Medicare Billing Tips | Don’t Miss the Asymptomatic Individuals for Smoking Tobacco Use Prevention and Cessation Counseling | Use G0436 G0437
Aug30

Medicare Billing Tips | Don’t Miss the Asymptomatic Individuals for Smoking Tobacco Use Prevention and Cessation Counseling | Use G0436 G0437

Don’t Avoid Billing Medicare for Smoking Tobacco Use Prevention and Cessation Counseling for Asymptomatic Individuals Most practice offices knows that effective on and after August 25, 2010, Medicare pays for claims that covers tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries. This article is focused more on Medicare’s coverage for counseling session to prevent tobacco use for; 1) who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease; 2) who are competent and alert at the time that counseling is provided; and 3) whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. These individuals who do not have signs or symptoms of tobacco-related disease will be covered under Medicare Part B when the above conditions of coverage are met, subject to certain frequency and other limitations (see below). The ICD-9 diagnosis codes that should be reported for these individuals are: 305.1 (non-dependent tobacco use disorder) ICD-10 Codes Effective October 01, 2015 F17.200: Nicotine dependence, unspecified, uncomplicated F17.201: Nicotine dependence, unspecified, in remission F17.210: Nicotine dependence, cigarettes, uncomplicated F17.211: Nicotine dependence, cigarettes, in remission F17.220: Nicotine dependence, chewing tobacco, uncomplicated F17.221: Nicotine dependence, chewing tobacco, in remission F17.290: Nicotine dependence, other tobacco product, uncomplicated F17.291: Nicotine dependence, other tobacco product, in remission or V15.82 (history of tobacco use) The ICD-10 Codes Effective October 01, 2015 Z87.891: Personal history of nicotine dependence In 2011, Medicare added two new G codes for billing for tobacco cessation counseling services to prevent tobacco and for asymptomatic individuals use for dates of service on or after January 1, 2011. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. Use HCPCS Codes to Use: (for Asymtomatic Individuals for Medicare) G0436: Smoking and tobacco cessation counseling visit forthe asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes *** FREQUENCY:  It allows 2 cessation counseling session attempts per 12-month period, with maximum of 4 intermediate or intensive sessions per attempt (8 Sessions per 12 Months Period). After eight sessions within the year, additional sessins are allowed only after 11 months since the first covered cessation counseling session. *** WAIVED:  Eligible beneficiaries are covered under Medicare Part B. Both the coinsurance and deductible are waived. CPT Codes to Use for your Symptomatic Patients and for Non-Medicare Payors 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes “Medicare will...

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How to Bill for BCA Body Composition Analysis for Obesity Services | CPT Code for Body Composition Analysis
Aug19

How to Bill for BCA Body Composition Analysis for Obesity Services | CPT Code for Body Composition Analysis

  “The American Medical Association’s (AMA) recent revision of Current Procedural Technology (CPT) Category III Code 0358T, the code that insurance companies use to recognize Whole Body Composition Analysis tests whose results are generated through a scale called the bioelectric impedance analysis (BIA). Previously, code 0358T had only covered body composition tests that were conducted while a subject tested in the supine position.  A testing period for the revised code will now follow the CPT editorial board’s decision.  The code is scheduled for early release onJuly 1st, 2015, and patients and practitioners can begin contacting their insurance companies for billing options from this date.  Implementation will follow on January 1st, 2016.” So here’s what we need to know, the BCA or the Body Composition code that we can utilize is from the revised Category III code 0358T which will take effect January 1st, 2016 but the providers has to start calling their insurance payors since this code is a CAT III (Contains Temporary Set of Codes) and may not be reimbursable. Source: http://www.inbodyusa.com/blogs/inbodyblog/29243713-inbody-announces-important-revision-to-body-composition-analysis-cpt-code     GOT Question? Connect with me! 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 Obesity Screening, Treatment and Counseling for Medicare and Commercial Payers
Jul12

Billing Obesity Screening, Treatment and Counseling for Medicare and Commercial Payers

