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CPT Codes for Echocardiogram and Echocardiography

<div dir="ltr" style="text-align: justify;" trbidi="on">Information about CPT Codes for Echocardiogram and Echocardiography is important to be known by all parties involved regarding Echocardiogram and Echocardiography performed such as cardiovascular doctors, patients, Echocardiogram and Echocardiography technicians, hospital administrators, people working in insurance companies and Medical Billing and Coding staff.<br />
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Echocardiogram, often referred to as a cardiac echo or simply an echo, is a sonogram of the heart. (It is not abbreviated as ECG, which in medicine usually refers to an electrocardiogram.) Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.<br />
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CPT stands for Current Procedural Terminology. CPT is a set of codes established by AMA (American Medical Association) that categorizes medical services and procedures into three categories. Category I of CPT Codes includes six main sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. Category II of CPT Codes is only for performance measurement. Category II of CPT Codes is not required to get reimbursement. Lastly, Category III of CPT Codes is for Emerging Technology. CPT Editorial Panel is responsible for reviewing, managing, and updating CPT Codes.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/12/cptcodesfor-echocardiogram-echocardiography.html"><img alt="CPT Codes for Echocardiogram and Echocardiography" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhi6iIQ9cBty5Z0lCTbWcKW_UnFEJW76YiAHFPLNET2RWObVlKh-vXNtP2lVFNP-YY9XeRIwopf-amRQGgy_9lB3FeqX24h5X1wzTFaePgf4d6D8tHU5zvepufnd8zof2IhbebnIwVrO7hd/s1600/cptcodesfor-echocardiogram-echocardiography.jpg" /></a></div><br />
Echocardiogram is a type of ultrasonography to examine the heart organ. A tool called a transducer, placed on the body, sends high frequency sound waves and picks up the echoes of the sound waves that are bounced back from the internal organs. In the case of Echocardiogram and Echocardiography, the high frequency sound waves bounce back from the heart organ. Echocardiogram and Echocardiography produce an image of the heart on a screen. The image can be moving or still, can also be two dimensional (2D) or three dimensional (3D), depending on the type of the device and which parts of the heart that need to be examined.<br />
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<h2>CPT Codes for Echocardiogram and Echocardiography</h2>CPT Codes for Echocardiogram and Echocardiography are codes related to Cardiovascular (CPT Code 92950 - 93799) under Medicine Section, in the Category I of CPT Codes. There are several CPT Codes for Echocardiogram and Echocardiography, depending on the techniques and procedures of Echocardiogram and Echocardiography performed. <br />
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<h4>Transthoracic Echocardiogram (TTE)</h4>There are several different techniques and procedures of Echocardiogram and Echocardiography that call for different CPT Codes for Echocardiogram and Echocardiography. The most commonly used technique of Echocardiogram and Echocardiography is <b>Transthoracic Echocardiogram (TTE)</b>. For TTE, the transducer is moved around different parts of chest and upper stomach. <br />
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<h4>Stress Echocardiogram</h4>Another technique of Echocardiogram and Echocardiography is called <b>Stress Echocardiogram</b>. True to its name, Stress Echocardiogram is an echocardiogram that is conducted after the heart is stressed. In other words, the patient needs to do an exercise or be injected by a medicine to make the heart work or beat faster before an echocardiogram is conducted. The purpose of Stress Echocardiogram is to diagnose the existence of coronary artery disease that may obstruct the flow of blood to the heart. <br />
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<h4>Doppler Echocardiogram</h4>Doppler Echocardiogram, yet another type of Echocardiogram and Echocardiography, is also related to the flow of blood. By implementing Doppler Echocardiogram, the direction and speed of the blood that flows to and from the heart can be measured. <br />
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<h4>Transesophageal Echocardiogram (TEE)</h4>The last technique of Echocardiogram and Echocardiography is TEE or Transesophageal Echocardiogram. For TEE, an anesthetic is applied on the back of esophagus or throat, and a transducer in the form of a probe is inserted down the esophagus or the throat. The placement of the transducer probe through the esophagus for TEE makes the image of the heart become clearer than the other techniques of Echocardiogram and Echocardiography since the transducer probe is placed nearer the heart without the blockage from the rib cages and the lungs. <br />
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In the other techniques of Echocardiogram and Echocardiography, the transducer is placed outside the body where the body tissues, rib cages, and lungs obstruct the high frequency sound waves produced by the transducer from effectively reaching the heart organ.<br />
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Echocardiogram are important tests to be conducted to detect heart problems such as congenital heart disease, coronary artery disease, inflammations or infections on the parts of the heart, abnormality on the heart valves or rhythms, etc. <br />
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<h3>CPT Codes for Echocardiogram and Echocardiography</h3>The new CPT Codes, the 2015 CPT Codes, have been released in October 2014. The 2015 CPT Codes will be in effect until January 1st, 2015. New Echocardiography CPT Codes changes are not much. The common changes made on CPT Codes are a more detailed description of a code and the changes in the fees and payments which usually increase. <br />
<ol><li><h4>CPT Codes for Transthoracic Echocardiogram (TTE)</h4>For 2014 CPT Codes for Echocardiogram and Echocardiography, CPT Code 93306, 93308, 93303, 93304, 93350 are the CPT Codes involving TTE or Transthoracic Echocardiogram. <br />
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</li><li><h4>CPT Codes for Stress Echocardiogram</h4>CPT Code 93015 is the code involving Stress Echocardiogram, and the CPT Codes involving Doppler Echocardiogram are CPT Code 93320, 93321, and 93325. The <br />
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</li><li><h4>CPT Codes for Transesophageal Echocardiogram (TEE)</h4>CPT Codes involving TEE or Transesophageal Echocardiogram are CPT Code 93312, 93313, 93314, and 93318.</li>
</ol>The 2014 CPT Codes for Echocardiogram and Echocardiography only provide information of the standard fees and payments for Echocardiogram and Echocardiography. The actual fees and payments for Echocardiography procedure may be different in different places. The standard fees listed in the 2014 CPT Codes for Echocardiogram done in hospitals are the same as in the physician offices. The standard costs for procedures involving TTE which are around $200 are cheaper than the standard costs for procedures involving TEE which are around $300.<br />
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CPT Codes for Echocardiogram and Echocardiography are important especially for cardiovascular physicians, patients who want to check the condition of their hearts, hospitals, and insurance companies. The information about the types of Echocardiogram and Echocardiography, the fees of the procedures, and the payments for the cardiovascular physicians and technicians can be worked out according to the CPT Code used. <br />
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With the detailed system of CPT Codes, misunderstandings among the physicians, patients, lab technicians, insurance people, hospital administrators about the procedures and the fees may be reduced or even prevented.<br />
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CPT Codes for Echocardiogram and Echocardiography

Information about CPT Codes for Echocardiogram and Echocardiography is important to be known by all parties involved regarding Echocardiogram and Echocardiography performed such as cardiovascular doct…

Breast Cancer ICD-10 Diagnosis Codes Conversion from ICD-9

<div dir="ltr" style="text-align: justify;" trbidi="on">Breast Cancer ICD 9, ICD 10 Diagnosis Codes are similar although ICD 10 diagnosis codes are more detailed than ICD 9. <br />
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ICD (International Classification of Diseases) are a series of codes created by WHO (World Health Organization) to make it easier to diagnose diseases, make health statistics, compare international health statistics, including morbidity and mortality statistics, from various countries across the world, synchronize various information, including signs, symptoms, causes, abnormalities, and statistics, of each disease. <br />
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ICD Codes are always updated by WHO. Formally, the current version used is ICD 10. However, United States of America still uses ICD 9 CM (ICD 9 Clinical Modification), a modification of ICD 9 by US National Center for Health Statistics (NCHS). There are not many differences between ICD 9 and ICD 10 or between ICD 9 and ICD 9 CM. WHO and NCHS keep the changes in ICD Codes on minimum so as to avoid the long period of adaption to the new version of ICD Codes. The differences of ICD 9 and ICD 10 are of the types of codes used. ICD 9 uses only numbers for the codes, but ICD 10 uses a letter and numbers.  <br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/12/breastcancer-icd9icd10-codesdiagnosisconversion.html"><img alt="Breast Cancer ICD-10 Diagnosis Codes Conversion from ICD-9" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoQtoN_DtKdmS6ax0Rsie0pwF8hbDRv23NpPEqFD1AN7O3jWIvkw-Vq182kDbB4T-YnxtWsNO1vsoLzyBYF61Z86hT9PZ9rTEu9H9nGf0Jy145Sz8aDywuXAcj7XPDt-mYLZUI8JHuibaS/s1600/breastcancer-icd9icd10-codesdiagnosisconversion.jpg" /></a></div><br />
<a href="http://cancerworld.info/inflammatorybreastcanceribc-symptomssignswarning-women/">Breast Cancer Symptoms</a> are often in the forms of abnormal lumps, weight loss, abnormal bleeding, etc. Cancer can be hereditary, but it can also develop from infections, radiations, pollutants, or chemicals in instant food. Exercise and eat healthy food such as fruits and vegetables to not only prevent cancer but also to boost the immune system so that the body is not prone to illnesses and diseases. <br />
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<h2>Breast Cancer ICD-10 Diagnosis Codes Conversion from ICD-9</h2>Cancer is abnormal growth of cells. An abnormal growth is usually only on one part of the body, but, in the case of cancer, it can spread to other parts of the body. That is why the term cancer is always malignant. Cancer can grow on any parts of the body, including breast. You can check out <a href="http://www.medicalbillingcodings.org/2014/10/breast-cancer-screening-icd9cpt-codes.html">Breast Cancer Screening ID 9 Codes</a>. Breast Cancer ICD 9, ICD 10 Diagnosis Codes and Conversion is given here under: <br />
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<h3>Breast Cancer ICD 9 Diagnosis Codes</h3>First, let’s review Breast Cancer ICD 9 Diagnosis Codes. Breast Cancer is coded under “Neoplasms (ICD 9 Code 140 - 239)”. Then, as cancer is the malignant form of neoplasm, look under Malignant Neoplasm of Bone, Connective Tissue, Skin, and Breast (ICD 9 Code 170 - 176) to find Breast Cancer ICD 9 Diagnosis Codes. Cancer of the female breast is coded differently from cancer of the male breast. The ICD 9 Code for female breast cancer is 174 whereas ICD 9 Code for male breast cancer is 175. The details of both codes can be seen below:<br />
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<h4>Female Breast Cancer ICD 9 Codes</h4>ICD 9 Code 174: malignant neoplasm of female breast:<br />
<ul><li>ICD 9 Code 174.0 for malignant neoplasm of nipple and areola of female breast.</li>
<li>ICD 9 Code 174.1 for malignant neoplasm of central portion of female breast.</li>
<li>ICD 9 Code 174.2 for malignant neoplasm of upper-inner quadrant of female breast.</li>
<li>ICD 9 Code 174.3 for malignant neoplasm of lower-inner quadrant of female breast.</li>
<li>ICD 9 Code 174.4 for malignant neoplasm of upper-outer quadrant of female breast.</li>
<li>ICD 9 Code 174.5 for malignant neoplasm of lower-outer quadrant of female breast.</li>
<li>ICD 9 Code 174.6 for malignant neoplasm of axillary tail of female breast.</li>
<li>ICD 9 Code 174.8 for malignant neoplasm of other specified sites of female breast.</li>
<li>ICD 9 Code 174.9 for malignant neoplasm of female breast, unspecified.</li>
</ul><h4>Male Breast Cancer ICD 9 Codes</h4>ICD 9 Code 175: malignant neoplasm of male breast:<br />
<ul><li>ICD 9 Code 175.0 for malignant neoplasm of nipple and areola of male breast.</li>
<li>ICD 9 Code 175.9 for malignant neoplasm of other and unspecified sites of male breast.</li>
</ul>For Breast Cancer ICD 9 vs ICD 10 Diagnosis Codes, the main differences are in a more detailed information about the location of the breast cancer. In Breast Cancer ICD 9 diagnosis codes, there are no specific codes for the specific location of the breast cancer. For example, ICD 9 Code 174.2 for malignant neoplasm of upper-inner quadrant of the female breast includes cancer on the right and/or left breast. In Breast Cancer ICD 10 diagnosis codes, the positions of the cancer are specified with different codes. <br />
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<h3>Breast Cancer ICD 10 Diagnosis Codes</h3>Similar as in ICD 9 diagnosis codes, Breast Cancer is located under "Neoplasms" although the codes of Neoplasms in ICD 10 diagnosis codes are C00 - D49. Then, Breast Cancer can be found under "Malignant neoplasms" of breast (ICD 10 Code C50 - C50). ICD 10 C50 malignant neoplasm of breast has sub categories as listed below:<br />
<ul><li>ICD 10 Code C50.0: malignant neoplasm of nipple and areola.</li>
<li>ICD 10 Code C50.1: malignant neoplasm of central portion of breast.</li>
<li>ICD 10 Code C50.2: malignant neoplasm of upper-inner quadrant of breast.</li>
<li>ICD 10 Code C50.3: malignant neoplasm of lower-inner quadrant of breast.</li>
<li>ICD 10 Code C50.4: malignant neoplasm of upper-outer quadrant of breast.</li>
<li>ICD 10 Code C50.5: malignant neoplasm of lower-outer quadrant of breast.</li>
<li>ICD 10 Code C50.6: malignant neoplasm of axillary tail of breast.</li>
<li>ICD 10 Code C50.8: malignant neoplasm of overlapping sites of breast.</li>
<li>ICD 10 Code C50.9: malignant neoplasm of breast of unspecified site.</li>
</ul>The next number of the code determines whether it is female (1) or male (2). For example, C50.01 is the ICD 10 Code for malignant neoplasm of nipple and areola, female whereas C50.02 is the ICD 10 Code for malignant neoplasm of nipple and areola, male. <br />
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Then, the next number after that determines the location of the breast cancer: right (1), left (2), or unspecified (9). For example, C50.111 is the ICD 10 Code for malignant neoplasm of central portion of the right female breast, C50.112 is the ICD 10 Code for malignant neoplasm of central portion of left female breast, and C50.119 is the ICD 10 Code for malignant neoplasm of central portion of the unspecified female breast. <br />
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The rules of the codes for Breast Cancer in ICD 10 are consistent like that until C50.9. Categories under ICD 10 Code C50 (C50.0 - C50.9) are similar to categories under ICD 9 Code 174. Breast Cancer ICD 9, ICD 10 Diagnosis Codes are not significantly different as they are easy to be understood and used.<br />
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Breast Cancer ICD-10 Diagnosis Codes Conversion from ICD-9

