CPT Codes Defined and Demystified
|
|
- Denis Nicholson
- 8 years ago
- Views:
Transcription
1 CPT Codes Defined and Demystified Office Visits, E&M, Evaluation and Management: Distinguish New or Established patient Must have a Diagnosis Charting reflects: Problem Focus, Complexity of History and Exam, Decision Making, and Time Spent with Patient (Exam always includes vital signs) 2009 CPT spiral bound code book pgs. 9 to 10 New Established Must have: Problem focused history 10 min 5 min Problem focused examination Straightforward medical decision making (Charting reflects CC + Brief HPI and Exam) Expanded problem focused history 20 min 10 min Expanded problem focused examination Straightforward medical decision making (Charting reflects CC + Brief HPI and Exam + Pertinent ROS) Detailed history 30 min 15 min Detailed examination Medical decision making of low complexity (Charting reflects CC + Detailed HPI and Exam + Additional ROS) Comprehensive history 45 min 25 min Comprehensive examination Medical decision making of moderate complexity (Charting reflects CC + Comprehensive HPI and Exam + Complete ROS) Comprehensive history 60 min 40 min Comprehensive examination Medical decision making of high complexity (Charting reflects CC + Comprehensive HPI and Exam + Complete ROS) Prolonged Office Visit (+) Coded in addition to an E&M Code (Office Visit) *Some feel these should only be used in unusual circumstances and that if used too often, it will trigger an audit CPT spiral bound code book pgs Direct (Face to Face): Reflects total time spent with patient that is beyond the time usually associated with the coded service. This reflects an Increase in time but not increase in complexity. This does not include time spent doing procedures, as those have their own time allotments.
2 minutes total time spent directly with patient minutes total time spent directly with patient (must be coded as the following: E&M Code ) Indirect (without Face to Face): Reflects total time spent before and after direct (face to face) time spent with the patient that was still related to patient care (eg. Review of extensive medical records or test results, communicating with other professionals/ family members) minutes total time spent indirectly regarding patient care minutes total time spent indirectly regarding patient care (must be coded as the following: E&M code ) Preventive Medicine Services Includes Well Child, Screening Gyn Exam, Screening Men s Health Exam, Screening Physical NO Diagnosis addressed at length other than need for screening Distinguish between New and Established patients If an abnormality is discovered requiring additional work perform the key components of an appropriate E&M visit, code for that E&M visit as well and use the 25 modifier to indicate this was done in addition to the screening exam. Not for Vaccine risk/benefit counseling and/or administration visits which are coded differently using Extent of focus depends on the age and sex of the patient Charting reflects: evaluation and management including age/gender appropriate history, exam, counseling/risk factor reduction interventions, ordering of lab/diagnostic procedures 2009 CPT spiral bound codebook pgs New Established Infant younger than 1 year Early Childhood age 1 4 years Late Childhood age 5 11 years Adolescent age years years years years Consultations Must be requested by another physician or other appropriate source (not initiated by patient or patient family) Physician has been requested to give opinion regarding evaluation or management of patient Chart notes must reflect communication back to original referral source via letter or phone call If mandated by third party use modifier 32 No distinguishing between New or Established patient
3 99241 Problem focused, 15 minutes Expanded problem focused, 30 minutes Detailed, 40 minutes Comprehensive, 60 minutes High comprehension, 80 minutes Telephone Services: Established patients only Not billed if office visit happened during previous 7 days Not billed if followed up with office visit within next 24 hours Count only the time related to medical discussion Must be supported by chart note detailing discussion and time spent on phone 2009 CPT code book pgs. 31 and 444 Physician Non Physician minutes minutes minutes On Line Medical Evaluation: Online evaluation and management service provided by a physician to an established patient, guardian, or health care provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network. (Do not report when using , for the same communication) Gynecology Procedures (other than screening annual exam) Screening annual exam coded as Preventive Medicine Services Coding depends on SPECIFIC AREA Examined and Treated 2009 CPT spiral bound code book pgs Colposcopy of vagina and cervix if present With biopsy of vagina or cervix modifier for each additional biopsy site Colposcopy of cervix and endocervix including upper/adjacent vagina With biopsy of cervix With biopsy of endometrial tissue (use in conjunction with 57420, 57421, ) Endometrial biopsy without colposcopy Escharotic treatment (verifying vagina chem. Tx or minor surgery chem. Application)
