MEDICAL BLOG

Properly Reporting Imaging Overreads (Including X-Rays)

Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
2021-04-08

hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.

Read More

Understanding Skin Biopsy Codes

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-03-23

A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...

Read More

COVID-19 Vaccines

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-03-10

To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...

Read More

Common Medical to Dental Procedures and Where to Find Them

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-12-08

With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ...

Read More

CDT and CPT - The Same but Different!

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-12-08

Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...

Read More

Final Rule on Communications Technology and 2021 Physicians Fee Schedule

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-12-08

To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...

Read More

Incident To

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-10-28

Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ...

Read More

OIG – Fraud and Abuse Study with COVID-19 Testing

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-10-27

According to the Office of Inspector General (OIG), “The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented demand for diagnostic laboratory testing to determine whether an individual has the virus. Beyond the COVID-19 tests, laboratories can also perform add-on tests, for example, to confirm or rule out diagnoses ...

Read More

My Location and CBSA is Missing!

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-09-23

We often get questions on missing Core Based Statistical Areas, known as CBSAs. CBSAs are used for pricing and other factors according to the geographical location. If you do not see your CBSA, it is important to note they are not missing - it may not have an assignment, according to ...

Read More

More COVID-19 Codes Added as of September 8, 2020

Wyn Staheli, Director of Research
2020-09-15

The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.

Read More
Show All