Breast Cancer ICD 9, ICD 10 Diagnosis Codes are similar although ICD 10 diagnosis codes are more detailed than ICD 9. ICD (International Classification of Diseases) are a series of codes created by W…

CPT Code for Suture Removal and ICD-10, ICD-9 Codes

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn ICD 10 and <b>CPT code for suture removal</b>.<br />
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Reviewing suture removal CPT Codes, ICD 9, ICD 10 Codes is necessary since each code entails different things. Both CPT and ICD Codes are regularly revised to keep with the latest knowledge and development though there will be no major changes of both codes to make it easier to implement each new version of both codes. <br />
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CPT (Current Procedural Terminology) Codes are codes about diseases, health services, and procedures created by AMA (American Medical Association). <br />
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On the other hand, ICD (International Classification of Diseases) Codes are also codes about diseases, health services, and procedures, but they are created by WHO (World Health Organization). <br />
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Both CPT and ICD codes are created with the purpose of simplifying communication about diseases, diagnostics, health services, and procedures. <br />
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Suture removal is usually a post-operative procedure. Suture removal is a part of a series of procedures under one diagnosis or one health case.<br />
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However, there are some cases that suture removal is reimbursed separately. CPT Code for Suture Removal can be quite confusing for the health administration staff, the physician, the patient, and the insurance company. <br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/12/suture-removal-cpt-icd9-icd10-codes.html"><img alt="CPT Code for Suture Removal and ICD-10, ICD-9 Codes" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-lKo65i3mR4ep-wKt6mc7Vo0PG2jmKIZFpn-QMjAluyUFzDMSKQ9EeCRd7RJDjY1LqHG4Ozw1b_avbvWpvruX21T7VSu24ap3qDCod1CVHnZ_tniNlLLiwQFMex0Dh6bQ3jCees-wwpoy/s1600/suture-removal-cpt-icd9-icd10-codes.jpg" /></a></div><br />
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<h2>Suture Removal CPT Code, ICD-10, ICD-9 Codes</h2>Some of suture removal CPT Codes, ICD 9, ICD 10 Codes can be used for reimbursement, and some cannot. Knowing which codes to use to get reimbursement for suture removal is important.<br />
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<h3>CPT Code for Suture Removal</h3>Of the suture removal CPT Codes, ICD 9, ICD 10 Codes, let’s discuss about <u>CPT code for suture removal</u> first. <br />
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There are 3 categories of CPT Codes, and each category is divided further into different sections. For suture removal, its code falls under medicine sections in Category I, where the <b>Suture Removal CPT Code is 99024</b>. <br />
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It is the code for post-operative visits that may include dressing change or suture removal. However, this code cannot be used for reimbursement since this code is already included in a series of procedures of a diagnosis. The proper use of this code is only internal, never to leave the physician office or the hospital administration. If this code appears in the claim sent to the insurance company or payer, please make sure that the charge for this code is 0. <br />
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<h4>CPT Code for Suture Removal during Global Period</h4>If a patient comes for postoperative treatment such as <b>Suture Removal during Global Period</b> of a set of procedures (usually 10 days for minor surgical procedures such as laceration repairs, and 90 days for major surgical procedures), code the visit using CPT Code 99024, and there will be no problem. <br />
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<h4>CPT Code for Suture Removal after Global Period</h4>However, questions are often asked about how to code postoperative treatments such as <b>Suture Removal after Global Period</b>? If for some reasons (such as holidays, the doctor or the patient has other pressing things, etc.), the last postoperative visit falls on the day after the global period ends, it is recommended to use another code for this visit. In this case, use the appropriate <b>CPT Code for Suture Removal under E&M</b> (Evaluation and Management) in Category I CPT Codes; use the codes for established patient which are 99211 - 99215. <br />
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However, 99211 is a nurse or a medical assistant service. The code cannot be billed for doctor service. Also, to bill 99211, a provider should present (even if the person is only in the office and not seeing the patient) when the nurse or the medical assistant performs the service that may be a wound check, a dressing change, or suture removal.<br />
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<h4>CPT Code for Suture Removal for different Provider</h4>Another asked question about removal CPT Codes, ICD 9, ICD 10 Codes is about how to code the suture removal if it is a different doctor who removes the sutures. For suture removal CPT Codes, Whether the doctor who removes the sutures practices in the same clinic with the Provider who puts the sutures on the patient or the Provider who removes the sutures does not even know the doctor who puts the sutures on the patient (let alone knowing whether the patient is still in <a href="http://www.medicalbillingcodings.org/2011/04/global-period.html">Global Period</a> or not), suture removal code listed under Evaluation and Management codes should be used in this case. <br />
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Use one of CPT Code 99201 - 99203 (also parts of Evaluation and Management CPT Codes) if the patient is new to the doctor who only removes the sutures without putting the sutures before, and CPT Code 99211 - 99215 if the patient is not new to the doctor who removes the sutures although it is not the doctor who has put the sutures on the patient.<br />
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<h3>ICD 10 Codes for Suture Removal</h3>Lastly in suture removal CPT Codes, ICD 9, ICD 10 Codes is reviewing <b>Suture Removal ICD 10 Codes</b>. Suture removal ICD 9 Code V58.32 is similar to suture removal code ICD 10 Code Z48.02. Just like ICD 9 Code V58.32, ICD 10 Code Z48.02 for removal of sutures is a billable code and also includes surgical staple removal. <br />
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The code is listed under "Encounter for Attention to Dressings, Sutures, and Drains (ICD 10 Code Z48.0)", under "Encounter for Other Postprocedural Aftercare (ICD 10 Code Z48)", in "Encounters for Other Specific Health Care (ICD 10 Code Z40-Z53)", in "Factors Influencing Health Status and Contact with Health Services (ICD 10 Code Z00-Z99)". <br />
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<h3>ICD 9 Codes for Suture Removal</h3>Next in suture removal CPT Codes, ICD 9, ICD 10 Codes is reviewing <b>Suture Removal ICD 9 Codes</b>. In ICD 9 Codes, suture removal code is V58.32. The code also includes surgical staple removal. It is a billable code. The code is listed under "Attention to dressings and sutures (ICD 9 Code V58.3)", under "Encounter for Other and Unspecified Procedures and Aftercare (ICD 9 Code V58)", in "Persons Encountering Health Services for Specific Procedures and Aftercare (ICD 9 Code V50-V59)", as referred in "Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (ICD 9 Code V01 - V91)". <br />
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Unlike suture removal CPT Codes, there is only 1 code for suture removal in each ICD 9 and ICD 10. Both ICD 9 Code V58.32 and ICD 10 Code Z48.02 can be used to get reimbursement in any circumstances regarding removal of sutures. Understand the circumstances first before choosing the appropriate suture removal CPT Codes, ICD 9, ICD 10 Codes.<br />
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CPT Code for Suture Removal and ICD-10, ICD-9 Codes

Learn ICD 10 and CPT code for suture removal. Reviewing suture removal CPT Codes, ICD 9, ICD 10 Codes is necessary since each code entails different things. Both CPT and ICD Codes are regularly revise…

