2021-05-29 09:56
ORGAN OR DISEASE ORIENTED PANELS CODE DESCRIPTION80048 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310), Carbon dioxide (82374), C… Read More
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Medical Billing Solution, Learn Medical Billing Process and Concept, Tips to become a best Medical Biller, Specialist. Medical Insurance Billing codes, Denial Guidelines. Usage of correct CPT and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and insurance eligibility and follow up How to Guide
2021-05-20 15:22
What Is Home Health Care?Home health care includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speechlanguage therapy, and medical s… Read More
2021-05-06 11:10
CPT code and Description 78350: Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry78351: Bone density (bone mineral content) study, 1 or more sites… Read More
2021-04-20 11:05
How Medicare started and history of Medicare historic eventsYear 1965Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act, providing hospital, pos… Read More
2021-04-14 11:01
Ritalin• The first ADHD medication used since 1950s* Comes in 3 preparations• Immediate release [IR] (lasting ~2-4 hours)• Sustained release [SR] (~4-6 hours, seldom use… Read More
2021-03-26 14:32
Code1 Code Description 44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) b… Read More
2021-03-20 14:31
What is an Esophagogastroduodenoscopy (EGD)?It is an endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.CPT© codes in this series… Read More
2021-02-09 11:10
Modifier code and DescriptionModifier 33 – Preventive Services: Preventive Services: When the primary purpose of the service is the delivery of an evidence based service in… Read More
2020-12-04 09:39
Procedure code and Description S5100 Day care services, adult; per 15 minutesS5110 Home care training, family; per 15 minutesS5102 Day care services, adult; per diemS510… Read More
2020-07-28 09:33
Background Information ModifiersModifiers are two-character suffixes (alpha and/or numeric) that are attached to a procedure code.CPT modifiers are defined by the American Medical Associatio… Read More
2020-06-12 13:19
Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural ServiceScopeThis policy applies to all Commercial medical plans, Medicare Advantage plans, and Oregon Medicaid/EOCCO plans.Reimbursemen… Read More
2020-02-21 11:08
Present On Admission (POA) Indicators Scope Description:Applies to Present On Admission (POA) Indicator requirement for all BlueCross BlueShield of TN lines of business.Subject: Presen… Read More
2020-01-05 12:10
Procedure code and DescriptionQ2034: Influenza virus vaccine, split virus, for intramuscular use (Agriflu)Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 year… Read More
2019-12-04 12:56
Procedure code and description 99050 Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday… Read More
2019-09-28 13:10
CPT code and Description G0446 – annual, face-to-face intensive behavioral counseling (IBT) for cardio-vascular disease (CVD), individual, 15 minutesG0447 – face-to-face behavior… Read More
2019-08-17 12:32
Lucrative career opportunities for medical billing specialistsWhen you think of large hospital networks, the first picture that comes to mind are doctors and nurses who are perhaps working r… Read More
2019-07-31 10:44
Medicaid Coverage of Dental Benefits for AdultsKey Points• Poor oral health is widespread among adults in the United States and especially affects those with low incomes.– Adults… Read More
2019-07-05 10:45
What Is Hospice Care?Medicaid participants can receive hospice care when they are terminally ill. “Terminally ill” means the patient has been diagnosed with a medical condition t… Read More
2019-06-13 11:24
Electronic Bill Attachments(a)Required reports and/or supporting documentation to support a bill as defined in Complete Bill Section 3.0 shall be submitted in accordance with this section. U… Read More
2019-05-23 13:31
Coding Code Description CPT 81401 MED12 (mediator complex subunit 12)(eg, FG syndrome type 1, Lujan syndrome), common variants (eg, R961W, N1007S) 81405 ACTA2 (actin, alpha 2, smooth m… Read More
2019-05-06 07:43
The Centers for Medicare & Medicaid Services (CMS) requires all health plans to submit Health Insurance Portability and Accountability Act (HIPAA)-compliant 837 claims transactions to CM… Read More
2019-03-29 10:40
Covered BENEFITSCSHCS covers services that are medically necessary, related to the beneficiary’s qualifying diagnosis(es), and ordered by the beneficiary’s CSHCS authorized speci… Read More
2019-03-22 13:27
Code Description CPT 0069U Oncology (colorectal), microrna, rt-pcr expression profiling of mir-31-3p, formalinfixed paraffin-embedded tissue, algorithm reported as an expression score 81229… Read More
2019-03-08 09:55
Code Description CPT20974 Electrical stimulation to aid bone healing; noninvasive (non-operative)20975 Electrical stimulation to aid bone healing; invasive (operative)HCPCSE0747 Osteogenesis… Read More
2019-02-22 09:48
