Healthcare Crossroads

A podcast showcasing the connections in Healthcare Data, Compliance and Patient Care

Spinal Fusion Coding CPT and PCS

Spinal Fusion coding can be complex especially if we do not understand Spinal Anatomy, Coding Guidelines and Payer Requirements. CMS and AMA can differ in their interpretation of documentation and bundling of Laminectomy and Arthrodesis. Do you understand all the elements of an Arthrodesis Procedure.

Lets Talk about it:

  • Spine Anatomy
  • Arthrodesis Components
  • Bundled Procedures
  • Co Surgery
  • PCS Guidelines for Fusion

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Global Billing, Modifiers and GI Examples 1 CEU

Modifiers can be confusing since we have so many of them. There are CPT® modifiers and Payer specific ones to navigate through. Today we will focus in the most commonly used ones with the Global Package and how to know when to apply them We will pick on the 59 modifier and give examples of GI procedures that are commonly denied and how to interpret the 59 modifier or X Modifiers.

  • Modifier Purpose
  • Global Modifiers
  • Surgery vs E/M Modifiers
  • Modifier 59 and GI Denials

Helpful Links:

59 Modifier for GI CMS

Modifier 53 for Colonoscopy

NCCI Manual Chapter 6 Digestive CMS

Proper Use of Modifiers 59 & –X{EPSU}

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Getting to Know your ICD10-CM Manual and No surprise Billing

As a Coder or Biller it is very important that we all understand the proper use of our Coding Manuals as the improper use of them can impact claims payment and increase denials of we do not follow the guidelines. The more we understand the manual and how it can help us, the more efficient we can be. We will discuss:

Introduction
Code Structure
Symbols and Colors
Appendices
Section Tips
No Surprise Billing and OON Negotiations

We have some helpful links below to help you navigate
ICD10-CM 2022 Official Guidelines
No Surprise Billing CMS

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Bonus: Coding with Authority and Orthopedic Reminders 1 CEU

In this episode we will talk about coding with Authority and the importance of using the right resources when we do research and when we educate physicians. We will also talk about some items to remember when coding for Orthopedic Services directly from our 2021 NCCI Manual from CMS.

  • Know the Authoritative sources for coding and reimbursement
  • Know when changes happen and keep up to date
  • Getting to know the NCCI Manual Chapter 4
  • Coding reminders for Arthroscopy and other reminders

Here are some helpful Link so you can do research on your own:

2021 NCCI Manual Chapter 4

E/M Services Guide CMS

Complying With Medical Record Documentation Requirements

Documentation Matters Toolkit

HCPCS Quarterly Updates

CMS Orthopedic ICD10-CM

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Prior Authorization Transparency and Effectiveness

Learn the importance of Prior Authorizations and how to protect your practice revenue as well as help ensure your patients are taken care of. We will discuss: Common Pitfalls Need for Communication Written policies Staff education

Check out AuthParency for an amazing Tool and Platform to organize your Prior Authorizations

Contact me for more Info

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Keep your Eye on Ophthalmology and Optometry Reimbursement

Ophthalmology and Optometry Coding and Billing has its own little niche that has many areas to be aware of:

Coding and Billing CPT/ICD10-CM
Injections
EM vs Ophthalmic Eye Codes
Surgical Coding Complexity
New Codes 2022
Prior Auth 
Cornea Transplant with ASC 

E&M or Eye Codes? How to Choose Which to Use
Eye Code Checklist
Coding Complex Cataract Surgery
Cornea Transplant Info
Glaucoma Coding for Stents
Diabetes ICD10-CM Decision Tree
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