Depression ICD-9-to ICD-10 Codes Conversion and Mapping

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn ICD 10 Code for Depression and ICD-9 to ICD-10 conversion, mapping or crosswalk of mental health codes.<br />
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You can also learn <a href="http://www.medicalbillingcodings.org/2013/11/icd10codes2014depression-mild-moderate-severe-psychotic-bipolar.html">ICD-10 Codes for Depression </a> and <a href="http://www.medicalbillingcodings.org/2014/06/ICD9cm-codes-depression-anxiety-insomnia-fatigue.html">ICD-9 Codes for Depression</a> w/o Anxiety, Insomnia, Fatigue etc.<br />
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ICD stands for International Classification of Diseases. ICD is made by WHO (World Health Organization) and has been used by many parties all over the world. ICD is very useful for the diagnostic tool as it does not only group similar diseases into one major category but also sorts and features the symptoms, complaints, external causes, social conditions, signs, and abnormalities of each disease. ICD is always revised by WHO to keep the codes always up to date though the change of the already existed codes in each revision is kept to be not too much so that people who use it would not take a lot of time to adapt to and implement the new ICD codes.<br />
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The current ICD featured by WHO is ICD 10, that was created in 1983, revised in 1990 during 43rd World Health Assembly, and started to be used in 1994. Nevertheless, ICD 9 CM (International Classification of Disease, Ninth Revision, Clinical Modification) is still used in US as the implementation of <a href="http://www.medicalbillingcodings.org/2014/03/ICD10-delay-news-SGRfixBill-medicare.html">ICD 10 CM is delayed</a> until October 2015. <br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/12/depression-icd9cmto-icd10cm-codesconversion.html"><img alt="Depression ICD 9 and ICD 10 Codes conversion, mapping or crosswalk" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXJ9FFoMcYTgpZMT-XeiX_zD4PNRb8lraw2RwONtPSP8R2O-XLdQBK9o5co-_sNRiXpYD8fDoJIJMgV_Gear6cwuw5diO4nSN9DWy85Ad0xymuHnhdJfkzLnc2IFQsNDG-3-hTJExZSkhW/s1600/depression-in-men.jpg" /></a></div><br />
ICD 9 CM, made by US National Center for Health Statistics (NCHS), is the modification of WHO’s ICD 9, which was created by WHO in 1975. ICD 9 CM is basically the same as ICD 9. The main difference between ICD 9 and ICD 9 CM is that ICD 9 CM contains detailed morbidity. ICD can be used for morbidity and mortality statistics, assisting diagnostics, information about medical procedures, reimbursement for inpatient, outpatient, and physician office, and supporting health care decision. <br />
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Because of the system of ICD codes, it is possible to compare health statistics, including morbidity and mortality statistics, among countries in all over the world. ICD codes contain around 155 thousand different codes, including Depression ICD 9 and ICD 10 Codes. However, there is a stark difference between ICD 9 and ICD 10. ICD 9 codes are only numbers while ICD 10 codes use a letter followed by numbers. <br />
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There are different kinds of depression related to different kind of diseases that's why there are different codes for Depression ICD 9 and ICD 10 Codes. In ICD 9 Codes, Depression is coded under Mental Disorders (Code 290 - 319). There following categories in Mental Disorders:<br />
<ul><li>Organic Psychotic Conditions</li>
<li>Other Psychoses</li>
<li>Neurotic Disorders</li>
<li>Personality Disorders</li>
<li>Intellectual Disabilities</li>
<li>Other Non-psychotic Mental Disorders</li>
</ul>Depression can be found in 2 categories "Other Psychoses (Code 295 - 299)" and "Neurotic Disorders, Personality Disorders, and Other Non-psychotic Mental Disorders (Code 300 - 316)". <br />
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For Depression NOS (Not Otherwise Specified), Depressive State NOS, or Depressive Disorder NOS, the ICD 9 Code used is under the "Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders (Code 300 - 316)" Category, specifically ICD 9 Code 311. <br />
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<h2>Depression ICD 9 to ICD 10 Codes Conversion</h2>ICD 9 Code 311 is similar to ICD 10 F32.9. This type of depression has many symptoms that so many people are familiar with at some points of their lives. The symptoms may include feeling lost, empty, unloved, unwanted, loss of feeling, masked depression, postpartum (after childbirth) depression, feeling that everything is futile, feeling depressed in the morning or in the day, feeling depressed, etc. <br />
Another type of Depression ICD 9 and ICD 10 Codes is Major Depressive Disorder. For Major Depressive Disorder, it is coded in ICD 9 Codes under "Other Psychoses (Code 295 - 299)", specifically under Code 296 Episodic Mood Disorders. The details of Major Depressive Disorder under Code 296 Episodic Mood disorders can be seen below<br />
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<h3>296.2 Major Depressive Disorder Single Episode Conversion</h3>Find below the ICD 10 conversion for the ICD 9 code 296.2 Major Depressive Disorder Single Episode:<br />
<ul><li>ICD 9 Code 296.20 Major Depressive Affective Disorder, single episode, unspecified. This is similar to ICD 10 Code F32.9.<br />
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<li>ICD 9 Code 296.21 Major Depressive Affective Disorder, single episode, mild. This is similar to ICD 10 Code F32.0.<br />
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<li>ICD 9 Code 296.22 Major Depressive Affective Disorder, single episode, moderate. This is similar to ICD 10 Code F32.1.<br />
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<li>ICD 9 Code 296.23 Major Depressive Affective Disorder, single episode, severe, without psychotic behavior. This is similar to ICD 10 Code F32.2.<br />
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<li>ICD 9 Code 296.24 Major Depressive Affective Disorder, single episode, severe, with psychotic behavior. This is similar to ICD 10 Code F32.3.<br />
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</li>
<li>ICD 9 Code 296.25 Major Depressive Affective Disorder, single episode, in partial or unspecified remission. This is similar to ICD 10 Code F32.4.<br />
<br />
</li>
<li>ICD 9 Code 296.26 Major Depressive Affective Disorder, single episode, in full remission. This is similar to ICD 10 Code F32.5.</li>
</ul><br />
<h3>296.3 Major Depressive Disorder Recurrent Episode Conversion</h3>Find below the ICD 10 conversion for the ICD 9 code 296.3 Major Depressive Disorder Recurrent Episode:<br />
<ul><li>ICD 9 Code 296.30 Major Depressive Affective Disorder, recurrent episode, unspecified. This is similar to ICD 10 Code F33.9<br />
<br />
</li>
<li>ICD 9 Code 296.31 Major Depressive Affective Disorder, recurrent episode, mild This is similar to ICD 10 Code F33.0<br />
<br />
</li>
<li>ICD 9 Code 296.32 Major Depressive Affective Disorder, recurrent episode, moderate. This is similar to ICD 10 Code F33.1<br />
<br />
</li>
<li>ICD 9 Code 296.33 Major Depressive Affective Disorder, recurrent episode, severe, without psychotic behavior. This is similar to ICD 10 Code F33.2<br />
<br />
</li>
<li>ICD 9 Code 296.34 Major Depressive Affective Disorder, recurrent episode, severe, with psychotic behavior. This is similar to ICD 10 Code F33.3<br />
<br />
</li>
<li>ICD 9 Code 296.35 Major Depressive Affective Disorder, recurrent episode, in partial or unspecified remission. This is similar to ICD 10 Code F33.40 for the unspecified remission and F33.41 for the partial remission.<br />
<br />
</li>
<li>ICD 9 Code 296.36 Major Depressive Affective Disorder, recurrent episode, in full remission. This is similar to ICD 10 Code F33.42</li>
</ul>There are not a lot of differences for Depression ICD 9 and ICD 10 Codes. In general, ICD 9 Code 296.2 for Major Depressive Disorder single episode is similar to ICD 10 Code F32, and ICD 9 Code 296.3 for Major Depressive Disorder recurrent episode is similar to ICD 10 Code F33. Other types of Depression are related to other diseases such as bipolar disorder, menopause symptoms or syndrome, psychosis, manic disorder, physical deformities, etc. Review Depression <a href="http://www.medicalbillingcodings.org/search/label/ICD%20Code%209">ICD 9 Codes</a> and <a href="http://www.medicalbillingcodings.org/search/label/ICD%2010%20Codes">ICD 10 Codes</a> for more detailed diagnostic information of depression.<br />
</div>

Depression ICD-9-to ICD-10 Codes Conversion and Mapping

Learn ICD 10 Code for Depression and ICD-9 to ICD-10 conversion, mapping or crosswalk of mental health codes. You can also learn ICD-10 Codes for Depression and ICD-9 Codes for Depression w/o Anxiety…

Radiology CPT Code Changes 2015: Diagnostic, Interventional

<div dir="ltr" style="text-align: justify;" trbidi="on">For 2015, there was several radiation oncology code pairs identified to be performed together in most of the time and so are considered for bundling by the CPT Editorial Panel. <br />
<br />
Radiology procedure CPT codes included in the current screening results include dual-energy X-ray absorptiometry, vertebroplasty, myelography and isodose calculation & planning. The radiology practices review the ways of procedures followed for the coded process. Also, they are expected to anticipate on how these bundled new code changes would impact the practices.<br />
<br />
The ACR in conjunction with many specialty societies have worked on code proposals for the code cycle 2015. As a result, there has been a number of radiology and radiation oncology codes were to be created and updated in the year 2015. <br />
<br />
It was assumed that a total of 22 out of the 35 newly accepted codes are from the requests of the AMA’s Relativity Assessment Workgroup (RAW). The purpose of RAW group is to identify the potentially disvalued services. <br />
<br />
<div style="text-align:center"><a href="http://www.medicalbillingcodings.org/2014/12/radiologycptcodechanges2015diagnosticinterventional.html"><img alt="Radiology CPT Code Changes 2015: Diagnostic, Interventional, Radiation" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfWTy_E9jqW_A8-5PZMCzWEmNYjEMkTnDFzwYgiY0eM4knn2xitYKaVWx_oHROgbsQFkb31YY4GH-mkIu5J3MZebL1Dcqn5d7YIq3sSB1ZgUjhV-Oru0Vftz6xJB6tULvEtQbMnpV7jdKx/s1600/Radiation-Oncology-CPTCodes-Billing-Coding.jpg"></a></div><br />
<h2>Radiology CPT Code Changes 2015</h2>Currently, the group has identified several codes that are performed together or that services which were flagged previously as new technology and CMS/Other time source. <br />
<br />
<h3>Diagnostic Radiology CPT Code Changes 2015</h3>This diagnostic radiology coding is directed by the certified coder from a nationally recognized diagnostic radiology coding and reimbursement expert. Since there are numerous radiology studies growing in the modern-day, there is always a shortage of certified coders. Moreover, there is lack of experience and training in this sphere. There are very few radiology coders who are certified for career commitment and quality of coding. Since the diagnostic radiology coding includes a variety of sub-specialties like Ultrasound, CAT, MRI, PET and Mammography, the coding guidelines and regulations are too many to be counted on. This makes the need for radiology coding an essential.<br />
<br />
<h4>Breast Tomosynthesis</h4>The ACR in conjunction with Radiological Society of North America and American Roentgen Ray Society has established three new Category I codes for describing the diagnostic & screening procedures for digital breast tomosynthesis. The present mammography codes in these procedures do not include any kind of additional physician work or practice expenses and so, new codes were necessary to describe the additional resources in the procedures involved in digital breast tomosynthesis.<br />
<br />
<h4>Breast Ultrasound</h4>Two new codes to describe either complete or limited breast ultrasound procedures were requested. The current breast ultrasound code of 76645 is proposed for a deletion. Code 76645, Ultrasound, real time with image documentation and breast(s) (unilateral or bilateral) was identified with a CMS/Other time source by the RAW screen of codes. <br />
<br />
<h4>Dual-Energy X-ray Absorptiometry (DXA)</h4>The dual-energy x-ray absorptiometry or the bone density study which includes vertebral fracture assessment and axial skeleton codes were identified as codes that are reported to be examined together in most of the times. The RAW requested that bundling of these 77080 and 77082 codes would be a solution for this family of codes. The deletion of 77082 along with an establishment of two new codes would help in describing DXA and vertebral fracture assessment in 2015 coding. <br />
<br />
<h3>Interventional Radiology CPT Code Changes 2015</h3>Interventional radiology requires a coding precision. The problems with these coders are numerous as there is a large number of coding to be read and interpret. Coding and radiology department are accountable for the quality of patient radiology coding. Most of the time, reports are less wordy and consist of codes which are to be ordered by the physician to the coder, in order to determine the necessity of patient examining. It is important for the professionals to share coding issues together with the radiology staff. For mitigating the results of confusion in the process of what is ordered and what is performed, reimbursement and compliance is critical.<br />
<br />
<h4>Cryoablation for Liver and Bone Tumors</h4>Because of the substantial clinical experience and clinical trial data that was published earlier recording the clinical benefits of cryosurgical ablation, have led to the proposal of two new codes for describing percutaneous cryosurgical ablation of liver and bone tumors. As for now, these procedures are described with an unlisted code.<br />
<br />
<h4>Myelography</h4>The code, 62284 for myelography lumbar injection and the codes 72240, 72265 and 72270 for imaging guidance were identified as codes reported together more of the time by the RAW. So, they were proposed for bundling by RAW to the specialty societies.<br />
<br />
Additionally, four new codes were proposed for bundling the injection and imaging guidance for myelography procedures. The current codes for injection and radiologic supervision & interpretation for myelography will be retained. This is because the procedure is performed by two physicians, as one performs the contrast injection and the other one provides radiological supervision and interpretation.<br />
<br />
<h4>Vertebroplasty</h4>Vertebral augmentation and percutaneous vertebroplasty CPT codes were identified as being reported together 75 percent or more of the time with the guidance code 72291, percutaneous vertebroplasty, Radiological supervision and interpretation, vertebral augmentation, or sacral augmentation. It also includes per vertebral body or sacrum, cavity creation, under fluoroscopic guidance. The multispecialty society workgroup bundled these codes, and also created an updated code family describing the other spinal procedures. As a result, six new codes were requested for vertebroplasty and vertebral augmentation i.e., kyphoplasty with imaging guidance. Moreover, few of the current codes are marked for deletion. The sacroplasty for vertebral augmentation Category III codes will be revised to include imaging guidance and extended for another five years.<br />
<br />
<h4>Endoscopic Foreign Body Retrieval</h4>There was a revision recommended to the imaging instructional parenthetical notes for directing the users to code 76000 which is for fluoroscopic guidance. This is particularly recommended when performed in conjunction with endoscopic foreign body retrieval.<br />
<br />
<h4>Arthrocentesis</h4>There were three new codes added a per the proposal for describing ultrasound imaging guidance. This was requested as an inclusive component of arthrocentesis, as well as aspiration or injection of a joint or bursa. However, fluoroscopic-guided arthrocentesis will be remained as a component coded.<br />
<br />
<h3>Radiation Oncology CPT Code Changes 2015</h3><h4>Isodose Calculation and Planning</h4>There were 5 new bundled codes created to reflect the process of brachytherapy and teletherapy isodose planning. Previously, both teletherapy and brachytherapy isodose planning codes are frequently reported to be used with basic radiation dosimetry calculation code. This was identified among the codes inherently performed together more than 75 percent of the time. This was because the planning codes require performance of dosimetry calculation as a part of the procedure.<br />
<br />
<h4>Radiation Treatment Delivery</h4>There were many changes for 2015 addressing a number of interrelated issues; clinical practice and CPT clarification were initiated. Three new codes are created to report the radiation treatment delivery services with clarification. These codes contain the technical or professional component or the both. Fourteen current codes describing the ultrasound guidance and Category III codes were proposed for deletion. Revisions in the guidelines and radiation treatment delivery codes are also made.<br />
</div>

