2019-11-29 14:19
Atrial fibrillation (AF) is a rapid, irregularly irregular atrial cardiac rhythm brought on when the twoupper chambers (atria) of the heart no longer contract together in a coordinated manne… Read More
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Interventional Radiology Medical Coding - Learn How To Code Blog
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a blog about medical coding and specially for interventional radiology coding and regarding the updates about CPT, ICD and modifiers.
2019-11-29 14:12
The services described in Oxford policies are subject to the terms, conditions and limitations of the member's contractor certificate. Unless otherwise stated, Oxford policies do not apply t… Read More
2019-10-23 08:57
CPT© Code: 90378Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, eachCriteria for CoverageSynagis® (palivizumab) will be allowed monthly… Read More
2019-10-23 08:40
Urine Culture, Bacterial1. Specific coding guidelines:a. Use CPT 87086 Culture, bacterial, urine; quantitative, colony count where a urineculture colony count is performed to determine the a… Read More
2019-10-23 07:45
OverviewThis Coverage Policy addresses manipulation under anesthesia (MUA).Coverage PolicyA single treatment of manipulation under anesthesia* (MUA) is considered as medically necessary forA… Read More
2019-10-23 06:09
ScopeThis policy applies to all Commercial, Medicare Advantage, and Medicaid/EOCCO claims.Reimbursement GuidelinesIf a CPT code descriptor includes the term “separate procedure”… Read More
2019-10-23 05:37
IntroductionOutpatient facility services are services provided by an acute care hospital, a psychiatric hospital, anambulatory surgical center (ASC), a clinic1 , or other treatment room sett… Read More
2019-10-23 04:15
Outpatient Interventional Pain ManagementProviders must request prior authorization for interventional pain management services throughNational Imaging Associates (NIA). Providers can contac… Read More
2019-10-14 11:10
OverviewManagement of back pain that is persistent and disabling despite the use of recommended conservative treatment is challenging. Numerous diagnostic and therapeutic injections and oth… Read More
2019-10-14 11:06
The CPT® 2019 Professional Edition, page 721 contains the following information and direction for CPT® codes to be used for the Administration of Chemotherapy:“Chemotherapy ad… Read More
2019-10-14 11:03
IntroductionThere are generally two types of plastic surgery, cosmetic and reconstructive. Cosmetic surgery is performed to improve appearance, not to improve function or ability. The plan… Read More
2019-10-09 14:33
The information contained in this document, including the codes supplied, is provided for informational purposes only. BD makes no statement, promise or guarantee concerning the appropriaten… Read More
2019-10-09 14:19
Harvard Pilgrim Health Care does not reimburse for the procedures or categories of codes outlined in this policy. This list is not all-inclusive.Denials include non-covered services defined… Read More
2019-10-09 13:11
The services described in Oxford policies are subject to the terms, conditions and limitations of the member's contract or certificate. Unless otherwise stated, Oxford policies do not apply… Read More
2019-07-27 10:19
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they… Read More
2019-07-26 10:15
Coverage Indications, Limitations, and/or Medical NecessityFor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necess… Read More
2019-07-26 10:13
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are c… Read More
2019-07-25 09:59
Coverage Indications, Limitations, and/or Medical NecessityIntroduction:The facet joints are potential causes of back pain. Facet joints are paired diarthrodial articulations of the superior… Read More
2019-07-25 08:32
Coverage Indications, Limitations, and/or Medical NecessityFor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necess… Read More
2019-07-25 06:04
Coverage Indications, Limitations, and/or Medical NecessityEtoposide (Etopophos®, Toposar®, VePesid®, VP-16)-J9181Etoposide is a podophyllotoxin which inhibits DNA synthesis prio… Read More
2019-07-25 05:58
Coverage Indications, Limitations, and/or Medical NecessityEpoetin alfa (Epogen® and Procrit®) and epoetin beta (Methoxy Polyethylene Glycol-Epoetin Beta; Mircera®) a… Read More
2019-07-25 05:34
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they… Read More
2019-07-24 08:28
Coverage Indications, Limitations, and/or Medical NecessityFor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necess… Read More
2019-07-24 05:28
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they… Read More
2019-07-23 05:24
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they… Read More
2019-07-22 07:57
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they… Read More
2019-07-22 05:47
