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Avoid denials with more specific diagnosis, documentation of anemia

04/29/2019

Providers tend to complain when they document a diagnosis of “anemia” and then receive a query from a payer requesting a more specific diagnosis. Such a query often causes frustration and yields a response like “anemia not otherwise specified” or “unable to determine.” To avoid queries for non-specific anemia diagnoses, brush up on documentation and coding requirements for different types of anemia in ICD-10-CM.

Radiation treatment codes decline in use in rocky regulatory environment

04/29/2019

by: Roy Edroso

Utilization of 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day) has been skyrocketing in recent years but CMS’ other radiation treatment codes have been going the other way.

Get ready for a sea of telehealth services under Medicare Advantage in 2020

04/22/2019

by: Richard Scott

Channel your tech savvy and prepare for a flight into the digital future now that CMS has loosened the reins on telehealth services for Medicare Advantage (MA) carriers in 2020.

New NCD promotes 24-hour BP readings – but be prepared to shell out to get in

04/22/2019

by: Roy Edroso

A proposed new national coverage determination (NCD) on ambulatory blood pressure monitoring (ABPM) may open up this service to a whole new subset of your patients – but also requires some investment on your part.

Prepare for a modifier 59 coding change that frees up pairing possibilities

04/22/2019

by: Richard Scott

You’ll soon find a reprieve when you turn to modifier 59 (Distinct procedural service) because you will be eligible to append the modifier to either code in a Correct Coding Initiative (CCI) bundled pair, CMS announced in a Feb. 15 transmittal.

Don’t bill for treating even extended family of the doctor — or her associates

04/22/2019

by: Roy Edroso

Question: In the “Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household” section of the Medicare Policy Manual, CMS lists several categories of persons whose treatment cannot be billed to Medicare when the related provider treats them. But if a doctor who is not related to me supervises my treatment, but the NPP who actually performs the treatment incident-to is related to me, can the doctor charge for that? Also, if I’m the spouse of one of the doctors in a practice, are all the doctors in that practice prohibited from charging for my treatment?

Extended blood-pressure monitoring proves a challenge, though some succeed

04/22/2019

by: Richard Scott

Cardiologists, internal medicine providers and nephrologists are the most likely specialty groups to report a series of ambulatory blood-pressure monitoring codes that, ultimately, don’t get much attention.

Plan for practice survival if a partner gets caught in the opioid crackdown

04/15/2019

by: Roy Edroso

With more doctors being picked up by law enforcement for the consequences of their opioid prescriptions, it’s a good idea to make sure your practice is protected from resulting legal problems.

Stick to ADA legal requirements when treating patients with disabilities

04/15/2019

by: Richard Scott

If your practice is not up to speed on providing equitable treatment to patients with disabilities, you may be running afoul of the law and leaving yourself legally exposed — not to mention providing a disservice to your patient care.

Find opportunity with home-visit codes under Medicare’s loosened policy

04/15/2019

by: Richard Scott

Going forward, you’ll find laxer coding and documentation requirements when reporting home-visit services (99341-99350) after Medicare eliminated the long-standing rules surrounding medical necessity and made it easier for providers to get paid in place-of-service 12 (Home).

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