Dec 18, 2011 | Medical billing basics
Assessing and Applying the 2012 eRx Payment Adjustment 2012 eRx Assessment An eligible professional who meets the eRx program inclusion criteria will be subject to the 2012 eRx payment adjustment if (s)he did not submit the following: • 10 valid 2011 eRx G-codes...
Dec 15, 2011 | Medical billing basics
2012 Electronic Prescribing (eRx) Payment Adjustment: Assessment and Application An eligible professional was included in the 2012 eRx payment adjustment analysis if they meet all of the following criteria: • Was a physician (MD, DO, or podiatrist), Nurse...
Nov 28, 2011 | Medical billing basics
Drug Administration Services and E/M Visits Billed on Same Day of Service CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or non-chemotherapy drug infusion code, or therapeutic or diagnostic injection code....
Nov 25, 2011 | Medical billing basics
Physicians in Group Practice Physicians of the same specialty in the same group practice must bill and be paid as a single physician. If more than one E/M (face-to-face) service is provided on the same day to the same patient by the same physician or more than one...
Nov 22, 2011 | Medical billing basics
Use of Highest Levels of E/M Codes To bill the highest levels of visit codes, the services furnished must meet the definition of the code (e.g., to bill a Level 5 new patient visit, the history must meet the CPT’s definition of a comprehensive history). The...
Nov 18, 2011 | Medical billing basics
Selection of Level of E/M Service Based on Duration of Coordination of Care and/or Counseling Time is the key factor in selecting the level of service when counseling and/or coordination of care dominates (more than 50 percent) the face-to-face physician/ patient...
Nov 17, 2011 | Medical billing basics
Example of information required to accompany an unclassified drug: HCPCS Code NDC NDC Description NDC Quantity* J3490 00409156029 Bupivacaine, 0.50% 1ml 10.00 J9999 55566830101 Degarelix 1 UN 1.00 J3490 00409427001 Lidocaine 1ml 6.50 *Two decimals. NDC quantity is...
Nov 15, 2011 | Medical billing basics
Signature Requirements Medicare requires a legible identifier for services provided/ordered. The method used must be handwritten or an electronic signature (stamped signatures are not acceptable) to sign an order or other medical record documentation for medical...
Nov 12, 2011 | Medical billing basics
Determining the Appropriate Primary ICD-9-CM Diagnosis Code for Diagnostic Tests Ordered Due to Signs and/or Symptoms Confirmed Diagnosis Based on Results of Test: If the physician has confirmed a diagnosis based on the results of the diagnostic test, the physician...
Nov 8, 2011 | Medical billing basics
DIAGNOSIS OVERVIEW ICD-9-CM Codes Physicians and Non-Physician Practitioners (NPP) must use the appropriate diagnosis code or codes to identify symptoms, conditions, problems, complaints or other reasons for the encounter or visit. Claims will be returned as...
