Explanation of Hernia Repair Codes in 2014 CPT Code Book.
Category Archives: CPT code list
CPT codes, Description, work RVU’s download website to Excel
This is a video which shows the step-by-step techniques for downloading the AMA copyright 2014 CPT codes wRVU and descriptions from a government web site to …
CPT Codes in Psychiatry: A Primer | Psych Central Professional
Since the start of 2013, we’ve all been using them—the new Current Procedural Terminology (CPT) codes for Psychiatry, and Evaluation and Management (E/M).
Despite the initial confusion, most of us have probably come up with some working system by now. In this article I’ll discuss the most frequently used codes for outpatient psychiatry, and other information that should help streamline the coding process and make it clearer and more bearable.
E/M codes were first introduced in 1992. The Centers for Medicare and Medicaid Services (CMS) published additional documentation guidelines for E/M codes in 1995 and 1997. The 1997 version specifically included a single-system psychiatric exam, which fully substituted for the multisystem physical exam required by the 1995 guidelines (Schmidt et al. Procedure Coding Handbook for Psychiatrists, 4th Ed. American Psychiatric Publishing; 2011). So E/M codes for psychiatry have been around for a while, but they were not very informative, particularly when a code like 90807 covered pretty much everything.
In 2010, the RUC (Relative Value Scale Update Committee) of the AMA reviewed psychotherapy codes for CMS and determined that they were “misvalued,” although they were not entirely clear on what that meant (http://bit.ly/10Rv42a). A more extensive review process ensued and culminated in the 2012 approval of a revised coding system by the CPT panel of the AMA (http://bit. ly/Z6WsMt).
So the reason for the switch from the old system had to do with the misvaluation of codes. An alternate explanation, promulgated by many within the psychiatric profession, is that it’s a matter of parity: if we want psychiatric diagnoses to be valued equivalently with non-psychiatric diagnoses, we need to bill that way. In other words, MDs shouldn’t bill like non-MD therapists, but rather, like other MDs.
CPT Coding Specifics
Now for the nitty gritty. It starts out easily enough: an initial evaluation with medication management has a CPT code of 90792, instead of the familiar 90801. Peculiarly, 90791, which is an initial evaluation without medication management, is currently reimbursed at a higher rate.
Outpatient sessions with an established patient use both a CPT code and an E/M code. Before 2012, the CPT code (90807, 90862) was the main event; now, the E/M code takes top billing, and the CPT psychiatry codes have been demoted to add ons. (Note: In the literature, an add on code is designated by a “+” icon in front of the code but you do not add the “+” icon when billing the code—see http://bit.ly/10HwRd5)
The definitions of E/M and CPT can be confusing. The E/M is how you evaluate what needs to be done: take a history, perform a psychiatric medical exam (formerly MSE). The CPT refers to what you actually do once you’ve figured out what needs to be done: in most cases, psychotherapy. In other words, psychotherapy is considered a procedure. Medication seems to fall under the heading of “management.”
The powers that reimburse don’t care what kind of psychotherapy you do. It can be dynamic, CBT, primal scream, whatever. What they do care about is how long you spend doing it. The following are frequently used procedure (ie, CPT) codes for psychotherapy, together with the minimum time required for each:
The weird minimum times here have to do with the fact that at least half of the incremental time interval is required for therapy. For example, 16 minutes is one minute more than half of 30, 38 is the first whole number greater than 37.5, the midway point between 30 and 45.
It’s important to note that these are face-to-face times. So if your patient shows up eight minutes late for a 45 minute session, you can only bill for a 90833, which is reimbursed at a lower rate than a 90836.
There’s not much more to CPT codes. You do some type of psychotherapy for a certain amount of time, and you slap on the appropriate number.
E/M codes, on the other hand, are more work. You don’t actually have to do more work than you normally would in a session. You just have to figure out how to document what you’ve done, and then determine which code fits the documentation.
The most frequently used E/M codes in an outpatient setting are 99212, 99213, and 99214. These represent increasing levels of complexity in the treatment of a given patient, in a given session. The higher the number, the more complex the session—and the greater the reimbursement.
E/M coding is based on three main elements: history, exam, and medical decision making (MDM). Each of these is broken down into a labyrinthine number of components and subcomponents.
To meet criteria for a level of care (ie, 99212, 99213, or 99214), the documentation for a session has to “attain” that level in two out of three of the main elements—meaning there have to be the right number of components and subcomponents documented.
One way to simplify this is to think of 99212 as the basic note. Then 99213 and 99214 become the basic note, plus some extras.
A 99212 note must include the following items: chief complaint (CC); HPI (history of the present illness) or interval history, exam, meds, plan, labs, diagnosis, psychotherapy, and time. To turn this into a 99213, you need to add one pertinent review of systems (ROS). For example, if your patient was depressed, you might add, “ROS: denies SI.” You would also need to make sure you had at least six elements on exam.