Radiology CPT Code Changes 2015: Diagnostic, Interventional

For 2015, there was several radiation oncology code pairs identified to be performed together in most of the time and so are considered for bundling by the CPT Editorial Panel. Radiology procedure CP…

Medicare Part-D 2015: Donut Hole, Costs, Drug Plans, Deductible

<div dir="ltr" style="text-align: justify;" trbidi="on">The Medicare Modernization Act (MMA) requires to announce each year the Medicare Part D standard defined benefit and Retiree Drug Subsidy (RDS) amounts for the coming year.<br />
<br />
Most Medicare Prescription Drug Plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs.<br />
<br />
<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/11/medicarepart-d2015donuthole-costsdrugplansdeductible.html"><img alt="Medicare Part-D 2015: Donut Hole, Costs, Drug Plans, Deductible" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBEDmG2p5ZdAHRl2EE5cBrysRDricrv6qrBfBEqcI5Y9KuiI0-zppSZ1P52fVp91cQHdY1RwryrjHiv1Mv-_0wH0yHVjuh-5Ddqrbhu6aR0MvKtq6p_1negXedUAlxKg3OnoKIETGFE8RV/s1600/medicare-part-d2015-donuthole-costs-drugplans-deductible.jpg" /></a></div><br />
<h2>Medicare Part-D 2015: Donut Hole, Costs, Drug Plans, Deductible</h2>The Centers for Medicare & Medicaid Services (CMS) recently released information about the Medicare Part D stand-alone prescription drug plans (PDPs) that will be available in 2015.<br />
<br />
<h2>Medicare Part D Benefit Parameters Comparison 2015</h2>Medicare & Medicaid Services (CMS) on April 7, 2014, has announced the Medicare Part-D 2015 rates, deductible and out-of-pocket limit. Here are the Medicare Part-D Benefit Plan changes from 2014 to 2015. These are the Standard Benefit plan changes. This "Standard Benefit Plan" is the minimum allowable plan to be offered.<br />
<ul><li><b>Medicare Part-D Initial Deductible 2015:</b> will be increased by $10 to $320 in 2015</li>
<li><b>Medicare Part-D Initial Coverage Limit 2015:</b> will increase from  $2,850 in 2014 to $2,960 in 2015</li>
<li><b>Medicare Part-D Initial Out-of-Pocket Threshold:</b> will increase from $4,550 in 2014 to $4,700 in 2015</li>
<li><b>Medicare Part-D Initial Donut Hole (Coverage Gap) 2015:</b> begins once you reach your Medicare Part D plan’s initial coverage limit ($2,960 in 2015) and ends when you spend a total of $4,700 in 2015. In 2015, Part-D enrollees will receive a 55% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 65% co-pay on generic drugs purchased while in the coverage gap. </li>
<li><b>Minimum Cost-sharing in the Medicare Part-D Catastrophic Coverage Portion of the Benefit:</b> will increase to greater of 5% or $2.65 for generic or preferred drug that is a multi-source drug and the greater of 5% or $6.60 for all other drugs in 2015</li>
<li><b>Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:</b> will increase to $2.65 for generic or preferred drug that is a multi-source drug and $6.60 for all other drugs in 2015</li>
</ul>For the defined standard Medicare Part-D plan, which will be higher than the 2014 amounts as shown in the Medicare Part D Benefit Parameters Comparison 2015 below:<br />
<style>
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<table cellpadding="1" cellspacing="0" bgcolor="#ffffff" border="0" class="tblData" valign="top"><tbody>
<tr class="tblhead"> <td align="left">Medicare Part-D Benefits</td> <td align="center">2015</td> <td align="center">2014</td> <td align="center">2013</td> <td align="center">2012</td> <td align="center">2011</td> </tr>
<tr> <td align="left"><h4>Medicare Part-D Deductible</h4>After the Medicare Part-D Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.</td><td align="center">$320</td><td align="center">$310</td><td align="center">$325</td><td align="center">$320</td><td align="center">$310</td> </tr>
<tr> <td align="left"><h4>Medicare Part-D Donut Hole</h4>Initial Coverage Limit: Medicare Part-D Coverage Gap (Donut Hole) begins at this point. The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold.</td><td align="center">$2960</td><td align="center">$2850</td><td align="center">$2970</td><td align="center">$2930</td><td align="center">$2840</td></tr>
<tr><td align="left"><b>Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap</b> - Catastrophic Coverage starts after this point.<br />
<br />
(Please see note 1 below)</td><td align="center">$6680.00 <br />
<br />
plus a 55% brand discount</td><td align="center">$6455.00 <br />
<br />
plus a 52.50% brand discount</td><td align="center">$6733.75 <br />
<br />
plus a 52.50% brand discount</td><td align="center">$6657.50 <br />
<br />
plus a 50% brand discount</td><td align="center">$6447.50 <br />
<br />
plus a 50% brand discount</td></tr>
<tr><td align="left"><b>Out-of-Pocket Threshold </b>- This is the Total Out-of-Pocket Costs including the Donut Hole.<br />
2015 Example:<br />
$320 (Deductible)<br />
+(($2960-$320)**25%) (Initial Coverage)<br />
+<u>(($6680.00-$2960)*100%) </u>(Cov. Gap)<br />
= $4700 (Maximum Out-Of-Pocket Cost prior to Catastrophic Coverage - excluding plan premium)</td><td align="center">$4700<br />
<br />
<br />
<br />
$320.00<br />
$660.00<br />
<br />
<u>$3720.00</u><br />
<br />
$4700.00<br />
<br />
<br />
</td><td align="center">$4550<br />
<br />
<br />
<br />
$310.00<br />
$635.00<br />
<br />
<u>$3605.00</u><br />
<br />
$4550.00<br />
<br />
<br />
</td><td align="center">$4750<br />
<br />
<br />
<br />
$325.00<br />
$661.25<br />
<br />
<u>$3763.75</u><br />
<br />
$4750.00<br />
<br />
<br />
</td><td align="center">$4700<br />
<br />
<br />
<br />
$320.00<br />
$652.50<br />
<br />
<u>$3727.50</u><br />
<br />
$4700.00<br />
<br />
<br />
</td><td align="center">$4550<br />
<br />
<br />
<br />
$310.00<br />
$632.50<br />
<br />
<u>$3607.50</u><br />
<br />
$4550.00<br />
<br />
<br />
</td></tr>
<tr><td align="left">Total Estimated Covered Part D Drug Out-of-Pocket Spending, including the Coverage Gap Discount (NON-LIS). See note 2 below.</td><td align="center">$7061.76</td><td align="center">$6690.77</td><td align="center">$6954.52</td><td align="center">$6730.39</td><td align="center">$6483.72</td></tr>
<tr><td align="center" colspan="6" valign="top"><h3>Medicare Part D Catastrophic Coverage Benefits</h3></td></tr>
<tr><td align="left">Generic/Preferred<br />
Multi-Source Drug</td><td align="center">$2.65</td><td align="center">$2.55</td><td align="center">$2.65</td><td align="center">$2.60</td><td align="center">$2.50</td></tr>
<tr><td align="left">Other Drugs</td><td align="center">$6.60</td><td align="center">$6.35</td><td align="center">$6.60</td><td align="center">$6.50</td><td align="center">$6.30</td></tr>
<tr class="tblhead"><td align="left">Full Benefit Dual Eligible (FBDE)</td><td align="center">2015</td><td align="center">2014</td><td align="center">2013</td><td align="center">2012</td><td align="center">2011</td></tr>
<tr><td align="left">Deductible</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td></tr>
<tr><td align="left">Copayments for<br />
Institutionalized<br />
Beneficiaries</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td></tr>
<tr> <td align="center" colspan="6" valign="top"><h3>Maximum Copay for Non-Institutionalized Beneficiaries</h3></td></tr>
<tr><td align="left" colspan="6" valign="top"><b>Up to or at 100% FPL:</b></td></tr>
<tr><td align="left" colspan="6" valign="top">Up to Out-of-Pocket Threshold</td></tr>
<tr><td align="left">Generic/Preferred<br />
Multi-Source Drug</td><td align="center">$1.20</td><td align="center">$1.20</td><td align="center">$1.15</td><td align="center">$1.10</td><td align="center">$1.10</td></tr>
<tr><td align="left">Other</td><td align="center">$3.60</td><td align="center">$3.60</td><td align="center">$3.50</td><td align="center">$3.30</td><td align="center">$3.30</td></tr>
<tr><td align="left">Above Out-of-Pocket<br />
Threshold</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td></tr>
<tr><td align="left" colspan="6" valign="top"><b>Over 100% FPL:</b></td></tr>
<tr><td align="left" colspan="6" valign="top">Up to Out-of-Pocket Threshold</td></tr>
<tr><td align="left">Generic/Preferred<br />
Multi-Source Drug</td><td align="center">$2.65</td><td align="center">$2.55</td><td align="center">$2.65</td><td align="center">$2.60</td><td align="center">$2.50</td></tr>
<tr><td align="left">Other</td><td align="center">$6.60</td><td align="center">$6.35</td><td align="center">$6.60</td><td align="center">$6.50</td><td align="center">$6.30</td></tr>
<tr><td align="left">Above Out-of-Pocket<br />
Threshold</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td></tr>
<tr class="tblhead"><td align="left">Part-D Non FBDE Full Subsidy</td><td align="center">2015</td><td align="center">2014</td><td align="center">2013</td><td align="center">2012</td><td align="center">2011</td></tr>
<tr><td align="left" colspan="6" valign="top">Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources <u><</u> $7160 (individuals) or <u><</u> $10750 (couples)</td></tr>
<tr><td align="left">Deductible</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td></tr>
<tr><td align="left" colspan="6" valign="top">Maximum Copayments up to Out-of-Pocket Threshold</td></tr>
<tr><td align="left">Generic/Preferred<br />
Multi-Source Drug</td><td align="center">$2.60</td><td align="center">$2.55</td><td align="center">$2.65</td><td align="center">$2.60</td><td align="center">$2.50</td></tr>
<tr><td align="left">Other</td><td align="center">$6.60</td><td align="center">$6.35</td><td align="center">$6.60</td><td align="center">$6.50</td><td align="center">$6.30</td></tr>
<tr><td align="left">Maximum Copay above<br />
Out-of-Pocket<br />
Threshold</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td><td align="center">$0.00</td></tr>
<tr class="tblhead"><td align="left">Medicare Part-D Partial Subsidy</td><td align="center"><b>2015</b></td><td align="center">2014</td><td align="center">2013</td><td align="center">2012</td><td align="center">2011</td></tr>
<tr><td align="left" colspan="6" valign="top">Applied and income below 150% FPL and resources between $7161-$13440 (individuals) or $10751-$26860 (couples) (category code 4)</td></tr>
<tr><td align="left">Deductible</td><td align="center">$66.00</td><td align="center">$63.00</td><td align="center">$66.00</td><td align="center">$65.00</td><td align="center">$63.00</td></tr>
<tr><td align="left">Coinsurance up to<br />
Out-of-Pocket<br />
Threshold</td><td align="center">15%</td><td align="center">15%</td><td align="center">15%</td><td align="center">15%</td><td align="center">15%</td></tr>
<tr><td align="left" colspan="6" valign="top">Maximum Copayments above Out-of-Pocket Threshold</td></tr>
<tr><td align="left">Generic/Preferred<br />
Multi-Source Drug</td><td align="center">$2.65</td><td align="center">$2.55</td><td align="center">$2.65</td><td align="center">$2.60</td><td align="center">$2.50</td></tr>
<tr><td align="left">Other</td><td align="center">$6.60</td><td align="center">$6.35</td><td align="center">$6.60</td><td align="center">$6.50</td><td align="center">$6.30</td></tr>
</tbody></table><ol><li>Total Covered Part D Spending at Out-of-Pocket Threshold for Non-Applicable Beneficiaries - Beneficiaries who ARE entitled to an income-related subsidy under section 1860D-14(a) (LIS)<br />
<br />
</li>
<li>Total Covered Part D Spending at Out-of-Pocket Threshold for Applicable Beneficiaries - Beneficiaries who are NOT entitled to an income-related subsidy under section 1860D-14(a) (NON-LIS) and do receive the coverage gap discount. For 2015, the weighted gap coinsurance factor is 90.693%. This is based on the 2013 PDEs (85.9% Brands & 14.1% Generics)<br />
<br />
</li>
<li>The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2014, beneficiaries would be charged $2.60 for those generic or preferred multisource drugs with a retail price under $52 and 5% for those with a retail price greater than $52. As to Brand drugs, beneficiaries would pay $6.60 for those drugs with a retail price under $132 and 5% for those with a retail price over $132.<br />
<br />
</li>
<li>The actual amount of resources allowable may be updated for contract year 2015</li>
</ol></div>

