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How Medicare Part D Works - Medicare Prescription Drug Costs Help

<h3>How Part D Works</h3>After you join, you will receive a membership card and materials via mail. You will pay a co-pay, co-insurance, or deductible when you use your card. 
Some Part D plans have a "coverage gap." A coverage gap means when you have spent a certain amount of money, you are responsible for paying the entire cost of prescriptions while you are in the gap until you reach the out-of-pocket limit. After you meet the out-of-pocket obligation, you will only have to pay a small co-pay or co-insurance for the remainder of the calendar year. 
<h3>Extra Help with Medicare Prescription Drug Costs</h3><div class="entry-image"></img></div>If you can't afford Part D costs, you may qualify for additional help. Several programs are available to assist with covering additional costs such as Medigap or Medicaid if you meet the income and resource requirements. 
 
If you already have coverage through a previous or current employer or union, you must contact your benefits administrator before you add or change your drug coverage. Joining Part D could result in the loss of your employer or union health or prescription coverage. 
A prescription drug plan can really take a lot of worry out of life. You never know what tomorrow may bring. Can you afford to risk your health? Prescription medications can cost hundreds of dollars a month, or even more in some cases. It is very important that you find a plan that will suit your budget and needs to insure that you have access to the prescription drugs you need.

How Medicare Part D Works - Medicare Prescription Drug Costs Help

How Part D WorksAfter you join, you will receive a membership card and materials via mail. You will pay a co-pay, co-insurance, or deductible when you use your card. Some Part D plans have a "coverage…

How to Get Medicare Advantage Plan Part D Coverage?

How to Get Part D Coverage?There are two ways to join the Medicare prescription drug coverage plan. The first is by adding it to your Original Medicare Plan or some Medicare cost plans, private fee-fo…

What is Part D (Medicare Prescription Drug Coverage)

<h1 class="entry-header"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCDWFHMGfPn5QuXZWj2NXNLyrprnga6rBEfsWxjZoK6F53a_AniF3APHLJOEQ0elZ6XxqYbHfoNVGnVjSVD5L9TzCeEdcSsSstCHdCVmp-MSFu_0fSWI7xv5Lka_y-dEnpOKQaJeSxBUU/s1600/medicare-part-b.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCDWFHMGfPn5QuXZWj2NXNLyrprnga6rBEfsWxjZoK6F53a_AniF3APHLJOEQ0elZ6XxqYbHfoNVGnVjSVD5L9TzCeEdcSsSstCHdCVmp-MSFu_0fSWI7xv5Lka_y-dEnpOKQaJeSxBUU/s400/medicare-part-b.gif" width="150" /></a></h1><div class="entry-content"><div class="entry-body"><h2>Explanation of Medicare Part D</h2>After reading about Medicare plans A, B and C, you might still bewondering where prescription drug coverage comes in, or how can you insure coverage for your medications. You'll find the answer in this next Medicare plan, or the final plan offered through Medicare, called Part D. 
 
<h3>What is Part D (Medicare Prescription Drug Coverage)?</h3>Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare. You need to enroll when you first become eligible to keep from paying a penalty cost later. Part D was designed to help people with Medicare to lower their prescription drug costs and to protect against future costs. A prescription drug plan will also enable you to have greater access to medically necessary drugs.</div></div>

What is Part D (Medicare Prescription Drug Coverage)

Explanation of Medicare Part DAfter reading about Medicare plans A, B and C, you might still bewondering where prescription drug coverage comes in, or how can you insure coverage for your medications.…

What Medicare Advantage (Part C) Plans are available?

<h3>What Medicare Advantage (Part C) Plans are available?</h3>There are several plans available for Medicare Advantage. The Part C plans include the following: 
 
<ul><li>Medicare Preferred Provider Organization (PPO) - You are able to see any doctor or specialist that you choose. If they are not in your PPO network, your cost will increase. You usually can see a specialist without a referral.</li>
<li>Medicare Health Maintenance Organizations (HMO) - You are able to visit doctors in the HMO network only. In most cases, you will be required to have a referral to visit a specialist.</li>
<li>Medicare Private Fee-for-Service (PFFS) - You are able to see any doctor or specialist, but they must be willing to accept the PFFS's fees, terms, and conditions. You do not have to have a referral to see a specialist.</li>
<li>Medicare Special Needs - These plans are designed for people with certain chronic diseases or other special health needs. These plans must include Part A, Part B, and Part D coverage.</li>
<li>Medicare Medical Savings Account (MSA) - There are two parts to this plan:</li>
</ul> 
<blockquote> 
<ol><li>A high-deductible plan with which coverage won't begin until the annual deductible is met.</li>
<li>A savings account plan where Medicare deposits money for you to use for health care costs.</li>
</ol></blockquote><h3>Do You Need Prescription Drug Coverage?</h3>Most Part C plans already include prescription drug coverage (Part D). If your plan offers drug coverage, you have to take it. If you have a stand-alone drug plan, and your Medicare Advantage Plan already has one, you will not be able to keep the Part C coverage. If you already have a prescription drug coverage, then you may choose a plan that does not have the drug plan included. 
<h3>Eligibility for Part C</h3>If you join Part C, you will still be in the Medicare Program and will have complete Part A and B coverage. You will continue to have Medicare rights and protection and in most cases, you will have prescription drug coverage (Part D) included as well. 
You can join Part C if you reside in the service area where you wish to join, if you already have Medicare Part A and B, and if you do not have End-Stage Renal Disease (with minor exceptions).

What Medicare Advantage (Part C) Plans are available?

What Medicare Advantage (Part C) Plans are available?There are several plans available for Medicare Advantage. The Part C plans include the following: Medicare Preferred Provider Organization (PPO) - …

Explanation of Medicare Advantage Plan Part C

<h1 class="entry-header"> </h1><div class="entry-content"><div class="entry-body"><div class="entry-image"></div><h2><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheIAuR1hkJCztVHD2uBTrJZIVMGNOGd5vYWGUgq_VTRNoOX15zFtymHbPt-wyJugitZD4FOm4wOqKbJPE5iXKYEOPqCkL6TpRZyx1No5RIrfVWiqxbLF8BqiZd4RhPpbXP8k6-6WDhN6k/s1600/medicare-part-b.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheIAuR1hkJCztVHD2uBTrJZIVMGNOGd5vYWGUgq_VTRNoOX15zFtymHbPt-wyJugitZD4FOm4wOqKbJPE5iXKYEOPqCkL6TpRZyx1No5RIrfVWiqxbLF8BqiZd4RhPpbXP8k6-6WDhN6k/s400/medicare-part-b.gif" width="150" /></a></div> 
Explanation of Medicare Part C</h2>When considering your Medicare options, it is easy to get confused and overwhelmed. Relax and take one section at a time to gain an overall understanding. Knowing what Medicare is and how it works will help you to make the best decision. One option is called Part C, or Medicare Advantage Plan (like HMO or PPO). 
<h3> </h3><h3> </h3><h3> </h3><h3>What is Part C?</h3>Medicare Part C combines your Part A and Part B options and must cover all medically needed services. The difference is that private insurance companies that are approved by Medicare provide this type of coverage. In most cases, Part C is a lower-cost alternative to the Original Medicare Plan, and providers usually offer extra benefits and include prescription drug coverage (Part D). 
Part C plans often have networks, and you must use the doctors or hospitals that belong to the plan. These plans help you coordinate and manage your overall care. Part C includes specialized care for people who need a large amount of health care services. If you find yourself needing medical attention while traveling out of your plan coverage area, you will still be covered for emergency or urgent care services.</div></div>

Explanation of Medicare Advantage Plan Part C

Explanation of Medicare Part CWhen considering your Medicare options, it is easy to get confused and overwhelmed. Relax and take one section at a time to gain an overall understanding. Knowing what …

Medicare Part B Cover? Doctor, Hospital, Home Health Care, Preventive Shots

<h3> </h3>Medicare Part B covers many services, tests, preventive treatments, etc. that are common among health care patients, but are not covered in the Part A plan. Though many services and products are covered, keep in mind that Part B is still not a 100% insurance coverage plan. So, as with any other insurance policy, you should understand the plan and coverage completely upon enrolling. Part B helps cover only the medically necessary services listed below: 
 
<ul><li>Tests, Labs and Screenings</li>
<li>Preventive services include exams, lab tests, or screening inoculations that will help prevent, manage, or diagnose a medical problem.</li>
<li>Glaucoma tests are covered once per year if performed by a legally authorized eye examiner.</li>
<li>Bone mass measurement is covered every two years (or as medically necessary). This is to see if you are at risk for broken bones.</li>
<li>Lab Services such as blood tests or urinalysis are covered.</li>
<li>Colorectal cancer screenings to find any pre-cancerous growths. Tests may include (a) annual fecal occult blood test, (b) flexible sigmoidoscopy (every four years), (c) screening colonoscopy (every ten years), or (d) barium enema (every four years).</li>
<li>Diabetic screenings are covered if you have high blood pressure, dyslipidemia, obesity, or high blood sugar.</li>
<li>Diabetic supplies covered include monitors, test strips, lancet devices, and therapeutic shoes.</li>
<li>Diabetic self-management training is covered if prescribed by your doctor</li>
<li>Cardiovascular screenings to help prevent heart attack or stroke are covered. A screening consists of testing your triglyceride, lipid, and cholesterol levels every five years.</li>
</ul> 
<h3>Doctor, Hospital and Home Health Care</h3> 
<ul><li>Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home use medical equipment such as wheelchairs, hospital beds, walkers, oxygen equipment, and other medical supplies.</li>
<li>Chiropractic services will be covered if it is to correct one or more of the bones that has moved out of place in your spine subluxation).</li>
<li>Ambulance services are covered if any other form of transportation would endanger your health.</li>
<li>Blood (pints) that you receive during an outpatient visit or another Part B covered service.</li>
<li>Clinical trials may be covered if it will help to diagnose, prevent, or treat diseases.</li>
<li>Ambulatory surgery center fees are covered for approved services.</li>
<li>Emergency room services for bad injuries, severe illness, or any time you believe your life is in danger</li>
<li>Doctor services do not include routine physical exams except the one time "Welcome to Medicare" exam.</li>
<li>Eyeglass coverage is limited to one pair of glasses and standard frames after cataract surgery.</li>
</ul> 
<h3>Preventive Shots</h3>Flu shots are covered one time per year during flu season. 
Three hepatitis B shots are covered if you are at medium or high risk. 
Additional services covered include, but are not limited to: 
 
