Ambiguities in the 1995 documentation guidelines create uncertainty. Editor’s Note: After this article was written, a Medicare administrative contractor announced new definitions for “detailed” and “expanded poblem-focused.” See the May issue of Healthcare Business Monthly to learn more. Within the Centers for Medicare & Medicaid Services’ (CMS) 1995 Documentation Guidelines for Evaluation and ...
A quote from the “The Great Debaters” has stuck with me since I saw the movie five years ago: “You do what you have to do, so you can do what you want to do.” It became my mantra, and it has gotten me through some tough times. If ever you lose your way on ...
In Audit
Jul 1st, 2014
Medicare’s Claims Processing Manual, section 30.6.1.A, stipulates, “Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code.” But in the everyday struggle to assign E/M codes, medical decision-making (MDM) is usually the best indicator of the E/M service level. When two of three components ...
Nov 1st, 2013
It’s a smart and inexpensive way to prep students for a coding exam. by Rena Hall, CPC Offering a free study assistance program in your chapter can be a valuable asset to members. Most coders aspiring to be certified have little or no money to spend on resources to help them understand coding concepts and ...
Oct 30th, 2013
The American Congress of Obstetricians and Gynecologists (ACOG) reports that some Medicare contractors are denying payment for routine pelvic and breast examinations reported with HCPCS Level II code G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination. “Specifically,” ACOG says, “payment has been denied when the documentation includes notation of surgically absent org...