Medicare Part-D 2015: Donut Hole, Costs, Drug Plans, Deductible

The Medicare Modernization Act (MMA) requires to announce each year the Medicare Part D standard defined benefit and Retiree Drug Subsidy (RDS) amounts for the coming year. Most Medicare Prescription …

Colon Cancer Screening Medicare Coverage Guidelines and Codes

<div dir="ltr" style="text-align: justify;" trbidi="on">Medicare does cover <b>Colon Cancer</b> also referred as <b>Colorectal Cancer</b>, <b>Rectal Cancer</b> or <b>Bowel cancer</b>. Which is the development of cancer in the colon or rectum in the lower part of the large intestine. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. <br />
<br />
<b>Colon Cancer Symptoms</b> and Signs include blood in the stool, a change in bowel movements, weight loss, and feeling tired all the time.<br />
<br />
<h3>Colon Cancer Screening</h3><b>Colon Cancer Screening</b> can be done by obtaining a sample of the colon during a sigmoidoscopy or colonoscopy. This is then followed by medical imaging to determine disease spread, colon cancer staging and prognosis. <br />
<br />
In US, Colon Cancer Screening is found effective to decrease colon cancer related deaths. Colon Cancer Screening is recommended starting at the age of 50 and continuing until the age of 75 in United States.<br />
<br />
<h2>Colon Cancer Screening Medicare Coverage Guidelines and Codes</h2>You can checkout the <a href="http://www.medicalbillingcodings.org/2014/10/Colorectal-cancer-screening-icd9cpt-codes.html">Colorectal Cancer Screening ICD 9 and CPT Codes</a> under which Medicare does cover colorectal (colon) cancer screenings.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/11/coloncancerscreening-medicarecoverageguidelines.html"><img alt="Colon Cancer Screening Medicare Coverage Guidelines and Codes" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgplTpGTiq6cMEoo8E6BcugpGCTydTOr3mVrhvMbP0DT5YQDh_9f5fz2ZGzHgFrW3R1iVUan_3z_wi1gj4D2stYRopkRMxEznlwaH7T8fhmyTYSApP8yM-jB0oYHqmDbceI5_F0A9C5Rjv6/s1600/Colorectal-cancer-screening-icd9cpt-codes.jpg" /></a></div><br />
<h3>Medicare Colon Cancer Screening Coverage Guidelines</h3>With Medicare, a patient must be 50 age or older to be eligible for <b>Medicare Colon Cancer Screening Coverage</b> for most of the colon cancer types. <br />
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However, there is an exception to this. For colonoscopy procedure (which can also diagnose colon cancer) there is no minimum age requirement. <br />
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Below are the medicare colon cancer screening coverage eligibility guidelines:<br />
<ul><li>Fecal occult blood test - once a year (every 12 months) for persons age 50 or older.<br />
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</li><li>Flexible sigmoidoscopy - once every four years (48 months) for persons at high risk and less frequently for other persons.<br />
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</li><li>Colonoscopy - once every two years (24 months) if you are at high risk for colorectal cancer (Have a family history of the disease or have had colorectal polyps or colorectal cancer, or have had inflammatory bowel disease).<br />
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</li><li>Medicare covers colonoscopies every 10 years (but not within 48 months of a screening flexible sigmoidoscopy) if you are not at high-risk.<br />
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</li><li>Barium enema – once every two years for persons at high risk and once every four year for others (but not within 48 months of a screening flexible sigmoidoscopy).</li>
</ul>From 2011, if you have original Medicare, no coinsurance or deductible applies to the fecal occult blood test, flexible sigmiodoscopy or colonoscopy if you see doctors who take assignment. Doctors and other health care providers who take assignment cannot charge you more than the Medicare approved amount. <br />
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From 2012, <b>Medicare Advantage Plans</b> will cover all preventive services the same as Original Medicare. This means Medicare Advantage (MA) plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply. Therefore, if you are in a Medicare Advantage plan, contact your plan to find out what rules and costs apply. <br />
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For <b>Barium Enema</b>, patient will pay 80 percent of the Medicare approved amount if the doctor takes assignment. The Medicare Part-B deductible does not apply.<br />
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For <b>Diagnostic Colon Cancer Screening</b>, if a patient undergoes colonoscopy and the provider finds and removes a polyp, the costs will apply. Patient would have to pay the coinsurance for the colonoscopy and the polyp removal because the Colon Cancer Screening became diagnostic. However, no deductible will apply.<br />
</div>

Colon Cancer Screening Medicare Coverage Guidelines and Codes

Medicare does cover Colon Cancer also referred as Colorectal Cancer, Rectal Cancer or Bowel cancer. Which is the development of cancer in the colon or rectum in the lower part of the large intestine. …

AR Analyst Role in Medical Billing Claims Review Process

<div dir="ltr" style="text-align: justify;" trbidi="on"><b>Account Receivables (AR)</b> in <b>Medical Billing and Coding</b> are defined as amounts due and expected to be collected by Medical billing / provider office for the services provided to individuals. <br />
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In <a href="http://www.medicalbillingcodings.org/2012/09/how-to-start-medical-billing-home-business.html">Medical Billing Business</a> receivables are handled by Account Receivables (AR) Department. Thus, Account Receivables (AR) Analyst's role is crucial in identifying and resolving issues which helps to reduce or clear receivables.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/11/aranalystrolemedicalbillingclaimsreviewprocess.html"><img alt="AR Analyst Role in Medical Billing Claims Review Process" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjt50cSS4FZOuYa5yckevJdyy3Y7drpT0v31BsowOLz1gGrzBOzNAmXGzaoT5hf4OLrMbJYfpO-zDoH-j65OjoxDQWP_i6MgkHjS4EZFttjK0mZZwg3gEidfwW0Isp46ARa0oKavM4On4/s1600/ar-analyst-role-medicalbilling-claims-review-process.jpg" /></a></div><br />
<h2>AR Analyst Role in Medical Billing Claims Review Process</h2><b>AR Analyst Role</b> and Responsibilities in Medical Billing Claims review process are based on ensuring timely, accurate and final settlement of medical insurance claims and patient bills by insurers or patients as appropriate. <br />
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The purpose of <b>Medical Billing Claim Analysis</b> is to identify and resolve medical claims billing and reimbursement issues aimed at maximizing collections and minimizing accounts receivables. <br />
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The scope of <b>AR Claim Analysis</b> is applicable to all health insurance claims and patient bills that have not been fully and finally settled by liable party or parties comprising health insurers, patients and others. It is the responsibility of the Accounts Receivables Analyst to ensure that AR is under control and acceptable by industry standards.<br />
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<h3>What is AR Department Role in Medical Billing?</h3>An AR analyst as a part of <b>Account Receivables (AR) Department</b> has to ensure steady inflow of money from the medical insurances to the provider and in turn medical billing company. <br />
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The main motive of this department is to collect money for all the treatments taken by the patients in a timely fashion. Usually the turn around period for the payment by the medical insurance companies is 30 to 45 days. Once the limit is exceeded AR department has to make an inquiry for the delay. There could be various reasons for the delay like:<br />
<ol><li>Correct details may not have been provided to the insurance companies.<br />
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</li><li>Claims were sent correctly but Insurance Company may not have received the claims.<br />
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</li><li>The checks issued might have been sent to the wrong address.<br />
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</li><li>The insurance company may delay the payments if they have a backlog and they would inform us by a letter that they have received the claims and would be making the payments shortly.</li>
</ol><h3>AR Analyst and Medical Billing Softwares</h3>In a medical billing business, AR department acts as a hub around which other departments revolve. This department can gather and update lot of billing information which is required to settle a claim. Account analyst uses various reports available in billing software to identify claims which have not been settled. <br />
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<a href="http://www.medicalbillingcodings.org/2013/07/best-medical-billing-coding-softwares-review.html">Medical Billing Softwares</a> are capable of running reports that pull out claims that are unpaid for greater than 30 days. These are called aging reports and these reports show pending payments in slots such as 0–30 days, 31-60 days and 61-90 days. <br />
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Medical billing Claims filed within the last 30 days will find themselves in the first slot (0-30days). Claims that are more than 30 days but less than 60 days old will be found in the 31-60 days slot. <br />
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A glance at this report will show the AR personnel the claims that need to be followed up on with the insurance company. <br />
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<h3>AR Follow up in Medical Billing</h3>In Medical Billing, AR analyst follow up the claims over the telephone, email or by written correspondence. It's his duty to find out why the claims are yet to be paid and what needs to be done to have these claims paid. <br />
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The delay and denials in claim reimbursement will be corrected by the billing office in coordination with the physician’s office and the insurance carriers. <br />
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The same applies when patient billing statements are sent out. The patient is given 3-4 weeks to pay the bill and if the payment is not received with in that time, the billing office will follow up with the patient.<br />
</div>

