HCPCS codes and Q0091 We received this question from one of our members: “We have a Medicare patient for whom we provided a pelvic and a breast exam and a pap smear. We submitted it to Medicare and it got denied. Â Can you tell me why?” Medicare doesn’t pay for “routine services”, but they do […]
Archives for June 2017
7 Sure Fire Ways to Owe the Government $4 million in Fines and Repayments | Coding Compliance
Most practices aren’t looking to pay the government any money in fines and repayment because of coding errors. Two recent OIG settlements described two practices that did just that. Most practices want to avoid this, of course, but some groups seem determined to achieve that outcome. In reviewing both of the settlements, there are some […]
Diagnosis Coding for Tick Bites
Question: Why is it so hard to have correct diagnosis coding for tick bites? And, how is it coded? Answer: The search function in electronic health records leads clinicians astray. And, diagnosis coding for tick bites requires two diagnosis codes, because it is an injury. It requires a code from the injury chapter in the […]
CPT® and CMS Rules for Critical Care | What’s the Difference?
CMS and CPT count critical care time differently. For Medicare patients, the full 30 minutes of 99292 must be met in order to use the code, not the midpoint (15 minutes) of the code. For Medicare patients: Use 99291 from 30 minutes until 103 minutes. Add on code 99292 only if the time meets 104 […]
Reporting a Problem-Oriented Visit on the Same Day as Welcome to Medicare (G0402) or Initial and Subsequent Wellness Visit (G0438, G0439)
I continue to hear that some consultants and coders don’t agree with reporting a problem oriented visit with welcome to Medicare or wellness visit The 2024 Physician Fee Schedule Final Rule commented on this What does CMS say about adding an E/M service to a Welcome to Medicare visit or annual wellness visit? About the […]
Primary Care and Post-Op Reporting | Medicare Requirements
Hey, primary care! This one’s for you too. Primary care doctors probably didn’t pay attention when the news broke that CMS is requiring reporting post op visits using code 99024 in nine states. After all, primary care isn’t doing major surgical procedures. However, the list includes minor procedures performed frequently in primary care and urgent […]