Billing & Coding

Adaptive Behavior Coding

On July 1, 2014, 16 new codes (0359T through 0374T) were added for reporting adaptive behavior assessments/interventions services. These codes were included with the mid-year release of CPT Category III codes.

These new codes have been added to Section H-Procedure Coding in the Behavioral Health MultiBook. and may be used by any physician or other qualified licensed healthcare professional.

The June 2014 edition of CPT Assistant stated the following about these codes (emphasis added):

Of nearly 15,000 test claims received by the Centers for Medicare & Medicaid for the first round of end-to-end ICD-10 testing, 81 percent were accepted, according to statistics revealed by the agency Wednesday.

Consumer Driven Plans

Consumer Directed Healthcare Plans (CDHP) were developed as a way to shift the control of healthcare dollars from the insurance companies to the patient (consumer). The goal of these types of plans is to allow the patient to take a more active role in their own health and healthcare decisions in an effort to control costs.

Medicare Definition of Timed Codes

Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. To clarify questions about this, the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services, states the following (emphasis added):

20.2 - Reporting of Service Units With HCPCS
(Rev. 3367, 10-07-15))

There are several new features in ICD-10-CM. Watch for these new features such as: 

Combination Codes

Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations

Examples:

•K57.21 – Diverticulitis of large intestine with perforation and abscess with bleeding;

•E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema; and

•I25.110 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

 

Supplies Resources (Resource 347)

Providing medical supplies to your patients can benefit both the patient and your practice. However, there are specific protocols that need to be followed in order to properly bill supplies. Not only do the proper codes need to be selected, but the appropriate use of modifiers is essential. Also, some payers have their own specific requirements that must be followed. For information on codes and modifiers, refer to Section I-Supply Codes of the Behavioral Health MultiBook.

Links:

TENS Rentals

Q: How do you submit TENS (Transcutaneous Electrical Nerve Stimulation) rentals for reimbursement? I have some insurance companies that pay without question and others that deny this.

A:Use the correct TENS unit code, either E0720 for two lead or E0730 for four lead, and append the modifier -RR to designate Rental. Example E0720-RR.

Other popular supply modifiers include -NU to signify a new product and -UE to signify the sale of a used product.

Supply Codes

Q: Is there more specific codes for supplies rather than using 99070?

 

A: Yes. The HCPCS supply code series includes multiple more specific supply codes. The HCPCS supply codes are still too often overlooked and unused by providers. You will find that the HCPCS supply codes are more specific and as a result, often has more applicable codes for accurate reporting than the standard 99070 which is a non-specific, general supply code.

Virtual Cards

Sometimes called "disposable," "temporary" or "one-time use" numbers, a virtual credit card number is "like putting a wall" between your transaction and your regular account, says Steve Kenneally, vice president of the American Bankers Association. Although these cards can protect the cardholder from fraud, the use of virtual cards as a form of electronic funds transfers (EFT) payments for healthcare services can present some problems for healthcare providers.

Healthcare Reform

Even though the health care system in the United States is one of the most expensive per capita in the world, we have a dismally low quality of care ranking. Healthcare reform (HCR) in its simplest terms is addressing these shortcomings in order to improve healthcare coverage, delivery, policies, or payment. According to Wikipedia, "healthcare reform typically attempts to:

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