Veterans Benefits and Medicare
VA benefits are primary to Medicare and Medicare should NOT be billed as the secondary insurance coverage: Medicare does not pay for services authorized under Veterans Health Administration (VHA) benefits. However, Medicare may cover and pay for services not authorized under VHA benefits. Both Medicare and and the U.S. Department of Veterans Affairs (VA) may […]
Continue readingM51.36 & M51.37 Code Changes
As of October 1, 2024, M51.36 & M51.37 the codes for ‘Other intervertebral disc degeneration, lumbar region / lumbosacral region’ are no longer valid. These codes must now be coded to the 6th digit. The new valid codes are as follows: M51.36 Other intervertebral disc degeneration, lumbar region M51.360 …… with discogenic back pain only M51.361 […]
Continue readingVerifying Insurance Deductibles
Insurance Course When verifying insurance coverage, it’s important to know when the next deductible comes due. Most insurance policies operate on a calendar year basis. The patient must meet a new deductible on January 1st every year. Some policies however may operate on a fiscal year basis. New deductibles could begin at any time during […]
Continue readingM50.22 Cervical Disc Displacement Code No Longer Valid
As of October 1, 2023, M50.22 (Other cervical disc displacement, mid-cervical region) is no longer a valid diagnosis code. It has been replaced by more specific codes. The new valid codes are as follows: M50.220 …… unspecified level M50.221 Other cervical disc displacement at C4-C5 level M50.222 Other cervical disc displacement at C5-C6 level M50.223 […]
Continue readingElectronic Health Records (EHR) Requirements
In order to meet the electronic health records requirements for Medicare billing, the software used must be CMS certified. Meaningful use must be established every year. In order to do that, 20 of 25 criteria and fifteen core objectives and five of ten menu objectives must be met. Plus you must enter the required data […]
Continue readingWireless (WiFi) Networks are NOT Secure
Wireless networks are subject to being breached and all your patient information being stolen. Stolen protected health information (PHI) is a serious HIPPA violation. Click here to see how wireless networks are compromised. Protect yourself and your patients … insist that your network be cabled … not wireless.
Continue readingModifier 59 – Manual Therapy & Diagnosis Pointers
The billing of an Adjustment (CMT 98940, 98941 or 98942) and a Manual Therapy Technique (97140) on the same visit is not generally allowed. The rationale is due to overlap of preservice, intraservice, and postservice work that is inherent to both codes. The intraservice overlap occurs as the provider identifies the osseous, articular, and soft […]
Continue readingProlonged Outpatient E/M Service
Evaluation and Management services (E/M) can be selected based on medical decision making (MDM) or Time. Codes should be chosen based upon the severity of the presenting problem, intensity of management and other aspects of medical necessity. A prolonged service is a service that requires more time than that specified in the E/M code. Prolonged […]
Continue readingM54.5 Low Back Pain Code No Longer Valid
As of October 1, 2021, M54.5 (Low Back Pain) is no longer a valid diagnosis code. It has been replaced by more specific codes. This means that all your existing patients with a M54.5 diagnosis must be updated. The new valid codes are as follows: M54.50 Low back pain, unspecified M54.51 Vertebrogenic low back pain […]
Continue readingNPI Numbers in Blocks 24j and 33a
The billing provider is the entity that is sending the insurance claim to the insurance company. This is usually the doctor’s corporation or the doctor himself if he is not incorporated or the company that is doing the billing for you. The billing provider is the entity that receives the insurance check when assignment is […]
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