AR Analyst Role in Medical Billing Claims Review Process

Account Receivables (AR) in Medical Billing and Coding are defined as amounts due and expected to be collected by Medical billing / provider office for the services provided to individuals. In Medica…

ENT CPT Codes Changes 2015 for Billing by AMA RUC

<div dir="ltr" style="text-align: justify;" trbidi="on">As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare and Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel, for the coming year. <br />
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In addition, CMS includes new or updated values, also known as relative value units (RVUs), for medical services which have undergone review by the American Medical Association’s Relative Update Committee (AMA RUC). <br />
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CMS has the discretion to accept the RUC's RVU recommendations for physician work, as well as recommendations for direct practice expense inputs, or it may exercise its administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. <br />
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The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/10/ENT-CPT-Codes-Changes2015Billing-AMARUC.html"><img alt="ENT CPT Codes Changes 2015 for Billing by AMA RUC" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFZVIV9Hw3wYkoUqhGNfkK6sEaLt4BzV64d6lbjsTwUBJiuFgz3bEWCp6G-RKkJVTs3TmMYpgYjbv8oVbPHUjzsfU48vIS14R40LYXognuqrqYc9smsmrEIH2zRPN7MiouarokiSlt208-/s1600/ENT-CPT-Codes-Changes2015Billing-AMARUC.jpg" /></a></div><br />
The Academy is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking processes. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery serviced for CY 2015. <br />
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The following outlines a list of coding changes, including new and revised CPT codes, as well as codes which were reviewed by the AMA RUC and could have modified Medicare reimbursement values for 2015:<br />
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<h2>ENT CPT Codes Changes 2015 for Otolaryngology Billing</h2>InCY 2015, a new CPT code and/or deleted CPT codes will be announced, including:<br />
<ol><li>1 New ENT CPT Code (43180) to report Endoscopic Zenker's Diverticulum</li>
<li>3 Deleted ENT CPT Codes (69400, 69401, and 69405) for Eustachian Tube</li> 
<li>An unlisted CPT code (69799) is recommended to report the work of 69400 or 69405</li> 
<li>For CPT Code 69401, the appropriate Evaluation and Management (E&M) office visit code is recommended.</li>
</ol><h3>ENT CPT Codes Reviewed by AMA RUC in CY 2014</h3>In addition to the creation of several new CPT codes for 2015, a number of existing CPT codes relating to Otolaryngology were reviewed by the AMA RUC and their RUC approved values were submitted to CMS for final determination for the CY 2015 final rule. <br />
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Members should be prepared for modified relative value units for some, or all, of these procedures in CY 2015. It is critical to note that once the final MPFS is issued by CMS, typically on or about November 1 of each year. Upon receipt, Academy health policy staff will summarize the final rule and alert members to any critical changes in reimbursement for any of the following medical procedures. Services which were reviewed include:<br />
<ol><li><b>92541</b> Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording</li>
<li><b>92542</b> Positional nystagmus test, minimum of 4 positions, with recording</li>
<li><b>92543</b> Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording</li>
<li><b>92544</b> Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording</li>
<li><b>92545</b> Oscillating tracking test, with recording</li>
</ol>For the following ENT CPT codes , only practice expense inputs are reviewed by the RUC in 2014, physician work was not surveyed or discussed for these codes.<br />
<ol><li><b>10021</b> Fine needle aspiration; without imaging guidance</li>
<li><b>30903</b> Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method</li>
<li><b>30905</b> Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial</li>
<li><b>31295</b> Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa</li>
<li><b>31296</b> Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, balloon dilation)</li>
<li><b>31297</b> Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation)</li>
<li><b>41530</b> Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session</li>
<li><b>30300</b> Removal foreign body, intranasal; office type procedure</li>
<li><b>30906</b> Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequent</li>
<li><b>40804</b> Removal of embedded foreign body, vestibule of mouth; simple</li>
<li><b>42809</b> Removal of foreign body from pharynx</li>
<li><b>69200</b> Removal foreign body from external auditory canal; without general anesthesia</li>
<li><b>69220</b> Debridement, mastoidectomy cavity, simple (eg, routine cleaning)</li>
<li><b>92511</b> Nasopharyngoscopy with endoscope (separate procedure)</li>
</ol></div>

ENT CPT Codes Changes 2015 for Billing by AMA RUC

As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare and Medicaid Services (CMS) includes the annual issuance of new and modified CP…

Colorectal Cancer Screening ICD 9 and CPT Codes

<div dir="ltr" style="text-align: justify;" trbidi="on">Colorectal Cancer is one of the leading causes of cancer deaths in the United States. Approximately 56,290 people died from colorectal cancer, and 145,290 people were newly diagnosed with the disease in 2005. Colorectal cancer is usually found in people ages 50 and older. Therefore, screening for colorectal cancer for people ages 50 and older is strongly recommended. <br />
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Fortunately, Colorectal cancers are some of the most preventable cancers because screening tests can detect growths before they become cancerous. Most colorectal cancers develop from polyps (growths on the lining of the colon). Polyps are usually noncancerous when they first appear. But they can turn into cancerous polyps (adenoma). Removal of these polyps can reduce risk of colon cancer by more than 80 percent.<br />
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Colon cancer most commonly occurs in the lower part of the colon. Cancer in the rectum is called rectal cancer. Together, they are referred to as colorectal cancer.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/10/Colorectal-cancer-screening-icd9cpt-codes.html"><img alt="Colorectal Cancer Screening ICD 9 and CPT Codes" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgplTpGTiq6cMEoo8E6BcugpGCTydTOr3mVrhvMbP0DT5YQDh_9f5fz2ZGzHgFrW3R1iVUan_3z_wi1gj4D2stYRopkRMxEznlwaH7T8fhmyTYSApP8yM-jB0oYHqmDbceI5_F0A9C5Rjv6/s1600/Colorectal-cancer-screening-icd9cpt-codes.jpg" /></a></div><br />
Colon cancer happens when cells that are not normal grow in your colon. These cells grow together and form tumors. Colonoscopy is the only colorectal screening test that examines the entire colon and can remove any polyps found during the test. There are other colorectal cancer screening tools, but colonoscopy is the gold standard.<br />
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<h3>Colorectal Cancer Screening ICD 9 for Colonoscopy</h3>Colonoscopy is a widely used endoscopic technique used to screen individuals for colorectal cancer. It is very sensitive in detecting colorectal cancers. Colonoscopy is an endoscopic procedure in which a thin tube with a camera at the tip is introduced through the anus till the start of the colon.<br />
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Colorectal Cancer Screening ICD-9-CM diagnosis code for an average risk patient presenting for colonoscopy is: <br />
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<b>V76.51 Special Screening for Malignant Neoplasm, Colon</b><br />
Code V76.51 should be the first listed diagnosis code if the reason for the visit is specifically for the screening exam. For high risk patients, the appropriate family or personal history V code identifying the risk should also be assigned. As with screening for malignant neoplasm of the breast, if a condition is discovered during the screening then the code for the condition may also be assigned as an additional diagnosis.<br />
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If the colonoscopy is performed because the patient has a sign or symptom, the sign or symptom code is used to explain the reason for the test, not the screening code. However, if positive findings are discovered during the diagnostic colonoscopy assign the code for these findings instead.<br />
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Colorectal cancer screening tests and procedures can be used alone or in various combinations and include fecal blood test, barium enema, flexible sigmoidoscopy and colonoscopy. Colonoscopy screening procedures are discussed here.<br />
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<h3>Colonoscopy CPT Codes for Colon Cancer Screening</h3>After the patient's bowel has been prepped, the physician inserts the colonoscope-a long, thin, flexible lighted tube-through the anus and advances the scope through the colon past the splenic flexure. The lumen of the colon and rectum is visualized. Most polyps and some cancers can be removed during this procedure. The colonoscope is then withdrawn.<br />
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HCPCS Level ll codes G0105 and G0121 should be reported for Medicare outpatients requiring screening colonoscopy for colorectal cancer:<br />
<ul><li>G0121 Colorectal cancer screening, colonoscopy on individual not meeting criteria for high risk</li>
<li>G0105 Colorectal cancer screening, colonoscopy on individual at high risk</li>
</ul>According to Medicare, a patient is considered to be at high risk if he or she has any of the following risk factors: <br />
<ol><li>Close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp</li> 
<li>Family history of familial adenomatous polyposis</li>
<li>Family history of hereditary nonpolyposis colorectal cancer</li> 
<li>Personal history of adenomatous polyps</li>
<li>Personal history of colorectal cancer</li>
<li>Inflammatory bowel disease, including Crohn's disease and ulcerative colitis</li>
</ol>Screening colonoscopy for non-Medicare patients is coded with 45378, Colonoscopy, flexible, proximal to splenic flexure, diagnostic.<br />
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If an abnormality is found during a screening colonoscopy and results in a therapeutic procedure, then the appropriate diagnostic colonoscopy CPT code (45379-45392) is used instead of codes G0105, G0121 or 45378. Therapeutic procedures include biopsy, polypectomy, etc.<br />
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Review the CCS Prep column titled, "Understanding How to Code Colonoscopies" for instructions on coding therapeutic procedures.<br />
Example: A patient is seen in the outpatient clinic for screening colonoscopy due to family history of colon cancer. The colonoscopy revealed a colonic polyp that was removed by snare technique. Assign CPT code 45385.<br />
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For Medicare OPPS coding, when a screening colonoscopy is attempted but due to extenuating circumstances cannot be completed, code G0105 or G0121 should be reported with either modifier -73 or -74 as appropriate.<br />
</div>

Colorectal Cancer Screening ICD 9 and CPT Codes

Colorectal Cancer is one of the leading causes of cancer deaths in the United States. Approximately 56,290 people died from colorectal cancer, and 145,290 people were newly diagnosed with the disease …