<ul><li>Hearing and balance exams</li>
<li>Mammograms</li>
<li>Dialysis</li>
<li>Pap tests or pelvic exams</li>
<li>Mental health care</li>
<li>Medical nutrition therapy</li>
<li>Hospital services</li>
<li>Occupational therapy</li>
<li>Outpatient surgery service and supplies</li>
<li>Limited prescription drugs</li>
<li>Practitioner services</li>
<li>Physical therapy</li>
<li>Prosthetic devices</li>
<li>Transplant services</li>
</ul>

Medicare Part B Cover? Doctor, Hospital, Home Health Care, Preventive Shots

Medicare Part B covers many services, tests, preventive treatments, etc. that are common among health care patients, but are not covered in the Part A plan. Though many services and products are cove…

Explanation of Medicare Part B

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<div>Explanation of Medicare Part B </div> 
<div> 
 
</div>Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan to fit your needs. One part of the Medicare program is called Part B. 
 
 
<div> 
 
 
Part B Premiums</div> 
Most people have to pay a premium for Part B. You can check to see if you are qualified to receive help from your state to pay for premiums or deductibles. Otherwise, the premium is usually deducted from a Social Security, Railroad Retirement or Civil Service Retirement check. The Part B premium can also be paid every quarter or through the electronic payment option, or Medicare Easy Pay. Premiums will be based on income beginning January of 2007. 
<div> 
 
What is Part B? 
 
Medicare Part B is a medical insurance provided by the federal government to eligible beneficiaries. The coverage provided by Part B includes medically necessary doctor's services, outpatient care, and most other services that Part A does not cover such as some physical or occupational therapies and some home health care services. Part B covers preventive services as well. </div>

Explanation of Medicare Part B

Explanation of Medicare Part B Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan t…

What does Medicare Part A Cover?

What does Part A Cover? 
Before learning about what Part A covers, you should also know that Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. Coverage amounts are based on which Medicare plan you have. Part A helps cover only the medically necessary services below: 
 
Blood Transfusions 
This is blood (pints) that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility. 
 
Hospital Stays 
Part A covers hospital stays, which includes a semi-private room, meals, general nursing, and miscellaneous hospital services and supplies. Inpatient care in critical access hospitals and mental health care (up to 190 lifetime maximum) are also covered. Hospital stays must be at least 3 days (72 hours). The time begins the first midnight after admission and does not include any hours on the discharge date. 
 
Nursing Home or Skilled Nursing Facility 
Nursing home or skilled nursing facility stays must be related to diagnosis during a hospital stay. For instance, your hospital stay was for a stroke. Then, a nursing home or skilled nursing facility stay for rehabilitation would be covered. A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and skilled nursing services and care. 
 
The coverage is limited to a maximum of 100 days in a benefit period. The first 20 days are paid in full, and the remaining 80 days will require a co-payment. Medicare Part A will not cover long-term care, non-skilled, daily living, or custodial activities. 
 
Home Health Services 
Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home-use medical equipment (wheelchairs, hospital beds, walkers, oxygen), and other medical supplies. 
 
Hospice Care 
Hospice care is for the terminally ill who have six months or less to live. Coverage includes pain relief and symptom control drugs, medical and support services, grief counseling, and other services. Care is provided by a nearby, Medicare-approved Hospice caregiver who will visit you at your home. Medicare also provides additional care for a Hospice patient so that the usual caregiver can take a time of rest. Medicare does not cover many of the services that are provided to patients who receive Hospice assistance.

What does Medicare Part A Cover?

What does Part A Cover? Before learning about what Part A covers, you should also know that Medicare does not cover everything, nor does it cover the total cost for many of the covered services or med…

Explanation of Medicare Part A

Medicare Part A 
 
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHWdNOP_w1Teo37xHLruXcv8yQMw0py4RisQzIeCydU7kfxBBbswTtG1rZpQ0flE3EX5f7ZZZIGQ0AY1utF9WLdNM8r80yr6zNc-AgljDOY_HAMeDATK9gLblS27oZzP8IaBRp7xO7ap0/s1600/medicare_A.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHWdNOP_w1Teo37xHLruXcv8yQMw0py4RisQzIeCydU7kfxBBbswTtG1rZpQ0flE3EX5f7ZZZIGQ0AY1utF9WLdNM8r80yr6zNc-AgljDOY_HAMeDATK9gLblS27oZzP8IaBRp7xO7ap0/s400/medicare_A.jpg" width="200" /></a></div>Explanation of Medicare Part A 
 
Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan to fit your needs. One part of the Medicare program is called Part A. Most people do not have to pay a premium for Part A because the individual or their spouse paid Medicare taxes while working. Others can buy Part A if they meet certain criteria. Below is an explanation of Medicare Part A and the coverage received under this plan. Use this information to decide if Part A is for you. 
 
What is Part A? 
Medicare Part A is a type of hospital insurance provided by Medicare. The coverage provided by Part A includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. Part A does not include long-term or custodial care. If you meet specific requirements, then you may also be eligible for hospice or home health care. 
 
Fiscal Intermediaries handle the claims for the Medicare Part A plan. These are private insurance companies that act as agents for the federal government in processing and paying Medicare claims. 
<div></div>

Explanation of Medicare Part A

Medicare Part A Explanation of Medicare Part A Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose t…

Differences between Medicare Parts A, B, C and D

What are the differences between Medicare Parts A, B, C and D?There are four parts to Medicare: Medicare Part A, Hospital Insurance; Medicare Part B, Medical Insurance; Medicare Part C (Medicare Advantage), which was formerly known as Medicare + Choice; and Medicare Part D, prescription drug coverage. Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant. Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services. Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A. Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee.You must have both Parts A and B to enroll in Part C. Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.

Differences between Medicare Parts A, B, C and D

What are the differences between Medicare Parts A, B, C and D?There are four parts to Medicare:Medicare Part A, Hospital Insurance;Medicare Part B, Medical Insurance;Medicare Part C (Medicare Advantag…

Types of Medical Transcription

Medical transcription is essential to the billing and record-keeping process of medical faculties. Doctors and nurses need to keep notes on procedures, diagnoses and any additional information needed on patients. The transcription of recorded notes acts to secure information, of which some is forwarded to coding and billing departments. Significance Medical transcriptionists can opt to complete a two-year associate's degree or a one-year certificate course in order to qualify for a position, as a person must learn medical terminology and procedures as well as grammar and perfect typing skills. Types Medical transcription can be specialized into different departments. They are often seperated by medical departments, which include general practice, radiation, dermatology, neurology, pain management, pediatrics and more. Benefits If a person were to specialize into a specific department of medical transcription, such as neurology, payment for services from an average transcriptionist might increase from around $10.00 to $12.00 per hour to $14.00 to $15.00 per hour. Benefits Many medical transcriptionists in every department are able to work on a telecommute basis, some under a per piece rate instead of a per hour rate, and a fast transcription typist might earn significantly more per hour than an average typist. Tasks Transcriptionists might be required to work with audio prerecorded to a computer file and then typed under a deadline, or they might also have to work in real time, inside meetings or virtually via phone and typing as spoken, depending on the needs of different medical offices

Types of Medical Transcription

Medical Transcription vs Medical Billing

Not everyone who works in the medical field provides direct patient care, like doctors and nurses. Other jobs in health care exist in the form of medical transcription and medical billing jobs. Like other jobs in the field, medical transcription and medical billing require a specific skill set for success. 
<div class="separator" style="clear: both; text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/04/medical-transcription-vs-medical.html" imageanchor="1" style="margin-left:1em; margin-right:1em"><img border="0" height="364" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTzGNIG19DrpsCub3VAKf1yxVzzR8O2Mknvd1UUtwpv-N3rahX8wZNNcyqIMrVYU4VUCw2hqJrEsj_8wttIjba2BqxMMjv91A_YDa3qVnoTz6M7Jml-jJryAM8Uksiq8rxKlDg4DKEumE/s1600/ace-process.jpg" width="452" /></a></div><h2>Medical Transcription vs Medical Billing: Basics</h2>As the name implies, medical transcriptionists listen to recordings made by physicians and other health care professionals and document them. This documentation comes in the form of patient discharge summaries, patient history reports, surgical reports or diagnostic imaging studies. Medical transcriptionists have to be well-versed in medical terminology, and employers look for individuals with a postsecondary degree in medical transcription, according to the Bureau of Labor Statistics. 
Medical billing involves working with patient health insurance claims. Since many hospitals and physicians' offices outsource billing and insurance claims to third parties, medical billers can find a reliable workload. They manage patient records, file insurance claims, prepare insurance forms and send bills to patients. Medical billers need to communicate with both insurance companies and physicians to ensure they properly code medical services. They need to understand medical coding so that insurance claims are processed accurately. 
<h3>Medical Transcription and Billing Process Similarities</h3>Both medical transcription and medical billing require specific knowledge in the medical field. While transcriptionists and billers do not have to know how to treat patients, they have to possess a specific set of medical knowledge--medical terminology for transcriptionists and coding for billers. 
Individuals in both Medical Transcription and Medical Billing can work in traditional health care settings in hospitals or physicians' offices or they can work for third parties or even for themselves from the comfort of home. 
<h3>Transcriptionist and Biller Differences</h3>Although both medical transcriptionists and medical billers provide services for hospitals and physicians' offices, their purpose is distinctly different. Medical transcriptionists work on the medical, patient-care side of health care, helping develop reports that physicians can assess and learn from. 
Medical billing is a part of the business side of health care. Medical billers help hospitals and physicians' offices ensure that their bills are paid, either by the insurance companies or the patients

