs Weekly Monitor, Issue 35, September 5, 2009
Q. A physician orders one dose of a medication to be administered intramuscularly (IM) or...
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APCs Weekly Monitor, Issue 35, September 4, 2009
In its 2010 OPPS proposed rule, CMS acknowledges never having specifically defined...
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CDI Strategies, Issue 18, September 3, 2009
Following a targeted review of 250 claims with DRG 247, TrailBlazer, the Medicare Administrative...
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CDI Strategies, Issue 18, September 3, 2009
Editor’s Note: The following tip was excerpted from the article “Tips for problematic...
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CDI Strategies, Issue 18, September 3, 2009
Editor’s note: The following Q&A first appeared in the August 20, 2009, edition of CDI...
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Briefings on APCs, Issue 9, September 1, 2009
In this issue, you will find an overview of the 2010 OPPS proposed rule, plus articles expanding on...
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Briefings on APCs, Issue 9, September 1, 2009
The text portion of the 2010 OPPS proposed rule is shorter than previous years’ rules, and...
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Briefings on APCs, Issue 9, September 1, 2009
Proposed changes to outpatient supervision could be a huge boon.
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Briefings on APCs, Issue 9, September 1, 2009
CMS proposes new methodology to calculate drug APC payment rates.
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Briefings on APCs, Issue 9, September 1, 2009
Several items of interest to OPPS hospitals from Open Door Forum call.
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Briefings on APCs, Issue 9, September 1, 2009
Q status indicators add to packaged vs. bundled confusion.
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Briefings on Coding Compliance Strategies, Issue 9, September 1, 2009
Robert S. Gold, M.D., helps coders decipher physician language in order to code hypertension and...
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APC Payment Insider, Issue 9, September 1, 2009
In this issue we look at how the new ICD-9-CM codes increase specificity.
Inside:
CMS...
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APC Payment Insider, Issue 9, September 1, 2009
CMS revised language to clarify outpatient observation services.
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APC Payment Insider, Issue 9, September 1, 2009
Physician can’t cross lesion to place noncoronary stent
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APC Payment Insider, Issue 9, September 1, 2009
What should you do if a physician can’t complete the procedure?
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APC Payment Insider, Issue 9, September 1, 2009
What should you do if a physician can’t complete the procedure?
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APC Payment Insider, Issue 9, September 1, 2009
Is charging a patient for a low level facility visit appropriate?
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APC Payment Insider, Issue 9, September 1, 2009
Make sure you include CPT and HCPCS codes for drugs
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APC Payment Insider, Issue 9, September 1, 2009
Know when to report an IV push of the same substance in ER
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APCs Weekly Monitor, Issue 32, August 21, 2009
Q: How should we code the following scenario: A patient arrives at the catheterization laboratory...
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APCs Weekly Monitor, Issue 31, August 13, 2009
Q: Is there a limit on how frequently patients may receive PET scans, such as 78815 (Tumor...
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APCs Weekly Monitor, Issue 31, August 13, 2009
No national guidelines for E/M leveling exist, so facilities must develop their own.
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APCs Weekly Monitor, Issue 30, August 7, 2009
Q. An APC edit states that 93005 (electrocardiogram, routine EKG with at least 12 leads; tracing...
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APCs Weekly Monitor, Issue 30, August 7, 2009
Coders need to be aware of a new set of E codes that detail injuries sustained by military...
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HIM Connection, Issue 31, August 4, 2009
On July 10, CMS issued Transmittal 1767 to change the description for revenue code 076X. The...
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HIM Connection, Issue 31, August 4, 2009
Despite several industry groups’ efforts to advocate for a moratorium on physician...
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Briefings on APCs, Issue 8, August 1, 2009
Facilities are failing to meet medical necessity requirements
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Briefings on APCs, Issue 8, August 1, 2009
In this issue, you will find information about the new updates to the ICD-9 codes and look at how...
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APC Payment Insider, Issue 8, August 1, 2009
In this issue we look at six questions you should ask when you evaluate coder productivity...