Coding Code Description CPT76120 Cineradiography/videoradiography, except where specifically included76125 Cineradiography/videoradiography to complement routine examination (list separately… Read More
2019-02-07 09:46
CodingIn 2015, the CPT codes combined the kyphoplasty procedure with all of the necessary imaging guidance; they are listed in the table below.Code Description CPT22513 Percutaneous vertebra… Read More
2019-01-25 09:41
Coding Code Description CPT81205 BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, Maple syrup urine disease) gene analysis, common variants (eg, R183P, G278S, E422… Read More
2019-01-02 09:33
Coding Code Description CPT0359T Behavior identification assessment – Used for initial evaluation/assessment, initial functional analysis, and periodic functional analysis re-assessmen… Read More
2018-12-14 09:20
Coding Medically Necessary Code Description CPT95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, ea… Read More
2018-11-30 09:15
Coding Code Description CPT0340T Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guida… Read More
2018-11-10 08:06
Code Description CPT 0013U Oncology (solid organ neoplasia), gene rearrangement detection by whole genome next - generation sequencing, DNA, fresh or frozen tissue or cells… Read More
2018-10-24 07:47
Code DescriptionCPT 81404 Molecular pathology procedure, Level 5 (eg, analysis of 2 - 5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6 -1… Read More
2018-07-07 10:01
Rural Health Clinic and Federally Qualified Health Center ServicesPayment may be made under Part B for the medical and other health services furnished by a qualified rural health clini… Read More
2018-06-20 11:17
If I receive a denial for a procedure bundled into another service, and I cannot find this code pair in the column 1/column 2 correct coding list of edits, where else should I look?Look in t… Read More
2018-06-07 10:29
WAIVER FORMNOTE: The waiver cannot be utilized for services considered to be content of another service provided.A. SITUATIONS REQUIRING A WAIVER1. Medical necessity denials2. Utilization de… Read More
2018-01-11 08:36
NURSING SERVICESNursing services are covered on an intermittent (separated intervals of time) basis when provided by, or under the direct supervision of, a registered nurse (RN).A nursing vi… Read More
2017-12-28 08:33
GENERAL INFORMATIONThis chapter applies to Home Health providers.Home health is a covered Medicaid benefit for beneficiaries whose conditions do not require continuous medical/nursing and re… Read More
2017-11-22 11:53
VISION SCREENINGPCPs must perform a subjective vision screening (i.e., by history) at each well child visit. For asymptomatic children 3 years of age and older, an objective screening must o… Read More
2017-11-07 11:31
CHILDREN’S MULTI-DISCIPLINARY SPECIALTY (CMDS) CLINIC REQUIREMENTSCMDS clinics are required to operate under the authority of hospitals or medical universities. Hospitals and medical u… Read More
2017-10-21 08:44
E87 Other disorders of fluid, electrolyte and acid-base balance Excludes1: diabetes insipidus (E23.2) electrolyte imbalance associated with hyperemesis gravidarum (O21.1) electrolyte imbalan… Read More
2017-09-08 10:30
CLINICAL RECORDSThe following table contains general guidelines for clinical documentation that must be maintained by all providers except nursing facilities. Clinical records other than tho… Read More
2017-07-28 11:40
Diseases of the blood and blood-forming organs and certain disorders involving the forming organs and certain disorders involving the forming organs and certain disorders involving the immun… Read More
2017-07-06 10:34
Claim DeterminationsWhen BCBSTX receives a properly submitted claim, it has authority and discretion under the Plan to interpret and determine benefits in accordance with the Plan provisions… Read More
2017-06-14 06:57
Procedure Code Description88305 Level IV surgical pathology, gross and microscopic examination…prostate needle biopsy…88307 (Level V -surgical pathology, gross and microscopic… Read More
2017-05-26 11:41
15570* Formation of direct or tubed pedicle, with or without transfer; trunk15731* Forehead flap with preservation of vascular pedicle (e.g., axial pattern flap, paramedian forehead flap)157… Read More
2017-05-24 10:36
CPT Code Description23470 Arthroplasty, glenohumeral joint; hemiarthroplasty23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement [e.g., total shou… Read More
2017-05-05 09:19
Procedure code and Description99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination;… Read More
2017-04-26 11:08
• G0502: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psych… Read More
2017-04-25 12:06
Q: My patient enrolled in a Medicare Advantage (MA) plan during the middle of the inpatient hospital stay. Who should I bill?A: When a patient enrolls or disenrolls in a MA plan during his/h… Read More
2017-04-21 07:30
Generally speaking, when we say 'objective measures,' what does that mean?Answer: Objective measures consist of standardized patient assessment instruments, outcome measurements tools o… Read More
