Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

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

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

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

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

Practice Exam

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

Practice Exam

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

Tag Archives: Revised

Rural Health Clinic Policies Revised

Posted on by

Don’t send another RHC claim until you’ve reviewed these key changes for 2022. A Rural Health Clinic (RHC) is a clinic located in a rural, underserved area with a shortage of primary care providers, personal health services, or both. Medicare pays RHCs for the provision of certain primary care and preventive health services in these […]

The post Rural Health Clinic Policies Revised appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Revised Guidelines for CPT 99441, 99442 & 99443

Posted on by

Updated May 9, 2020, with information from the 4/30/20 rule

CMS will pay for phone calls using codes 99441—99443. The 4/30/20 rule adds these to the telehealth list and increased payment for these services

CMS continues did not add 98966–98968 to the telehealth list

These codes previously had a non-covered status

Physicians, nurse practitioners, and physician assistants should use codes 99441—99443

Other qualified health care professionals who may bill Medicare for their services, such as registered dietitians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968

New! 99441–99443 have been added to the telehealth list, so use the place of service that would have been furnished. In most cases, this will be place of service office (11) or outpatient department (19, 22). Since they are now telehealth services, add modifier 95

CMS has changed the rates for codes 99441–99443 to the rates for 99212–99214.

***Telephone codes 99441–99443 require audio only but will pay at the rates of 99212–99214

“List of Telehealth CPT Codes”Click Here 


Coding Ahead

2020 ICD-10 CM Revised Codes Effective from October 1, 2019

Posted on by

Revised Codes


B96.21 Shigatoxin-producingEscherichiacoli[E.coli][STEC]O157asthecauseofdiseasesclassifiedelsewhere
B96.22 OtherspecifiedShigatoxin-producingEscherichiacoli[E.coli][STEC]asthecauseofdiseasesclassifiedelsewhere
B96.23 UnspecifiedShigatoxin-producingEscherichiacoli[E.coli][STEC]asthecauseofdiseasesclassifiedelsewhere
G43.A0 Cyclicalvomiting,inmigraine,notintractable
G43.A1 Cyclicalvomiting,inmigraine,intractable
I70.238 Atherosclerosisofnativearteriesofrightlegwithulcerationofotherpartoflowerleg
I70.248 Atherosclerosisofnativearteriesofleftlegwithulcerationofotherpartoflowerleg
J44.0 Chronicobstructivepulmonarydiseasewith(acute)lowerrespiratoryinfection
M50.120 Mid-cervicaldiscdisorder,unspecifiedlevel
M66.88 Spontaneousruptureofothertendons,othersites
M67.839 Otherspecifieddisordersofsynoviumandtendon,unspecifiedwrist
M77.5 Otherenthesopathyoffootandankle
M77.50 Otherenthesopathyofunspecifiedfootandankle
M77.51 Otherenthesopathyofrightfootandankle
M77.52 Otherenthesopathyofleftfootandankle
N35.814 Otheranteriorurethralstricture,male
R82.993 Hyperuricosuria
T40.906 Underdosingofunspecifiedpsychodysleptics[hallucinogens]
T40.906A Underdosingofunspecifiedpsychodysleptics[hallucinogens],initialencounter
T40.906D Underdosingofunspecifiedpsychodysleptics[hallucinogens],subsequentencounter
T40.906S Underdosingofunspecifiedpsychodysleptics[hallucinogens],sequela
T40.996 Underdosingofotherpsychodysleptics[hallucinogens]
T40.996A Underdosingofotherpsychodysleptics[hallucinogens],initialencounter
T40.996D Underdosingofotherpsychodysleptics[hallucinogens],subsequentencounter
T40.996S Underdosingofotherpsychodysleptics[hallucinogens],sequela
T44.1X6 Underdosingofotherparasympathomimetics[cholinergics]
T44.1X6A Underdosingofotherparasympathomimetics[cholinergics],initialencounter
T44.1X6D Underdosingofotherparasympathomimetics[cholinergics],subsequentencounter
T44.1X6S Underdosingofotherparasympathomimetics[cholinergics],sequela
V43.13 Carpassengerinjuredincollisionwithpick-uptruckinnontrafficaccident
V43.13XA Carpassengerinjuredincollisionwithpick-uptruckinnontrafficaccident,initialencounter
V43.13XD Carpassengerinjuredincollisionwithpick-uptruckinnontrafficaccident,subsequentencounter
V43.13XS Carpassengerinjuredincollisionwithpick-uptruckinnontrafficaccident,sequela
Z45.42 Encounterforadjustmentandmanagementofneurostimulator
Z68.43 Bodymassindex(BMI)50.0-59.9,adult
See Also Deleted Codes