4 Diaphragm (or cervical cap) fitting and instructions IUD placement IUD removal Fitting and insertion of pessary or any other intravaginal support device IV Therapy All codes include time required to monitor vital signs and perform periodic patient assessment If Evaluation and Management of patient is performed outside of routine vital signs and monitoring during therapy, code for additional appropriate E&M service If hydration is incidental to administration of another fluid, it is not reported separately IV Push, 1 substance Additional push of new substances Additional push of same substance IV Infusion (chart should specify substance or drug) Up to first hour Each additional hour Additional sequential infusion up to 1 hour Concurrent infusion IV Hydration (do not report if under 30 minutes) 31 minutes to first hour Each additional hour Injectibles Given correct J Code according to content of IV Injection IM and Sub Q Single tendon Tendon/origin Trigger Point Injection 1 2 muscles muscles Arthrocentesis Small Joint (hand, wrist, foot, ankle, TMJ) Medium joint (elbow, shoulder, sacroiliac occasionally ankle) Large joint (knee, hip, occasionally shoulder or sacroiliac) Cervical/thoracic facet injection 64470
5 Cervical/thoracic facet injection, additional injection Lumbar facet injection Lumbar facet additional injection Hydrotherapy Code for the individual components of the specific hydrotherapy performed Constitutional Hydrotherapy: E/M as appropriate (99211) Hot/Cold (not measured in units) E stimulation (unattended, not measured in units) E stimulation (attended, measured in 15 minutes units) Hot Fomentation: E/M as appropriate (99211) Hot/Cold (not measured in units) Lymphatic drainage, manual therapy Russian Steam Bath: Contrast bath (by 15 minute units) Colonic Irrigation: Unlisted therapeutic procedure (by 15 minute units) (specify activity in chart) (More hydrotherapy procedures will be added as needed) Physical Medicine: 3 potential codes for any type of touch therapy Manual Therapy (highest reimbursement potential d/t highest level of training required): Includes joint mobilization, manipulation and lymphatic drainage, manual traction, myofascial release (billed by 15 minute increments, usually billed up to 4 units) Neuromuscular Re education Movement, balance coordination, kinesthetic sense, posture and/or proprioception (billed by 15 minute increments, usually billed up to 4 units) Massage Effleurage, petrissage and/or tapotement (billed by 15 minute increments, usually billed up to 4 units) Authors: Marnie Loomis and Karen Frangos 9/2/09, rev. 10/4/09
Chiropractic Billing Guide
Chiropractic Billing Guide Independence Blue Cross (IBC) has created this 2006 Chiropractic Billing Guide Supplement in order to provide clear and helpful information about billing requirements for chiropractic
More informationChiropractic Billing Guide
Chiropractic Billing Guide AmeriHealth HMO Inc., and its affiliates (AmeriHealth) have created this 2006 Chiropractic Billing Guide Supplement in order to provide clear and helpful information about billing
More informationTimed Therapeutic Procedures
Timed Therapeutic Procedures Policy Number: 10.01.526 Last Review: 4/2015 Origination: 4/2009 Next Review: 4/2016 Policy Documentation to support the reporting of timed procedure codes is required. The
More informationCoding and Billing for Physical Therapy and Occupational Therapy Services
Coding and Billing for Physical Therapy and Occupational Therapy Services -CPT Codes-97000 series -Timed Based Codes -Service Based Codes -CMS - "8" Minute Rule -ICD-9 codes -CCI edits -HCPCS(DME) MODALITIES
More informationPhysical Therapy 12/4/2014. Agenda. Time Based Billing. Presented by Regan Tyler, CPC, CPC-H, CPC-I, CPMA, CEMC Senior Consultant & NAMAS Instructor
Physical Therapy Presented by Regan Tyler, CPC, CPC-H, CPC-I, CPMA, CEMC Senior Consultant & NAMAS Instructor Agenda Time based billing Therapeutic procedure(s) documentation Group therapy documentation
More informationOccupational Therapy
Occupational Therapy I. Policy University Health Alliance (UHA) will reimburse for occupational therapy when it is determined to be medically necessary and when it meets the medical criteria guidelines
More informationPhysical Therapy. Physical Therapy Payment Policy Policy number M.RTH.02.120301 effective 10/01/2015. Page 1
Physical Therapy I. Policy University Health Alliance (UHA) will reimburse for physical therapy when it is determined to be medically necessary and when it meets the medical criteria guidelines (subject
More informationWithlacoochee Technical College Course Syllabus Massage Therapy Program
Withlacoochee Technical College Course Syllabus Massage Therapy Program Course Description: The WTC Massage Therapy Program offers a sequence of courses that provides coherent and rigorous content aligned
More informationCMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009
CMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009 OP 8: MRI LUMBAR SPINE FOR LOW BACK PAIN Measure Description: This measure estimates the percentage
More information2001 physical therapy and occupational therapy CPT and HCPCS code changes
May 2001 No. 2001-12 PHC 1795 To: Nursing Homes Occupational s Physical s Rehabilitation Agencies Therapy Groups HMOs and Other Managed Care Programs 2001 physical therapy and occupational therapy and
More informationPhysical Therapy MM.09.005 07/15/2003
Physical Therapy Policy Number: Original Effective Date: MM.09.005 07/15/2003 Line(s) of Business: Current Effective Date: HMO; PPO; EUTF; HSTA; QUEST; Federal Plan 87 09/28/2012 Line(s) of Business Excluded:
More informationOccupational Therapy
Occupational Therapy Policy Number: Original Effective Date: MM.09.003 07/15/2003 Line(s) of Business: Current Effective Date: HMO; PPO; EUTF; HSTA; QUEST; Federal Plan 87 02/01/2012 Line(s) of Business
More informationPREVENTIVE MEDICINE AND SCREENING POLICY
REIMBURSEMENT POLICY PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.13 T0 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...
More informationChiropractic. Manual for Physicians and Providers Chiropractic
Chiropractic www.bcbsfl.com 1 Introduction This section of the Manual for Physicians and Providers contains Chiropractic Billing and Coding Guidelines, developed with consideration of the latest coding
More informationProcedure. 2 29827 $ 3,560 $ 1,476 Arthroscopy, shoulder, surgical; with rotator cuff repair 5.5% 241.1%
Exhibit 1 Top 50% of Payments for Surgical s (Physician costs) On average, Workers' payments for Surgical s in are 256% the average allowed claim costs for Healthcare in. $6,000 $5,000 $4,000 Allowed Claim
More informationModifiers 25 and 59. Modifier 25
Modifiers 25 and 59 This article discusses the appropriate use of modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure
More informationUTILIZING STRAPPING AND TAPING CODES FOR HEALTH CARE REIMBURSEMENT:
UTILIZING STRAPPING AND TAPING CODES FOR HEALTH CARE REIMBURSEMENT: A GUIDE TO BILLING FOR SPIDERTECH PRE-CUT APPLICATIONS AND TAPE Billing and coding taping and strapping services can be a complex issue.
More informationReview of Texas Medicaid Acute Care Therapy Programs. Prepared by: Strategic Decision Support Health and Human Services Commission
Review of Acute Care Therapy Programs Prepared by: Strategic Decision Support Health and Human Services Commission February 25, 2015 TABLE OF CONTENTS TABLE OF CONTENTS. i INTRODUCTION, BACKGROUND, & SUMMARY
More informationPhysical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy
REIMBURSEMENT POLICY Policy Number Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy 2015R0101B Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee
More informationCPT Coding Changes for 2013
CPT Coding Changes for 2013 Getting Prepared Presenter Ronald Burd, MD Psychiatrist, Stanford Health, Fargo, ND Chair, APA Committee on Codes, RBRVS and Reimbursements APA Representative, AMA s RBRVS Update
More informationCHAPTER 515 COVERED SERVICES, LIMITATIONS, AND EXCLUSIONS FOR OCCUPATIONAL/PHYSICAL THERAPY SERVICES CHANGE LOG
CHAPTER 515 COVERED SERVICES, LIMITATIONS, AND EXCLUSIONS FOR OCCUPATIONAL/PHYSICAL THERAPY SERVICES CHANGE LOG Replace Title Change Date Effective Date Section 515.1 Definitions 02/08/05 05/01/05 Section
More informationPhysical and Occupational Therapy Services Program Rulebook
Health Services Office of Medical Assistance Programs Physical and Occupational Therapy Services Program Rulebook Includes: 1) Table of Contents 2) Current Update Information (changes since last update)
More informationPreschool/School Supportive Health Services Program (SSHSP)
Evaluation 90801 2000 PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION Psychotherapy includes continuing psychiatric evaluation, codes 90801 and 90802 are not separately reportable with individual psychotherapy
More informationPhysical and Occupational Therapy Services Program Rulebook
Division of Medical Assistance Programs Physical and Occupational Therapy Services Program Rulebook Includes: 1) Table of Contents 2) Current Update Information (changes since last update) 3) Other Provider
More informationPreschool/School Supportive Health Services Program (SSHSP)
SSHSP providers must use this select list of Current Procedural Terminology () codes to bill Medicaid for SSHSP services. This handout contains codes for the following SSHSP services that can be billed
More information10-144 Chapter 101 MAINECARE BENEFITS MANUAL CHAPTER III
Last updated:. *Please note: As of the effective date of this rule, Family Planning agencies will be reimbursed at the same fee for service rates as other providers of these services, including Section
More informationKaiser Permanente 2015 Sample Fee List 1 Members in any deductible plan can use this list to help estimate their charges.