If you are doing Obesity Screening and Counseling Services in your practice, here are the codes and guidelines I want to share with you: Keyword Tag: Billing Obesity Billing Obesity Screening, Treatment and Counseling for Medicare Keyword Tag: Billing Obesity HCPCS/CPT Codes G0447 – Face-to-face behavioral counseling for obesity, 15 minutes G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes Keyword Tag: Billing Obesity ICD-9-CM Codes for Obesity Screening, Treatment and Counseling for Medicare Keyword Tag: Billing Obesity Cross-over Diagnosis Codes (Choose 1)    –  V85.30–V85.39, V85.41–V85.45  V85.30 Body Mass Index 30.0-30.9, adult (Use ICD-10 Code Z68.30 – Effective October 1, 2015) V85.31 Body Mass Index 31.0-31.9, adult (Use ICD-10 Code Z68.31 – Effective October 1, 2015) V85.32 Body Mass Index 32.0-32.9, adult (Use ICD-10 Code Z68.32- Effective October 1, 2015) V85.33 Body Mass Index 33.0-33.9, adult (Use ICD-10 Code Z68.33 – Effective October 1, 2015) V85.34 Body Mass Index 34.0-34.9, adult (Use ICD-10 Code Z68.34 – Effective October 1, 2015) V85.35 Body Mass Index 35.0-35.9, adult (Use ICD-10 Code Z68.35 – Effective October 1, 2015) V85.36 Body Mass Index 36.0-36.9, adult (Use ICD-10 Code Z68.36 – Effective October 1, 2015) V85.37 Body Mass Index 37.0-37.9, adult (Use ICD-10 Code Z68.37 – Effective October 1, 2015) V85.38 Body Mass Index 38.0-38.9, adult (Use ICD-10 Code Z68.38 – Effective October 1, 2015) V85.39 Body Mass Index 39.0-39.9, adult (Use ICD-10 Code Z68.39 – Effective October 1, 2015) Keyword Tag: Billing Obesity V85.41 Body Mass Index 40.0-44.9, adult (Use ICD-10 Code Z68.41 – Effective October 1, 2015) V85.42 Body Mass Index 45.0-49.9, adult (Use ICD-10 Code Z68.42 – Effective October 1, 2015) V85.43 Body Mass Index 50.0-59.9, adult (Use ICD-10 Code Z68.43 – Effective October 1, 2015) V85.44 Body Mass Index 60.0-69.9, adult (Use ICD-10 Code Z68.44 – Effective October 1, 2015) V85.45 Body Mass Index 70 and over, adult (Use ICD-10 Code Z68.45 – Effective October 1, 2015)     Keyword Tag: Billing Obesity Who Is Covered for Billing Obesity Screening, Treatment and Counseling for Medicare? Keyword Tag: Billing Obesity Medicare beneficiaries: • With obesity (Body Mass Index [BMI] ≥ 30 kilos) • Who are competent and alert at the time counseling is provided; and • Whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting 01 – General Practice 08 – Family Practice 11 – Internal Medicine 16 – Obstetrics/Gynecology 37 – Pediatric Medicine 38 – Geriatric Medicine 50 – Nurse Practitioner 89 – Certified Clinical Nurse Specialist 97 – Physician Assistant Keyword Tag: Billing Obesity Frequency for Billing Obesity Screening, Treatment and Counseling for Medicare • First month: one visit every week; • Months 2 – 6: one visit...

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Medicare G0473 New Code for Obesity Treatment
Mar19

Medicare G0473 New Code for Obesity Treatment

Medicare G0473 New Code for Obesity Treatment Professional Billing Requirements:  (Effective January 05, 2015) CMS will allow coverage for: Face-to-Face Behavioral Counseling for Obesity, 15 minutes, (G0447), Face-to-Face behavioral counseling for obesity; Group (2-10), 30 minute(s) (G0473), along with 1 of the … ICD-9 codes for BMI 30.0-BMI 70 (V85.30- V85.39 and V85.41-V85.45) Make sure you use and cross over your DX as shown above!  List of Eligible Specialty 01 – General Practice 08 – Family Practice 11 – Internal Medicine 16 – Obstetrics/Gynecology 37 – Pediatric Medicine 38 – Geriatric Medicine 50 – Nurse Practitioner 89 – Certified Clinical Nurse Specialist 97 – Physician Assistant 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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Coding Preventive Care with Same Day Sick Visit – 3 TIPS
Nov24

Coding Preventive Care with Same Day Sick Visit – 3 TIPS

Coding Preventive Care with Same Day Sick Visit – 3 TIPS Billing for Preventive Service Combined with a Problem Focused Service can be challenging. But I can show you 3 practical tips on how to tackle this challenge and make it more sense to you on how you should approproate bill and code for these… 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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Can I use Modifier 33 on CPT 99385, 99397 or 99402, 99403
Nov24

Can I use Modifier 33 on CPT 99385, 99397 or 99402, 99403

Question: Can I use Modifier 33 on CPT 99397 or 99402? Answer: NO. If you are going to look at the description of Modifier 33 – it is for “Preventive Service”. These 2 codes 99397 and 99402 are already “inherently” preventive service by nature. And since the 99402 is in the “Preventive Medicine Service” – then you CANNOT use the modifier 33 for codes that are already “inherently” Preventive. Append your Modifier 33 to codes (procedures) that turned out to be preventive… one very good example is also your 80061. Always make sure you have strong documentations and always based on Medical Necessity. ** AMA GUIDELINES: Modifier 33 was created by the AMA and effective January 1, 2011, in response to a need for payers and health plans to identify services that are NOT inherently preventive but provided as a result of preventive service. Modifier 33 is THEREFORE used to identify to a payer that the copayment and deductible for a preventive services under the Patient Protection and Affordable Care Act PPACA; it requires all insurance carriers to cover preventive service and immunizations without cost-sharing. Here’s a guideline from the American Medical Association who owns CPT. AMA Mod 33 new-cpt-modifier-for-preventive-services (in PDF file) *** You can append Modifier 25 on the Problem-Focused Code 99213-99214 / 99203-99205 if the encounter is due to patient’s illness or is “problem-focused. Related Article on “When to Use Modifier 33”  http://www.mspinkymaniri.com/2016/03/when-to-use-modifier-33/   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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