2017-04-04 10:25
Allergic rhinitis due to pollen J30.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This is the American ICD-10… Read More
2017-03-28 09:17
ICD10 code for Vitamin D deficiency E20.0 Idiopathic hypoparathyroidismE20.8 Other hypoparathyroidismE20.9 Hypoparathyroidism, unspecifiedE21.0 -E21.3 Hyperparathyroidism and other diso… Read More
2017-03-15 09:06
DESCRIPTIONAllergy testing, evaluations, and immunotherapy are eligible for coverage according to the schedule of covered services in plan documents. Testing or treatment methods not conside… Read More
2017-03-06 10:35
CPT/HCPCS CodesGroup 1 Codes:92507 Speech/hearing therapy92508 Speech/hearing therapy92521 Evaluation of speech fluency92522 Evaluate speech production92523 Speech sound lang comprehen92524… Read More
2017-02-28 13:12
Group 1 Codes:J3489 INJECTION, ZOLEDRONIC ACID, 1 MGCoverage Indications, Limitations, and/or Medical NecessityIndicationsZoledronic acid is indicated for the treatment of:Acute Hypercalcemi… Read More
2017-02-25 13:03
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:J0585 INJECTION, ONABOTULINUMTOXINA, 1 UNITJ0586 INJECTION, ABOBOTULINUMTOXINA, 5 UNITSJ0587 INJECTION, RIMABOTULINUMTOXINB, 100 UNITSJ0588… Read More
2017-02-21 11:40
HCPCS CODES:Group 1 Codes:A9270 NON-COVERED ITEM OR SERVICEJ8498 ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIEDJ8597 ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIEDJ8999 PRESCRI… Read More
2017-02-15 10:54
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:82306 VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMEDCoverage… Read More
2017-02-07 09:13
Procedure code and DescriptionGroup 1 Codes:93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY93976… Read More
2017-01-27 10:48
Procedure codes and DescriptionGroup 1 Codes:11055 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION11056 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESIO… Read More
2017-01-23 09:31
Procedure Codes and DescriptionGroup 1 Codes:G0477 Drug test presump opticalG0478 Drug test presump opt instG0479 Drug test presump not optG0480 Drug test def 1-7 classesG0481 Drug test def… Read More
2017-01-19 09:22
Procedure Codes and DescriptionGroup 1 Paragraph: N/AGroup 1 Codes:11920 TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF SKIN, INCLUDING MICROPIG… Read More
2017-01-16 11:18
Coverage Indications, Limitations, and/or Medical NecessityFor the purposes of this LCD and consistent with standard community understanding and the recommendations of specialty societies, p… Read More
2017-01-13 11:06
Coverage Indications, Limitations, and/or Medical NecessityNote: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medi… Read More
2017-01-10 13:07
Procedure Codes and DescriptionGroup 1 Paragraph: 36299* is used for sclerotherapy with mechanical agitation (e.g. Clarivein® device).37799* should be used to report "Trivex Procedure"36… Read More
2017-01-07 09:25
• Up to twelve diagnoses can be reported in item 21 on the CMS-1500 paper claim (02/12)DIAGNOSIS – ICD Indicator Enter 9 for ICD-9 diagnosis codes and 0 for ICD-10 diagnosis codes… Read More
2017-01-05 09:07
what is copay?Copayments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service.Definition of terms: Copayment (copay): A predeterm… Read More
2017-01-04 08:49
Hyposmolality and/or hyponatremiaE87.0 Hyperosmolality and hypernatremiaE87.1 Hypo-osmolality and hyponatremiaE87.2 AcidosisE87.4 Mixed disorder of acid balanceE87.3 AlkalosisNephrology ICD… Read More
2016-12-31 13:09
Coverage Indications, Limitations, and/or Medical NecessityBackgroundA major limitation of external beam radiation therapy (EBRT) is a curative dose cannot be used because normal tissues can… Read More
2016-12-27 12:22
BackgroundRepetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive treatment that uses magnetic resonance pulsed fields to induce an electric current in the brain. Repetitive TM… Read More
2016-12-15 14:37
Filing Adjustments for a Medicare/Medicaid Claim When a provider has filed a claim with Medicare, Medicare reimburses the claim, then the claim becomes a “crossover” to Medi… Read More
2016-12-10 14:00
HYSTERECTOMYFederal regulations governing payment of a hysterectomy under Medicaid (Title XIX) prohibit payment for a hysterectomy under the following circumstances:• If the hysterectom… Read More
2016-12-09 14:55
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple43239 with biopsy, single or multiple GI ProceduresEGD Procedures • Use code 43235 for a… Read More
2016-12-09 14:43
Modifier 33: Preventive service; when the primary purpose of the service is the delivery of an evidence based service in accordance with a US Preventive Services Task Force A or B ratin… Read More
2016-12-09 14:12
49585 Repair umbilical hernia, age 5 years or older; reducibleHospital Outpatient DepartmentAPC 5341APC DescriptionPeritoneal and Abdominal Procedures (CPT codes: 49491, 49492, 49495, 49496… Read More
2016-12-09 13:51
