Medical Coding Rights

To qualify for Skilled Nursing Facility (SNF) extended care services coverage, Medicare patients must meet the 3-day rule before SNF admission.  The 3-day rule requires, Three-day-consecutive inpatient hospital stay.  Three-day-consecutive stay counts inpatient setting. Starting with the calendar day of hospital admission. Doesn’t include the day of discharge or any pre-admission time spent in the ER or outpatient observation. SNF extended care services are an extension of care a patient needs after a hospital discharge or within 30 days of their hospital stay (unless admitting them within 30 days is medically inappropriate). Example A 68-year-old male patient went to the hospital ER after falling on May 17th from his home and a physician admitted him to the hospital on the same day. On subsequently May 20, the hospital discharged him to SNF extended care services.  For this case, the patient did qualify the 3-day rule. Hospitals can count the admission day (May 17th to May19th), but n

In March 2020 the Novel Coronavirus Disease, COVID-19, was declared a pandemic by the World Health Organization. The Centers for Disease Control (CDC), under the National Emergencies Act Section 201 and 301, is announcing further additions to the ICD-10-CM Classification related to COVID-19, which will become effective January 1, 2021. As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and\ Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing additional codes into ICD-10-CM for reporting to include, Encounter for screening for COVID-19  - Z11.52 Contact with and (suspected) exposure to COVID-19 - Z20.822 Personal history of COVID-19 - Z86.16 Multisystem inflammatory syndrome (MIS) - M35.81 Other specified systemic involvement of connective tissue - M35.89 Pneumonia due to coronavirus disease 2019 - J12.82 COVID-19 Positive - U07.1 These new codes will be effective January 1, 2021, to identify conditions resulting from C

A patient presents with cognitive impairment and or identified during the encounter then Medicare covers a separate visit for a cognitive assessment. So, the provider can more thoroughly evaluate the patients for cognitive function and help with care planning. Any clinician eligible to report evaluation and management services can offer this service, including physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants. The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam. The physician can collect the information from the physical examination to create a written care plan. The resulting written care plan includes initial plans to address as following, Neuropsychiatric symptoms Neurocognitive symptoms Functional limitations The Patient and or caregiver referrals to community resources, as needed, with initial education and support. Ef

The below-mentioned place of service codes is used more frequently. Check the detail updates following, Frequently Used Place of Service 2 Telehealth 11 Office 12 Home 13 Assisted Living Facility 15 Mobile Unit 19 Off Campus-Outpatient Hospital 20 Urgent Care Facility 21 Inpatient Hospital 22 On Campus-Outpatient Hospital 23 Emergency Room – Hospital 24 Ambulatory Surgical Center 31 Skilled Nursing Facility 32 Nursing Facility 33 Custodial Care Facility 34 Hospice 49 Independent Clinic 51 Inpatient Psychiatric Facility 52 Psychiatric Facility-Partial Hospitalization Insight about Place of Service POS - 2 The location where health services and health-related services are provided or received, through a telecommunication system. POS - 11 Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, state or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health

The Modifier QW is defined as a Clinical Laboratory Improvement Amendment (CLIA) waived test and it is used to identify waived tests and would be submitted in the first modifier field. The modifier QW is accepted by CMS for CPT 87637 and effective from date October 06,2020 and the implementation date July 06, 2021. Also, the modifier QW allowed for HCPCS code 0240U & 0241U 87637 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique 0240U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected 0241U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targe

The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism inclusive of deep venous thrombosis and pulmonary embolism on warfarin. The patient has been anticoagulated for at least three months prior to use of the home INR device and he/she undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home. The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following initiation of home monitoring and home-testing with the device occurs no more frequently than once a week Managing Anticoagulation There are at least three strategies for managing warfarin anticoagulation, Physician office-based testing and management Anticoagulation clinics Home PT/INR monitoring with patient reporting or physician-directed self-management. Most patients being anticoagu