Coverage Indications, Limitations, and/or Medical Necessityb> PurposeUrine drug testing (UDT) provides objective information to assist clinicians in identifying the presence or absen… Read More
2019-07-21 05:41
Coverage Indications, Limitations, and/or Medical NecessityFor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necess… Read More
2019-07-21 05:37
Coverage Indications, Limitations, and/or Medical NecessityThis Local Coverage Determination (LCD) addresses the colonoscopies that are NOT performed for colorectal cancer screening. Colorec… Read More
2019-07-21 05:33
Coverage Indications, Limitations, and/or Medical NecessityThis LCD only applies to diagnostic colonoscopies and sigmoidoscopies. Refer to the Medicare Internet Only Manuals (IOM)… Read More
2019-07-20 05:31
Coverage Indications, Limitations, and/or Medical NecessityThis is a non-coverage policy for serum or other body fluid testing for levels of Coenzyme Q10 (CoQ10 or Q10), also known as ubiqui… Read More
2019-07-19 04:50
Coverage Indications, Limitations, and/or Medical NecessityChemodenervation refers to the use of chemical agents to produce neuromuscular blockade for the purpose of selective weakening of s… Read More
2019-07-18 08:59
Coverage Indications, Limitations, and/or Medical NecessityNoninvasive peripheral arterial studies include two types of testing, noninvasive physiologic studies and duplex scans. Nonin… Read More
2019-07-18 08:51
Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. The codes in this local coverage determination (LCD) cover debridement o… Read More
2019-07-17 08:41
Coverage Indications, Limitations, and/or Medical NecessityArteriovenous (AV) dialysis access (AV fistula, AV dialysis graft) interventions are intended to restore and/or maintain functional… Read More
2019-07-17 05:04
Coverage Indications, Limitations, and/or Medical NecessityAbstract:Chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function… Read More
2019-07-16 05:55
There are some situations where a hospital or office may purchase a drug for a medically reasonable and necessary prolonged drug infusion, then begin the drug infusion in the care setting us… Read More
2019-07-16 05:43
Coding Guidance CPT code 96360 with/without CPT code 96361 will be paid once per session. Medicare would not expect to see CPT code 96360 billed more frequently than once per… Read More
2019-07-15 09:29
Coverage Indications, Limitations, and/or Medical Necessity CPT code 71045, 71046, 71047, 71048Radiographs of the chest are common tests performed in many outpatient offices (radiology… Read More
2019-07-15 07:51
Coverage Indications, Limitations, and/or Medical NecessityAbstract:This LCD describes magnetic resonance imaging of the breast, ultrasonic evaluation of the breast, and ductography.Breast s… Read More
2019-06-30 10:31
Coverage Indications, Limitations, and/or Medical NecessityCovered IndicationsThis is a limited coverage LCD for BRCA 1 and BRCA 2 genetic testing. BRCA 1 and BRCA 2 genetic testing has been… Read More
2019-06-29 10:23
Coverage Indications, Limitations, and/or Medical NecessityFor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necess… Read More
2019-06-29 10:20
Coverage Indications, Limitations, and/or Medical NecessityBone and/or joint imaging, also known as a bone scan, skeletal scintigraphy, or a radionuclide bone scan is a nuclear medicine stud… Read More
2019-06-29 05:53
Coverage Indications, Limitations, and/or Medical NecessityThis policy applies to the following: seborrheic keratoses, skin tags, milia, molluscum contagiosum, sebaceous (epidermoid) cysts… Read More
2019-06-29 05:45
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are c… Read More
2019-06-28 06:01
Coverage Indications, Limitations, and/or Medical NecessityDental services are excluded from coverage in connection with the care, treatment, filling, removal, or replacement of teeth, or st… Read More
2019-06-28 05:53
Coverage Indications, Limitations, and/or Medical NecessityA cranial Computerized Tomographic (CT) Scan is a very useful and informative neurodiagnostic tool. Scanning of the head in success… Read More
2019-06-27 05:42
Coverage GuidanceCoverage Indications, Limitations, and/or Medical NecessityAccording to the American Society of Plastic Surgeons, the specialty of plastic surgery includes reconstructive su… Read More
2019-06-27 05:24
Coverage Indications, Limitations, and/or Medical NecessityAbstract:Corneal Pachymetry is the measurement of corneal thickness and commonly uses either ultrasonic or optical methods. Measure… Read More
2019-06-26 04:38
Coverage GuidanceCoverage Indications, Limitations, and/or Medical NecessityA computed tomographic (CT) image is a display of the anatomy of a thin slice of the body developed from multiple… Read More
2019-06-26 04:11
Coverage GuidanceCoverage Indications, Limitations, and/or Medical NecessityThis LCD addresses the colonoscopies that are NOT performed for colorectal cancer screening. Colorectal cancer scr… Read More
2019-06-25 06:34