Kaiser Permanente 2015 Sample Fee List 1 Members in any deductible plan can use this list to help estimate their charges. COLORADO As your partner in health, we want to help you manage your health care
More informationChiropractic Reference Manual
Chiropractic Reference Manual Table of Contents Overview... 3 Definitions... 4 Documentation Guidelines... 5 Daily Treatment Documentation Documentation for Initial/New Patient Diagnosis Codes... 7 Modifiers...
More informationHow To Bill For Physical Therapy
Procedure Codes for Occupational & Physical Therapy Practitioners BILLING CPT DEFINITION HOW ABBREV. CODE BILLED P 97001 Physical Therapy Evaluation Event B 97002 Physical Therapy Re-evaluation Event O
More informationBilling, Coding and Documentation for MSK US Ken Mautner, MD Emory Sports Medicine Center Atlanta, GA
Billing, Coding and Documentation for MSK US Ken Mautner, MD Emory Sports Medicine Center Atlanta, GA Disclaimer The following is my opinion ONLY I am a doctor not an expert in billing and coding Even
More informationPart B Education Exclusive: Modifier 59 Edit Update Questions
Cahaba GBA would like to provide some clarification of the use of Modifier 59. The modifier is not limited to National Correct Coding Initiative (NCCI) pairs. We apologize for any confusion our July article
More informationCoding for same-day visits and procedures By Emily Hill, PA-C
Coding for same-day visits and procedures By Emily Hill, PA-C Can you get insurers to pay you for a procedure like endometrial biopsy performed at the same time as a problem-oriented visit? Sometimes.
More information*SB0028* S.B. 28 1 MASSAGE PRACTICE ACT AMENDMENTS. LEGISLATIVE GENERAL COUNSEL 6 Approved for Filing: RCL 6 6 01-07-98 4:11 PM 6
LEGISLATIVE GENERAL COUNSEL 6 Approved for Filing: RCL 6 6 01-07-98 4:11 PM 6 S.B. 28 1 MASSAGE PRACTICE ACT AMENDMENTS 2 1998 GENERAL SESSION 3 STATE OF UTAH 4 Sponsor: R. Mont Evans 5 AN ACT RELATING
More informationCPT Coding in Oral Medicine
CPT Coding in Oral Medicine CPT - Current Procedural Terminology Medical Code Set (00000-99999) Established as an indexing/coding system to standardize terminology among physicians and other providers
More informationSection 2. Licensed Nurse Practitioner
Section 2 Table of Contents 1 General Information... 2 1-1 General Policy... 2 1-2 Fee-For-Service or Managed Care... 2 1-3 Definitions... 2 2 Provider Participation Requirements... 3 2-1 Provider Enrollment...
