ABN Form Change
The Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage (Form CMS-R-131) for renewal. This renewed form expires January 31, 2026. The expiration date is the only change to the form. You may use the renewed form now, but you must use it beginning June 30, 2023, when the previous version expires. […]
Continue readingWhen Medicare is Secondary
Medicare should not be billed for services if payment has been made or can reasonably be expected to be made, by the following primary plans when certain conditions are satisfied: Group health plans Workers’ compensation plans Liability insurance No-fault insurance The details of the ‘certain conditions’ are spelled out in our Medicare Course If the […]
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 Deleted
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 It has been replaced by more specific codes.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 […]
Continue readingR51 Headache Code Change
R51 – headache (cephalgia) became invalid 10-01-2020 as it has been replaced by more specific codes. Headache R51- Type 2 Excludes atypical face pain (G50.1) migraine and other headache syndromes (G43-G44) trigeminal neuralgia (G50.0) R51.0 Headache with orthostatic (relating to or caused by an upright posture) component, not elsewhere classified R51.9 Headache, unspecified ICD-10 coding […]
Continue readingBilling Spinal X-Rays
Full spine x-rays are not considered to be of diagnostic quality. This is expecially true of 14×36 film. So if a chiropractor decides to x-ray the patient’s entire spine, he should take sectional views and bill the exam using three codes as follows: 72040 Radiologic examination, spine, cervical; 2 or 3 views 72070 Radiologic examination, […]
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