Coverage Indications, Limitations, and/or Medical NecessityThe clinical use of contrast echocardiography (ECHO) is appropriate in selected patients to:Evaluate myocardial ischemiaQuantify my… Read More
2019-06-24 09:53
HCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) is included in the allowance for CPT Codes 65778 and 65779. In an inpatient facility reimbursement for HCPCS c… Read More
2019-06-24 09:12
Coverage Indications, Limitations, and/or Medical NecessityIntroduction:This policy does not address sacral conditions, injections or neurotomies. Sacral injections, identified on the claim… Read More
2019-06-23 10:00
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULESFor any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the… Read More
2019-06-23 09:45
Arthroscopy is a surgical procedure that allows the direct visualization of the interior joint space. In addition to providing visualization, arthroscopy enables the process of joint cleansi… Read More
2019-06-23 09:24
The following coding guidance is published based on the requirements in effect as of the effective date of this article and no longer addresses past coverage. Prior coverage may be different… Read More
2019-06-23 08:52
DefinitionsFor allergen immunotherapy purposes a dose describes the amount of antigen(s) administered in a single injection from a multi-dose vial.CPT codes 95115-95117 describe the professi… Read More
2019-06-22 08:46
Effective November 18, 2011, September 21, 2012, July 29, 2014, October 6, 2014, March 25, 2015, and May 13, 2019 respectively, Aflibercept (EYLEA®) was approved by the Food and Drug Adm… Read More
2019-06-22 08:37
Article Text:Both fiducial artificial markers and implanted markers are used as a guide to provide a clear and accurate reference point(s) for any type of imaging modality, image guided surg… Read More
2019-06-22 05:13
Occupational Therapy Guidance for use of CPT code 96125• Occupational therapy evaluations include an occupational profile, medical and therapy history, relevant assessments, and develop… Read More
2019-06-21 09:00
Vascular access is the location(s) where the patient’s vascular system is entered. The common femoral artery (CFA) and brachial arteries are the most frequently used.A vascular family… Read More
2019-06-21 04:31
CF. Conversion factor (in dollars per RVU), adjusted annually and used by the CMS to convert RVUs to dollars.CMS. The Center for Medicare and Medicaid Services (formerly the HCFA), the feder… Read More
2019-06-20 04:23
BackgroundObservation care is a well-defined set of specific, clinically appropriate services,which include:• Ongoing short term treatment,• Assessment,• ReassessmentThese are… Read More
2019-06-18 04:23
Coverage GuidanceCoverage Indications, Limitations, and/or Medical NecessityCardiac computed tomographic angiography (CCTA), also known as computed tomography of the heart and coronary arter… Read More
2019-06-17 10:31
Common Vitrectomy CodesCode Short Descriptor CPT Descriptor67036 Removal of inner eye fluid Vitrectomy, mechanical, pars plana approach67039 Laser treatment of retina Vitrectomy, mechanical… Read More
2019-06-17 09:47
The following pages providesa summary of which CPT codes and procedures are associated with the Primary Surgeryauthorization  &hell…Read More
2019-06-16 16:12
PolicyBlue Cross Blue Shield of Massachusetts (Blue Cross*) reimburses contracted health care providers for covered, medically necessary behavioral health telehealth (telemedicine) services… Read More
2019-06-16 05:35
IntroductionThe administrative handling of Tier 2 Molecular Pathology CPT codes 81400-81408 is addressed by this guideline. The assessment of medical necessity of tests billed with tier 2 mo… Read More
2019-06-15 05:19
PolicyHarvard Pilgrim reimburses contracted providers for the provision of cardiology services delivered in settings such as an office or free-standing facility, and for inpatient admissions… Read More
2019-06-15 05:08
INSTRUCTIONS FOR USEThe services described in Oxford policies are subject to the terms, conditions and limitations of the member's contract or certificate. Unless otherwise stated, Oxford po… Read More
2019-06-14 03:26
INSTRUCTIONS FOR USEThe services described in Oxford policies are subject to the terms, conditions and limitations of the member's contract or certificate. Unless otherwise stated, Oxford po… Read More
2019-06-11 16:30
Inpatient facilities (for example, hospitals) are responsible for providing drugs during a beneficiary’s inpatient stay. However, once the beneficiary has returned home, Part B supplie… Read More
2019-06-11 16:28
Diagnostic Nuclear Medicine Procedures on the Endocrine System (78012-78099)78012Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discha… Read More
2019-06-10 16:26
CLIA regulations require a facility to be appropriately certified for each test performed. To ensure that CMS only pays for laboratory tests categorized as waived complexity under CLIA in fa… Read More
