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Medicare Changes to 2010 CPT Inpatient Consultation Codes

Prevent 99251-99245 denials in 2010 with this checklist.
Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.
Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles […]

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CMS Makes Key Changes to ABN Modifiers

We’ve got the new instructions you’ll need to follow.
CMS will update the ABN modifiers effective April 1, according to MLN Matters article MM6563, dated Oct. 29.
The ABN descriptors will read as follows:

Modifier GA — Revised to read, “Waiver of liability statement issued as required by payer policy.” You’ll use this when a required ABN was issued.
Modifier GX — […]

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HCPCS 2010: CMS Debuts New J Codes

Synvisc, penicillin get new codes — along with injectibles for neurology, bleeding.
Hot on the heels of the new CPT codes, CMS follows suit by publishing the 2010 HCPCS code set, posted on the CMS Web site on Nov. 3. You’ll find scores of changes.
What follows is a small sampling of what you’ll face in 2010:
Synvisc: HCPCS will […]

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CPT 2010 Update: Non-Face-to-Face Prolonged Services

New Year’s hats & horns for looser guidelines that let you count work spread over days.
Groaning thinking of all the time you’ll never capture for complex cases requiring extensive pre-visit time? CPT 2010 brings you hope.
Extensive guideline revisions “liberalize prolonged non-face-to-face services codes,” reports Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in […]

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Big Insurers Underspend On Medical Care, Senate Probe Finds

Which big health insurance company did lawmakers single out? Is it the one that gives you the most denials trouble?
A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care.
Insurance industry officials say that […]

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Surgical Coding Update: 21930, 21931 & More Debut for CPT 2010

Tumor excision codes get specific. Will surgical oncology practices take a reimbursement hit?
We’re starting to learn what new CPT codes we’ll be using come January 1, 2010. Coding News will keep you posted over the coming weeks, along with analysis from coding experts around the country so that you know what to expect for your practice’s […]

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OIG Auditors to Cardiologist: You’re Billing Medicare Properly

Report reveals what he and his billing staff did right. Does your practice have the right stuff?
Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about.
A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s […]

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A Physician Coder’s Guide to the 2010 OIG Work Plan

If your practice does lab panels, sleep studies, hospice visits and more, take heed.
The HHS Office of Inspector General has published its 2010 Work Plan, which should give us all a heads up on what the watchdog agency will be auditing and evaluating this year.
Why you should care: The 115-page document is like a map […]

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More Health Care Services = Higher Costs

Private nursing homes now cost $10 more than it did last year.

You may have to allot more on long term care from your budget as the yearly survey by a financial firm has found its costs are continuously on…

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