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42 FAQs clarify the finer points of billing during the three-day payment period. A Dec. 3, 2020, MLN Matters® article reaffirms appropriate billing procedures and compliance associated with the three-day window. The article was prompted by the Office of Inspector General (OIG) May 2020 report Medicare Made $ 11.7 Million in Overpayments for Nonphysician Outpatient Services […]
The post Do You Know Your 3-Day Payment Window Rules? appeared first on AAPC Knowledge Center.
In an age where digital information is constantly under threat, taking every step possible to protect that information would seem to be paramount for any institution. Which is why you may be surprised to learn that one tool used to protect digital information — encryption — is not a mandatory component of the Health Insurance […]
The post Unlocking the HIPAA Security Rule’s Stance on Encryption appeared first on AAPC Knowledge Center.
The multiple surgery calculation for nasal endoscopy codes is changed when multiple nasal endoscopies are performed in the same session on the same day. For Calendar Year 2020, instead of paying the multiple surgeries at 50 percent, surgeons will be paid the difference between the fee for the procedure performed and the base code for […]
The post Special Rules Apply to Endoscopic Sinus Surgeries appeared first on AAPC Knowledge Center.
Rik Salomon, CPC, CRC, CEDC, CEMA, CMCS, and I recently got into a rather spirited debate with a group of Certified Professional Coders (CPCs®) on coding guidelines and how they govern our medical coding. CPT® and ICD-10 guidelines are the primary determinants for how we code. We ignore all rules from Medicare and other payers […]
The post ICD-10 Guidelines: Sometimes You Have to Break the Rules appeared first on AAPC Knowledge Center.
Facilities may also perform TAVRs not expressly listed as an FDA-approved indication when performed within a clinical study if it fulfills standard and added research protocol.
Coding the TAVR:
Coding TAVR is complex, since it’s an intravenous procedure relying on radiology. Medical necessity is key to Medicare reimbursement, and the patient will no doubt be run through a gamut of tests, such as an echocardiogram, CT scan, angiogram, or electrocardiogram. The patient must be in a heart program, and the decision to perform a TAVR isn’t quick. Once confirmed, aortic stenosis is easy to find in ICD-10-CM.
Be sure to correctly note the families of arteries through which the catheters are routed. TAVR cardiovascular access and delivery procedures are reported with CPT 33361-33366 with the appropriate add-on codes for bypass (33367-33369).
Source: TAVR Rules Changes
Updated NCD list:Click Here
Additional Information:
1. The claim must have a Place of Service (POS) 21
2. Also, the claim lines for these procedure codes on professional clinical trial claims must have the modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study
3.Similarly, professional claims for TAVR procedure codes must have modifier 62
4.Finally, the clinical trial claim line must contain the secondary diagnosis code of ICD-10 of Z00.6
5. Claim must have Clinical Trail Number (8 digit number
Transcatheter aortic valve replacement (TAVR) national coverage policy rules have been streamlined by the Centers for Medicare & Medicaid Services (CMS) as the minimally invasive intravenous procedure becomes more commonplace. However, it is still consider a clinical trial because of its relatively recent development. CMS said it will continue to cover TAVR under coverage with evidence […]
The post TAVR Rules Changed by CMS appeared first on AAPC Knowledge Center.
The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 2259, a modification to the claims processing logic for Modifiers 59, XE, XS, XP, and XU, on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair per CCI as long as the modifier indicator is 1. […]
The post New Rules Issued for Modifiers 59, XE, XS, XP, and XU appeared first on AAPC Knowledge Center.
CMS has issued waivers to ensure Medicare beneficiaries affected by the storm receive healthcare services. President Trump declared a state of emergency on Sept. 11 for North Carolina, South Carolina, and the Commonwealth of Virginia. That same day, U.S. Department of Health and Human Services Secretary Alex M. Azar II declared a public health emergency for […]
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