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Expert Q&A: HIPAA audits, cybersecurity, patient record access and more

07/04/2022

Question: What are some ways we should prepare for a HIPAA audit from the Office for Civil Rights (OCR)?

Consider payer preferences when debating modifiers LT/RT and 50

07/04/2022

Question: I am confused about procedure modifiers pertaining to sides of the body and when to use them. What are the main differences between modifiers LT (Left side), RT (Right side) and modifier 50 (Bilateral procedure)?

Cigna revises modifier 25 policy, targets unbundled office visits

07/04/2022

by: Julia Kyles, CPC

Cigna’s plan for unbundled office visits is likely to increase your paperwork and slow reimbursement.

Modifier LT, RT claims outpace bilateral procedures

07/04/2022

by: Richard Scott

Practices were far more likely to report a right- or left-side service over a bilateral procedure in 2020, although they faced a bit more resistance in getting their side-specific claims paid than before.

FY2023 ICD-10-CM guideline updates cover dementia, underdosing

06/27/2022

by: Julia Kyles, CPC

Now that the revised diagnosis code set is out, don’t forget about the official coding guidelines. On June 10, along with the thousands of ICD-10-CM code updates, the CDC issued the 2023 Official Guidelines for Coding and Reporting.

Suit against ‘anti-racism plan’ MIPS activity likely to fail: Experts

06/27/2022

by: Roy Edroso

A lawsuit brought by a pair of doctors in Mississippi claiming that the new “create and implement an anti-racism plan” improvement activity (IA) in the Merit-Based Incentive Payment System (MIPS) is unconstitutional and should be removed is unlikely to prevail in courts, experts tell Part B News.

Quarterly CCI edits boost allowable prolonged services time

06/27/2022

by: Richard Scott

You’ll have the opportunity to report additional prolonged service units when Correct Coding Initiative (CCI) version 28.2 edits take effect July 1.

Use definitions, doctor’s work to prepare for 135 new endometriosis codes

06/27/2022

by: Julia Kyles, CPC

The next ICD-10-CM update, released June 10 with an effective date of Oct. 1, includes 135 new codes for endometriosis that are based on location, laterality and depth.

PAs, NPs beat AMA in House on federal workers’ comp. role

06/27/2022

by: Roy Edroso

The U.S. House passed a bill expanding the rights of physician associates (PA) and nurse practitioners (NP) — albeit in a limited way — over the objections of the AMA, offering further evidence that the strength of these non-physician providers in U.S. health care continues to grow.

Provider response is mixed when category III codes become permanent

06/27/2022

by: Julia Kyles, CPC

When the AMA replaced 10 temporary category III codes with 14 permanent category I codes in 2019, providers generally — but not always — boosted their reporting of the replacement codes. The category III codes, also known as T codes, were carrier-priced, which means that each Medicare administrative contractor (MAC) decides whether it will cover the service and how much it will pay on a case-by-case basis. Permanent codes are usually assigned an active payment status.

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