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MEDICAL BLOG

Understanding ASCs and APCs: Indicators and Place of Service

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-10-28

The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

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Dental-Provider Specialty Taxonomy Codes

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-10-06

The National Uniform Billing Guidelines require the use of taxonomy codes for claims submissions on the ADA-Dental claim form and the CMS-1500 Medical Claim form. When reporting the taxonomy code, be sure the provider is contracted with the payer under the taxonomy code being reported. We have listed the general ...

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Injection Services

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-09-29

Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...

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When is it Proper to Bill Nurse Visits using 99211

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-09-28

When vaccines or injections are given in the office, coding can often get confusing; for example, is it correct to report a nurse visit using 99211 and an E/M office visit reporting 99202 ‑ 99215 and include injection fees with the vaccine product? In addition, the reporting of evaluation and management (E/M) during the same visit ...

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Billing Dental Implants under Medical Coverage

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-08-12

Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...

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Understanding How Place of Service Codes Work

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-08-04

The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...

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Chronic Pain Coding Today & in the Future

Wyn Staheli, Director of Research
2021-07-19

Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

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How to Properly Assign ICD-10-CM Codes for Pain

Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
2021-07-14

Pain is a common diagnosis among all specialties so it should not be surprising to find there are 162 ICD-10-CM codes for reporting it and over 80 mentions in the ICD-10-CM Official Guidelines for Coding and Reporting which describe when certain types of pain should be reported and how the codes should be sequenced.

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Compliance in the Dental Office or Small Practice

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-06-29

If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...

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Important Changes to Shared/Split Services

Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
2021-06-16

Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.

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