Our experts answer questions about NCCI edits for injections, modifier -25, modifier -59, laminotomy with insertion of Coflex distraction device, billing mammogram for needle placement, and auditing electronic orders.
CMS released a number of proposed changes to the outpatient prospective payment system (OPPS) July 8. The 2014 OPPS proposed rule (available at http://tinyurl.com/oyu33jx) is shorter than normal at 718 pages, but the proposed changes are significant and probably the most sweeping since the inception of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting in Washington, D.C.
E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT® codes with three G-codes.
Our experts answer questions about billing vasectomy and sperm analysis, coding for ED visit when the patient is admitted for surgery, billing glucose reading before a PET scan, documentation required for the functional limitation codes, and appropriate reporting of observation.
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable). These G codes are to be reported in conjunction with therapy services (physical, occupational, and speech). CMS also introduced seven complexity/severity modifiers to be used with these G codes.