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APCs Weekly Monitor, Issue 29, July 31, 2009
Q: What are the guidelines for physician supervision for physical therapy/occupational therapy and...
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APCs Weekly Monitor, Issue 28, July 24, 2009
Q: I work in a hospital outpatient clinic setting. Has CMS issued a deadline for developing...
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APCs Weekly Monitor, Issue 28, July 24, 2009
Providers must ensure the medical necessity of procedures they perform. To reduce revenue loss...
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APCs Weekly Monitor, Issue 28, July 17, 2009
Q: We know we should append CPT modifier –25 to the visit level when one of our EDs or...
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APCs Weekly Monitor, Issue 28, July 17, 2009
When setting productivity goals, don’t forget to include non-coding responsibilities when...
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HIM Connection, Issue 28, July 14, 2009
Outpatient facilities and pharmacies hoping to see an increase in reimbursement for separately...
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APCs Weekly Monitor, Issue 27, July 10, 2009
Q: Which CPT code is appropriate for blood glucose monitoring with a device such as...
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APCs Weekly Monitor, Issue 26, July 3, 2009
Q: My question pertains to CPT code 96376 (therapeutic, prophylactic, or diagnostic injection...
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APC Payment Insider, Issue 7, July 1, 2009
In this issue we look at CMS’ recent decision to expand coverage of testing for obstructive...
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Briefings on APCs, Issue 7, July 1, 2009
For years, it has been a challenge for healthcare facilities to determine whether Medicare will...
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Briefings on APCs, Issue 7, July 1, 2009
As the current economic climate continues to constrict cash flow for consumers and payers alike...
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Briefings on APCs, Issue 7, July 1, 2009
In this issue, you will find information about how your facility can increase its revenue by...
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APCs Weekly Monitor, Issue 25, June 26, 2009
Q: How should we report hydration services that run past midnight into the next calendar day along...
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APCs Weekly Monitor, Issue 25, June 26, 2009
Establishing coding productivity standards is a necessary and challenging aspect of managing an...
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APCs Weekly Monitor, Issue 24, June 19, 2009
Q: My question pertains to critical care provided in an ER at a Level 1 Trauma Center. If a patient...
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APCs Weekly Monitor, Issue 23, June 12, 2009
Q: Please clarify the overlap between CPT code 97760 and the L-code. Precisely, when and...
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Briefings on APCs, Issue 6, June 1, 2009
CMS released its April 2009 quarterly update to the integrated outpatient code editor on March 13.
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Briefings on APCs, Issue 6, June 1, 2009
With increased ED volume and the demands of more complete documentation, now is the time to...
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Briefings on APCs, Issue 6, June 1, 2009
Inside:
Go electronic to improve compliant charge capture
Strong documentation puts OSA coverage...
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APC Payment Insider, Issue 6, June 1, 2009
CMS discussion of direct supervision requirements likely to spark more questions.
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APC Payment Insider, Issue 6, June 1, 2009
In this issue, we cover CMS’ updated clarifications regarding incident-to services and looks...
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APCs Weekly Monitor, Issue 21, May 29, 2009
Q: The nurse practitioner (NP) and physician assistant (PA) staff the off-campus clinic with...
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APCs Weekly Monitor, Issue 20, May 22, 2009
Q: What if your hospital doesn’t have a DME license? Do you still use only the L codes?
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APCs Weekly Monitor, Issue 20, May 22, 2009
The 2009 OPPS final rule further divided the Q status indicator into three subcategories, with...
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APCs Weekly Monitor, Issue 19, May 15, 2009
Q: A patient is seen in the ED for laceration repair and then returns for suture or staple removal...
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Briefings on APCs, Issue 5, May 1, 2009
Q. Is it appropriate to assign an IV injection code when facility nursing documentation does not...
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Briefings on APCs, Issue 5, May 1, 2009
Hospitals looking for more discussion about CMS? recent clarification of the direct supervision...
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Briefings on APCs, Issue 5, May 1, 2009
In 2008, CMS greatly expanded the number of packaged items and services payable under the OPPS...
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Briefings on APCs, Issue 5, May 1, 2009
As always, E/M levels must reflect resources consumed, and you still must have written policies and...