2019-06-08 16:14
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) has new codes in 2019. New DMEPOS codes added to the HCPCS file, effective January 1, 2019, where applicable, are… Read More
2019-05-01 04:02
Medical Coding Example Report 1PREOPERATIVE DIAGNOSIS: Enlarged left groin lymph nodes, history of B-cell lymphoma.POSTOPERATIVE DIAGNOSIS: Enlarged left groin lymph… Read More
2019-01-22 14:07
0001M Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, a… Read More
2019-01-22 14:02
0335T Insertion of sinus tarsi implant 0362T Behavior identification supporting assess… Read More
2019-01-22 13:47
0505T Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any metho… Read More
2018-12-12 16:53
Basics about CPT code 79101 & 79005Radiopharmaceutical therapy by intravenous (IV) administration requires the establishment of an IV access line followed by the injection of a dose-spec… Read More
2018-12-11 16:44
Basics of CPT code 78451 & 78452Myocardial perfusion imaging is a nuclear medicine procedure used to evaluate the heart muscle and blood flow to the heart. An intravenous line is inserte… Read More
2018-12-10 14:39
Basics about CPT code 93282, 93283 & 93284An in-person programming evaluation is performed on a transvenous implantable defibrillator system with iterative adjustment of the implantable… Read More
2018-12-07 14:27
Basics about CPT code 93286 & 93287A peri-procedural device evaluation is performed with programming of the device system parameters before or after surgery, a procedure, or other test i… Read More
2018-12-05 14:07
Basics about CPT code 93260 & 93261An in-person programming evaluation is performed on an implantable subcutaneous lead defibrillator system with iterative adjustment of the implantable… Read More
2018-12-04 13:34
Basics about CPT code 33270, 33271, 33272 & 33273A permanent subcutaneous implantable defibrillator system consists of a pulse generator and a lead wire containing sensing electrodes and… Read More
2018-12-03 13:01
Basics about CPT code 33212 & 33213A permanent cardiac pacemaker pulse generator is inserted and attached to an existing lead(s). Cardiac pacemakers deliver an electronic impulse to the… Read More
2018-12-02 12:45
Basics about CPT code 33206, 33207 & 33208A permanent cardiac pacemaker system is inserted or replaced, including subcutaneous insertion of the pulse generator and transvenous placement… Read More
2018-11-21 13:35
Appendix Lin CPT code book consist of Vascular families. I think Interventional radiology (IVR) coders will be aware of Vascular families and the some of the coding rules for coding each fam… Read More
2018-10-30 13:47
List of New ICD 10 codes for 2019 C43.111 Malignant melanoma of right upper eyelid, including canthusC43.112 Malignant melanoma of right lower eyeli… Read More
2018-10-30 13:43
List of Deleted ICD 10 codes for 2019 for medical codersC43.11 Malignant melanoma of right eyelid, including canthusC43.12 Malignant melanoma of left eyelid, including… Read More
2018-10-30 13:42
Below are the list of Changes ICD 10 codes for 2019A92.5 Zika virus diseaseE67.1 HypercarotenemiaE72.53 Primary hyperoxaluriaE75.29 Other sphingol… Read More
2018-10-02 13:53
HCPCS level II should be used very smartly. These modifiers also affects lot of medicare payment. Today, we will checkout few of these modifiers. AU, AV & AW modifiers.AU Item furnished… Read More
2018-07-12 14:23
Modifier 58- Staged or Related Procedure or Service by the Same Physician During the Postoperative PeriodReport when a procedure or service during the postoperative period was:Planned p… Read More
2018-07-11 14:58
Modifier 54 Surgical Care OnlyUsed to indicate when one physician or other qualified healthcare professional performs the surgical care only and another physician performs the pre-opera… Read More
2018-07-09 14:45
In Radiology, their are many procedure codes which are very different from others. Some of them need lot of attention because of their complex nature. Today, I would like to share some… Read More
2018-05-01 14:36
Ultrasound is a procedure that uses sound waves to "see" inside your body. This procedure is performed to evaluate symptoms including leg pain or swelling, excessive varicose veins, sho… Read More
2018-04-01 15:46
As a medical coder, you always want to be get certified either from AAPC or AHIMA. There are lot of advantages once you become a certified medical coder from AAPC or AHIMA. The most common e… Read More
2018-03-26 15:09
Errors are very important part of our life. When we do mistake, we learn from it. But, it is equally important that we do not repeat the same mistake.In medical coding also, because of so ma… Read More
2018-03-14 14:39
A ventilation and perfusion scan is most often done to detect a pulmonary embolus (blood clot in the lungs). It is also used to: Detect abnormal circulation (shunts) in t… Read More
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