Billing for Therapy Functional Reporting Therapy G Codes PT OT SLP
Jan10

Billing for Therapy Functional Reporting Therapy G Codes PT OT SLP

We saw this change Effective January 1, 2013 – The Therapy Functional Reporting Therapy G Codes The Policy: Therapy Functional Reporting Therapy G Codes   WHY the Change?   Section 3005(g) of MCTRJCA says, “The Secretary of Health and Human Services shall implement, beginning on January 1, 2013, a claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services subject to the limitations of section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)). Such strategy shall be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes. This claims-based data collection system is being implemented to include both the reporting of data by therapy providers and practitioners furnishing therapy services and the collection of data by the contractors. This reporting and collection system requires selected claims for therapy services to include nonpayable G-codes and related modifiers. These nonpayable G-codes and severity/complexity modifiers provide information about the beneficiary’s functional status at the outset of the therapy episode of care, at specified points during treatment, and at the time of discharge. These G-codes and related modifiers are required on selected claims for all outpatient therapy services – not just those over the therapy caps. Source: CR-8005 Claims-Based Data Collection Requirement for Outpatient Therapy The Therapy Functional Reporting Therapy G Codes for CY 2013 and the Severity/Complexity Modifiers   Mobility: Walking & Moving Around   Therapy Functional Reporting G Codes are: G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting Determine the Appropriate severity/complexity modifier: CH 0 percent impaired, limited or restricted CI At least 1 percent but less than 20 percent impaired, limited or restricted CJ At least 20 percent but less than 40 percent impaired, limited or restricted CK At least 40 percent but less than 60 percent impaired, limited or restricted CL At least 60 percent but less than 80 percent impaired, limited or restricted CM At least 80 percent but less than 100 percent impaired, limited or restricted CN 100 percent impaired, limited or restricted Changing & Maintaining Body Position     Therapy Functional Reporting Therapy G Codes are: G8981 Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals G8982 Changing & maintaining body position functional limitation, projected...

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How to Bill and Code for Urine Drug Screen to Medicare
Jan07

How to Bill and Code for Urine Drug Screen to Medicare

*** 2017 NEW CPT CODES FOR URINE DRUG SCREENING – READ AND CLICK HERE! Here’s an article on How to Bill and Code for Urine Drug Screen to Medicare The Necessity of Drug Screening A pain doctor may perform drug screening test on his patients making sure his patients are compliant with their prescribed pain medication especially when they are on narcotic pain medications. But how to bill and code for urine drug screen to Medicare is different when billing to the Commercial Insurance payers. Since 2011, your drug screening codes from your CPT Coding Book is non billable and cannot be reported to Medicare when reporting for drug screenings tests. The Following Codes are no longer accepted by Medicare since January 1, 2011 80100 (has not been priced under Medicare effective January 1, 2011) 80101 (has not been priced under Medicare effective July 1, 2010) 80104 (has not been priced under Medicare effective January 1, 2011) So when you are billing Medicare for Drug Screening, you have 2 HCPCS codes to choose from.  G0431  (Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter) will be used to report more complex testing methods, such as multi-channel chemistry analyzers, where a more complex instrumented device is required to perform some or all of the screening tests for the patient. Note that the descriptor has been revised for CY 2011. May only be reported when tests are performed using instrumented systems (i.e., durable systems capable of withstanding repeated use).  Do not report with Modifier QW (CLIA-waived)   Report only one unit per patient per encounter, regardless of the number of drug classes being tested (or detected)  G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter)  Report only one unit per patient per encounter, regardless of the number of drug classes being tested (or detected)  (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter)  Append Modifier QW (CLIA-Waived)  This will be used to report very simple testing methods, such as dipsticks, cups, cassettes, and cards, that are interpreted visually, with the assistance of a scanner, or are read utilizing a moderately complex reader device outside the instrumented laboratory setting (i.e., non-instrumented devices). Keypoints to always remember on how to bill and code drug screen to Medicare 1. Render service based on medical necessity 2. G0431 or G0434 can only be reported one unit of service per patient encounter, regardless of the number of drug classes being tested (or detected) 3....

