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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

CMS Proposes Rule to Expand Access to Health Information and Improve Prior Authorization Process

Proposed rule seeks to reduce administrative burdens and address delays in patient care. The Centers for Medicare & Medicaid Services (CMS) announced a proposed rule on Dec. 6, 2022, aimed at improving the prior authorization process and interoperability between providers, payers, and patients. The Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P) seeks […]

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AAPC Knowledge Center

Medicare Suspends Prior Authorization Requirements for Some DME

Prior authorization is no longer required for certain DME when it risks the health of the patient. The Centers for Medicare & Medicaid Services (CMS) has suspended the prior authorization requirements for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when waiting for prior authorization would delay healthcare and risk the life or health […]

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AAPC Knowledge Center

Prior Authorization for Non-Emergent Ambulance Transports Back on Track

Find out what you’ll need to do to get these claims paid. Expansion of the Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transports (RSNAT) will begin as early as Dec. 1 for some independent ambulance suppliers, according to a notice in the Aug. 27 Federal Register. Medicare Part B Coding and Coverage Prior authorization […]

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AAPC Knowledge Center

The When and How of Prior Authorization

Prior authorization for healthcare services is required for certain services. If authorization is not obtained prior to performing the service, the insurer may not reimburse for the procedure. Most services requiring prior authorizations are surgical procedures or high-cost ancillary services or may be determined as not necessary in some circumstances. The requirement for prior authorizations […]
AAPC Knowledge Center

Hospital Discharge workup prior to the actual discharge date

Hello,

I need some clarification on the scenario below. Please help!

On 08/02/2018, Ms. G was admitted to the hospital. On 8/04/2018, Dr. X examined the patient and found she was stable and ready to be discharged. Dr. X discussed the discharge to a nursing home with Ms. G and she agreed. Dr. X created the Discharge Summary and coded the encounter as a Discharge. There was a transportation issue with the nursing home and Ms. G ended up staying inpatient for another night.

On 8/05/2018, Dr. K was doing rounds at the hospital and examined Ms. G. She was still stable and agreed to be discharged. Dr. K created a Progress Note and coded a subsequent inpatient code.

Both physicians are Internal Med. specialists.

My questions are:
Can the discharge summary be created prior to the actual discharge date, causing the date of service to be different then the actual discharge date?
Can a subsequent inpatient code (99231-99233) be billed after the discharge code (99238) was billed? If not, what should be billed?

Thank you for your help!

Medical Billing and Coding Forum

Prior Auth for Echo

Has anyone been getting denials recently on their echos? My office bills only the professional component. We have been using the date that the cardiologist reads the echo, which is not matching up to the authorization for the date of service the echo is performed. We had not had problems in the past until prior authorizations were required. Our date of reading is not on the authorized date of service. How do we handle this?

Medical Billing and Coding Forum

Z01.818 for E/M visits prior to chemo treatment

We are trying to get more information on using Z01.818 for office visits for patients prior to chemo treatments as they evaluate the effects of chemo on the patient and whether they can continue with their treatment on that day or not. Of course, if no treatment is given, this code cannot be used. These office visits are usually a level 3 or 4, sometimes a 5. We know that the chemo admin code has a low level inherent E/M included. One of the descriptions we found for Z01.818 is "an encounter for examination prior to antineoplastic chemotherapy".

Does anyone use this code? Are there issues with denials and/or certain payers? What is the criteria you use to use this dx?

Thank you.

Medical Billing and Coding Forum