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Briefings on APCs, Issue 5, May 1, 2009
Inside:
Solve the twin problems of ED revenue loss and compliance risk
Overcome critical care...
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APC Answer Letter, Issue 5, May 1, 2009
Inside:
Blood procedures: Code correctly when the only service is specimen collection via...
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APC Payment Insider, Issue 5, May 1, 2009
Inside: Watch for changing physician supervision requirements: today’s oversight may be...
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APCs Weekly Monitor, Issue 18, May 1, 2009
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APCs Weekly Monitor, Issue 16, April 17, 2009
How you report what appear to be multiple initial scenarios depends on the documentation in the...
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APCs Weekly Monitor, Issue 16, April 17, 2009
Everyone knows that an immense amount of teamwork is necessary for a CDI program to truly be...
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APCs Weekly Monitor, Issue 16, April 17, 2009
Christina Benjamin, MA, RHIA, CCS, CCS-P, presents several compliance traps that coders should...
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APCs Weekly Monitor, Issue 14, April 3, 2009
An increase in the Medicare payment for bilateral procedures with a status indicator of T slipped...
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APC Answer Letter, Issue 4, April 1, 2009
Inside:
Charging for multiple ventricular leads
Quick coding quiz
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Briefings on APCs, Issue 4, April 1, 2009
It's often difficult for coders and providers to determine when it's appropriate to append modifier...
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Briefings on APCs, Issue 4, April 1, 2009
The departure of modifier -21 (prolonged E/M services), effective with the 2009 CPT Manual, isn't...
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Briefings on APCs, Issue 4, April 1, 2009
Five successive pieces of CMS guidance in the past year have altered the landscape. They are...
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APC Payment Insider, Issue 4, April 1, 2009
Inside: Control charge compression by knowing your costs, because consumer reaction may cost you...
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APC Payment Insider, Issue 4, April 1, 2009
Assuming you meet all other documentation and trauma status criteria, you may report the trauma...
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Briefings on APCs, Issue 4, April 1, 2009
Inside:
Watch for changing physician supervision requirements
Few changes to date in HCPCS...
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APC Payment Insider, Issue 3, March 27, 2009
This is the second of two articles on this year?s CPT changes, effective January 1. Part two covers...
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APCs Weekly Monitor, Issue 11, March 13, 2009
The NCCI manual instructions state that:
Procedures routinely performed as part of a comprehensive...
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APCs Weekly Monitor, Issue 10, March 6, 2009
Education alone is not a separate E/M service. However, it is customary to establish facility E/M...
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APC Answer Letter, Issue 3, March 1, 2009
Inside:
DME licenses
Giving supplies away? Here’s how to become a supplier
Nonchemotherapy...
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APC Payment Insider, Issue 3, March 1, 2009
Inside: CMS opens the door to outpatient HAC program CPT checkup: Review the major changes for...
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APC Payment Insider, Issue 3, March 1, 2009
At a December 18, 2008, listening session, CMS presenters discussed possibilities for extending the...
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APCs Weekly Monitor, Issue 9, February 27, 2009
It’s hard to think of a situation in which you would use modifier -58 in the ED
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Coding Educator, Issue 2, February 9, 2009
February is Low Vision Awareness Month, so I would like to take the opportunity to share a bit...
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APCs Weekly Monitor, Issue 6, February 6, 2009
New CMS guidance describes the processes for using unlisted CPT codes.
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Briefings on APCs, Issue 2, February 1, 2009
Pay attention to new details in all three categories of CPT codes For many coders, the Category II...
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APCs Weekly Monitor, Issue 5, January 30, 2009
Q&A: Why drug administration CPT codes are not hitting CCI edits.
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APCs Weekly Monitor, Issue 5, January 30, 2009
The Category II and Category III sections of the 2009 CPT Manual have seen many changes for 2009.
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HIM Connection, Issue 2, January 13, 2009
CMS revised its July 2008 RAC appeal update to include appeals statistics through August 31, 2008.
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APCs Weekly Monitor, Issue 2, January 9, 2009
The AMA has updated its list of errata to the 2009 CPT Manual.