Medical Transcription vs Medical Billing

How to Prepare for ICD-10 Medical Classifications

The time of the new ICD-10 codes is coming. Information on federal web sites indicates the ICD-10 category will soon be in use and the AHIMA (American Health Information Management Association) claims that legislative processes are under way to set up the required use of ICD-10 codes by 2010. The new ICD-10s as adopted by the World Health Organization provide for documenting many different types of diseases and conditions and will help to supplement the outdated ICD-9 system now in use at US hospitals and medical offices. Instructions 1- Start early. The AHIMA site recommends preparing for ICD-10s years in advance. Health care professionals are scrambling to identify, analyze and be aware of ICD-10 codes now so that they can include them in billing systems by 2010. 2- Prepare for clerical changes. According to AHIMA, the ICD-10 set will include changing alphanumeric codes and restructuring chapters or categories of the current ICD book. Look at how your office will change to fit in the wider range of ICDs. 3- Prepare for detail expansions. Along with clerical changes, the ICD-10s may expand the detailing of conditions to accommodate more specific varieties of illness or injury. Look at how the ICD-10 will expand current descriptions of conditions and the kind of conditions to which new codes will be relevant. 4- Get memorandums out to all departments relevant to your office including billing, reimbursement, coding, registration and all other areas where a contact person can train staff to prepare for the ICD-10s. All of the branches of a medical office will be affected by the change. 5- Talk to colleagues about how the ICD-10s will affect different types of care, from in-patient to out-patient visits, including psychological care, home health care and drug and alcohol services. 6- Continue to monitor developments through AHIMA's site and through federal sites that show how legislators are approaching a possible update

How to Prepare for ICD-10 Medical Classifications

What Is HCPCS? Identification, Types, History, Functions, Uses

HCPCS is used in the operation of medical office administration and billing. It is a code set up to help insurance providers and medical staff communicate more effectively when billing for medical services, products and procedures. There is specialized training for this type of work, which is often used by one or two office personnel to properly handle billing issues with third-party providers. 
 
Identification 
 
The letters HCPCS are the acronym for Heathcare Common Procedure Coding System. The name stands for a system used to organize and sort medical claims processed for payment in the United States each year. There are people working in medical offices who specialize in knowing this system. 
 
History 
 
Level I codes were created before the 1980s as a way for medical administration staff to standardize billing and other records for insurance payments. As new procedures and systems came into use, Level II was created during the 1980s to accommodate the newly added services and supplies. Level III came into existence around 2003 because of new procedures and medical tools becoming available to localized markets. This system was created by the director of Health and Human Services, which gave authority of the system to the Center for Medicare and Medicaid Services (CMS) under the 1996 Health Insurance Portability and Accountability Act (HIPAA) legislation. 
 
Function 
 
Level I of the coding system is used for medical treatments and tools when billing insurance companies. Level I is used for any in-patient or office visits where the treatment or supplies is used in the medical facility. Level II is used when billing for ambulance services, prosthetics, orthotics and other supplies used outside of the doctors office. Level II is mostly used by Medicare and other insurance to cover items outside of an office visit. 
 
Types 
 
There are three levels of HCPCS codes. These are known as levels I, II and III. The first level is used for Current Procedural Terminology (CPT) codes which are numbered codes of groups of five numbers maintained by the American Medical Society and are used for identification of medical services and procedures. Level II codes are used as a method to code services, supplies and other procedures not used in CPT code. Level II codes are made up of single letters followed by four numbers. Level III codes are used for local coding when the procedure or service is not listed within the other two levels. 
 
Use 
 
The oversight of the coding system is maintained by both the American Medical Association (AMA) and the CMS. The system is run as a clearinghouse for administration purposes to centralize and better organizes billing procedures. Questions and issues in dealing with this system are sent to the clearinghouse for clarification. These issues can include proper code use, new code issues, or insurance and billing claims using the system

What Is HCPCS? Identification, Types, History, Functions, Uses

How to Test for Medical Coding Certification

The AAPC provides worldwide medical coding certification. Since 1988 the American Association of Professional Coders has provided medical coding certification for medical coders in physicians' offices, outpatient facilities and provider facilities. You'll need to pass the Certified Professional Coder examination in order to be certified as a professional medical coder by the AAPC. You'll also need to provide the AAPC with proof that you have worked as a medical coder for two years without a degree, that you have worked as a medical coder for one year with a degree or certificate, or that you have completed an online coding course through the AAPC. Difficulty:Challenging Instructions Things you'll need: • $300 for exam fee • $125 for AAPC membership • No. 2 pencils • Government-issued photo ID • AAPC member ID • AMA CPT, ICD-9-CM, and HCPCS II coding manuals Experience Requirement 1. Work for two years as a medical coder. Obtain two signed letters of recommendation from your employer indicating you have two years of experience and furnish them to the AAPC. 2. Work for one year as a medical coder and obtain a degree or certificate. This requires at least 80 hours of coding training. You'll need a transcript on school letterhead and a single letter of recommendation from an employer. 3. Acquire virtual experience through the AAPC website in lieu of real world experience. You must pay $200 to enroll in an online coding course and must code at least 720 out of 800 cases correctly, an accuracy rate of 90 percent. If you don't pass the test on the first try, you will have two opportunities to re-code the incorrect cases and achieve a 90 percent score. Certification Exam 1. Locate an exam in your area through the AAPC scheduling website. Select the country or state you live in and click "Search." Review the list and choose the exam session you would like to attend. Click "Details" next to the session for more information. 2. Complete the registration form. For question one, indicate whether your AAPC membership is current or whether you need a new membership; memberships cost $125 or $75 for students. Next select the "CPC" examination from the drop-down menu. The exam costs $300. 3. Check the boxes indicating you will provide proof of experience and that you agree to the terms of service. Click the "Purchase" button and provide the AAPC with your payment details. 4. Attend the examination session you signed up for. Bring several No. 2 pencils, a government-issue picture ID and your AAPC member ID with you. You should also bring copies of the AMA CPT, ICD-9-CM and HCPCS II industry standard coding manuals. 5. Complete the examination. The exam contains 150 multiple choice questions and takes about 5 hours and 40 minute to complete. If you fail your first attempt, you can retake the test once for free

How to Test for Medical Coding Certification

The AAPC provides worldwide medical coding certification. Since 1988 the American Association of Professional Coders has provided medical coding certification for medical coders in physicians' offices…

Medical Coding Tips for Certification Test

Medical coding certification exams, like the CPC (Certified Professional Coder) tests administered by the American Academy of Professional Coders (AAPC), consists of 150 multiple choice questions. As noted on their website (aapc.com), the questions involve the correct application of CPT, HCPCS Level II procedure and supply codes and ICD-9-CM diagnosis codes used for billing professional medical services to insurance companies. In order to identify the accurate code and pass the examination, candidates must be proficient in anatomy and physiology, coding divisions & guidelines, medical terminology and practice management and reimbursement methodologies. Understanding the Basics Familiarize yourself with medical terminology and the linguistic formation it follows. This includes the word root, prefix, suffix and combining form/vowel. Combining forms (generally 'i' or 'o') are situated in between the word parts and assist with pronunciation. Since the exam measures a physician practice coder's knowledge of the body's structures, make certain you're adept when it comes to the following systems: digestive, endocrine, hemic & lymphatic, integumentary, musculoskeletal, nervous, reproductive (male/female), respiratory and urinary. For Reimbursement Methodologies, go over the various kinds of insurance plans (HMO, PPO, POS and EPO), the Health Insurance Portability and Accountability Act (HIPAA), fundamental health insurance (coinsurance, co-payment, covered expense, deductable, premium) and reimbursement procedures. Coding Systems Learn the different systems, when they are used, what they're used for and the specific criterion surrounding each. The American Medical Association (AMA) founded the CPT (Current Procedural Terminology) coding system; the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs (ama-assn.org). There are three different CPT Category codes: Category I CPT codes are employed by physicians and outpatient providers to depict a procedure or service identified with a five-digit CPT code and descriptor nomenclature. Category I CPT codes are divided into the following categories: evaluation and management, anesthesiology, surgery, radiology, pathology, laboratory and medicine. According to the AMA website, CPT Category II codes are supplemental tracking codes that can be used for performance measurement; using them is optional and they are not necessary for correct coding and can't be used as a substitute for Category I codes. As noted on ADVANCE for Health Information Professionals, Category II Codes are alphanumeric and consist of four digits followed by the alpha character 'F'; they're arranged according to the following categories: composite measures, patient management, patient history, physical examination, diagnostic/screening processes or results, and therapeutic, preventive or other interventions. Category III codes are for emerging technology and intended for data collection purposes in the FDA approval process or to substantiate widespread usage. The "International Classification of Diseases, Ninth Revision, Clinical Modification," ("ICD-9-CM"), is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics surveys (cdc.gov). The "ICD-9-CM" includes a list of the disease code numbers in tabular form; an alphabetical index to the disease entries; and a classification system for surgical, diagnostic, and therapeutic procedures. HCPCS Level II (Healthcare Common Procedure Coding System) is a standardized coding system used to name supplemental medical equipment, products, and services that are not incorporated in the CPT codes. The Centers for Medicare & Medicaid Services, explains that Level II HCPCS codes were established so Medicare and other insurers could submit claims for items such as ambulance services, and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office

Medical Coding Tips for Certification Test

Healthcare Common Procedure Coding System (HCPCS) Guidelines

The Healthcare Common Procedure Coding System (HCPCS) refers to a standardized coding system used by Medicare and other health insurance programs to identify medical procedures, equipment and services. The HCPCS contains two subsystems: Level I and Level II. 
 
