Billing & Coding

Using Modifiers 96 and 97

The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. As of January 1, 2018, there are two informational modifiers which should be used when reporting these two different types of services.

Billing Nutrition Counseling

Billing nutrition counseling services may not be as straight-forward as you might think.

Documentation for Home Health Services (Part A non DRG)

The Medical Learning Network provides coverage guidance, which should be documented, for home health services.

Regarding inadequate physician certification/re-certification

Physicians or Medicare allowed NPPs must certify that:

New Bipartisian Budget Act of 2018 Provisions

On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References.

Anthems original plan was to take a 50% reduction when providers reported claims using modifier 25, it was then lowered to a 25% reduction and has now been fully rescinded, to the relief of providers.  The policy was to go into effect March 1, 2018, however, due to strong opposition from the American Medical Association and other groups Anthem decided it was not in the best interest between payers and providers. 

Whenever there is a high-cost item, CMS has historically evaluated usage to determine appropriateness of billing and this is another example. A Decision Memo was released on February 15, 2018 which included the following changes:

New Modifiers Released in 2018

There were 13 new modifiers released in 2018, be sure you are using them if appropriate.  The five new HCPCS modifiers or the  "X" modifiers are used for voluntary reporting and do not change the meaning of the procedure being reported. These are used for MACRA patient relationship categories and codes. 

Q: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?

A: Please click on the link: https://www.chirocode.com/blog/241

Traumatic Subluxation Coding Controversy

There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated.

How to Properly Report Prolonged Evaluation and Management Services

Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?

Pages

Subscribe to RSS - Billing & Coding