Breast Cancer Screening ICD 9 and CPT Codes

<div dir="ltr" style="text-align: justify;" trbidi="on">Breast Cancer is the most common type of cancer in women in the United States. However, there are screening procedures available to diagnose breast cancers in the early stage. <br />
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We are listing the Breast Cancer Screening ICD and CPT Codes invloved in the diagnoses and procedures coding for screening malignant neoplasm of the breast. <br />
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Screening is the testing for diseases in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. If testing is performed because the patient has a sign or symptom, the sign or symptom code is used to explain the reason for the test, not the screening code.<br />
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A screening code may be the first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an encounter for other health problems. If a condition is discovered during the screening, the code for the condition may be assigned as an additional diagnosis.<br />
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<h2>Breast Cancer Screening ICD 9 and CPT Codes</h2>The following ICD 9 V Code categories are reported to indicate that a screening exam is planned. A procedure code is also required to confirm that the screening was performed. ICD 9 V73-V82 Special screening examinations are used for the purpose.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/10/breast-cancer-screening-icd9cpt-codes.html"><img alt="Breast Cancer Screening ICD 9 and CPT Codes" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6g3LOG6jXlQemTLYsW0pCWT-u8IeZaNBJjO2LhoKz6tQDvQANxYarVvA_XeCIkwYNCa6YTDdyEKlGIjjahdLooqK9k330F7Mw1epbY1K55a73AByP9So50-NgNKeR9HWMPv2I_aqvoy-M/s560/breast-cancer-screening-icd9cpt-codes.jpg" /></a></div><br />
When the reason for performing a test is because the patient has had contact with, or exposure to, a communicable disease, the appropriate code from category V01, Contact with or exposure to communicable diseases, should be assigned, not a screening code.<br />
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<h3>ICD 9 Codes for Breast Cancer Screening Mammograms</h3>Every woman is at risk for developing breast cancer, and the risk increases with age. According to the Center of Disease Control and Prevention (CDC), approximately 94 percent of breast cancers are diagnosed in women older than age 40. Mammography is the best available way to detect breast cancer early, when it is most curable. Timely screening can reduce breast cancer mortality in women 40 and older by 17 percent to 30 percent. <br />
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The National Cancer Institute (NCI) guidelines for screening mammography recommend that asymptomatic women 40 years or older be screened every 1 to 2 years and women aged 50 or older be screened every 1 to 2 years. NCI further recommends that younger women who are at higher risk for developing breast cancer consult with their physician regarding screening mammography and the frequency of such screenings.<br />
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Diagnostic mammograms differ from screening mammograms. Screening mammograms are for patients without documented problems. Diagnostic mammograms are performed when there is a problem such as a breast mass, pain, discharge, etc. Code any positive findings found on the diagnostic mammogram as the first listed diagnoses. If there are no reported findings, assign the reason for the test. The ICD 9 diagnoses codes for encounters for screening mammogram are:<br />
<ul><li>V76.11 and V76.12 Special screening for malignant neoplasm, other screening mammography.</li>
<li>V76.11, Special screening for malignant neoplasm, screening mammogram for high-risk patients.</li>
</ul><blockquote><b>Example</b>: A healthy 40-year-old woman presents to the radiology department for a screening mammogram. The patient has no symptoms or known risks for breast cancer. Assign code V76.12.</blockquote>The following ICD 9 codes may be assigned with code V76.11 to identify why the patient is considered to be at high-risk:<br />
<ul><li>V10.3, Personal history of malignant neoplasm, breast</li>
<li>V16.3, Family history of malignant neoplasm, breast</li>
<li>V15.89, Other specified personal history presenting hazards to health, other</li>
</ul><blockquote><b>Example</b>: A woman with no symptoms is referred to the hospital for screening mammogram. The patient is considered high risk for breast cancer secondary to family history of breast malignancy in the mother and sister. Assign code V76.11 followed by code V16.3.</blockquote>If a condition is found during the screening, then the code for the condition may be used as an additional diagnosis. The rationale for this is that even though a condition is found during the mammography, the visit is still considered a screening.<br />
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For Medicare services, diagnosis codes V76.11 and V76.12 must be the first listed diagnosis on all encounters for screening mammography services. However, effective Oct. 1, 2006, this requirement will change to allow the reporting of any applicable diagnosis code as a primary diagnosis on claims containing other services in addition to a screening mammography. Continue reporting diagnosis codes V76.11 and V76.12 as the first listed diagnosis codes on claims that contain only screening mammography services.<br />
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<h3>Breast Cancer Mammography CPT Codes</h3>A mammogram is a low-dose X-ray of the breast that can find lumps that are too small to be felt during a breast examination. The breast is compressed firmly between two planes and pictures are taken. This spreads the tissue and allows for a lower X-ray dose. A screening mammogram is used to detect breast changes in women who have no signs of breast cancer. When the patient has signs or symptoms of a suspected disease then a diagnostic mammogram is performed and coded instead.<br />
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A screening mammogram is inherently bilateral and is reported with Breast Cancer Screening CPT Codes 76092 and G0202 given below:<br />
<ul><li>76092, Screening mammography, bilateral (two view film study of each breast)</li>
<li>G0202, Screening mammography, producing direct digital image, bilateral, all views</li>
</ul>Code 76083, Computer aided detection (CAD); screening mammography, may be assigned as an additional procedure code when it is performed in addition to the primary procedure. The additional CAD code indicates that a laser beam was used to scan the mammography film and then the image was converted to digital data for computer analysis.<br />
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As mentioned earlier, if a condition is discovered during the screening, then the code for the condition may be used as an additional diagnosis. In this instance, if the radiologist performing the mammogram orders additional films based on the condition discovered during the screening mammogram, both may be coded. <br />
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When a screening mammogram is converted to a diagnostic mammogram on the same day append modifier GG, Performance and payment of a screening mammography and diagnostic mammography on same patient same day, to the diagnostic mammography code. Modifier GG indicates that the test changed from a screening test to a diagnostic test. If not performed on both breasts, it is also important to append the appropriate anatomic modifier, RT or LT, to indicate which side the diagnostic mammogram was performed on.<br />
</div>

Breast Cancer Screening ICD 9 and CPT Codes

Breast Cancer is the most common type of cancer in women in the United States. However, there are screening procedures available to diagnose breast cancers in the early stage. We are listing the Brea…

Radiation Oncology CPT Codes and Billing Coding Guidelines

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn all about Radiation Oncology CPT Codes and Billing Coding Guidelines. Radiation Oncology is a specialty that involves treatment of various forms of Cancer through radiation. This forms of therapy use carefully selected targeted and regulated doses for the process of killing cancer cells. <br />
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The cancer cells normally die as a result of destruction of chromosomes and DNA, preventing them from further growing, thus preventing a tumor from growing.<br />
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<div style="text-align:center"><a href="http://www.medicalbillingcodings.org/2014/10/radiation-oncology-cptcodes-billingcoding.html"><img alt="Radiation Oncology CPT Codes and Billing Coding Guidelines" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfWTy_E9jqW_A8-5PZMCzWEmNYjEMkTnDFzwYgiY0eM4knn2xitYKaVWx_oHROgbsQFkb31YY4GH-mkIu5J3MZebL1Dcqn5d7YIq3sSB1ZgUjhV-Oru0Vftz6xJB6tULvEtQbMnpV7jdKx/s1600/Radiation-Oncology-CPTCodes-Billing-Coding.jpg" /></a></div><br />
For proper reimbursement from insurance companies, Medical Billing staff working for a Radiologist, Oncologist or Radiology Practice need to document proper disease and diagnosis coding through the use of ICD and CPT codes. <br />
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<h2>Radiation Oncology CPT Codes and Billing Coding Guidelines</h2>Radiology CPT codes comprise of 70,000 series of codes that are normally organized depending on the type of radiology and the purpose of the service. Radiation oncology CPT code are normally classified as shown below:<br />
<ul><li>Diagnostic Radiology CPT Codes 70000 - 76499</li>
<li>Diagnostic Ultrasound CPT Codes 76500 - 76999</li>
<li>Radiologic Guidance CPT Codes 77001 - 77032</li>
<li>Breast, Mammography CPT Codes 77051 - 77059</li>
<li>Bone/Joint Studies CPT Codes 77071 - 77084</li>
<li>Radiation Oncology CPT Codes 77261 - 77999</li>
<li>Nuclear Medicine CPT/HCPCS Codes 78000 – 79999</li>
</ul>Two CPT codes are primarily used for reporting  Intensity Modulated Radiation Therapy (IMRT). CPT Code 77301 for Radiotherapy dose planning, and CPT Code 77418 for Radiotherapy treatment delivery.<br />
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Radiation CPT code 77301 is commonly utilized as an intensity modulated radiotherapy plan that includes dose volume histograms for target and critical structure partial tolerance specifications. <br />
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Radiation CPT code 77418 is one the other hand normally used as a delivery single or multiple fields/arcs via narrow spatially and temporary modulated beams. CPT code 77418 is a technical-component only code which can be used by physicians when services are performed in a non-facility setting such as the office.<br />
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<h3>Billing Radiation Oncology Services</h3>Radiological service can be billed for the physician's work as well as the use of equipment or supplies. The technical component (TC) includes facility charges, equipment, supplies, pre/post injection services, staff and so on. The professional component (PC) involves studying and making inferences about the radiological test and submitting a written report with the findings.<br />
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<h3>Radiation Oncology CPT Code Modifiers</h3>Modifiers are used to signify the technical and professional components in a radiological service. They are 2-digit numbers that are used to explain a procedure in more detail. They can indicate repeat or multiple procedures, such as radiography performed bilaterally. When billing for the technical component only, the modifier 52 has to be used; when billing only for the professional component, the modifier 26 is to be used. In the latter case, a written report by the physician providing the services is required to avoid claim denial.<br />
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Some of the main challenges that radiologists face include understatement of procedures carried that many at times result in insufficient reimbursement. On the other hand overstatement might result in risk of abuse repayments and fines.<br />
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Radiologists can resolve all these issues by going in for the services of professional medical coding companies. That's why Radiology Practices need professional Medical Billers skilled to document correct ICD and CPT coders to do the job. <br />
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You can also checkout <a href="http://www.medicalbillingcodings.org/2013/06/echocardiogram-cpt-codes-changes-2013.html">Echocardiogram CPT Codes</a>, CPT codes for <a href="http://www.medicalbillingcodings.org/2013/07/cptcodesmri-lumbarspine-brain-breast-shoulder.html">MRI of Brain, Breast, Lumbar Spine and Shoulder</a>, <a href="http://www.medicalbillingcodings.org/2013/05/cardiology-cpt-codes-new-changes.html">Cardiology CPT Changes</a> and other <a href="http://www.medicalbillingcodings.org/2014/09/Medical-Billing-Coding-Updates-Changes-News.html">Medical Billing and Coding Updates 2014</a> to learn further.<br />
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Effective reimbursement of Radiation Oncology services, in-depth knowledge of the medical billing coding systems, application of coding principles, and thorough understanding of documentation is required. That's why most of the professional companies utilize <a href="http://www.medicalbillingcodings.org/2013/07/best-medical-billing-coding-softwares-review.html">Best Medical Billing Softwares</a> to guarantee efficiency and accuracy in billing and coding, for checking local coverage determination and so on to ensure that all claims are reimbursed.</div>

Radiation Oncology CPT Codes and Billing Coding Guidelines

Learn all about Radiation Oncology CPT Codes and Billing Coding Guidelines. Radiation Oncology is a specialty that involves treatment of various forms of Cancer through radiation. This forms of therap…