Coding Ahead

Revised NCD list Effective from January’2020

Posted on by

This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs effective from January 2020

These NCD coding changes are the results of newly available code sets and coding revisions to NCDs released separately.

The revised NCD lists are,

NCD110.18 Aprepitant:

  • Contractors shall add J9036 as covered effective July 1, 2019. 
  • Contractors shall delete S0178 as covered effective October 1, 2015.

NCD150.3 Bone Mineral Density Studies:

  • Contractors shall make a change to CR7818.5 requirement as follows: If HUBC is received with no modifier, post as both Professional Component (PC) and Technical Component (TC). 
  • Contractors shall add Current Procedural Terminology (CPT) 0554T, 0555T, 0556T, 0557T, 0558T as covered effective July 1, 2019 and apply same rules applied to CPT 77078. 
  • Contractors shall end-date ICD-10 dx M85.9, M89.9, M94.9, Q55.4 effective December 31, 2019.
  • CWF: Remove M89.9, M94.9 from error code 5805 effective January 1, 2020.

NCD220.4 Mammography:

  • Contractors shall add ICD-10 dx N63.15, N63.25 to covered dx effective October 1, 2019. 
  • Contractors shall end-date ICD-10 dx C44.501, C44.509, C50.911, C50.912, C50.921, C50.922, D05.91, D05.92, D49.2, D49.3, M70.90, M70.98, M70.99, M79.9, N60.91, N60.92, N63.10, N63.20, S21.001A, S21.002A, S29.001A, S29.009A, S29.9xxA, S39.001A, S39.91xA effective December 31, 2019.

NCD220.13 Percutaneous Image-Guided Breast Biopsy:

  • Contractors shall add ICD-10 dx N63.15, N63.25 to covered dx effective October 1, 2019. 
  • Contractors shall end-date ICD-10 dx C50.911, C50.912, C50.921, C50.922, D05.91, D05.92, N63.10, N63.20 effective December 31, 2019.

NCD270.3 Blood Derived-Products for Chronic, Non-Healing Wounds:

  • Contractors shall add ICD-10 dx as covered effective October 1, 2019: L89.016, L89.026, L89.116, L89.126, L89.136, L89.146, L89.156, L89.216, L89.226, L89.316, L89.326, L89.46, L89.516, L89.526, L89.616, L89.626, L89.816, L89.896

NCD20.7 Percutaneous Transluminal Angioplasty:

  • Contractors shall end-date ICD-10 procedure codes effective September 30, 2019: 037G346, 037G356, 037G366, 037G376, 037G3D6, 037G3E6, 037G3F6, 037G3G6, 037G446, 037G456, 037G466, 037G476, 037G4D6, 037G4E6, 037G4F6, 037G4G6, 037H346, 037H356, 037H366, 037H376, 037H3D6, 037H3E6, 037H3F6, 037H3G6, 037H446, 037H456, 037H466, 037H476, 037H4D6, 037H4E6, 037H4F6, 037H4G6, 037J346, 037J356, 037J366, 037J376, 037J3D6, 037J3E6, 037J3F6, 037J3G6, 037J446, 037J456, 037J466, 037J476, 037J4D6, 037J4E6, 037J4F6, 037J4G6, 037K346, 037K356, 037K366, 037K376, 037K3D6, 037K3E6, 037K3F6, 037K3G6, 037K446, 037K456, 037K466, 037K476, 037K4D6, 037K4E6, 037K4F6, 037K4G6, 037L346, 037L356, 037L366, 037L376, 037L3D6, 037L3E6, 037L3F6, 037L3G6, 037L446, 037L456, 037L466, 037L476, 037L4D6, 037L4E6, 037L4F6, 037L4G6, 037M346, 037M356, 037M366, 037M376, 037M3D6, 037M3E6, 037M3F6, 037M3G6, 037M446, 037M456, 037M466, 037M476, 037M4D6, 037M4E6, 037M4F6, 037M4G6, 037N346, 037N356, 037N366, 037N376, 037N3D6, 037N3E6, 037N3F6, 037N3G6, 037N446, 037N456, 037N466, 037N476, 037N4D6, 037N4E6, 037N4F6, 037N4G6.