More informationProcedure Based Coding
Procedure Based Coding Jon K. Hathaway Objectives Review Global definition Review common modifiers Procedure plus E&M codes 2013 MSACOG Snow Meeting 1 Vacuum assisted Vaginal Delivery was first reported
More informationEnrolled Copy S.B. 28 MASSAGE PRACTICE ACT AMENDMENTS
Enrolled Copy S.B. 28 MASSAGE PRACTICE ACT AMENDMENTS 1998 GENERAL SESSION STATE OF UTAH Sponsor: R. Mont Evans AN ACT RELATING TO OCCUPATIONS AND PROFESSIONS; AMENDING THE SCOPE OF PRACTICE FOR MASSAGE
More informationHands-On Care Physical Therapy P.C PhysioCare Physical Therapy P.C EXPLANATION OF PROCEDURES
EXPLANATION OF PROCEDURES Welcome to our practice. You are here because you have been referred to us by your doctor for Physical Therapy. Physical Therapy is defined as: The evaluation, treatment or prevention
More informationPhysical Therapy/Occupational Therapy Utilization Management Program FAQs November 2015
Physical Therapy/Occupational Therapy Utilization Management Program FAQs November 2015 Background: Effective November 1, 2015, Anthem Blue Cross and Blue Shield (Anthem) implemented a physical therapy
More informationCOVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions:
Exhibit D-3 HMO 1000 Coverage Schedule ROCKY MOUNTAIN HEALTH PLANS GOOD HEALTH HMO $1000 DEDUCTIBLE / 75 PLAN EVIDENCE OF COVERAGE LARGE GROUP Underwritten by Rocky Mountain Health Maintenance Organization,
More informationSchool Based Health Services Medicaid Policy Manual MODULE 6 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES
School Based Health Services Medicaid Policy Manual MODULE 6 OCCUPATIONAL AND PHYSICAL THERAPY SERVICES BACKGROUND Administrative Requirements SCHOOL BASED HEALTH SERVICES ARE REGULATED BY THE CENTERS
More informationUntimed Billing Procedure CPT Codes Effective February 1, 2010
20552 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 1 or 2 muscles 20553 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 3 or more
More informationIowa Wellness Plan Benefits Coverage List
Iowa Wellness Plan Benefits Coverage List Service Category Covered Duration, Scope, exclusions, and Limitations Excluded Coding 1. Ambulatory Services Primary Care Illness/injury Physician Services Should
More informationChiropractic Coding. Michael D. Miscoe JD, CPC, CASCC, CUC, CCPC, CPCO, CHCC. Disclaimer
Chiropractic Coding Michael D. Miscoe JD, CPC, CASCC, CUC, CCPC, CPCO, CHCC 1 Disclaimer DISCLAIMER This presentation is for general education purposes only. The information contained in these materials,
More informationPreventive Medicine and Screening Policy
REIMBURSEMENT POLICY Policy Number 2015R0013C Preventive Medicine and Screening Policy Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT
More informationPart 1 General Issues in Evaluation and Management (E&M) in Headache
AHS s Headache Coding Corner A user-friendly guide to CPT and ICD coding Stuart Black, MD Part 1 General Issues in Evaluation and Management (E&M) in Headache By better understanding the Evaluation and
More informationTherefore, a physician should only bill for new patient services when the elements of the definition is met.
Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
More informationLaser Treatment Policy
Laser Treatment Policy Pursuant to federal law 21 CFR 812.2(c)7 and 812.3(b), physician(s) at this pain center may advise and use unapproved laser s on patients under one or more of the following conditions:
More informationMONTANA. September 2015
September 2015 NCCI s Medical Data Report and its content are intended to be used as a reference tool and for informational purposes only. No further use, dissemination, sale, assignment, reproduction,
More informationCurrent Procedural Terminology (CPT) Code Changes for 2013
Current Procedural Terminology (CPT) Code Changes for 2013 For 2013 there have been major changes to the codes in the Psychiatry section of the AMA s Current Procedural Terminology, the codes that must
More informationChemotherapy Administration, Hydration and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions
Chemotherapy Administration, Hydration and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions Table of Contents: Overview... Professional Services... 2 Services... 4 Overview Chemotherapy
More informationWorkers Compensation Insurance
Workers Compensation Insurance New Hampshire Insurance Department Detailed Medical Cost Comparison The following exhibits compare the cost of Workers Compensation Medical services in New Hampshire to our
More informationAdvanced Elvarez Workshop. Common Fallacies About Cancer Pain
Sponsor Biologix Solutions BSN Name of Course Ethics for Physical Therapy Professionals Advanced Elvarez Workshop Common Fallacies About Cancer Pain Back in Action with Joint Replacements Part 2 ABCs of
More informationCPT Pediatric Coding Updates 2009. The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009.