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Billing Chemodenervation for Pain Management
Jan06

Billing Chemodenervation for Pain Management

If you are among physician offices, coders and billers who are still confused on how to code and do billing chemodenervation for pain management, I hope this article will help you clear the confusion. Billing Chemodenervation for Pain Management It is a challenge billing chemodenervation for pain management for any billers, coders and physicians. In 2014, we… Please LOGIN HERE to view this content. Or, REGISTER HERE Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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Billing Paravertebral Facet Joint Nerve Destruction RFL
Jan06

Billing Paravertebral Facet Joint Nerve Destruction RFL

It can really be very challenging to properly  do … Billing Paravertebral Facet Joint Nerve Destruction or the Radiofrequency Nerve Ablation   According to CPT     CPT® Changes 2012 explained the reason for the change. “Prior to 2012, the unit of service used to report these procedures was a single nerve at a single vertebral level. However, two nerves innervate each facet joint, and there are two facet joints at each vertebral level. One or two facet joints at the same level potentially could be treated. As such, the vertebral level is of less significance than the number of facet joints treated, so using vertebral level as the unit of service did not adequately reflect the work performed.”   Here are your codes when Billing Paravertebral Facet Joint Nerve Destruction     64633   Destruction by neurolytic agent, paravertebral facet joint nerve (s) with imaging guidance (fluoroscopy or CT); cervical or thoracic; single facet joint +64634   cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) 64635   Destruction by neurolytic agent, paravertebral facet joint nerve (s) with imaging guidance (fluoroscopy or CT); lumbar or sacral; single facet joint +64636   lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) POINTS: When Billing Paravertebral Facet Joint Nerve Destruction   1. These codes are no longer billable at a service unit(s) on a per single nerve at a single vertebral level; 2. You have to remember that there are 2 spinal nerves that innervates each single facet joint; 3. Anatomically, there are 2 facet joints (left and right) on each vertebral level; 4. These codes are billable per facet joint; which means, if 2 facet joints were treated on the same vertebral level, then you will report the primary code with a modifier -50 to indicate a bilateral procedure; Know your Spinal Nerves and Focus on them when billing paravertebral facet joint nerve destruction.  There’s a total of 31 pairs. Cervical (8 pairs) Thoracic (12 pairs) Lumbar (5 pairs) Sacral (5 pairs) Coccyx (1 pair)     Also note that imaging guidance is inclusive and that per the CPT guideline, fluoro or CT (imaging guidance) is required for the performance of these procedures. 77003 is inclusive and not billable when billing paravertebral facet joint nerve destruction. Otherwise, we are being further instructed that if imaging guidance (Fluoro or CT) is not used, it is appropriate to use the unlisted procedure code 64499 (Nervous System).   Useful References and Policy Guidelines from other Payers Local Coverage Determination LCD for Destruction of First Coast Florida Ucare Policy for Radiofrequency Ablation for Chronic Spinal Pain Facet Joint Denervation Policy Number 141 Blue Cross Blue...

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What Modifier for Global Surgery Should You Use?
Jan06

What Modifier for Global Surgery Should You Use?

Modifier for Global Surgery  (when used during the Surgical Global Days) Modifier 24 Evaluation and management service performed during the postoperative period for reasons unrelated to the original surgical procedure. Modifier 57 Evaluation and Management service involving the initial decision to perform surgery either the day before or the day of a 90-day major surgery. Append when the decision to perform surgery is made the day before or day of a 90-day major surgery. An Evaluation and Management service resulted in the initial decision to perform surgery during the E/M encounter. Let’s describe this modifier 57: An OB/GYN Doc sees a patient who complains with severe abdominal pain. It turned out (through ultra sound, radiology and all other diagnostic testing and documentations), the patient is having an ectopic pregrancy. The OB/GYN performs the laparoscopic surgery on the same day. The E/M encounter will then be reported with modifier 57 which resulted to decision for surgery. The laparoscopic surgery should also be reported as performed on the same day without a modifier. The following are your Modifier for Global Surgery (Postoperative) While the patient is covered by a global period, the following three modifiers may be appended to surgical CPT codes to indicate that an unrelated surgical procedure is being reported: Modifier 58: Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period References you can read: (Modifier for Global Surgery) Chapter 12 – Physicians Nonphysician Practitioners What Modifier for Global Surgery Should You Use?  How to Use Billing Modifiers in Medical Coding Searched Keyword: Modifier for Global Surgery Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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