Coding/Billing Tips & Resources

CMS Revises Part D Prior Authorization Requirement for Hospice Patients

The Centers for Medicare & Medicaid Services (CMS) released a memorandum July 18 notifying Part D sponsors and hospices that it has revised its March 10 guidance on prior authorization.
Recognizing that requiring prior authorization for all drugs could prevent hospice patients...

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"History of" Begins When Active Treatment Ends

Question: When does a "history of cancer" diagnosis begin? For example, if a patient has been diagnosed with cancer, does a "history of" diagnosis start immediately, or after a predetermined time?
Answer: According to ICD-9-CM guidelines, "history of" means the condition no longer exists and ...

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Defining "Simple" vs "Complex" Intracranial Aneurysm

When coding for treatment of intracranial aneurysm, you must select between codes describing "simple" aneurysm and "complex" aneurysm, as follows...

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