According to Section 5501(a) of the Affordable Care Act the Primary Care Physicians (PCP) and NPPs who furnish specified primary care services will receive 10 percent of incentive payment for the services rendered on or after January 1, 2011 and continuing through December 31, 2015 Eligibility of New Providers for Payment under PCIP For primary…
CPT codes 62310 – CPT 62311 and CPT 62318-62319 (Epidural or subarachnoid injections of diagnostic or therapeutic substance) may be reported on the date of surgery if performed for postoperative pain management rather than as the means for providing the regional block for the surgical procedure. If a narcotic or other analgesic is injected postoperatively…
The Health and Human Services Office of General Counsel (OGC) has provided guidance that Medicare contractors that process both institutional and professional claims have discretion to automatically deny claims billed with the GZ modifier. The GZ modifier indicates that an Advance Beneficiary Notice (ABN) was not issued to the beneficiary and signifies that the provider…
The procedure-to-device edit files included in the January 2012 (V13.0) and April 2012 (V13.1) integrated outpatient code editor (I/OCE) do not allow the device described by the Healthcare Common Procedure Coding System (HCPCS) code C1882 (Cardioverter-defibrillator, other than single or dual chamber (implantable)) to satisfy the edit in place for CPT code 33249 (Insertion or…
Bisphosphonate therapy:The following bisphosphonate injections (administered IV) are considered medically reasonable and necessary when administered as outlined below. The coverage of IV bisphosphonates must be supported in the medical record. The documentation should include the following information:• Criteria for the diagnosis of osteoporosis, and• History of treatment as related to progression of disease and ongoing…
The Department of Health and Human Services (HHS) announced a proposed rule that would delay, from October 1, 2013 to October 1, 2014, the compliance date for the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). The ICD-10 compliance date change is part of a proposed rule that would adopt a standard…
According to ‘Change Request 7701’ Physician Assistants can Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications. CR7701 directs Medicare contractors to recognize that, effective with services furnished on or after January 1, 2011, physician assistants can perform the required initial certification and periodic recertifications of a beneficiary’s need for a SNF level…
CPT codes 94002-94004, CPT code 94660-94662 (Ventilation management/CPAP services) If these services are performed during a surgical procedure, they are included in the anesthesia service. These services may be separately reportable if performed by the anesthesia practitioner after post-operative care has been transferred to another physician by the anesthesia practitioner. Modifier 59 may be reported…
Both residents and teaching physicians may document physician services in the patient’s medical record. The documentation must be dated and contain a legible signature or identity and may be: • Dictated and transcribed;• Typed;• Hand-written; or• Computer-generated. A macro is a command in a computer or dictation application in an electronic medical record that automatically…
Medicaid reimburses for adult dental services rendered by licensed, Medicaid-participating dentists. Medicaid reimbursable adult dental services are provided to recipients age 21 and older. Services include: • Diagnostic examination for the denture services; • Radiographs necessary for dentures; • Extractions and other surgical procedures essential to the preparation of the mouth for dentures if the…