Level I 
 
Level I codes identify medical procedures and services. This system is also called Current Procedural Terminology and is defined and revised by the American Medical Association. Level I codes are composed of five numbers. 
 
Level II 
 
Level II codes identify medical supplies and products, such as prosthetics, ambulance services or orthotics. Level II codes contain one letter and four numbers. 
 
Considerations 
 
Level III codes, also called local codes, are codes developed by private insurers and state Medicaid programs to identify services or products that did not have a Level I or II code. These codes were eliminated on December 31, 2003.

Healthcare Common Procedure Coding System (HCPCS) Guidelines

United Health Care and HCPCS Codes for Varicose Vein Procedures

The Healthcare Common Procedure Coding System, or HCPCS, is a set of procedure codes for health care providers. 
HCPCS codes include and are based on the Current Procedural Terminology or, CPT, established by the American Medical Association. 
Since 1978, HCPCS has been used to describe specific medical procedures and is used by private health insurers as well as Medicare and Medicaid in determining eligibility and claims processing. 
 
The 1996 Health Insurance Portability and Accountability Act of 1996 mandated the use of HCPCS codes for health care transactions. The term "UHC codes" refers to the use of these HCPCS codes by United Healthcare, a major health insurance company in the United States. 
 
<h3>Surgical Excision</h3>Surgical excision is used to eliminate large and bulging varicose veins. Other terms for surgical excision include litigation and stripping or the newer phrase "stab phlebectomy." Tiny skin incisions are made and the varicose veins are grabbed and pulled out with small hooks or clamps. The HCPCS or UHC code for surgical excision CPT code is 37718 for the short saphenous vein andCPT code 37722 for the long saphenous vein. 
 
<div style="clear: both; text-align:center;"><a href="http://www.medicalbillingcodings.org/2011/04/united-health-care-and-hcpcs-codes-for.html"><img alt="United Health care and HCPCS Codes for Varicose Vein Procedures" border="0" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1uU8atjx2yqycuRDEXvlFbEdfJHPp2nzbSFrOIZbL4uqLKBWLaIIoS28ZvxJcNgKN2bbYO6ogv3UxHg3L-jjgQOzAcYeNggkqK5uwHo1yQMPkqaPvuLoLtPaTDG4IutDSB3Tb0MV5SsU/s1600/medical+billing.bmp" width="273" /></a></div> 
<h3>Endovenous Laser Ablation</h3>Endovenous laser ablation is used to treat large varicose veins in the legs. It is a relatively noninvasive procedure in which a laser fiber is inserted directly into the varicose vein. The laser then heats the vein's lining, causing it to shrink, collapse and ultimately disappear. The HCPCS or UHC codes for endovenous laser ablation CPT codes are 36478 for the first treated vein and 36479 for the second and subsequent veins. 
 
<h3>Radiofrequency Ablation</h3>Radiofrequency ablation works on the same principle as laser ablation of varicose veins. Radiofrequency waves are applied to cause heating and collapse of the varicose vein lining. In the radiofrequency ablation procedure, a small catheter is inserted at an incision by the knee and extended up to the groin before the application of radiofrequency waves. The HCPCS or UHC codes for radiofreqency ablation CPT codes are 36475 for the first vein and 36476 for second and subsequent veins

United Health Care and HCPCS Codes for Varicose Vein Procedures

The Healthcare Common Procedure Coding System, or HCPCS, is a set of procedure codes for health care providers. HCPCS codes include and are based on the Current Procedural Terminology or, CPT, establ…

Varicose Vein Procedures CPT-4 Codes: Treatment, Supplies and Evaluation

Learn CPT-4 Codes for Varicose Vein Procedures involved in Treatment Therapy, Supplies, Evaluation. 
 
Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can be painful for many people, whether they're walking or staying still. 
 
Many treatment recommendations exist on how to reduce the swelling of varicose veins, including surgical options. For medical billing purposes, these procedures need to be coded, as do the supplies that may be used. 
 
For clarification purposes, procedures codes are called CPT-4 codes, although many people use that term and HCPCS interchangeably. HCPCS codes actually refer to what's known as Level II codes, which cover extended procedures and supply codes. Code descriptions can be very long; they are truncated here, so it's recommended you read through the manuals for complete descriptions. 
 
<div class="separator" style="clear: both; text-align:center;"><a href="http://www.medicalbillingcodings.org/2011/04/varicose-vein-procedures-codes.html" imageanchor="1"><img alt="Varicose Vein Procedures CPT-4 Codes: Therapy, Supplies and Evaluation" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvNMDedUkzveFz6FUeOZI-1DRIZGkAdd1c2s8CzIz3OjztRCXRs58OD2w1WYXsIExIEq0VsvcxVr6SsnHAoAbVgcQKyTpH5S9z9Kd2y_OI7D7k4X3jqgDBBvvHiALsapndTNaOItgK3hml/s420/Varicose_veins.jpg" width="420" /></a></div><ins class="adsbygoogle" style="display:block" data-ad-client="ca-pub-6428896324980307" data-ad-slot="4680777871" data-ad-format="auto"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script> 
<h2>CPT Codes for Varicose Vein Evaluation</h2>Before any treatment can begin, evaluations must be given to determine the type of treatment that needs to take place. The CPT-4 codes used for those determinations include the following codes. The initial one is a radiology code, while the other codes are categorized as Extremity Venous Studies. These codes are: 
<ol><li>CPT Code 76942 Ultrasonic Guidance for Needle Placement.</li>
<li>CPT Code 93965 Noninvasive Physiologic Studies of Extremity Veins.</li>
<li>CPT Code 93970 Duplex Scan of Extremity Veins.</li>
<li>CPT Code 93971 Duplex Scan of Extremity Veins.</li>
</ol><h2>Varicose Vein Procedures Types</h2>There are three main treatment categories for varicose veins. Though all of the codes are listed within the surgical category of CPT-4 codes, not all of the procedures are actually surgical procedures. Also, none of these codes are exclusive during a day of treatment. 
 
It means if a physician wishes to perform multiple procedures in one day, it can be done as long as the medical documentation supports it. However, some codes can't be billed together on the same day, so it's best to verify those codes through the coding manual. 
 
The least invasive of the three varicose vein surgical treatments introduces solutions into the veins, usually via a drip process to try to reduce the hardening that's taken place. 
<ul><li>CPT Code 36468 Single or Multiple Injections of Sclerosing Solutions.</li>
<li>CPT Code 36470 Injection of Sclerosing Solution; Single Vein.</li>
<li>CPT Code 36471 Injection of Sclerosing Solution; Multiple Veins, Same Leg.</li>
</ul><h3>Endovenous Ablation Therapy CPT Codes</h3>Ablation therapy means varicose veins will be treated by inserting a solution and then heating it up with an outside source. The source is indicated within the codes below: 
<ul><li>CPT Code 36475 
Ablation therapy of incompetent vein, percutaneous, radiofrequency; first vein treated 
<li>CPT Code 36476 
Ablation therapy of incompetent vein, percutaneous, radiofrequency; second and subsequent veins 
<li>CPT Code 36478 
Ablation therapy of incompetent vein, percutaneous, laser; first vein treated 
<li>CPT Code 36479 
Ablation therapy of incompetent vein, percutaneous, laser; second and subsequent veins 
</ul><h3>Vein Ligation Surgery CPT Codes</h3>These codes indicate actual surgical procedures. Hospitals might not use these codes for billing purposes, deciding instead to use surgical ICD-9, or diagnosis codes, but physicians will need to use at least one of these codes: <ul><li>CPT Code 37700 
Ligation and division of long saphenous vein at saphenofemoral junction. 
<li>CPT Code 37718 
Ligation, division, and stripping, short saphenous vein. 
<li>CPT Code 37722 
Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below. 
<li>CPT Code 37735 
Ligation and division and complete stripping of long or short saphenous veins. 
<li>CPT Code 37760 
Ligation of perforator veins, subfascial, radical. 
<li>CPT Code 37765 
Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions. 
<li>CPT Code 37766 
Stab phlebectomy of varicose veins, one extremity; more than 20 incisions. 
<li>CPT Code 37780 
Ligation and division of short saphenous vein at saphenopopliteal junction. 
<li>CPT Code 37799 
Unlisted procedure, vascular surgery. 
</ul><h3>HCPCS Procedure</h3>There is one last procedure that, unfortunately, isn't covered by most insurance companies because, as of mid-2009, they see it as an experimental procedure. That code is: <h3>CPT Code S2202 Echosclerotherapy Supplies</h3>Compression stockings are the most used supply item in the treatment of varicose veins. Not all insurance companies will pay for this item, as it's considered take-home equipment, which usually isn't covered. The range of HCPCS codes for this item is from A6533 through A6549, with the only difference being the size and length of the stocking.

Varicose Vein Procedures CPT-4 Codes: Treatment, Supplies and Evaluation

Learn CPT-4 Codes for Varicose Vein Procedures involved in Treatment Therapy, Supplies, Evaluation. Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can…

New Ophthalmological (CPT) Services Codes 2011

The following new and revised codes will be listed in the 2011 CPT Coding Manual and are effective January 1, 2011. CPT Code 92135 has been deleted and replaced by the following: <ul> <li>CPT 92132 - Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral (Replaces 0187T) </li> <li>CPT 92133 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve </li> <li>CPT 92134 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina The Ophthalmoscopy codes have also been revised to include the following: </li> <li>CPT 92227 - Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral </li> <li>CPT 92228 - Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral Additional changes/revisions address the following codes: </li> <li>CPT 66174 - Transluminal dilation of aqueous outflow canal; without retention of device or stent (Replaces 0176T) </li> <li>CPT 66175 - Transluminal dilation of aqueous outflow canal; with retention of device or stent (Replaces 0177T) </li> <li>CPT 65778 - Placement of amniotic membrane on the ocular surface for wound healing; self-retaining </li> <li>CPT 65779 - Placement of amniotic membrane on the ocular surface for wound healing; single layer, sutured </li> <li>CPT 65780 - Ocular surface reconstruction; amniotic membrane transplantation, multiple layers </li> <li>CPT 66761 - Iridotomy / iridectomy by laser surgery (e.g., for glaucoma) (per session) </li></ul>

New Ophthalmological (CPT) Services Codes 2011

The following new and revised codes will be listed in the 2011 CPT Coding Manual and are effective January 1, 2011. CPT Code 92135 has been deleted and replaced by the following: CPT 92132 - Scanning …

No more CPT 92135 code for Ophthalmologists

2011 CPT Addresses New Ophthalmological Services Codes The following new and revised codes will be listed in the 2011 CPT Coding Manual and are effective January 1, 2011. Code 92135 has been deleted a…

What Supplies can Podiatrists Bill to Insurance Companies?

