Table of Contents CPT® HCPCS Modifiers NCCI Multiple procedures Fee calculation Global surgical payment Diagnosis … [Read more...]
Imaging guidance as part of a procedure
Question: A colleague and I are trying to figure out the best way to think about imaging guidance versus ultrasound guidance (in this case for PICC … [Read more...]
Medicare National Coverage Determination (NCD) for Ambulatory Blood Pressure Monitoring (ABPM): CPT® and ICD-10 Coding
CMS released an NCD for ABPM on July 2, 2019. CMS has expanded the coverage for ABPM by allowing it for a greater range of BP measurements. Of course, … [Read more...]
Physician specialty codes and claims processing
When physicians enroll in Medicare, they self-elect their specialty designation. In the enrollment process, there are fields to indicate primary and … [Read more...]
NGS changing processing of same day NP/PA claims
Is NGS your MAC? Did you see their announcement that for claims processed on or after Sept 15, 2018, they will no longer deny claims for a second … [Read more...]
Fee-for-service medicine | The rumors of my death have been greatly exaggerated!
Let me start with apologies for stealing Mark Twain’s words! And, a quick search will show I'm not the only one to apply these words to … [Read more...]
Two visits for the price of one? | Multiple medical visits on the same day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel … [Read more...]
Diagnosis Coding | Not just for claims anymore
Physician claims paid based on CPT®, are often denied based on diagnosis codes Physicians use CPT® or HCPCS codes to tell the payer WHAT was done … [Read more...]
Who is responsible for coding physician services? The medical provider or the coder?
Legally, when a physician, physician assistant (PA) or nurse practitioner (NP) enroll in a Medicare, Medicaid or commercial insurance, the … [Read more...]
OB Coder Survey | Billing extra visits during pregnancy
Thank you to the 63 generous coders and billers who answered my questions about billing extra OB visits during the maternity period. If we and our … [Read more...]
Skin Test for Tuberculosis (PPD)
How do we bill for placing the skin test for tuberculosis? To bill for placing the purified protein derivative (PPD) skin test for tuberculosis, use … [Read more...]
My payer doesn’t follow CPT® rules. What am I to do?
Why Are Medical Claims Denied? Most medical claim denials in practices aren’t related to coding. Medical claims are most frequently denied because … [Read more...]
Facility versus Non-Facility in the Physician Fee Schedule
CMS develops and publishes the Physician Fee Schedule in November of each year, as part of the Physician Fee Schedule Final Rule The fee schedule … [Read more...]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies. Private payors publish their own … [Read more...]
How Fees are Set in the Medicare Fee Schedule
How does Medicare calculate payments? This overview provides information and examples to explain how fees are set in the Medicare Fee Schedule. … [Read more...]
Secrets of the Medicare Fee Schedule
The Medicare Fee Schedule is much more than Relative Value Units! It is the source of global days and status indicators. It tells if a service can be … [Read more...]
How Physician Services are Paid – Infographic
CPT® Codes for Medical Reimbursement CPT® codes, HCPCS, modifiers, global surgical packages, CMS formulas, diagnosis codes, location, and more...how … [Read more...]
How Physician Services are Paid
Have a new staff member or physician who needs a primer on "how physician services are paid?" This short video is a must see! Learn how all the pieces … [Read more...]