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APCs Weekly Monitor, Issue 1, January 2, 2009
CPT coders face a lengthy list of changes for 2009. According to the American Academy of...
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APC Answer Letter, Issue 1, January 1, 2009
Inside:
Blood draw via hep lock
Cardiac catheterization: LIMA visualization
Fluoroscopy for...
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APCs Weekly Monitor, Issue 52, December 26, 2008
How to submit facility critical care claims for 2009
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APCs Weekly Monitor, Issue 50, December 12, 2008
For 2009, hospitals must continue to use their internally developed guidelines for ED and clinic...
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Coding Educator, Issue 12, December 1, 2008
December is national hand washing month. It does seem like there is a season for everything, but...
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APCs Weekly Monitor, Issue 47, November 14, 2008
You may report EKGs performed before or after cardiac catheterization with modifier -59. You cannot...
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APCs Weekly Monitor, Issue 46, November 7, 2008
Charge CPT procedure codes to inpatients under certain conditions
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Briefings on APCs, Issue 11, November 1, 2008
Differentiate transfers, flaps, and grafting procedures, and make use of new codes and any trick to...
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APCs Weekly Monitor, Issue 45, October 31, 2008
Use revenue code plus CPT, without HCPCS, to bill albuterol or Duoneb via nebulizer
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APCs Weekly Monitor, Issue 42, October 17, 2008
Dispel the assumption that an integumentary code is the only solution. Decipher complex repairs and...
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Briefings on APCs, Issue 10, October 1, 2008
On June 18, CMS issued MLN Matters article SE0821, a reminder that Medicare pays for diabetes...
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Briefings on APCs, Issue 10, October 1, 2008
Be aware of all your options when coding integumentary procedures so that you arrive at the most...
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Briefings on APCs, Issue 10, October 1, 2008
Editor’s note: Susan Garrison, CHCA, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, executive vice...
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APCs Weekly Monitor, Issue 39, September 26, 2008
Q&A: Follow the infusion hierarchy, not chronological order of administration, when reporting...
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APCs Weekly Monitor, Issue 38, September 19, 2008
Why we shouldn’t append modifier -53 to the procedure if the patient is in the room, we...
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APCs Weekly Monitor, Issue 36, September 5, 2008
Q: Is it inappropriate to bill all self-administered drug (SAD) charges as integral to a procedure...
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Briefings on APCs, Issue 9, September 1, 2008
Encoders are among the most valuable coding resources on the market, but software is just one tool...
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APCs Weekly Monitor, Issue 35, August 29, 2008
Report CPT code 45331 when a physician performs a sigmoidoscopy with biopsy. This code is...
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Coding Educator, Issue 8, August 1, 2008
Children do not come with instruction manuals, but there are many books available to help us along...
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APCs Weekly Monitor, Issue 24, June 13, 2008
There are many legitimate uses for modifier -59. But, with drug administration, as with other types...
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APCs Weekly Monitor, Issue 22, May 30, 2008
Part 2 of a 2-part series. See the May 23, 2008 APCs Weekly Monitor for the CMS stance on...
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APCs Weekly Monitor, Issue 22, May 30, 2008
Report code 90772 (therapeutic, prophylactic or diagnostic injection; subcutaneous of...
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APCs Weekly Monitor, Issue 21, May 23, 2008
Do CMS and the Office of Inspector General (OIG) consider the intentional unbundling of codes to be...
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APCs Weekly Monitor, Issue 20, May 16, 2008
We are negotiating to provide pain stimulator services. We will report code 63650 for the trial and...
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APCs Weekly Monitor, Issue 19, May 9, 2008
Lingering coding and billing difficulties, 2008 CPT/HCPCS changes, and OIG scrutiny promise to keep...
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APCs Weekly Monitor, Issue 19, May 2, 2008
We have had claims rejected for nuclear medicine procedures when we report both a procedure and a...
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APCs Weekly Monitor, Issue 18, May 2, 2008
It is not acceptable to make assumptions about duration of drug infusion therapy solely based on...