I have been questioned on more than one occasion, what a Podiatrist can bill an insurance company for office supplies, or supplies used during office surgeries. This is pretty basic information, but it may help some: Supplies Associated With Office Surgery The majority of supplies related to office surgery are considered part of the surgical procedure. If a surgery performed in the office requires casting material, you may bill these supplies in addition to the surgical procedure code, on a separate line(s). When appropriate, you may use the following HCPCS codes to bill casting material: A4580.....................Plaster Cast A4590.....................Fiberglass Cast Q4037–Q4051........Cast/splint supplies (fiberglass or plaster, by age) Supplies Associated With an Office Visit Supplies are normally considered part of the office visit/surgery charge and should not be billed separately. Examples of supplies considered part of the office call/surgery include, but are not limited to: • cotton balls • facial tissue • tongue depressors • topical ointments • gloves • cotton swabs • gowns • paper sheets/towels Supplies should be billed only if they are “over and above those usually included with the office visit.” Wellmark considers nonprescription or over-the-counter drugs, vitamins, minerals, or nutritional supplements noncovered materials. Bill these materials with procedure code 99070. Noncovered services are the member's responsibility. Unna Boots Unna boots are commercially prepared, medically impregnated material used as a support dressing. Use CPT code 29580 to bill unna boots. Unna boots are a covered benefit when billed with one of these primary diagnoses: Primary Diagnoses for Unna Boots HCPCS casting codes 454.0 454.1 454.2 459.11 459.12 459.13 459.19 459.31 459.33 686.00–686.9 707.06 707.07 707.12 707.13 707.14 707.15 707.9 719.07 726.70 726.71 726.72 726.79 727.06 727.68 727.81 733.94 733.95 824.0–827.1 845.01 845.02 845.03 845.09 845.11 845.12 845.19 891.0 891.1 891.2 892.0 892.1 892.2 924.20 924.21 948.00 998.83

What Supplies can Podiatrists Bill to Insurance Companies?

I have been questioned on more than one occasion, what a Podiatrist can bill aninsurance company for office supplies, or supplies used during office surgeries.This is pretty basic information, but it …

Wound Care surgery codes

A newly introduced coding concept related to the reporting of wound débridements is also significant. The code range 11040–11044 has been completely revised; the major changes are as follows: <ul> <li>CPT codes 11040 and 11041 have been eliminated; they are replaced by CPT codes 97597 and 97598 as appropriate for débridement of dermal and epidermal skin layers. Check the manual for the new definitions. </li> <li>The reporting of wound débridement is now based on the depth of tissue débridement and the size of the wound in square centimeters. </li> <li>Surgeons must “sum” the surface areas of multiple wounds of the same depth; each wound should be reported separately if the tissue débridements are of different depths. </li> <li>New add-on codes (11045, 11046, and 11047 for each additional 20 sq cm, based on the depth of the debridement) were introduced </li></ul> As a result of these changes, CPT code 11042 now reads, “Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.” The associated new add-on code 11045 should be reported for each additional 20 sq cm or part thereof. Additionally, the surgeon’s documentation must include the size of the wound(s) (eg, 4 cm x 5cm) and the depth of tissue débridement for each individual wound for which the procedure is performed. The guidelines for the repair (closure) codes were revised related to the definition of a complex repair, and the definition of débridement and services included have been added to the repair codes. Surgeons performing complex repairs are now allowed to report this work separately when done in conjunction with débridement codes, excision of benign or malignant lesion codes, excisional preparation of a wound bed codes, or débridement of an open fracture or open dislocation codes. Changes to the skin substitutes guidelines reinforce the range of codes that are “skin substitutes” and include specific instructions for using these codes. As an example, skin substitute codes should not be reported when the products are used as mesh or for internal reconstructive work such as a rotator cuff repair. These codes should only be reported when the product is used as a skin substitute.

Wound Care surgery codes

A newly introduced coding concept related to the reporting of wound débridements is also significant. The code range 11040–11044 has been completely revised; the major changes are as follows: CPT code…

Global Period Calculator: CPT Codes, Services and Package Information

Global Period is a time frame following surgery during which routine care by the physician i.e., all necessary services normally furnished by a physician [before (Pre-operative), during (Intra-Operative), and after (Post-operative) the procedure] are included in the reimbursement of the original surgery and they cannot be separately reported. 
 
Each CPT has a Global period status indicator as per the CMS Payment Policies. The list of such status indicators are listed below 
 
000 Endoscopies or minor procedure with preoperative and postoperative relative values on the day of the procedure only are reimbursable. Evaluation and Management services on the same day of the procedure are generally not payable. (For example: CPT 45378, 43235, 31622) 
 
010 Minor procedures with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are reimbursable services. Evaluation and Management services on the day of the procedure and during the 10-day postoperative period are not reimbursable. (For example: CPT 10060, 11401, 46221) 
 
090 Major procedures with one day preoperative period and 90-days postoperative period are considered to be a component of global package of the major procedure. Evaluation and Management services on the day prior to the procedure, the day of the procedure, and during the 90-day postoperative period are not reimbursable. (For example: CPT 32100, 39000, 41520) 
 
<div style="text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/04/global-period.html"><img alt="Global Period Calculator: CPT Codes, Services and Package Information" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxdlxnUgPNn3z8xsvF4BMa-JQq7dFd-ND1Pu2BzLulcaHGU0UB8NzOHtYL4srwxPve3zZZJL8bZ60GEpbk6iZNtnRDD7oLJd2QC4oTBGzOKLRhO3SXZ5btGyH-NFNT4ZQBJCvMagTcBHw/s1600/claim+processing.jpg" /></a></div> 
MMM Maternity codes; the usual global period concept does not apply. (For example: CPT 59610, 59620) 
 
XXX The global concept does not apply to this code. (For example: Evaluation and Management services, Anesthesia, Laboratory and Radiology procedures) 
 
YYY These are unlisted codes, and subject to individual pricing. (For example: CPT 29999, 32999. 42999) 
 
ZZZ These represent add-on codes. They are related to another service and are always included in the global period of the primary service. (For example: 17003, 26125) 
 
The Global period status indicators and the CPT's Relative Value Units are available <a href="http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp" target="_blank">here</a>. Click the link and select Payment policies indicator under Type of information to view the Global period of each CPT. 
 
<h3>Calculating Global Period Duration</h3>Each surgery CPT has a Global surgery status indicator in which the minor surgery has Global surgery status indicator of 10 days and the major surgery has Global surgery status indicator of 90 days. 
 
To determine the global period for minor surgeries: 
 
Count the day of surgery (Pre-operative and Intra-operative services would be on the same day of surgery) and 10 days immediately following the date of surgery. 
 
To determine the global period for major surgeries: 
 
Count 1 day immediately before the day of surgery (Pre-operative), the day of surgery (Intra-operative), and the 90 days immediately following the date of surgery (Post-operative / follow ups) 
 
Global period calculator for the major surgery is available <a href="http://www.medicarenhic.com/providers/billing/billing_calc_global_period.html" target="_blank" rel="nofollow">here</a>. 
 
<h3>Global Period Services and Package Information</h3>Medicare approved amount (based on the Resource Based Relative Value Scale) for the surgery (minor / major) includes following services when furnished by the physician who actually performs the surgery. The services included in the global surgical package may be furnished in any setting, i.e. in hospitals, ASC’s, physicians offices and such services / procedures / supplies related to the original surgery are not to be reported separately in the claim form since these are considered as a component of the approved amount. 
 
<h4>Services included in Global Period Package</h4>The following services are included in the global package: 
<ol><li>Pre-operative visits – Pre-operative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures. 
 
</li><li>Intra-operative services – lntra-operative services that are normally a usual and necessary part of a surgical procedure. 
 
</li><li>Complications following surgery / Post-Operative visits – Refers to 'Aftercare' following the surgery i.e. all routine additional medical or surgical services required of the surgeon during the post-operative period of the surgery. These services include complications that do not require additional trips to the operating room.</li>
</ol>Along with all of the above global package of a surgery includes Items such as dressing changes; local incisional care that includes removal of operative pack and dressing change, cutaneous sutures and staples (removals), lines, wires, tubes, drains, casts and splints, insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes, changes and removal of tracheostomy tubes. 
 
<h4>Services not included in Global Period Package</h4>Following are the services that are not included in the Global period package: 
 
In certain circumstances some of the services / procedures are also paid if performed in the Global period. Appending correct modifier is mandatory for reimbursement. The services / procedures that are not included and are reimbursable during the Global period are as follows. 
<ol><li>The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. The correct modifier is to be appended in case of minor and major surgery for a proper reimbursement. 
 
Minor Surgery with 10 day Global period - Modifier 25 (Significant, separately identifiable E & M service by same Physician on same day of procedure or other service) should be applied for an Evaluation and Management services rendered on the same day of surgery. 
 
For example: If a patient is encountered for a follow up office for his neck pain and in addition if the patients needs his / her leg abscess to be drained and if the physician does both on the same day then the claim would be billed as: 
CPT 99213-25 --------> (Follow up Office visit level 3 with Modifier 25) 
ICD 723.1 -----------> (Neck pain) 
CPT 10060 -----------> (Incision and Drainage of abscess; simple or single) 
ICD 682.6 -----------> (Leg Abscess) 
 
Since CPT 10060 has a global period of 10 days the services and the procedures performed including dressing change during this period would be considered as a part of global component and no separate reimbursement are made. 
 