Repair initial incisional or ventral hernia; reducible 49560Incarcerated or strangulated 49561 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair, or… Read More
2016-12-07 01:02
Procedure Code 30140, 30802, 30930procedure code 30802 - Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg. electrocautery, radiofrequen… Read More
2016-12-05 10:27
Induced AbortionMedicaid payment for induced abortion is restricted to those that meet the following criteria:• A physician has found, and so certifies in his/her own handwriting, that… Read More
2016-11-29 10:29
A. Any entity which provides and/or bills members and/or BCBSKS for health care services which advertises or represents itself to the general public as being owned, controlled, managed, affi… Read More
2016-11-22 10:28
A. The conditions of these policies and procedures and the contracting provider agreement apply to all benefit programs, indemnity and to self-insured plans administered by BCBSKS or its sub… Read More
2016-11-19 10:09
A. All non-physicians, who are defined as eligible providers under the member’s BCBSKS contract and who are providing services as defined in their Kansas licensure or certification, sh… Read More
2016-11-14 05:36
Timeframe for Claims SubmissionProviders must submit clean claims within 90 days of the date of services or the date of discharge for inpatient services. The 1199SEIU Benefit Funds may deny… Read More
2016-11-09 14:30
Primary care practitioners are defined as:(1) A physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine for whom pr… Read More
2016-11-06 14:46
Bundling of Payments for Services Provided in Wholly Owned and Wholly Operated Entities (including Physician Practices and Clinics): 3-Day Payment WindowIn accordance with section 102(… Read More
2016-11-02 14:41
Effective: 01-01-11 and 04-04-11, Implementation: 01-03-11 for the claim identification of the incentive and 04-04-11 for full implementation)The incentive payment applies to major surgical… Read More
2016-10-31 10:16
ICD 9 code for Hypertension 401401.9 - Essential hypertension; unspecified Toggle Dictionary Definitions401Includes: high blood pressure, hyperpiesia, hyperpiesis, arterial hypertensio… Read More
2016-10-28 14:38
For services with dates of service prior to January 1, 2005, physicians must indicate that their services were provided in an incentive-eligible rural or urban HPSA by using one of the follo… Read More
2016-10-24 14:37
HPSA designations are made by the Health Resources and Services Administration’s (HRSA) Division of Shortage Designation (DSD). An automated file of areas eligible for the HPSA bonus p… Read More
2016-10-21 10:10
procedure code and description36561- Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older - average fee payment - $1250 … Read More
2016-10-20 09:50
procedure code and description27130- Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft - average fee payme… Read More
2016-10-19 06:57
procedure code and description69209- Removal impacted cerumen using irrigation/lavage, unilateral - average fee payment - $10 -$2069210 Removal impacted cerumen requiring instrumentation, un… Read More
2016-10-18 06:34
procedure code and description90832 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes with the patient and/or family member (time range 16-37 minut… Read More
2016-10-16 09:22
The HCPCS has been selected as the approved coding set for entities covered under the Health Insurance Portability and Accountability Act (HIPAA), for reporting outpatient procedures.The HCP… Read More
2016-10-12 09:17
Diagnosis codes must be reported based on the date of service (including, when applicable, the date of discharge) on the claim and not the date the claim is prepared or received. A/B MACs (A… Read More
2016-10-08 09:14
Inpatient Claim Diagnosis ReportingOn inpatient claims providers must report the principal diagnosis. The principal diagnosis is the condition established after study to be chiefly responsib… Read More
2016-10-08 06:40
procedure code and description99241 - Office consultation level 199245 - Office consultation for a new or established patient, which requires these 3 key components: A comprehensive his… Read More
2016-10-07 06:22
procedure code and description99221 - Initial hospital care - average fee payment - $100 - $120When we can bill procedure code 99221When a patient is admitted to inpatient hospital care for… Read More
2016-10-06 05:49
Implementation of New Influenza Virus Vaccine Code Implementation Date: January 3, 2017 Change Request (CR) 9793 which informs MACs about the changes to instructions for &nbs&hell…Read More
2016-10-04 07:10
Institutional providers may submit a taxonomy code on claims they submit to Medicare. Medicare does not use the taxonomy code for matching a provider’s NPI to the appropriate legacy id… Read More
2016-10-03 08:56
97799 Unlisted physical medicine/rehabilitation service or procedure:For all claims submitted for unlisted services or procedures, the following documentation must be submitted:* A descripti… Read More
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