Sep 8, 2016 | Medical billing basics
The CMS shall provide to the standard systems and carriers a file of zip codes for the automated payment of the primary care and specialty physician scarcity bonus. The file will be effective for claims with dates of service on or after January 1, 2005, through...
Sep 6, 2016 | Medical billing basics
CPT CODE AND Description 98960 – Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual...
Sep 3, 2016 | Medical billing basics
ICD 9 and ICD 10 code for Anemia ICD-9-CM 285.9 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 285.9 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date...
Sep 1, 2016 | Medical billing basics
ICD 10 CODE FOR Knee Pain ICD-9-CM for Knee Pain is 719.46. Convert to ICD-10-CM is M25.569 Pain in unspecified knee. Arthralgia (joint pain) of lower leg. M25.561 – Pain in right knee M25.562 – Pain in left knee M25.569 – Pain in unspecified...
Aug 30, 2016 | Medical billing basics
What is Cost Sharing? Cost sharing is the patient balance that remains after the insurance plan has applied payment for covered services according to the benefit plan. Your share of costs for services that a plan covers that you must pay out of your own pocket...
Aug 28, 2016 | Medical billing basics
Clinical consultations are paid under the physician fee schedule only if they: a. Are requested by the patient’s attending physician; b. Relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the...
Aug 25, 2016 | Medical billing basics
Specific Hematology, Cytopathology and Blood Banking Services Cytopathology services include the examination of cells from fluids, washings, brushings or smears, but generally excluding hematology. Examining cervical and vaginal smears are the most common service in...
Aug 19, 2016 | Medical billing basics
Power Mobility Devices (PMDs) Section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) sets forth revised conditions for Medicare payment of Power Mobility Devices (PMDs). This section of the MMA states that payment...
Aug 17, 2016 | Medical billing basics
Examples of Billable Prolonged Services EXAMPLE 1 A physician performed a visit that met the definition of an office visit code 99213 and the total duration of the direct face-to-face services (including the visit) was 65 minutes. The physician bills code 99213 and...
Aug 17, 2016 | Medical billing basics
Provider Action Needed The Centers for Medicare & Medicaid Services (CMS) will implement Change Request (CR) 9252 on January 4, 2016, effective October 1, 2015. (See related MLN Matters® article MM9252.) This CR establishes the list of covered conditions and...
