Billing & Coding

According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:

Medicare Requiring Specific Modifiers on Therapy Services

Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:

Psychiatric Partial Hospitalization Programs

BACKGROUND

One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).

At HIPAA Summit, OCR head Jocelyn Samuels also outlines forthcoming efforts with ONC, FDA.

Phase II of the federal HIPAA audit program remains "under development," Jocelyn Samuels, director of the Health and Human Services Department's Office for Civil Rights, said Monday at the 23rd National HIPAA Summit in the District of Columbia.

Read the entire article by FierceHealthIT here.

Bill chronic care management (CCM) services on the last day of the calendar month the service was done. Therefore, if the service began in January, you would bill 99490 with the date of service as January 31. 

You cannot bill CCM for the care of a patient only due to having two chronic illnesses; to bill CCM, the chronic conditions must be showing significant risk of death, acute exacerbation, decompression or functional decline.

Definition

  • Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter

Appropriate Usage

  • Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
  • Documentation indicates the services were provided during separate patient/provider encounter
  • Use Modifier XE with the Column 2 procedure code in the NCCI files
  • Use Modifier XE only when there is no other modifier to describe the situation

Inappropriate Usage

(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, implementation: 04-07-08)

Centers for Medicare & Medicaid Services (CMS) is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

Be sure your billing staff is aware of the modifier changes!

The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as to identify:

  • Different encounters;
  • Different anatomic sites; and
  • Distinct services.

 The -59 modifier is:

Joint DME MAC/PDAC Publication

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have evaluated the MyoPro® upper extremity assist device and determined that it falls within the Durable Medical Equipment (DME) benefit category. Claims for MyoPro® should be submitted using the DME miscellaneous code E1399.

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