Remote physiologic monitoring (RPM) technology comes in various devices that monitor glucose levels, BP, weight management, sleep patterns, heart rate, vital signs, and many other types of patient data. RPM allows patients to be involved in their own care by giving them access to their health data in real-time. For providing RPM services to the patients and staff time spent monitoring the respective beneficiary. These actions are billable through four CPT codes, 99453 - Initial set up and patient education 99454 - Supply of devices and collection, transmission, and summary of services 99457 - First 20 minutes of remote physiologic monitoring by clinical staff/MD/QHCP 99458 - For an additional 20 minutes of remote physiologic monitoring by clinical staff/MD/QHCP Initial Set-Up & Patient Education - CPT 99453 It is reported for each episode of care. An episode of care is defined as beginning when the remote monitoring physiologic service is initiated and ends with the attainment of t

Initial hospital care is reported for a patient who is being admitted to the hospital as an inpatient. The level of service is decided based on the three major key components of history, examination, and medical decision-making. There are divided into three types. Inpatient Admit or Initial Care - 99221,99222 & 99223 Subsequent Hospital or Follow Up - 99231, 99232 & 99233 Discharges - 99238 & 99239 Guidelines Do not report another E/M service along with the inpatient admission code even though if the patient is seen by the same physician for a different reason on the same day. E.g.,  The physician sees the patient in the ED and after a thorough examination, decides to admit the patient to the hospital. Report only the appropriate level of inpatient admission code and the ED service is considered the part of admission services when the same service is rendered by the same provider. If the admission is on a subsequent date from an ED service, both the services can be reported

There are four different types of administration of vaccine CPT codes found. Pediatrics patients up to 18 years of age - CPT 90460 & 90461. Adult age patients - CPT 90471 & 90472. For Intranasal or oral route - CPT 90473 & 90474 For COVID-19 vaccines - CPT 001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, 0042A If the provider and or other qualified healthcare professional administers more than one vaccine, use the appropriate add-on codes. 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered +90461 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) 90471 - Immunization

Preventive Service Codes The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient. The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age. Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387 Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397 The Medicare insurance would be covered by "G" codes instead of the above codes. The details below, Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare) Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment) Subsequent Annual Wellness Visit - G0439 Initial Visits Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticip

Definition and Details of  History Level of  History There are four levels of History found in E/M, Problem Focused History Expanded Problem Focused History Detailed History Comprehensive History   The  problem focused history requires documentation of the chief complaint (CC) and a brief history of present illness (HPI),  The Expanded Problem Focused History requires documentation of the chief complaint (CC) and a brief history of present illness (HPI) and Problem Pertinent review of system The Detailed history requires the documentation of a CC, an extended HPI, plus an extended review of systems (ROS), and pertinent past, family, and/or social history (PFSH). The Comprehensive history requires the documentation of a CC, an extended HPI, plus an Complete review of systems (ROS), and Complete past, family, and/or social history (PFSH). Chief Complaint (CC)  A Chief Complaint or reason visit/ reason for appointment is a concise statement that describes the symptom, problem, conditio

The CMS included new coding and payment for a monthly bundle of services for the treatment of ( Opioid Use Disorder)  OUD that includes, Overall management Care coordination Individual and group psychotherapy Substance use counseling Add-on code for additional counseling The provider to bill for a group of services in the office setting similar to the services covered under the Opioid Treatment Program benefit for clinics.   Clinicians providing these bundled services to Medicare patients should use these codes, G2086 - In the first calendar month, Developed the treatment plan Coordinated care Provided at least 70 minutes of individual therapy and group therapy and counseling G2087 - In a subsequent calendar month, Coordinated care Provided at least 60 minutes of individual therapy and group therapy and counseling G2088 -   In a subsequent calendar month, Coordinated care Provided more than 120 minutes of therapy and counseling Note: Bill each additional 30 minutes separately and inclu