Look at diagnosis history changes and Medicare’s national and local coverage determinations for greater insight into denied claims. Coverage determinations for hyperbaric oxygen therapy (HBOT) for radiation proctitis make getting paid for physician services tricky. A review of historical diagnosis code changes, and the effect these changes have had on Medicare coverage determinations is necessary ...
In Billing
Apr 9th, 2018
Effective April 30, four HCPCS Level II codes for certain durable medical equipment (DME) will no longer require prior authorization. If your medical office or facility sells or rents DME, it’s time to update your list. Master List Agenda The Centers for Medicare & Medicaid Services (CMS) published a final rule in the March 30 Federal Register to ...
In Billing
Feb 14th, 2018
There are new and changed modifiers to use if you are adjusting oxygen volume. The Centers for Medicare & Medicaid Services (CMS) updated an October Transmittal better defining how to report oxygen amounts below 1 liter per minute, which reduces the fee schedule monthly amount for stationary oxygen by 50 percent. CMS’ rules for  volume adjustment say if ...
In Coding
Dec 4th, 2017
The Centers for Medicare & Medicaid Services (CMS) finalized in the 2018 Medicare Physician Fee Schedule (MPFS) final rule their proposal to remove oxygen gas supply item (SD084) from a series of CPT codes that were previously valued with moderate sedation as an inherent part of the procedure. It occurred to CMS, after finalizing the ...
In Billing
Apr 27th, 2015
By Brad Ericson, MPC, CPC, COC National Government Services, the Jurisdiction B durable medical equipment (DME) administrative contractor, has seen an increase of incorrect Certificate of Medical Necessity (CMN) submissions when a portable oxygen system is added subsequent to the initial certification of a stationary system. When this occurs, they remind you should submit a ...