NCD110.23 Stem Cell Transplantation:

  • Contractors shall end-date ICD-10 procedure codes 30250G0, 30250Y0, 30253G0, 30253Y0, 30260G0, 30260Y0, 30263G0, 30263Y0, 30250G1, 30250Y1, 30253G1, 30253Y1, 30260G1, 30260Y1, 30263G1, 30263Y1 effective September 30, 2019.

Click here for more information

Reference: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11392.pdf


Coding Ahead

Revised guidelines for E&M When Performed with Superficial Radiation Treatment effective from January 1, 2019

Posted on by


CR11137 revises Chapter 13 of the Medicare Claims Processing Manual to allow providers to bill E/M codes 99211, 99212, and 99213 for Levels I through III, when performed with superficial radiation treatment delivery (up to 200 kV), when performed for the purpose of reporting physician work associated with,

  • Radiation therapy planning
  • Radiation treatment device construction
  • Radiation treatment management when performed on the same date of service as superficial radiation treatment delivery.

According to Current Procedural Terminology (CPT) guidance, providers should not report superficial radiation (up to 200 kV) with CPT codes for planning and management.

Billing of these E/M codes with modifier 25 may be necessary if National Correct Coding Initiative (NCCI) edits apply.

Source: Revised E/M Guidelines for Superficial Radiation Treatment


Coding Ahead

Revised Guidelines for Implantable Cardioverter Defibrillator (ICD)

Posted on by

As Per the National Coverage Determination (NCD) for Implantable Automatic Defibrillators (20.4) . CMS mandates that providers bill the Q0 modifier for all primary prevention diagnosis codes to ensure that claims are reported appropriately to the registry. Modifier Q0 is not required to be appended for secondary prevention. (Secondary prevention codes are listed below the table)

Q0 – Append this modifier on a category B IDE code (e.g. CPT 33249- Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber) if data is submitted to an FDA-approved category B IDE clinical trial, a trial under the CMS Clinical Trial Policy, or a qualifying data collection system, including approved clinical trials and registries.

Modifier Q0 is only required when the ICD was implanted for primary prevention of sudden cardiac death. If the ICD procedure was performed for primary prevention, and modifier Q0 is not appended, coverage for the ICD implantation cannot be established and the service will be denied.

For CPT codes 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33244, 33249,33262, 33263, 33264, 33270, 33271, 33272, 33273 & G0448 the claim must be reported with a secondary diagnosis as described below,
  • ICD-10-CM code I25.2, I25.5, I42.0, I42.6, I42.7 or I42.8 must be billed with one of the following ICD-10-CM codes I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43 (Secondary)
  • ICD-10-CM code Z76.82 must be billed with ICD-10-CM code I50.84 (Secondary)

ICD-10 CODE DESCRIPTION

I25.2 Old myocardial infarction
I25.5 Ischemic cardiomyopathy
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I45.6 Pre-excitation syndrome
I45.81 Long QT syndrome
I45.89 Other specified conduction disorders
I46.2 Cardiac arrest due to underlying cardiac condition
I46.9 Cardiac arrest, cause unspecified
I47.2 Ventricular tachycardia
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.3 Ventricular premature depolarization
I49.9 Cardiac arrhythmia, unspecified
I50.21 Acute systolic (congestive) heart failure 
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.84 End stage heart failure
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.129A Displacement of unspecified cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial encounter
T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
Z00.6 Encounter for examination for normal comparison and control in clinical research program
Z45.02 Encounter for adjustment and management of automatic implantable cardiac defibrillator
Z76.82 Awaiting organ transplant status
Z86.74 Personal history of sudden cardiac arrest

