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Each edit is associated with a disposition. For example, there can be a rejection of the line item itself or a rejection of the entire claim. In addition to edit dispositions, the program assigns an overall disposition to the claim. The below lists the edits currently applied to non-OPPS hospital outpatient claims with their dispositions. … Read more
Payment adjustment flag 0 – No payment adjustment 1 – Paid standard amount for pass-through drug or biological (status indicator G) (discontinued effective October 2016, v17.3) 2 – Payment based on charge adjusted to cost (status indicator H) (discontinued effective October 2016, v17.3) 4 – Deductible not applicable (specific list of HCPCS codes) or condition … Read more
Status Indicators “It is a payment indicator that identifies whether a service represented by a CPT or HCPCS code is payable under the OPPS APC or another payment system” A – Services not paid under OPPS; paid under fee schedule or other payment system, including unclassified drugs and biologicals reportable under HCPCS code C9399 B … Read more
Although when coding OB/GYN, the particular ICD-10 codes are rarely used because medical coders know exactly which codes to use for which patient symptoms. These codes rarely show up in the offices of other emergency or cardiology professionals due to the delicate nature of women’s health. As a result, when coding and billing for OB/GYN … Read more
Eligible Professionals for PQRS Under Physician Quality Reporting System (PQRS), covered profession al services are those paid under or based on the Medicare Physician Fee Schedule (PFS). To the extent that eligible professionals are providing services which get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment … Read more
Basics of CPT Code 90832, 90833, 90834, 90836, 90837, 90838 Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing. In medical coding, we have separate procedure … Read more
Basics of CPT code 97116 The provider instructs the patient in the proper ways of practicing various exercises, including climbing stairs, focusing on one or more areas, that assist them in walking comfortably and without strain for a period of 15 minutes. Below is the code description for CPT code 97116. 97116 Therapeutic procedure, 1 … Read more
Basics of 90686 CPT code The provider administers into a muscle of a patient, a preservative–free, four–strain influenza virus vaccine, in a 0.5 mL dose to provide immunity to four forms of influenza, a severe and infectious respiratory disease. Below is the description of 90686 CPT code. 90686 Influenza virus vaccine, quadrivalent, split virus, preservative … Read more
Basics of 97530 CPT code The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity. Below is the description of 97530 CPT code. 97530 -“Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each … Read more
Basics of 97140 CPT code Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy helps in improving joint mobility, alignment, tissue repair, lymphatic drainage, and traction. Below is description of 97140 CPT … Read more