CPT Pediatric Coding Updates 2009 The 2009 Current Procedural Terminology (CPT) codes are effective as of January 1, 2009. NEW CODES Evaluation and Management Services Normal Newborn Care Codes 99431-99440
More informationPayment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
More information76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642 limited
2015 CPT Code Update The ACR, either alone or in conjunction with other specialty societies, worked on a number of code proposals for the 2015 code cycle. This update provides a listing of code changes
More informationAlaska Workers Compensation Fee Schedule Comparative Survey
Alaska Workers Compensation Fee Comparative Survey As part of the Division s analysis of workers compensation medical costs in Alaska, we asked the National Council on Compensation Insurance (NCCI) to
More informationWorkers Compensation Medical Costs in NH Significantly Higher
EMBARGOED: FOR RELEASE THURSDAY, MAY 22, 10 AM NOT FOR RELEASE UNTIL: May 22, 2014 Contact: Danielle Barrick, director of communications, (603) 271-7973, ext. 336, danielle.barrick@ins.nh.gov; Deb Stone,
More informationPediatric Case Study OCCUPATIONAL THERAPY EVALUATION REPORT AND INTERVENTION PLAN. Setting: community out-patient in-patient home based
I. BACKGROUND INFORMATION Pediatric Case Study OCCUPATIONAL THERAPY EVALUATION REPORT AND INTERVENTION PLAN Date of report: Date of onset: Date of birth: Client s name: Date of referral: Age on date of
More informationKaiser Permanente 2016 Sample Fees List 1
Kaiser Permanente 2016 Sample Fees List 1 SOUTHERN CALIFORNIA Knowing how much you can expect to pay for care and services can give you peace of mind. This Sample Fees List shows you estimated fees for
More informationKaiser Permanente 2016 Sample Fee List *
Kaiser Permanente 2016 Sample Fee List * NORTHWEST What s a Sample Fee List? Knowing how much you can expect to pay for care and services can help give you peace of mind. As a deductible plan member, you
More informationBilling Code DOS Issue Law Payments Award
Billing Code DOS Issue Law Payments Award DRG 460 64635 64636 93307 93320 1 1-18-to 01-23- February 11, February 11, February 12, February 12, Implants not separately reimbursed for DRG 460 Denial of the
More informationPrerequisites. Authorization, Notification and Referral. Limitations ANESTHESIA SERVICES
ANESTHESIA SERVICES Policy NHP reimburses participating providers for the administration of general and regional anesthesia, and supportive services performed in conjunction with covered obstetrical, surgical,
More informationCPT Code Changes for 2013 (Behavioral Health)
CPT Code Changes for 2013 (Behavioral Health) Overview Effective January 1, 2013 there will be changes to some Current Procedural Terminology (CPT) codes deleted codes and replacement codes. The list of
More informationCNH7 Provide Massage Therapy to clients
B CNH7 Provide Massage Therapy to clients OVERVIEW Massage Therapy means the systematic use of classical Massage and soft tissue techniques, to improve physical and emotional well being. The Massage Therapist,
More informationEliminating Infusion Confusion. Agenda
Eliminating Infusion Confusion (Drug Administrations in Facility and Non-facility Settings) Presented by Maria Rita Genovese, CPC, PCS & Maryann C. Palmeter, CPC, CENTC 1 Agenda Review of CPT codes What
More informationDocumentation Summary for Chemotherapy Administration, Nonchemotherapy Injections and Infusions
Documentation Summary for Chemotherapy Administration, Nonchemotherapy Injections and Infusions Documentation to Support Medical Necessity of Chemotherapy Services Date: April 23, 2012 Source Information:
More informationWe Bring The Pieces Together For You
Modifier 25 Visit No how-de-do visits in Hematology Oncology MOASC Discussion of Meaningful Information Compliance Education We do it right. We Bring The Pieces Together For You NBC Neltner Billing & Consulting
More informationModifier -52 Reduced Services
Manual: Policy Title: Reimbursement Policy Modifier -52 Reduced Services Section: Administrative Subsection: Policy Number: RPM 003 Date of Origin: Insert date approved Last Updated: same IMPORTANT STATEMENT
More informationDocumentation Guidelines for Physicians Interventional Pain Services
Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record
More informationEarly Intervention Service Procedure Codes, Limits and Rates
BABIES INFORMATION AND BILLING SYSTEM Early Intervention Service Procedure Codes, Limits and Rates Georgia Department of Public Health Office of Maternal and Child Health Children and Youth with Special
More informationHow Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-9, and CPT
How Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-9, and CPT Aaron Michelfelder, M.D. Associate Professor of Family Medicine, and Bioethics & Health Policy Goals Define the Acronyms CMS, RVU, ICD-9,
More informationLocal Education Agency
KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Local Education Agency Updated 08/07 PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Local Education Agency Billing Instructions...........
