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Repeating a test? Check with your MAC, use correct modifier and no do-overs.

02/17/2020

Question: We had to do a series of electrocardiograms (ECG) on a patient in the course of the same day. Is it appropriate to use modifier 76 (Repeat procedure or service by same physician) for this? Also, is 76 appropriate to use for other tests that are repeated for a patient?

Repeat modifier 76 works great in most cases – but sometimes wipes out

02/17/2020

by: Roy Edroso

Modifier 76 (Repeat procedure or service by same physician) is a pretty good bet in most cases, but there are a lot of codes for which it’s seldom or never accepted.

Revive infection control protocols to protect against emerging Coronavirus epidemic

02/10/2020

by: Roy Edroso

HHS announced Jan. 31 the novel Coronavirus virus – aka 2019-nCoV – that went epidemic in the Hubei province of China last year and has since been detected in a handful of cases here constitutes a public health emergency in the U.S. This is a cue for you to check and, if necessary, tighten infection control in your office.

Revive infection control protocols to protect against emerging coronavirus epidemic

02/10/2020

by: Roy Edroso

Secretary of Health and Human Services Alex Azar announced Jan. 31 that the novel coronavirus — aka 2019-nCoV — that went epidemic in the Hubei province of China and has since been detected in a handful of cases stateside constitutes a public health emergency in the U.S.

CMS allows coverage of genomic testing to go beyond advanced cancer diagnoses

02/10/2020

by: Jim Dresbach

Medicare will allow providers to harness a powerful DNA sequencing technology that can rapidly monitor a patient’s genome and pinpoint harmful disease characteristics — and the applications may extend well beyond cancer.

New Calif. law accelerates disclosure timeline against sexually predatory docs

02/10/2020

by: Roy Edroso

New, expansive requirements for reporting providers accused of sexual misconduct have become law in California, suggesting that the trend presaged by #MeToo could require practices to step up their reporting in other states as well.

Update: ICD-10-CM panel issues tabular instructions for new vaping code

02/10/2020

by: Laura Evans

When you encounter vaping-related injury or illness cases in a clinical setting, you are to report the new emergency vaping code, U07.0 (Vaping-related disorder), as the primary diagnosis, according to newly issued tabular guidance for the code from the ICD-10-CM Coordination and Maintenance Committee.

One genomic testing code skyrockets, another fluctuates, but denials remain lofty

02/10/2020

by: Jim Dresbach

As practices find expanded coverage of Next Generation Sequencing tests, two CPT codes used most frequently — 81432 (Genomic sequencing procedures and other molecular multianalyte assays) and 81445 (Targeted genomic sequence panel, neoplasm, 5-50 genes) — are on divergent paths.

Protect your patients from Medicare scams with proactive education, tips

02/03/2020

by: Jim Dresbach

Medical practices that want to protect their patients should pay close attention to fraudsters looking to make major, illegal dollars off Medicare in 2020. Officials warn that scams tend to escalate when health care is in the news, and since 2020 is an election year, you can expect an increase in scammers seeking to raid Medicare accounts.

Direct Contracting, launching soon, pushes practices to put more skin in the game

02/03/2020

by: Roy Edroso

The Direct Contracting (DC) demonstration model that CMS is rolling out brings some free-market features to Medicare, letting practices negotiate with providers on how much of the capitated payments they’ll receive. Experts think this represents a trend in CMS’ approach to value-based care.

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