Major Surgery with 90 days global period - Modifier 57 (Decision for surgery) has to be applied for an Evaluation and Management services to report that the decision for major surgery was made during the service either the day before the surgery or the day of surgery. 
 
</li><li>Visits unrelated to the original surgery i.e., if the physician encounters a patient for a different condition that was not related to the surgery. Modifier 24 should be applied for an E & M services to state that the service performed during a postoperative period for reason(s) unrelated to the original procedure. This applies for both minor and major procedures. 
 
</li><li>Diagnostic tests and procedures, that includes diagnostic radiological procedures performed in the post operative period to the operated site. No modifiers other than the informational modifiers (modifiers like RT / LT) are needed. 
 
</li><li>Distinct surgical procedures for a different diagnosis during the post-operative period which are not repeat operations or treatment for complications. A new post-operative period begins with the subsequent procedure. Modifier 79 (Unrelated procedure or service by same physician during postoperative period) should be applied to the newly performed surgery. 
 
</li><li>Treatment for post-operative complications that requires a return visit to the operating room. In such case Modifier 78 (Return to the operating room for related procedure during postoperative period) should be added for the procedure performed during the return visit.</li>
</ol>Please have a look into Medicare Claim Processing for the payment of Evaluation and Management services provided during Global period of surgery.

Global Period Calculator: CPT Codes, Services and Package Information

Medical Billing & Medical Transcription

Job opportunities for professionals in the healthcare industry are on the rise across the United States, with medical billing and medical transcriptionists in high demand. This increase correlates directly to the 60 million plus baby boomers and more than 1,500 healthcare plans now available to cover the aging U.S. population. 
 
<h2>Medical Billers vs Medical Transcriptionists</h2>When researching careers in medical billing or medical transcription, you'll likely find certain similarities-both of these jobs usually require staff to work in a doctor's office, hospital, medical center or dentist's office, and both of these professions require knowledge of medical terms. That, however, is usually where the similarities end. The two professions have distinct roles that are often confused. The following is a quick reference guide outlining the differences between medical billers and medical transcriptionists. 
 
<H3>Medical Billers Duties</H3>A medical biller manages the processing of medical bills in doctor's offices, medical centers, 
hospitals, etc. It is the duty of a medical biller to transmit the claim (medical procedure and diagnosis codes) to the payer (insurance). Typically, this information is transmitted electronically. 
 
<H3>Medical Billers Job Skills</H3>A successful medical billers must understand medical terminology (including jargon and abbreviations), be proficient with computers and understand the latest industry and legal standards. A thorough comprehension of different insurance plans and accompanying governing laws/regulations is also necessary to any adept medical biller. 
 
Typically, post-secondary education is required for medical billing, and degrees are often offered through vocational schools, community colleges, or online training programs offered by online colleges and universities. 
 
<H3>Medical Billers Salary</H3>PayScale.com reports medical billers with one to four years of experience earn an average salary of around $30,000. If they have five to nine years of experience, the average salary is more than $32,000. 
 
<H3>Future Growth Opportunities for Medical Billers</H3>According to the U.S. Department of Labor, the job outlook for the medical billing industry is expected to increase at a rate of four percent. 
 
<H3>Medical Transcriptionist Duties</H3>An employee working in the medical transcription field is generally referred to as a medical transcriptionist or medical transcriber. The main role of a medical transcriptionist is to listen to dictated recordings made by healthcare professionals and subsequently transcribe that information into typewritten formats such as: medical history/physical examination reports, discharge summaries, consultation reports, referral letters, progress notes, operative reports, autopsy reports, and diagnostic imaging studies. These documents are then sent to the healthcare professional for review/signature or correction, after which they become a part of the patient's permanent medical history. 
 
<H3>Medical Transcriptionists Job Skills</H3>To become a successful medical transcriptionist, a working knowledge of medical terminology (including jargon and abbreviations), computer proficiency, and comprehension of current industry and legal standards is required. Post-secondary education is generally required to obtain a medical transcriptionist position, and can be obtained through a career college, community college, or an online course offering. 
 
<H3>Medical Transcriptionist Job Salary</H3>PayScale.com reports the average salary for a medical transcriptionist with one to four years of 
experience is more than $28,000. Medical transcriptionists with five to nine years of experience make on average close to $30,000. 
 
<H3>Medical Transcriptionist Job Future</H3>According to the U.S. Department of Labor, the job outlook for medical transcriptionists looks 
optimistic. Medical transcription jobs are expected to increase by 14 percent between 2006 and 2016.

Medical Billing & Medical Transcription

Understanding Evaluation and Management

Factors Considered in E&M Coding Type of Service: Services covered in the E&M section include, but are not limited to, physician encounters in all locations for "well" or "sick" visits, patient transport, case management services, preventative medicine services and prolonged services. Place of Service: For payment purposes the place of service needs to match the type of service. The places of service are as follows: Office (11) Nursing facility (32) Patient's home (12) Custodial care facility (33) Inpatient hospital (21) Hospice (34) Outpatient hospital (22) Federally qualified health center (50) Emergency department (ED) hospital (23) Inpatient psychiatric facility (51) Ambulatory surgery center (ASC) (24) Partial hospitalization, psychiatric facility (52) Birthing center (25) Community mental health center (53) Skilled nursing facility (SNF) (31) Psychiatric residential treatment center (56) Comprehensive outpatient rehabilitation facility (62) Comprehensive inpatient rehabilitation facility (61) End-stage renal disease treatment facility (65) Other unlisted facility (99) State or local public health clinic (71) Rural health clinic (72) Patient Status. Many of the CPT codes are classified by whether a patient is a new or established patient. A new patient is new to the practice or has not been seen by the specialty in group practice for more than 3 years. An established patient is one who has a continuing relationship with the practice and has been seen within the last 3 years. Levels of E&M Services To understand the levels of history it is important to know the definition and components of the patient's history. The history relates to the patient's clinical picture and depends on the patient for answers to specific questions. The history is composed of the chief complaint, or reason the patient is being seen. This is usually in the patient's own words. The history of present illness (HPI) identifies the location, severity, timing, modifying factors, quality, duration, context and associated signs and symptoms relating to the chief complaint. The review of systems (ROS) has the patient answer questions about the following systems: constitutional, eyes, ear/nose /throat (ENT) and mouth, cardiac, gastrointestinal, muscu¬loskeletal, endocrine, neurological, integumentary, psychi¬atric, genitourinary, allergic/immunologic, respiratory, and hematological/lymphatic. The past medical (PMH), family, and social history (PFSH) is important, because patients' experiences with illness and surgery, whether they smoke, use illicit drugs and/or alcohol, if they are married, have children, where they live, and what diseases their blood relatives have had play an extremely important part in determining their risk factors for illness Now that we understand what makes up the history, the various levels can be discussed. Problem Focused: A problem-focused history con¬centrates on the chief complaint; it looks at the symptoms, severity, and duration of the problem. It usually does not include a review of systems (ROS) or family and social history. Expanded Problem Focused: The physician proceeds the same as for the problem-focused history but includes a review of the systems that relate to the chief complaint. Usually past, family, and social histories are not included. Detailed: The physician will document a more exten¬sive history, ROS, and will document pertinent past, family, and social histories. Comprehensive: The physician will document res¬ponses to all of the components listed previously. A comprehensive history is usually taken during an initial visit with patients who have a significant history of illness. MEDICAL DEDISION MAKING When a physician makes medical decisions, the decisions are based on many years of education and experience. To understand what goes into these decisions, the following guidelines have been developed. NUMBER OF DIAGNOSES/MANAGEMENT OPTIONS. When we read the note the physician writes, we should be able to tell whether the patient's problem is minor or an established problem that is stable or getting worse or whether the patient has a new problem that the physician wants to watch or perhaps to order or perform more tests on. AMOUNT AND COMPLEXITY OF DATA REVIEWED. The physi¬cian's note should tell us what laboratory tests, x-ray diagnostic procedures, and other tests have been ordered or reviewed. RISK OF COMPLICATIONS AND MORBIDITY OR MORTALITY. There is often risk involved in medical care, either from the treatment given to the patient or from the lack of treatment and professional care. Morbidity, the relative incidence of disease, and mortality, which relates to the number of deaths from a given disease, are part of the assessment of risks made by the physician. These three elements play a role in the complexity of the decision-making process used when treating a patient. The physician determines the level of care given to a patient, but must consider these three factors when choosing the E&M levels assigned to a patient on a given encounter. The physician cannot base the choice of E&M levels solely on the time spent with the patient. All elements must be considered when assigning the code. Usually, the physician circles this service code and other procedure codes on the encounter form as or just after the patient is seen in the office. Although a physician may allow the medical assistant to make notations on the encounter form, only the physician makes the decision as to which services and procedures are performed. MEDICAL DECISION-MAKING COMPLEXITY LEVELS Straightforward: Minimal diagnosis/management options, minimal/none for the amount and complexity of data to be reviewed, and minimal risk to the patient of complications or death if untreated. Low-complexity: Limited number of diagnoses/ management options, limited data to be reviewed, and low risk to the patient of complications or death if untreated. Moderate-complexity: Multiple diagnoses/management options, moderate amount and complexity of data to be reviewed, and moderate risk to the patient of complications or death if untreated. High-complexity: Extensive diagnoses/management options, extensive amount and complexity of data to be reviewed, and high risk to the patient for com¬plications and/or death if the problem is untreated. EXAMINATION The examination is the objective part of the patient's visit. The physician examines the patient and makes notes referring to body areas and/or organ systems: Body areas: Head including face and neck, chest, including breasts and axillas, abdomen, genitouri¬nary (GU), back, including spine and extremities. Organ systems: Constitutional, eyes, ears/nose/throat and mouth, cardiovascular, respiratory, gastrointestinal (Gl), GU, musculoskeletal, skin, neurological, psychiatric, and hematological/lymphatic/immunologic. The examination is divided into the following levels: Problem focused: The examination is limited to the single body area or single system mentioned in the chief complaint. Expanded problem focused: In addition to the limited body area or system, related body areas or organ systems are examined. Detailed: An extended examination is performed on the related body areas or organ systems. Comprehensive: A "complete" multi-system examina¬tion is performed. CONTRIBUTING FACTORS Although the determining factors just discussed are the basis for E&M coding, there are circumstances in which other factors contribute to determining the level of service. Counseling. Almost all E&M services contain a degree of counseling with the patient and/or the family. This is factored into the E&M code, and as long as this factor does not exceed 50 % of the time spent with the patient, it is included in the E&M code. Coordination of Care. Some patients need assis¬tance in arranging for care beyond the visit or hospi¬talization. Some will need care in a skilled nursing facility or home health care. Others will need hospice care. The primary physician usually coordinates this care. Nature of the Presenting Problem. The presenting problem is usually explained in the chief complaint. It can range from something as simple as a cold in an otherwise healthy patient to a life-threatening problem. Time. CPT has provided assigned times for each of the CPT E&M codes. Time should not be the determining factor, with one exception: if more than 50 % of the visit is spent counseling, only time determines the level of complexity. PUTTING IT ALL TOGETHER TO DETERMINE THE CODE 1. Determine whether the patient is new or established. 2. Where is the patient being seen-office, hospital, or other setting? 3. Is this a patient of the practice, or is someone requesting a consultation? 4. Is the patient "sick" or here for preventative medicine services? 5. Is the history problem-focused, expanded problem-focused, detailed, or comprehensive? 6. Is the examination problem-focused, expanded problem-focused, detailed, or comprehensive? 7. Is medical decision making straightforward, low, moderate, or high? 8. Pick the code. CPT Coding Definitions Bundled codes describe procedures or services that are grouped together and paid as one. An example would be code 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine for intramuscular use. Unbundled codes describe separating the components of a procedure and reporting them separately. To use the diphtheria example, if someone reports the three vaccines separately, it gives the impression that three injections rather than one were given. Upcoding is a deliberate increase in a CPT code to receive higher reimbursements. This is a target of CMS investigations and should never be done. Downcoding is usually done by the insurance companies if, on review, the examiner feels the documentation does not match the code description. CRITICAL THINKING APPLICATION If a patient was referred for epigastric pain and if; Shuman performed an ultrasound examination of the gallbladder, what would Kay need to consider to properly Code this encounter? CODING TIPS AND HINTS ● Always have the latest edition of CPT and HCPCS. . Follow the “CCI” information quarterly. . Never code something because it is "close" to the description; research it further. ● Review the guidelines and refer to them as part of your routine. It would be extremely difficult for anyone person to know all the specific guidelines. ● Keep the lines of communication open with the physician and never hesitate to ask for clarification. ● Develop am! use an audit sheet that you are comfortable with and do periodic code reviews. This may not be your responsibility, but understanding how a chart auditis done can help you in your coding responsibilities. ● Know the modifiers and use them when appropriate. ● Know abbreviations, especially for laboratory procedures. Legal and Ethical Issues Medical assistants must be responsible and remain knowl¬edgeable about CPT to ensure that no fraud takes place in the coding and claims submission process. Medical assis¬tants should also ensure that proper precautions are taken to avoid incorrect coding, data entry errors, and false claims submissions. Codes or narratives should not be altered in patient chart documentation to increase insurance reimburse¬ment or to accommodate policy coverage requirements. Deliberate misrepresentation may carry criminal and/or civil penalties.