More informationFRIEND TO FRIEND CPT CODES 2015 2016. Diagnostic digital breast tomosynthesis, unilateral (list separately in addition to code for primary procedure)
FRIEND TO FRIEND CPT CODES 2015 2016 CPT CODE SERVICE DESCRIPTION FEE EFFECTIVE G0101 Screening pelvic examination $36.69 01 Jan 16 G0202 Mammography, screening, digital, bilateral (2 view film study of
More informationPhysical Therapy Program
Health and Recovery Services Administration Physical Therapy Program Billing Instructions ProviderOne Readiness Edition [WAC 388-545-0500] About This Publication This publication supersedes all previous
More informationDry Needling Corporate Medical Policy
Dry Needling Corporate Medical Policy File name: Dry Needling File code: UM.REHAB.09 Origination: 04/2015 Last Review: New policy Next Review: 04/2016 Effective Date: 9/1/2015 Description Myofascial pain
More informationOCCUPATIONAL THERAPY
OCCUPATIONAL THERAPY This document is subject to change. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota
More informationSECTION 1.1 PERSONNEL
A. JOB DESCRIPTIONS The following are examples of job descriptions for staff working in Title X Family Planning Clinics. Each agency should have internal job descriptions that reflect the functions, duties,
More informationA Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH)
A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) Introduction Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a phenomenon that more commonly affects older males. It is associated
More informationEphraim K. Brenman, D.O.
Updated 5/1/16 Curriculum Vitae ADDRESS: (Office) 400 Concord Plaza Dr. #300 San Antonio, Texas 78216 (210) 804-5927 MEDICAL LICENSURE Texas # L2151(exp.7/16) Ohio #8248 (exp. 7/31/16) DIPLOMATE National
More informationOMT Documentation & Coding. John J. Wolf, DO, FACOFP
OMT Documentation & Coding John J. Wolf, DO, FACOFP OBJECTIVES Improve financial reimbursement for additional time spent treating patients Enhance knowledge of specific Tx areas to maximize patient benefit
More informationChapter 24: Physical Medicine Services
Payment Policies for Healthcare Services Provided to Injured Workers and Crime Victims Effective July 1, 2014 Link: Look for possible updates and corrections to these payment policies at: http://www.lni.wa.gov/claimsins/providers/billing/feesched/2014/
More informationRegions Hospital Delineation of Privileges Nurse Practitioner
Regions Hospital Delineation of Privileges Nurse Practitioner Applicant s Last First M. Instructions: Place a check-mark where indicated for each core group you are requesting. Review education and basic
More informationClinical Scenarios CODING AND BILLING 101. Daryn Eikner, Family Planning Council Ann Finn, Ann Finn Consulting
Clinical Scenarios CODING AND BILLING 101 Daryn Eikner, Family Planning Council Ann Finn, Ann Finn Consulting 1 Always remember Follow coding guidelines If you didn t write it down, it didn t happen The
More informationRehabilitation Documentation and Proper Coding Guidelines
Rehabilitation Documentation and Proper Coding Guidelines Purpose: 1) Develop a guide for doctors in South Dakota to follow when performing reviews on rehabilitation cases. 2) Provide doctors in South
More informationHot Topics in E & M Coding for the ID Practice
Hot Topics in E & M Coding for the ID Practice IDSA Webinar February, 2010 Barb Pierce, CCS-P, ACS-EM Consulting, LLC barbpiercecoder@aol.com www.barbpiercecodingandconsulting.com Disclaimer This information
More informationOCCUPATIONAL THERAPY Corporate Medical Policy. Medical Policy
OCCUPATIONAL THERAPY Corporate Medical Policy File name: Occupational Therapy File code: UM.REHAB.03 Origination: 01/1997 as a component of PT/OT/ST Medical Policy Last Review: 02/2014 (ICD-10 Remediation
More informationOUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY PROTOCOL GUIDELINES
OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY PROTOCOL GUIDELINES General Therapy Guidelines 1. Therapy evaluations must be provided by licensed physical and/or occupational therapists. Therapy evaluations
More informationThe file and the documentation should create a clean chronological record of the patient and their interactions with the provider.