Arteriovenous (AV) Fistula/Shunt/Graft:36147 vs 36148,75791

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn the difference between CPT Code 36147 vs 36148, 75791 for correct coding of Arteriovenous (AV) Fistula/Shunt/Graft.<br />
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An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm. <br />
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While if we take a look at Arteriovenous (AV) Shunt definition according to CPT guidelines: <br />
<blockquote>For diagnostic studies, the arteriovenous (AV) dialysis shunt (AV shunt) is defined as beginning with the arterial anastomosis [opening between two normally separate structures] and extending to the right atrium.</blockquote>This definition includes all upper and lower extremity AV Shunts, Arteriovenous Fistulae (AVF) and Arteriovenous Grafts(AVG).<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/10/av-arteriovenous-fistula-shunt-graft36147vs36148-75791.html"><img alt="Arteriovenous (AV) Fistula/Shunt/Graft:36147 vs 36148,75791" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgak-NIil5uyEzahqcMN6F_lbwPSRuNjoolAwwjnYx3ndDQJDaye5bwtq_kGPa9_8K9Cr2irc3TUvWEUXtkc8NdAvVqACCodq8BgrCQjnebU7Dm93g9FwVvHFQxF9cw7DICpQxlOgdG7XAn/s1600/Arteriovenous-AV-Fistula-Shunt-Graft-36147-vs-36148-75791.jpg" /></a></div><br />
An AVF for dialysis is surgically created by cutting an opening in an artery and an opening in a nearby vein and then joining the openings together so that blood can communicate between the artery and the vein. An AVG also involves creating openings in an artery and a vein, but uses an artificial vessel to link the two openings<br />
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<h2>Arteriovenous (AV) Fistula, Shunt, Graft: 36147 vs 36148 vs 75791</h2>Medical Coders typically use CPT 36147 for patients with end-stage renal disease (ESRD), having trouble with his AV shunt for dialysis and requires an evaluation.<br />
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CPT can pack a lot into one little code. Let's take a closer look at Arteriovenous (AV) Fistula/ Shunt/ Graft coding with using CPT codes 36147, 36148 and/or 75791:<br />
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<h3>36147 Access AV Dial Grft for Eval</h3><b>CPT Code 36147 Description</b><br />
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava).<br />
<b>When CPT Code 36147 is Used</b><br />
CPT Code 36147 is reported when the physician performs a fistulagram to evaluate a dialysis arteriovenous fistula or graft. This code includes all components of the fistulagram, including the work of the initial puncture into the graft or fistula and all of the necessary imaging from the arterial anastomosis through the entire venous outflow – including the central veins and superior or inferior vena cava. This code also includes all of the catheter manipulation to perform the diagnostic examination, including advancement of the catheter to the cava if necessary to fully visualize the central veins. <br />
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<h3>36148 Access AV Dial Grft for Proc</h3><b>CPT Code 36148 Description</b><br />
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic intervention (list separately in addition to code for primary procedure).<br />
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<b>When CPT Code 36148 is Used</b><br />
CPT Code 36148 was established to describe the placement of a second (additional) access that may be necessary to perform a therapeutic procedure (e.g., percutaneous transluminal angioplasty, thrombolysis). Please note that code 36148 is an add-on code that is reported only in conjunction with code 36147. <br />
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<h3>75791 AV Dialysis Shunt Imaging</h3><b>CPT Code 75791 Description</b><br />
Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation.<br />
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<b>When CPT Code 75791 is Billed</b><br />
CPT Code 75791 is reported to describe the imaging of the arteriovenous dialysis fistula or graft performed through an existing access (e.g., patient presents from the dialysis suite with needles placed into the graft or fistula, or from a remote access such as the femoral artery that is not a direct puncture to the graft, or images from an operative angiogram that are submitted for interpretation only). The imaging includes the entire length of the graft or fistula and all of the outflow veins through the central veins, including the vena cava. <br />
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When procedure codes 36147 and 75791 are used to report the services described in this LCD (appropriate evaluation of the patency of an established hemodialysis fistula and the percutaneous interventions needed to enhance or re-establish patency of that hemodialysis fistula), the following diagnosis codes will be considered by Medicare to support medical necessity:<br />
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<table cellspacing=1 cellpadding=2 border=1 bordercolor='silver' style='border-collapse:collapse;'><tbody><tr><th>Code</th><th>ICD code description</th></tr><tr><td>440.31</td><td>ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT OF THE EXTREMITIES</td></tr><tr><td>440.32</td><td>ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT OF THE EXTREMITIES</td></tr><tr><td>442.0</td><td>ANEURYSM OF ARTERY OF UPPER EXTREMITY</td></tr><tr><td>442.3</td><td>ANEURYSM OF ARTERY OF LOWER EXTREMITY</td></tr><tr><td>444.21</td><td>ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY</td></tr><tr><td>444.22</td><td>ARTERIAL EMBOLISM AND THROMBOSIS OF LOWER EXTREMITY</td></tr><tr><td>447.0</td><td>ARTERIOVENOUS FISTULA ACQUIRED</td></tr><tr><td>447.1</td><td>STRICTURE OF ARTERY</td></tr><tr><td>451.82</td><td>PHLEBITIS AND THROMBOPHLEBOTIS OF SUPERFICIAL VEINS OF UPPER EXTREMITIES</td></tr><tr><td>453.40</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY</td></tr><tr><td>453.41</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF PROXIMAL LOWER EXTREMITY</td></tr><tr><td>453.42</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF DISTAL LOWER EXTREMITY</td></tr><tr><td>453.50</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY</td></tr><tr><td>453.51</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF PROXIMAL LOWER EXTREMITY</td></tr><tr><td>453.52</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF DISTAL LOWER EXTREMITY</td></tr><tr><td>453.6</td><td>VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITY</td></tr><tr><td>453.71</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VEINS OF UPPER EXTREMITY</td></tr><tr><td>453.72</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF UPPER EXTREMITY</td></tr><tr><td>453.73</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED</td></tr><tr><td>453.74</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS</td></tr><tr><td>453.75</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEINS</td></tr><tr><td>453.76</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF INTERNAL JUGULAR VEINS</td></tr><tr><td>453.77</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS</td></tr><tr><td>453.79</td><td>CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS</td></tr><tr><td>453.81</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VEINS OF UPPER EXTREMITY</td></tr><tr><td>453.82</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF UPPER EXTREMITY</td></tr><tr><td>453.83</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED</td></tr><tr><td>453.84</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS</td></tr><tr><td>453.85</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEINS</td></tr><tr><td>453.86</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF INTERNAL JUGULAR VEINS</td></tr><tr><td>453.87</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS</td></tr><tr><td>453.89</td><td>ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS</td></tr><tr><td>459.2</td><td>COMPRESSION OF VEIN</td></tr><tr><td>996.1</td><td>MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT</td></tr><tr><td>996.62</td><td>INFECTION AND INFLAMMATORY REACTION DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT</td></tr><tr><td>996.73</td><td>OTHER COMPLICATIONS DUE TO RENAL DIALYSIS DEVICE IMPLANT AND GRAFT</td></tr><tr><td>996.74</td><td>OTHER COMPLICATIONS DUE TO OTHER VASCULAR DEVICE IMPLANT AND GRAFT</td></tr></tbody></table><br />
A medical coder should report 36148 (additional access for therapeutic intervention [List separately in addition to code for primary procedure]) in addition to 36147 if the initial evaluation (36147) prompts a therapeutic intervention requiring a second shunt catheterization.<br />
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CPT Code 36148 is not used to identify a second diagnostic injection procedure from a second access point. Use 36148 when an interventional procedure is provided from that second access point.<br />
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If percutaneous access had already been established prior to the service, 36147 would not be appropriate. You should instead report 75791 (Angiography, arteriovenous shunt [e.g. dialysis patient fistula/graft], complete evaluation of dialysis access, including fluoroscopy, image documentation and report [includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava], radiological supervision and interpretation).<br />
</div>

Arteriovenous (AV) Fistula/Shunt/Graft:36147 vs 36148,75791

Learn the difference between CPT Code 36147 vs 36148, 75791 for correct coding of Arteriovenous (AV) Fistula/Shunt/Graft. An arteriovenous fistula is an abnormal connection or passageway between an ar…

XE,XS,XP,XU with CPT Modifier 59 for Medicare Reimbursement

<div dir="ltr" style="text-align: justify;" trbidi="on">As we has already posted that Modifier 59 has been split between XE, XS, XP, XU sub codes for Medicare reimbursement. These <a href="http://www.medicalbillingcodings.org/2014/09/CPT29Modifier-59changes2015-distinctProceduralService.html">CPT Modifier 59 Changes</a> takes effect from Januaray 2015, under Distinct Procedural Service.<br />
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The Medicare National Correct Coding Initiative (NCCI) has Procedure to Procedure (PTP) edits to prevent un-bundling of services, and the consequent overpayment to physicians and outpatient facilities. The underlying principle is that the second code defines a subset of the work of the first code. Reporting the codes separately is inappropriate. Separate reporting would trigger a separate payment and would constitute double billing.<br />
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<h3>XE,XS,XP,XU with CPT Modifier 59 for Medicare Reimbursement</h3>CR8863 discusses changes to HCPCS modifier -59, a modifier which is used to define a “Distinct Procedural Service.” Modifier -59 indicates that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled.<br />
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The -59 modifier is the most widely used HCPCS modifier. Modifier -59 can be broadly applied. Some providers incorrectly consider it to be the “modifier to use to bypass (NCCI).” This modifier is associated with considerable abuse and high levels of manual audit activity; leading to reviews, appeals and even civil fraud and abuse cases.<br />
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<div style="text-align:center;"><a href=""><img alt="XE, XS, XP, XU with CPT Modifier 59 for Medicare Reimbursement" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3eiZGwZVQr3sYh9-pju8q9f2_ercA2EQLGEspEYlY02ydy0mgP8QqePB43CIDrQWv5HP30VFEQi33bQ42HmrCpaN4s-2ZK8LMtcxd3SJ9iuthAue-dQ_F-7BQnqO_a_RutvHPM6Y7Jp_F/s1600/Medical-Billing-Coding-Updates-Changes-News2014.jpg" /></a></div><br />
The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as to identify:<br />
<ul><li>Different encounters.</li>
<li>Different anatomic sites.</li>
<li>Distinct services.</li>
</ul>The -59 modifier is:<br />
<ol><li>Infrequently (and usually correctly) used to identify a separate encounter.</li>
<li>Less commonly (and less correctly) used to define a separate anatomic site.</li>
<li>More commonly (and frequently incorrectly) used to define a distinct service.</li>
</ol>The -59 modifier often overrides the edit in the exact circumstance for which CMS created it in the first place. CMS believes that more precise coding options coupled with increased education and selective editing is needed to reduce the errors associated with this overpayment.<br />
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CR8863 provides that CMS is establishing the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59<br />
modifier:<br />
<ul><li>XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter.</li>
<li>XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure.</li>
<li>XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner.</li>
<li>XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct  Because It Does Not Overlap Usual Components Of The Main Service.</li>
</ul>CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available. While CMS will continue to recognize the -59 modifier in many instances, it may selectively require a more specific - X{EPSU} modifier for billing certain codes at high risk for incorrect billing. For example, a particular NCCI PTP code pair may be identified as payable only with the -XE separate encounter modifier but not the -59 or other -X{EPSU} modifiers. The -X{EPSU} modifiers are more selective versions of<br />
the -59 modifier so it would be incorrect to include both modifiers on the same line.<br />
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The combination of alternative specific modifiers with a general less specific modifier creates additional discrimination in both reporting and editing. As a default, at this time CMS will initially accept either a -59 modifier or a more selective - X{EPSU} modifier as correct coding, although the rapid migration of providers to the more selective modifiers is encouraged.<br />
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However, please note that these modifiers are valid even before national edits are in place. MACs are not prohibited from requiring the use of selective modifiers in lieu of the general -59 modifier, when necessitated by local program integrity and compliance needs.</div>

XE,XS,XP,XU with CPT Modifier 59 for Medicare Reimbursement

As we has already posted that Modifier 59 has been split between XE, XS, XP, XU sub codes for Medicare reimbursement. These CPT Modifier 59 Changes takes effect from Januaray 2015, under Distinct Proc…

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