Posted and filed under Coding, Healthcare.

Critical Care and What it Means

CPT Defines critical care as the direct delivery, by a physician(s) or other qualified health care professional, of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems in such that there is a high probability of imminent or life threatening deterioration…

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Posted and filed under Healthcare.

The Two Midnight Rule 2016 Exception

CMS released CY 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule (CMS 1633 P). In which they propose to allow an exception to the controversial Two Midnight Rule. This proposed change is in recognition that there may be times when an inpatient admission (Part A payment) may be clinically warranted for stays that span less…

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Posted and filed under Dental, Healthcare.

Are you Tired of the Sales Pitch From Your Dentist?

Many times when going into a dentist appointment recently, dentists are always trying to sell add on dental products to the patient. Even when going in for a simple routine visit, your appointment turns into a pressured sales pitch! The add-on dental products to expect include: In office bleaching Take home bleaching 1000 different paste (Sensitivity, whitening, fluoride…) Rinses…

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Posted and filed under Coding, Healthcare.

Importance and Usage of Modifier 25

Modifier 25 Appropriate Use Modifier 25 indicates a “significant, separately identifiable evaluation & management (E&M) service by the same physician on the same day of the procedure or other therapeutic service.” Both services rendered must be significant, separate and distinct Medicare will not make separate payment unless the documentation supports significantly, separately identifiable service that…

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Posted and filed under Healthcare.

Top Oral Cancer Indicators

Oral Cancer is a growth or sore in the mouth that does not go away. Oral Cancer can be life threatening if not diagnosed or treated early. According to the American Cancer Society, men face twice the risk of developing cancer as women. Men who are over 50 face the greatest risk. It is estimated…

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Posted and filed under Coding, Healthcare, ICD-10.

Why Are Medical Professionals Panicking?

This is an actual experience from one of our Advize Health employees. This morning I went to the doctor’s office and the entire mood of the office was different. The staff including the nurses, doctors, and PA’s was panicking and many of them appeared to be upset. Why is this?  It is October 2, 2015,…

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Posted and filed under Coding, Healthcare.

Clearing Up Some Eye Exam Confusion

How are eye exam codes defined? CPT includes four codes that specifically describe eye exams: 92002:  Medical exam and evaluation with initiation of diagnostic and treatment program; intermediate, new patient. 92004:  Medical exam and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits. 92012:  Medical exam and evaluation with…

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Posted and filed under Compliance, Healthcare.

What to Watch Out For With Credit Balance

In May 2014, the Department of Health and Human Services, Office of Inspector General (OIG) published a proposed rule updating its regulations. The proposed rule will authorize civil monetary penalties for “failure to report and return a known overpayment,” among other issues.   The rule has outlined the penalty for failure to report and return overpayments…

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Posted and filed under Healthcare.

What is the Underlying Cause of Tooth Decay?

Our diet! Tooth decay results from the acid produced when sugar and oral bacteria in the mouth combine and feed off each other. Frequently consuming foods higher in acid content can lead to irreversible dental erosion.  Dental erosion is the breakdown of the tooth’s structure; the outer layer called enamel.  Dental enamel is the thin…

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Posted and filed under Coding, Healthcare.

Chiropractic Coding

Many years ago when I first began my career in the health field I worked for a chiropractic office as I was becoming familiar with their computer system, codes, and billing forms I had a lot of questions! Over 15 years, work on a bachelors degree and multiple coding and billing certifications later, I realize…

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