To turn that 99213 into a 99214, you need to add one more system on ROS, and one element of pertinent past medical, family, and social history (PFSH), such as: “The patient is divorced and in the middle of a custody battle with his ex-wife.” You also need to make sure you had at least four HPI elements. Then you either need to have at least nine elements on exam, or make sure MDM was at least “moderate.” See the table, “Required Main Elements to Meet Criteria for E/M Levels (2/3)” for the specific numbers needed for each E/M code. For an exhaustive, and exhausting, review of what constitutes each note category, see http://bit.ly/17pHAwg.
Reimbursement with CPT Codes
Patient notes started out as a way to record what happens with the patient over time, and this was done to improve patient care. Notes later became legal documents to protect us in case of a lawsuit. And now, under this new system, notes function mainly as a way to justify reimbursement. After all, the guidelines really have nothing directly to do with what happens in each session, only what’s documented for each session. It would be nice to think that all this documentation effort pays off.
Let’s compare Medicare reimbursement between 2012 and 2013. In 2012, a 90805 paid $71.82. In 2013, the equivalent, 90833, with E/M 99212 pays $85.43, and with a 99214, $148.06. Similarly, a 90807 paid $99.39 in 2012, and a 90836 pays $111.30 with a 99212, and $173.93 with a 99214 in 2013 (values obtained from http://bit.ly/12IkOxv). So things are looking up.
This assumes, of course, that the APA’s footnote to this data, “Dollars based on 2012 conversion factor NOT 2013 conversion factor ($25) which is set to drop due to SGR formula,” doesn’t bode ill. It also assumes that insurance companies don’t refuse to pay claims—something the American Psychiatric Association has already warned us to be vigilant against (http://bit.ly/ZCzCj2).
Certainly it’s appropriate to code for the highest legitimate E/M level. But there’s a grey area. If you’re treating a patient whose depression has been stable for years, and you spend the session talking about his mother, is it legitimate to bill for a 99213 by including, “no current SI,” on ROS, and, “gait normal,” on exam? If you’re evaluating a new patient for medication, is it legitimate to bill for a 90791 because it pays better? There’s also the rule that if greater than 50% of the session is spent in “counseling and coordination of Care,” then E/M level is determined only by time. But can you always be sure that most of the session was spent that way?
A Better Way?
The jury is still out on the results of the new coding system. In early February 2013, NBC News reported that many insurance companies are making mistakes that can threaten patient care due to rejected claims (http://nbcnews.to/XT74LQ). The APA and the Connecticut Psychiatric Society have filed suit against Anthem Health Plans for using the codes to pay psychiatrists less than what they pay other physicians, an act the APA calls “discriminatory” (Psych News, April 11, 2013). Some patients paying off their deductibles don’t know how much they’ll be reimbursed, while many doctors are still confused about the split billing requirement (E/M and CPT codes need to be listed on separate lines on a CMS-1500 form, with a separate fee for each).
TCPR’s VERDICT: The reasons for the switch to the new coding system are not entirely clear, but it’s apparently here to stay. Hopefully it will result in better reimbursement, as long as you’re willing to do the work required for proper documentation—and third-party payers play by the rules.
This article originally appeared in:
This article was published in print 5/2013 in Volume:Issue 11:5.
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Last reviewed: By John M. Grohol, Psy.D. on 20 Jul 2014
Complexity of Submitting a Clean Medical Claim | MDeverywhere
A medical claim is simply data – I saw this patient (patient demographics), on this day (DOS encounter data), they have this problem (coding), I did this for them (coding) and they have this insurance (insurance data). Get those five pieces of data right and you will get paid; get any of them wrong or miss any data elements and getting paid if at all is a long, hard trek.
Sounds simple, right? And it is conceptually. But actually getting all the data elements complete and accurate in a busy practice environment – in an area with the potential for a lot of staff turnover – can be a challenge. Add to that, the constantly changing requirements of your payer mix, state requirements, and changing reimbursement methods, and the process gets far more complicated.This is where a good claims editing system comes in, as a tool or set tools that can be deployed to ensure process rigor and data integrity.
Here are some common data errors that can result in a denied claim and loss of payment:
- Assignment: “Accept assignment” box checked inappropriately.
- Authorization: Claim form did not list the mandatory authorization number or referral form is missing
- Invalid CPT code
- Contract number: Subscriber’s contract number missing or invalid.
- Dates: Missing or incorrect dates, such as admission and discharge dates, duplicate dates of service for same procedure code, or dates of first symptom.
- Diagnosis: Diagnosis code missing or invalid.
- Group number: Missing group number on claim form.
- ID number: Physician’s national provider identification (NPI) number missing on claim form.
- Insurance information: Subscriber’s name, gender, Social Security number, group, and/or plan number missing or invalid.
- Modifiers: Missing modifier on procedure that mandates usage of one.
