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The AMA has announced a number of changes and additions to the CPT codes for 2013, so we?ve compiled some of the key changes that apply to all specialties in this article. For changes applicable to specific specialties, see the blog posts identified by specialty below. You can also see the slides from the AMA meeting outlining the 2013 CPT code changes.

2013 Brings Hundreds of Coding Changes

By Virginia Martin, CPC, CHBC, Medical Economics

Overall, there are 186 new Current Procedural Terminology?? (CPT) codes, 148 deleted codes, and 263 revised codes, including changes to the description of a service provider, according to the American Medical Association’s (AMA’s) 2013 CPT changes book, An Insider’s View. Here is a closer look at what is changing in 2013 and what isn’t. Read More

Avoid Claim Denials Due to New Medical Codes

By Raemarie Jimenez, CPC, AAPC News

It is extremely important to monitor payment denials due to coding errors that are a result of the new CPT codes. Monitoring the denials allows you to identify if a particular payer is not processing the codes correctly or if you have an error in your billing/practice management system that is causing the denial.

In order to avoid these denials, follow these steps:

1. When the code changes are released, update your encounter forms/super bills and systems where codes are stored and used for claim submission.

2. Educate providers and coders on the new and revised codes and the documentation needed to support the codes.

3. Review the revised CPT?? coding guidelines. These can be quickly identified because the changes are in green text in the CPT?? code book. Sometimes the guidelines will change or clarify proper code selection even though the codes are not changed.

4. Update your fee schedules to include the payment rates for the new and revised codes.

5. Review the CMS National Coverage Determinations (NCD) and Local Coverage Determinations (LCD). Also review the payment policies from private insurers. These are often available on the payer?s website. This is an important step because these policies clarify code use, identify the diagnoses that support medical necessity, and provide documentation requirements.

6. Review the National Correct Coding Initiative (NCCI) edits to determine the bundling of codes.

Read More

Medicare Therapy Services Require Level III Codes/Modifiers in 2013


If you report outpatient therapy services for Medicare patients, get ready for a change. Beginning Jan. 1, claims filed at specified points during treatment must include a G code to describe certain functional limitations the patient may have, as well as a modifier to describe the extent of that limitation. Read More

Understand and Follow Basics of Incident-to Requirements


Mid-level providers such as physician assistants, nurse practitioners, and nurse specialists are used??to fill in??gaps in practices, helping physicians with a busy patient load, but how do you assure you are getting proper reimbursement for their expertise? Read More

Four Rules to Report POS Correctly


The Centers for Medicare & Medicaid Services (CMS) has updated its policy on place of service (POS) coding. The revisions are more about ??housekeeping?? than substantive change, but with the Office of Inspector General (OIG) continuing to target POS assignments as a problem area, there?s no time like the present to perfect your POS coding.

Medicare POS guidelines are set forth in the Medicare Carriers Manual, Chapter 12, section 20.4.2, and boil down to four basic rules:

1. Services rendered to a patient who is a registered inpatient should be reported with POS code 21 (or other appropriate inpatient code), regardless of where the services were provided. If you know the exact setting in which the patient is a registered inpatient, you may report another appropriate inpatient POS code (rather than POS 21).

2. Service rendered to a patient who is a registered outpatient should be reported with POS code 22 (or other appropriate outpatient code), regardless of where the services were provided. If you know the precise setting in which the patient is a registered outpatient, you may report another appropriate outpatient POS code (instead of POS 22).

3. When face-to-face services are provided for a patient who is not a registered inpatient or outpatient, the POS code should match the setting in which the beneficiary received the face-to-face service.

4. When there is no face-to-face service (e.g., the physician provides interpretation of a diagnostic test, only), the POS is that in which the beneficiary received the technical component (TC) of the service.

Read More

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