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Latest articles

Delving Into the 360 Assessment Fraud Complaint
November 17th, 2021 - Jessica Hocker, CPC, CPB

The Department of Justice is pursuing claims of healthcare fraud against Cigna Health-Spring Medicare Advantage plan based on how they used data from their 360 Program in 2012. A review of the allegations may help other payers avoid similar accusations.

Lessons Learned from a RADV Audit Report
November 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content

If given an opportunity to know ahead of time the questions that would be asked of you in an upcoming interview or quiz, it is likely the outcome would be significantly better than if you were surprised by the questions. This same concept may be applied to audits of risk ...

Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022
November 11th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS

Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time ...

Reporting and Auditing Drug Testing Services
November 9th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT

Drug testing is a common medical service used to manage prescription medications, verify someone is not taking illegal substances or too much of a prescribed substance, and monitor for toxicity and therapeutic dosing. It is customary for patients in treatment programs for chronic pain management or substance use disorders (SUD) to undergo random urine drug testing (UDT) or urine drug screening (UDS) as part of their individual treatment plan. Drug testing is regulated by federal and state laws (e.g., OSHA, CLIA), which must be carefully adhered to.

Understanding ASCs and APCs: Indicators and Place of Service
October 28th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS

The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

Editors choice articles

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!
May 25th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Coding Lesions and Soft Tissue Excisions
April 29th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
COVID-19 Vaccines
March 10th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Not Following the Rules Costs Chiropractor $5 Million
September 1st, 2020 - Wyn Staheli, Director of Research
Is COVID-19 Causing Risk Adjustment “Gotcha’s”?
August 27th, 2020 - Wyn Staheli, Director of Research

Latest questions/posts

Can 67904 and 67908 be billed together (bundled)?
1^st Nov 30th, 2021 - ectdocs

Two adjustment codes
Nov 17th, 2021 - phil.jen 2

Reduction Ascending Aortoplasty
1^st Oct 29th, 2021 - Christine1229

Geico Denying Modifier 59 & 25. Why?
1^st Sep 29th, 2021 - DDoug

EKG and Spirometry with E&M same DOS
1^st Sep 29th, 2021 - sbt

OTC or RX management in MDM
Sep 17th, 2021 - sharris

Coding an E/M in place of a minor procedure that will not be paid
Sep 16th, 2021 - sschwartz 4

Medicare Part A billing for CPT 27447
1^st Jul 1st, 2021 - Boss Lady

Chiropractic Billing
1^st Jul 1st, 2021 - GCGchiro

integmentary biopsy
1^st Jun 18th, 2021 - Sunny_day3

ER/Hospitalist Professional Visits
1^st Jun 4th, 2021 - Dawna 1

GA GY necessary on therapies not covered by Medicare?
1^st May 25th, 2021 - TammyC

97140 or 97124 and What Modifier?
1^st May 19th, 2021 - Anj 1

Hello Everyone
1^st Apr 9th, 2021 - evopryseo 3

chiropractic body region question
1^st Mar 15th, 2021 - GregoryH

biopsy of a perianal lesion/malignancy.
1^st Mar 10th, 2021 - btalley

Cardiothoracic Coders
Feb 8th, 2021 - rdinaso 12 1

water massage table
1^st Jan 27th, 2021 - KayC

Code G8730 rejection
1^st Jan 20th, 2021 - LEEs

Combination Codes
1^st Jan 7th, 2021 - BeckyR

Insurance Rejections For Medical Necessity - Can 2nd insurance be billed?
Dec 29th, 2020 - sharris

If you know a procedure will be denied as cosmetic can an E/M be charged instead?
Dec 1st, 2020 - sschwartz 4

Elongated Toenails
Nov 23rd, 2020 - sharris

Does National CPT Tracking exist?
1^st Nov 12th, 2020 - ShawnV

Bought out an Existing Practice
1^st Nov 5th, 2020 - SBerg

Nail Debridement vs Nail Trimming
Nov 5th, 2020 - sharris

AT modifier use for spinal manipulation services
Nov 2nd, 2020 - JBrooks 1

GA modifier
1^st Sep 30th, 2020 - ACC

97110, 97530, 97012
1^st Sep 24th, 2020 - ChiroCasey

Manipulation Therapy & Habilitative/Rehabilitative Services
1^st Sep 22nd, 2020 - Coding&Thriving

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