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Watch federal ‘network adequacy’ standards for ACA plans

05/09/2022

On April 28, CMS released the 2023 Notice of Benefits and Payment Parameters Final Rule, which issued new provisions for health plans operating on the federally-facilitated marketplace (FFM). The rule may serve to buoy access to physician providers, but in the longer term it could also have implications on your patient intake policies.

Unpack CPT coding for implant and foreign body removals

05/09/2022

by: Sarah Gould

When coding for removal or insertion, it’s imperative to understand the difference between a foreign body and an implant, and coders must be familiar with new CPT definitions for implants and foreign bodies that went into effect Jan. 1.

No time limit on incident-to billing if problems are unchanged

05/09/2022

by: Richard Scott

Question: I read your recent article about incident-to billing. One of my practitioners has a question I am unable to answer. Is there a time limit on what is considered a new problem? For example, if a patient is not treated for a particular problem in over a year, is it now considered a new problem? Please advise.

Hospital code use took double-digit hit in 2020, but denials stayed light

05/09/2022

by: Roy Edroso

Like many other services, hospital inpatient and observation numbers took a hit in the first pandemic year of 2020. But providers performed better in getting their claims accepted than before.

CMS adds flexibilities to final Aduhelm NCD, but usage could be rare

05/02/2022

by: Roy Edroso

CMS’ final national coverage determination (NCD) on the Alzheimer’s drug Aduhelm may provide a clearer path to use, but critics warn the way CMS handled the approval issues could presage problems with other big-ticket drug decisions down the line.

ABN guide: How to apply HCPCS modifiers for non-covered services

05/02/2022

by: Sarah Gould, CPC

When you know a service will not be covered under Medicare, you are required to issue an advance beneficiary notice of non-coverage (ABN). Sharpen your modifier know-how so that you can accurately report claims when an ABN is involved.

T is for telephone: Appendix T lists 38 audio-only CPT codes

05/02/2022

by: Julia Kyles, CPC

You won’t find the new appendix for audio-only services in the print version of your CPT manual until the 2023 edition. But Appendix T (CPT codes that may be used for synchronous real-time interactive audio-only telemedicine services) went into effect April 1 and was added to the electronic version of the CPT manual in March.

CMS releases Moderna booster codes after FDA approval

05/02/2022

by: Richard Scott

As the COVID public health emergency endures, you’ll find a new code that you can report when providing a Moderna booster shot, along with a complementary administration code.

Didn’t get discharge data? Sorry, you can’t charge TCM

05/02/2022

by: Roy Edroso

Question: We performed transitional care management (TCM) on a patient who had been discharged as an inpatient by a provider from a different practice. When our claim went in, the payer did not have the discharge summary on file and denied our claim. What can we do?

Turn to Q codes, modifier JW for discarded CTP products

05/02/2022

by: Sarah Gould, CPC

Question: How do you code and bill for wound debridement involving the disposal of unused cellular-based tissue product (CTP)?

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