Understanding Evaluation and Management

Factors Considered in E&M CodingType of Service: Services covered in the E&M section include, but are not limited to, physician encounters in all locations for "well" or "sick" visits, patient transpo…

CPT Procedural Coding Basics

<div>Current Procedural Terminology (CPT) codes is a Medical Billing Coding set maintained by the editorial panel of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page" target="_blank" rel="nofollow">American Medical Association</a> (AMA). The CPT Procedural Coding set is used for standard documentation of medical, surgical and diagnostic services among physicians, patients, coders, accreditation organizations, insurance payers and medical data analysts. 
<div class="separator" style="clear: both; text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/03/basics-of-procedural-coding_12.html" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="CPT Procedural Coding Basics" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTQQldWOIOcuTlO5TOGMIOqbKbXpgeJ0F5E9INYoFSgroJOwp-4_y07y1YomuN_Vdcsml9iLuiXaAkYwd-8-CHvlU_m8bCHUK48HEw8CTR8yyW9rnYrg4cxqejtYtqttT8nOfboYCdez5s/s250/2013_CPT_Coding_Book.jpg" /></a></div>CPT Procedural Coding is used by Medicare, Medicaid and most commercial insurance companies to identify and classify claims for payment. Although its use is standard in physicians' practices, CPT is not recognized in some facility settings or under special guidelines within an insurance company. Physicians and Healthcare Practices use CPT Coding to: 
<ul><li>Submit claims for services and procedures</li>
<li>Track utilization of services and procedures</li>
<li>Measure physician productivity</li> 
</ul>Medical Biller, Medical Coder or Medical Billing Specialist are expected to adhere to ethical standards when involved in all aspects of coding. Again, as with diagnostic coding, the Medical Coder should consult the attending healthcare provider for clarification when a question arises. Medical Coder, because of their involvement in both clinical and administrative aspects of the health care setting, are key persons in converting the verbal and written reasons for an encounter into the universally accepted numeric and alphanumeric codes of CPT. 
 
As with <a href="http://www.medicalbillingcodings.org/search/label/ICD%20code">ICD Diagnostic Coding</a>, accurate use of the CPT codes is essential for a Medical Biller. Medical Billing Specialist facilitates the accurate medical record keeping and the efficient processing of claims reimbursement by using the CPT Codes, which identifies appropriate procedures and services performed by the physician office. CPT-4 Codes are used in the claims submission process to receive reimbursement from payers as well as to track physician productivity. CPT4 codes must be maintained, following the changes in guidelines and regulations. 
 
<h3>Evolution of CPT Coding</h3>Current Procedural Terminology was first published in 1966 by the American Medical Association. It was based on the California Relative Value Study, developed by the California Medical Society. Its primary purpose was to simplify the reporting of procedures and/or services provided by physicians. 
 
In 1992 the most significant change was made to CPT Coding with the replacement of the office and hospital visit codes with the Evaluation and Management (E&M) codes, identifying key elements to be documented in the medical record. CPT has been revised three times; the edition in current use is CPT-4. 
 
<h3>Updates to the CPT</h3>CPT is updated every October by the AMA and published for the next calendar year. The CPT Codes are available as a printed manual or as an electronic file. As with the ICD-9CM, it is ideal to purchase the printed version to be certain you have the entire contents for CPT Codes Reference. 
 
Because, medical practice is constantly changing and new procedures are being developed, the AMA encourages suggestions from physicians, medical societies, and organizations. <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/applying-cpt-codes/request-form-categories-i-iii.page" target="_blank" rel="nofollow">Forms</a> are available from the AMA CPT Editorial Research and Development Department and on the AMA website. These changes are found in Appendix B of the CPT manual. 
 
<h2>Format of the CPT Codes</h2>There are three levels of CPT: 
 
Level I CPT Codes codes are developed by the AMA and contained in the current CPT Manual. They are 
five-digit codes and two-digit modifiers. 
 
Level II CPT Codes codes, known as HCPCS, are national codes developed by CMS to describe medical services and supplies not covered in the CPT. They consist of alphabetic characters (A through V) and four digits. Modifiers are either alphanumerical or two letters (AA to VP). 
 
Level III CPT Codes codes are local codes. Unlike Level I and II, these codes are not common to all carriers. They are assigned by local Medicare carriers to describe new procedures that are not yet in Levels I and II. These codes start with a letter (W through Z) followed by four digits. 
<blockquote style="color:red">Note: when the HIPAA Standards for Electronic Transactions are fully implemented, Level III CPT Codes will no longer be recognized for reimbursement reporting.</blockquote>Following are the sections of CPT Codes: 
 
<h3>Evaluation and Management (E&M)</h3>The E&M section appears in the front of the CPT Manual and must be thoroughly understood. There is the most room for error when coding in this section. Since all specialties bill these services and these codes constitute 65% of the total Medicare part B payments to physicians, it is extremely important to understand this section. A full section devoted to understanding E&M coding appears later in this chapter. 
 
<h3>Anesthesia Codes</h3>This section contains anesthesia and modifier codes plus the very specific physical status modifiers developed by the American Society of Anesthesiologists to rank patients by level of complexity. The modifiers range from PI (normal healthy) through P6 (brain dead) patients whose organs are being removed for transplantation. There are also add-on codes (+) that explain difficult circumstances. These are located in the Anesthesia Guidelines found at the beginning of the section and also in the medicine section of the CPTA. 
 
<h3>Surgery</h3>The surgery section is further divided into 18 subsections by specific type of surgery. General guidelines are found at the beginning of the section and apply to all subsections. The subsections have specific guidelines that apply to that particular area. The subsections are further divided into subheadings. One of the most important explanations in the general guidelines is the definition of the surgical package; it is essential to know exactly what is and is not included in the package. All surgeries have global periods. These range from 0 (the actual calendar day of the procedure) up to 90 days (starting the day before the surgery and continues for 90 days). These global periods cover normal "routine" care during that time. Complications, new problems, or other injuries are reported using modifiers. 
 
<h3>Radiology</h3>In addition to radiology (x-ray diagnostic procedures), this section includes nuclear medicine and diagnostic ultrasound. This section requires a written report from the radiologist to the physician that ordered the test. 
 
