When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required.
New Patient: A patient that has not received any professional services i.e., E&M or any other face to face service from the physician or group within the previous three years. Be sure you code as an encounter for health exam using the following Z-Codes:
Z00.110 Health supervision for newborn under 8 days old or Z00.111 Health supervision for newborns 8 to 28 days old or Z00.121 Routine child health exam with abnormal findings Z00.129 Routine child health exam without abnormal findings
Z00.00 General adult medical exam without abnormal findings Z00.01 General adult medical exam with abnormal findings
Also remember to used modifier 33 if the service was initiated as a preventative service even if the visit required additional services. Be sure to code any abnormal findings as well. Read the attached article to verify the preventative service requires the use of modifier 33, Modifier 33 for Preventive Care. As part of the Patient Protection and Affordable Care Act (PPACA), healthcare insurance companies are required to pay for some preventive services, and many have already deemed such services as immunizations, screenings, well-child examinations, and screening mammograms among others.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.
The use of Modifier 25 is one example ...
To determine the dosage, size, doses per package and how many billing units are in each package, refer to the NDC number.
Take a look at the following
J1071 - Injection, testosterone cypionate, 1mg
For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL
(100 mg/mL = 1 mL and there are ...
As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.
The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).
The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.
ICD-10-CM Official Coding Guidelines - ...
On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.
Risk adjustment is simply a way of making sure that there are sufficient funds to adequately take care of the healthcare needs of a certain population. It’s a predictive modeling methodology based on the diagnoses of the individuals in that population. As payers move to value based models, they heavily rely on risk adjustment to ensure proper funding.
All healthcare providers who are currently participating in the MIPS portion of Medicare’s Quality Payment Program may want to participate in the new COVID-19 Clinical Trials improvement activity. Read more about it here.