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Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
The post CMS Updates Medicare Part B Drug Prices appeared first on AAPC Knowledge Center.
Make sure you’re using the latest code files for your Medicare claims. A second quarter update to the HCPCS Level II code set used for reporting products, supplies, and services adds 23 codes. Additionally, six codes are revised and 12 are discontinued, effective April 1, 2021. There are also two codes with changes to Medicare […]
The post April Updates Bring HCPCS Changes appeared first on AAPC Knowledge Center.
CMS continues to phase in the Quality Payment Program while MACRA mandates loom. The long-awaited Physician Fee Schedule (PFS) final rule, now pending publication in the Federal Register, finalizes proposed updates to the Quality Payment Program (QPP) and its two tracks — the Merit-Based Incentive Payment System (MIPS) and Advanced Alternate Payment Models (APMs) — […]
The post Final Rule Updates MIPS for 2021 and beyond appeared first on AAPC Knowledge Center.
Guest Post from Deborah Marsh, JD, MA, CPC, CHONC, a senior content specialist for TCI SuperCoder.
Payers don’t accept deleted CPT® codes, so your claims can’t succeed if your medical procedure codes are out of date. But do you know how often you need to update your CPT® code set? It may be more often than you think. Here are some pointers to keep in mind to give your claims their best chance at accurate payment.
Each year, a new CPT® code set is effective on January 1. For instance, for CPT® codes, 2018 codes will give way to the 2019 code set on Jan. 1, 2019.
If you use an online CPT® code search product, you’ll want to be sure that the updates are searchable January 1. It’s also helpful if the CPT® lookup includes deleted codes (marked with the deletion date) because you use the code set based on the date of service. You may need access to previous code sets to finish filing claims and for working on appeals.
The AMA, which owns and maintains the CPT® code set, implements certain types of codes more than once a year. You should be aware of these updates and have a strategy for ensuring you have them when you need them. All specialties may see CPT® updates throughout the year, but path/lab coders need to watch for a few special categories that apply to them.
Category III and vaccine codes: Category I vaccine codes and Category III codes (temporary codes for emerging technology and services) are implemented January 1 and July 1. You’ll typically find them posted on the AMA site six months before the codes are effective, giving you time to learn how to apply them.
Category II: Category II codes are tracking codes that you may use for performance measurement programs, like MIPS. The AMA site indicates you may see release March 15, July 15, and November 15, with implementation three months after release.
Molecular pathology tier 2 codes: To help with reporting MoPath procedures, these codes go from approved to effective fairly quickly. After approval by the CPT® Editorial Panel, codes are released to the AMA site March 1, September 1, and December 1. The effective date may be as soon as one month after the release.
Administrative MAAA codes: Similar to the MoPath codes, Multianalyte Assays with Algorithmic Analyses (MAAA) see a quickened schedule. After Panel approval, the codes are released to the AMA site March 1, September 1, and December 1. The effective date is typically one month after release, although some codes are held until the major January 1 update.
PLA: The schedule for proprietary laboratory analyses (PLA) code changes is quarterly, but publication and effective dates have varied as this new-ish type of code got off the ground. For 2018, the effective dates are January 1, April 1, July 1, and October 1.
Tip: This schedule of updates throughout the year is one reason why having an online CPT® code lookup resource is a good idea. Whether it’s in addition to your paper manual or an alternative to it, automatically updated CPT® codes online ensure you have the correct codes available to you.
The AMA posts an Errata and Technical Corrections file on its site, and you need to be sure you check it regularly or make sure your online code-lookup provider incorporates any corrections. Often the AMA posts corrections before code set implementation as people report issues they find while preparing for the transition. But updates and corrections may occur at any point in the year, so don’t assume you can let down your guard early in the year.
Bottom line: Healthcare providers need access to up-to-date CPT® codes to ensure their claims are accurate for the date of service reported. Keeping codes current isn’t as simple as updating once a year in January. Make a plan to update your coding resource or keep an eye on your online coding solution to be sure it’s doing the update work for you.
Deborah Marsh, JD, MA, CPC, CHONC, is a senior content specialist for TCI SuperCoder, working on everything from online tool enhancements and data updates to social media and blog posts. Deborah joined TCI in 2004 as a member of TCI’s respected Coding Alert editorial team.
— This post Limit Your CPT® Code Set Updates to January? Here’s Why That’s a Bad Idea was written by Manny Oliverez and first appeared on CaptureBilling.com – Medical Billing Services. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.
On April 1, 2020, the National Center for Health Statistics (NCHS) formally issued updates to the ICD-10-CM List of Diseases and Injuries and the ICD-10-CM Official Coding and Reporting Guidelines, respectively. These updates will offer some essential collective guidance on COVID-19 coding and reporting for the extent of this public health emergency (PHE). Take These […]
The post Get the Most Out of New ICD-10-CM Addenda and Guideline Updates appeared first on AAPC Knowledge Center.
Amidst a pandemic unprecedented in modern times, the long-term care industry is scrambling to keep vulnerable nursing facility residents safe. Recent updates indicate that the repercussions will extend at least through fall, with the Centers for Medicare & Medicaid Services (CMS) releasing a bare-bones announcement that the proposed updates to the Minimum Data Set (MDS), […]
The post Proposed Minimum Data Set Updates Delayed appeared first on AAPC Knowledge Center.
April 1 is around the corner and you know what that means: quarterly updates. The Centers for Medicare & Medicaid Services (CMS) has released payer and provider guidance. Make sure all coding and billing staff are aware of the Medicare fee schedule changes. Two New Physical Therapy Codes MLN Matters® article MM1161 Revised, issued Feb. […]
The post April 1 Updates to MPFS Are no Joke appeared first on AAPC Knowledge Center.
Updates to the list of codes that sometimes or always describe therapy services under Medicare Part B go into effect Jan. 1, 2020. Make sure your coding and billing staff are aware of the following updates impacting coding for physical therapy, occupational therapy, and speech-language pathology service claims. Biofeedback Coding Two new biofeedback training CPT® codes […]
The post 2020 Therapy Services Code Updates appeared first on AAPC Knowledge Center.
Changes to diagnosis codes mean NCD coding changes. Diagnosis codes changes went into effect Oct. 1, as usual, and the Centers for Medicare & Medicaid Services (CMS) is updating National Coverage Determinations (NCDs) to reflect those changes. NCDs Affected by Updates to Diagnosis Codes CMS notes the following NCD coding changes in Change Request (CR) […]
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