***ICD-10-CM codes I25.2, I25.5, I42.0, I42.6, I42.7, I42.8 and Z76.82 must be reported with a secondary diagnosis as described above. ***

Secondary Prevention of Sudden Cardiac Death:

I47.0 Re-entry Ventricular Arrhythmia
I47.2 Ventricular Tachycardiaselect
I49.3 Ventricular Premature depolarization
I49.01 Ventricular Fibrillation
I49.02 Ventricular Flutter
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I49.9 Cardiac arrhythmia, unspecified
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial
encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.129A Displacement of unspecified cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial
encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial
encounter
T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
Z86.74 Personal history of sudden cardiac arrest
Z45.02 Encounter for adjustment and management of automatic implantable cardiac
defibrillator

When any of the above codes appear on a claim, the Q0 modifier is not required. 

References:

NCD 20.4 Implantable Cardiac Defibrillators (ICDs)

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_Part1.pdf

https://med.noridianmedicare.com/documents/10546/7933826/Implantable+Automatic+Defibrillators+Coding+and+Billing


Coding Ahead

Revised Payment Indicator for Flu Vaccine (CPT 90689)

Posted on by
CPT- 90689 Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use.


Guidelines:


The provider injects 0.25 mL of a four–strain influenza virus vaccine into a patient’s muscle to provide immunity to four forms of influenza, a severe and infectious respiratory disease; the vaccine is free of preservatives and derived from cell cultures of a killed virus and contains a substance that increases the patient’s immune response.


Payment Indicator for ASC:


CMS is revising the status indicator from “E1” to “L1” Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made for CPT code 90689 retroactive to Jan. 1, 2019.


Currently, CPT code 90689 is assigned to status indicator “E1” in the OPPS to indicate that the vaccine is not paid by Medicare when submitted on outpatient claims. This policy is also applicable to ASCs. 


However, as noted in Change Request 10871 (Quarterly Influenza Virus Vaccine Code Update – January 2019), Transmittal 4141, dated September 27, 2018, effective for claims with dates of service on or after January 1, 2019, CPT 90689 will be payable by Medicare.


The vaccine is packaged in the ASC payment system; therefore, CMS revising the status indicator to “L1” (L1:Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made.) for CPT code 90689 retroactive to January 1, 2019.


Please note that packaged codes should not be separately billed by ASCs



Coding Ahead

Revised Moh’s Surgery Guidelines

Posted on by

Revised Moh’s Surgery (MMS-  Mohs Micrographic Surgery) Guidelines:

The mentioned below updates are effective from dates of service on and after Sept. 1, 2019.

According to CMS, Mohs surgery should only be performed by a “doctor of medicine (MD) or doctor of osteopathic medicine (DO)” who is specifically trained and highly skilled in Mohs techniques and pathologic identification

In order to maintain the quality of care and services delivered to our members, UnitedHealthcare will only reimburse Mohs surgery to an MD or DO who is specifically trained in both dermatology and pathology

If either the removal of the tumor or the pathology is delegated to another physician or other qualified health care professional, not under the same tax ID number, the Mohs code will be denied.

CMS guidance indicates that pathology examination of the tissue specimen is an inclusive component of Mohs and should not be reported separately.

Accordingly, UnitedHealthcare will deny the pathology examination, if separately reported.

Source: New Guidelines for Mohs Surgery


Coding Ahead

Revised Safety Guidance Affects All Healthcare Providers

Posted on by

CMS clarifies immediate jeopardy, creates surveyor tool, and offers public online training. Revisions to the State Operations Manual (SOM 100-07), Appendix Q, are intended to help federal and state inspectors quickly identify violations of health and safety regulations. In a March 5 blog, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said new […]

The post Revised Safety Guidance Affects All Healthcare Providers appeared first on AAPC Knowledge Center.

AAPC Knowledge Center