Documentation and Coding Guidelines for Athletic Trainers Table of Contents What is documentation and why is it important? Documentation and SOAP What do payers want and why? General guidelines of medical
More informationCarter Physiotherapy, PLLC. Patient Contact Information
Carter Physiotherapy, PLLC Patient Contact Information Patient Name Today s Date Address City State Zip Code DOB Gender Marital Status Occupation Home Phone Work Cell Other Fax Email Employer Work Address
More informationChapter 47b Massage Therapy Practice Act. Part 1 General Provisions
Chapter 47b Massage Therapy Practice Act Part 1 General Provisions 58-47b-101 Title. This chapter is known as the "Massage Therapy Practice Act." 58-47b-102 Definitions. In addition to the definitions
More informationThe ASA defines anesthesiology as the practice of medicine dealing with but not limited to:
1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia
More informationCPT Development. CPT Coding for Outpatient PT. Who Can Use CPT Codes? Current Procedural Terminology (CPT) 4/17/2014
CPT Coding for Outpatient PT Current Procedural Terminology (CPT) Kathleen Picard PT MNPTA Spring Conference St. Paul, Minnesota April 25, 2014 Descriptive terms and identifying codes for reporting medical
More informationFAQ for Coding Encounters in ICD 10 CM
FAQ for Coding Encounters in ICD 10 CM Topics: Encounter for Routine Health Exams Encounter for Vaccines Follow Up Encounters Coding for Injuries Encounter for Suture Removal External Cause Codes Tobacco
More informationITEC Level 5 Certificate in Sports Massage Therapy Unit 460 Provide Complex Massage Techniques for Sports Massage
ITEC Level 5 Certificate in Sports Massage Therapy Unit 460 Provide Complex Massage Techniques for Sports Massage Recommended Learning Hours GLH 85 Credit Value 18 QCF Qualification Reference Number J/506/9016
More information101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES 101 CMR 312.00: FAMILY PLANNING SERVICES
101 CMR 312.00: FAMILY PLANNING SERVICES Section 312.01: General Provisions 312.02: General Definitions 312.03: General Rate Provisions 312.04: Reporting Requirements 312.05: Severability 312.01: General
More informationAn Easy Guide to TENS Pain Relief. Distibuted By: LgMedSupply.com PO Box 913 Cherry Hill, NJ 08003 www.lgmedsupply.com
An Easy Guide to TENS Pain Relief Distibuted By: LgMedSupply.com PO Box 913 Cherry Hill, NJ 08003 www.lgmedsupply.com 1 LOW BACK PAIN MODE: C Mode PULSE WIDTH: 260 PULSE RATE: 50-80Hz comfortable intensity
More informationCorporate Medical Policy Spinal Manipulation under Anesthesia
Corporate Medical Policy Spinal Manipulation under Anesthesia File Name: Origination: Last CAP Review: Next CAP Review: Last Review: spinal_manipulation_under_anesthesia 5/1998 1/2015 1/2016 1/2015 Description
More informationA WCRI FLASHREPORT. Benchmarking Pennsylvania s Workers Compensation Medical Fee Schedule. Stacey Eccleston Xiaoping Zhao. Updated February, 2002
A WCRI FLASHREPORT Benchmarking Pennsylvania s Workers Compensation Medical Fee Schedule Stacey Eccleston Xiaoping Zhao Updated February, 2002 FR-01-06 WCRI FLASHREPORTS are data-based analyses of specific
More informationSENATE BILL 1204 AN ACT
PLEASE NOTE: In most BUT NOT ALL instances, the page and line numbering of bills on this web site correspond to the page and line numbering of the official printed version of the bills. Senate Engrossed
More information