<h3>Pathology and Laboratory CPT Codes</h3>Pathology and Laboratory codes in the pathology and laboratory section cover laboratory tests and services of pathologists. It is important to understand that some tests are grouped into panels. These panels give a clearer picture of problems with an organ or disease. 
 
<h3>Medicine CPT Codes</h3>The medicine section covers a multitude of services provided to patients ranging from immunization through testing that is not included in other sections to services provided by a psychiatrist or a physical therapist, and osteopathic manipulation to home healthcare. 
 
<h2>CPT Procedure Codes Look up</h2>Attempting to code services without a working knowledge of the guidelines can lead to improper coding and possibly loss of revenue. Thus, a Medical Coder needs to carefully read and understand these guidelines. Each section is unique and has very specific requirements. 
 
Guidelines at the beginning of each section of the CPT manual refer to the whole section. Guidelines specific to the subsections are listed as Notes at the beginning of the subsection. Below is the explanation of CPT classifications of Sections for an easy CPT Procedure Codes Look up: 
 
Section is highest level grouping of codes e.g Surgery, Laboratory, Radiology. 
SubSection better defines the Section. 
SuHeading further defines the SubSection. 
Category directs you to the specific CPT Procedures in which you will find the right code to use. 
 
<h3>Steps in CPT Coding</h3>The following is a brief outline of the considerations a Medical Coder is required to use in CPT coding: 
<ol><li>Know the CPT code book; there are changes each year, so even if you have been coding for years, you need to read the introduction, guidelines, and notes. 
 
</li><li>Review all services and procedures performed on the day of the encounter. Include all medications administered and trays and equipment used. 
 
</li><li>Find the procedures and/or services in the index in the back of the CPT book. This will direct you to a code (not a page number!). The code you are looking for may be listed as a procedure, body system, service, or abbreviation (this will usually refer you to the full spelling). 
 
</li><li>Read the description in the code and also any related descriptions that follow a semicolon; this will lead you to the most accurate code. 
 
</li><li>If the service is an E&M Code, identify and perform the following: <ul><li>Whether this is a new or established patient.</li> 
<li>Whether this is a consultation.</li> 
<li>Where the service was performed.</li> 
<li>Review the documentation to determine the level of service.</li> 
<li>Check to determine whether there is a reason to use a modifier.</li> 
<li>Assign the five-digit CPT code.</li></ol></li></ul> 
<h3>Medical Billing and Coding Vocabulary</h3>Bundled Codes - Procedures or services that are grouped together and paid as one. 
Unbundled codes - Separating the components of a procedure and reporting them separately. 
Component - A constituent part; a part of a larger group. 
Upcoding - A deliberate increase in a CPT code to receive higher reimbursements. 
Downcoding - A change in code done by the insurance company that receives a claim resulting in a lesser reimbursement. The change will usually be the code closest to the one submitted on the claim, because the code does not match in some way to the specifications of the insurance company. 
Modifiers - Code additions that explain circumstances that alter a service that has been provided and clarify exactly what was done to the patient. 
Morbidity - The relative incidence of disease. 
Mortality - The number of deaths in a given time or place. 
Revenue - The total income produced by a given source. 
Utilization - Related to the process of reviewing procedures and services for medical necessity. 
 
<h2>CPT Coding Assignment for Medical Billers</h2>By the time you reach here, reading this article, we expect you have established a good basic understanding on CPT coding. Below is an assignment for Medical Billing beginners to further their knowledge: 
<ul><li>Define and Spell the Terms listed in the Vocabulary above.</li>
<li>Identify Three purposes of the CPT.</li>
<li>List the Classifications of Sections in the CPT.</li>
<li>Explain the use of Guidelines and where they are located.</li>
<li>Discuss the Importance of Modifiers.</li>
<li>Briefly explain the importance of correctly assigning E&M codes.</li> 
<li>Define up-coding and explain why it must be avoided.</li>
<li>Accurately assign a CPT code based on medical documentation.</li> 
</ul> 
 
</div>

CPT Procedural Coding Basics

Current Procedural Terminology (CPT) codes is a Medical Billing Coding set maintained by the editorial panel of the American Medical Association (AMA). The CPT Procedural Coding set is used for standa…

Influenza, Pneumococcal Billing & Reimbursement

When the same type of vaccine is administered to fewer than 5 Medicare beneficiaries on the same day, you must submit the claim(s) individually via the 'Home Health' Option 26 from the Claims Entry Menu. 
 
The influenza virus vaccine and pneumococcal pneumonia vaccination (PPV) are billed on a 341 type of bill (home health outpatient Part B benefit). 
 
The beneficiary must be eligible for Medicare Part B to receive reimbursement for these services. 
<ul><li>Children, ages 6-35 months 
90655 - Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use</li>
<li>Children, ages 0 months through age 18.99 
90660 – Influenza virus vaccine, live, for intranasal use 
90670* - Pneumococcal conjugate, 13 valent, for intramuscular use 
*Replaces 90669 7/1/2010</li>
<li>Children, ages 2+ 
90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use 
90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use 
90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use</li>
<li>Children, under age 9 
Reimbursement for administration of both doses of seasonal influenza are eligible in the following situations as indicated by HEALTH: 
 
<div style="text-align: center;"><a href="http://www.medicalbillingcodings.org/2011/03/2010-2011-influenzapneumococcal-billing_12.html" imageanchor="1" style="clear:right; float:right; margin-left:1em; margin-bottom:1em"><img alt="2010-2011 Influenza/Pneumococcal Billing & Reimbursement" border="0" height="227" src="http://1.bp.blogspot.com/-fV1i5HgM23o/Tzkr1A0nBfI/AAAAAAAAADA/IRGzoQ-O4kI/s320/medicalCareer.jpg" width="320" /></a></div> 
If they did not receive H1N1 flu vaccine last year* 
First time ever receiving flu vaccine* 
Received seasonal flu last year, but only one dose was administered</li>
<li>Adults 19-65* 
90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use 
90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use 
90660 – Influenza virus vaccine, live, for intranasal use (members aged 19-49 only) 
90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use 
*Members who are enrolled on Extended Family Planning (EFP) benefits are not eligible.</li>
<li>Vaccine Administration Coding (under 8 years) 90465 – Initial IM 
90466 - Subsequent IM (add-on code) 
90467 – Initial oral/nasal 
90468 – Subsequent oral/nasal (add-on code) 
90465 & 90467 will bundle when billed together on the same day and deny.</li>
<li>Vaccine Administration Coding (all ages) 
90471 - Initial IM 
90472 – Subsequent IM (add-on code) 
90473 – Initial oral/nasal 
90474 – Subsequent oral nasal (add-on code) 
90471 & 90473 will bundle and deny if billed together on the same day</li>
</ul>

Influenza, Pneumococcal Billing & Reimbursement

Medical Billing and Coding: Statement of Coding Ethics

In this era of payment based on diagnostic and procedural coding, the professional ethics of health information coding professionals continue to be challenged. A conscientious goal for coding and maintaining a quality database is accurate clinical and statistical data. The following standards of ethical coding, developed by AHIMA's Coding Policy and Strategy Committee and approved by AHIMA's Board of Directors, are offered to guide coding professionals in this process. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR2NlRZa4J4byLhppyCyoLPkN781GMJgf5vZ2ARFTaQ5zBGKV5Pm8epqsuyDU2XH1qjV5SY_V7MNCIYM-udHielOJWKWxw5uYF0icNLnmQO-D-fB176pdsoezAQbSIEmCpvhcjzNeAeT8/s1600/ethics.jpg" imageanchor="1" style="clear:right; float:right; margin-left:1em; margin-bottom:1em"><img border="0" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR2NlRZa4J4byLhppyCyoLPkN781GMJgf5vZ2ARFTaQ5zBGKV5Pm8epqsuyDU2XH1qjV5SY_V7MNCIYM-udHielOJWKWxw5uYF0icNLnmQO-D-fB176pdsoezAQbSIEmCpvhcjzNeAeT8/s200/ethics.jpg" width="200" /></a></div> 
 
 
 
1. Coding professionals are expected to support the importance of accurate, complete, and consistent coding practices for the production of quality healthcare data. 
 
2. Coding professionals in all healthcare settings should adhere to the ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification) coding conventions, official coding guidelines approved by the Cooperating Parties,* the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets for applicable healthcare settings. 
 
3. Coding professionals should use their skills, their knowledge of currently mandated coding and classification systems, and official resources to select the appropriate diagnostic and procedural codes. 
 
4. Coding professionals should only assign and report codes that are clearly and consistently supported by physician documentation in the health record. 
 
5. Coding professionals should consult physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record. 
 
6. Coding professionals should not change codes or the narratives of codes on the billing abstract so that meanings are misrepresented. Diagnoses or procedures should not be inappropriately included or excluded because payment or insurance policy coverage requirements will be affected. When individual payer policies conflict with official coding rules and guidelines, these policies should be obtained in writing whenever possible. Reasonable efforts should be made to educate the payer on proper coding practices in order to influence a change in the payer's policy. 
 
7. Coding professionals, as members of the healthcare team, should assist and educate physicians and other clinicians by advocating proper documentation practices, further specificity, and re-sequencing or inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity, and the occurrence of events. 
 
8. Coding professionals should participate in the development of institutional coding policies and should ensure that coding policies complement, not conflict with, official coding rules and guidelines. 
 
9. Coding professionals should maintain and continually enhance their coding skills, as they have a professional responsibility to stay abreast of changes in codes, coding guidelines, and regulations. 
 
10. Coding professionals should strive for optimal payment to which the facility is legally entitled, remembering that it is unethical and illegal to maximize payment by means that contradict regulatory guidelines. 
 
Revised 12/99 The Cooperating Parties are the American Health Information Management Association, American Hospital Association, Health Care Financing Administration, and National Center for Health Statistics. All rights reserved. Reprint and quote only with proper reference to AHIMA's authorship.

Medical Billing and Coding: Statement of Coding Ethics

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