- Patient information: Patient’s gender missing or invalid, patient’s address invalid, birth date missing.
- Place:n Place of service incorrect or inconsistent with service provided.
- Provider: Provider (physician) information missing or incorrect (for example, NPI).
- Referral: Referring physician’s name and/or NPI missing on claim form.
- Service type: Type of service listed incorrectly on claim form.
Smart claims editing enables your practice to apply pre-adjudication edits to the claims specific to your practice, payer mix, and state, giving you the chance to identify and correct the error before the claim is submitted.
Unfortunately, these tools are not available in your traditional practice management systems (PMS). In fact, most PMS systems are “dumb” data input systems – accepting whatever data is put in regardless of whether it is accurate or even complete. Leading to dirty data and ultimately to lost cash as claims go out the door only to be denied payment. Faced with a constantly changing regulatory guidelines, including ICD-10, a state-of-the-art claims editing tool ensures that your organization reduces claims denials while optimizing quick and accurate reimbursements. The payors all have automated systems that analyze claims to flag errors and trigger denials. Providers need the same sorts of tools to keep up and maintain reimbursement.
Savvy practices will look beyond their PMS vendor and bring in an revenue cycle partner that offers state-of-the-art claims editing technology, as well as experienced billing experts, to help them improve clean claim rates and reduce denials. That is the type of purpose-built RCM system MDeverywhere has built from the ground up.
In fact, we recently implemented our solution, at an OB/GYN practice. Within a 60 day period their clean claim rate improved from 60% to 92% and collections improved 20%. This is the power of a knowledge driven revenue cycle process.
Download ICAI CA CPT Merit List 2014 Results Rank Card Details
ICAI CA CPT Merit List 2014
ICAI CA CPT Merit List 2014 : Institutes of Chartered Accountants of India has declared the ICAI CPT Merit List 2014 of official portal www.icai.nic.in which was held in the month of June 2014 at the various location of Delhi.According to official notification huge no of candidates had written this ICAI common proficiency test. After the written test examination candidates are very excited to know theirs ICAI CA CPT Merit List 2014 and to check the results candidates will have enter theirs CPT registration no or date of birth through www.icai.nic.in. According to merit list and rank card of written test examination candidates will be shortlisted for this selection process. So here we are providing complete information regarding ICAI CA CPT Merit List 2014/other Information about how to download or check your results through online mode.
Name of the Organization:Institutes of Chartered Accountants of India
Official Web Site: www.icai.nic.in
Category: Results
Job Role: Chartered Accountants
Name of the Results: ICAI CA CPT 2014
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CPT Codes for Psychology Services | Psych Central
Current Procedural Terminology or CPT codes are used by psychologists and other mental health professionals in order to bill their services to an insurance company or Medicaid. This is not a complete list, but simply a list of some of the most commonly used CPT codes in mental health and psychology services, meant as a quick-reference sheet. It has been updated for 2014 code changes.
Notes: Small type denotes medical payment codes. Facility: Includes hospitals (inpatient, outpatient, and emergency department), ambulatory surgical centers (ASCs), and skilled nursing facilities (SNFs). Non-facility: everything else.
You can look up the cost of a particular CPT code in your city or state on the AMA website.
Last reviewed: By John M. Grohol, Psy.D. on 18 Jul 2014
Published on PsychCentral.com. All rights reserved.
Medicare modifier EY, GA, GK – Medical billing CPT modifiers and …
Modifier – EY
No Physician or Other Licensed Health Care Provider Order for this Item or Service
No Physician or Other Licensed Health Care Provider Order for this Item or Service
None, cannot be used when HHABN or ABN is required, recommend documenting records; liability is provider unless other modifiers are used (-GL, -GY, or –TS)
To signify a line-item should not receive payment when Medicare requires orders to support delivery of a item or service (i.e., TOBs 21x, 22x, 32x, 33x, 34x, 74x, 75x, 76x, 81x, 82x, 85x)
When orders required, line item is submitted as non-covered and services
Modifier GA
Waiver of Liability Statement Issued, as Required by Payer Policy
ABN required; beneficiary liable
To signify a line item is linked to the mandatory use of an ABN when charges both related to and not related to an ABN must be submitted on the same claim
Line item must be submitted as covered; Medicare makes a determination for payment
Modifier GK
Reasonable and Necessary Item/Service Associated with a –GA or –GZ modifier
ABN required if –GA is used; no liability assumption since this modifier should not be used on institutional claims
Not used on institutional claims. Use –GA or –GZ modifier as appropriate instead
Institutional claims submitted using this modifier are returned to the provider
HIV/AIDS Care Pathology and Laboratory CPT Service Codes
Part 2 of a 4-session webcast series on enhancement of billing systems to maximize revenues, this session, reviews CPT codes necessary to report HIV pre-test…
Custom Post Type used for FAQs Accordion – WordPress …
OK, so I asked this earlier and no one had any answer for me. I have a CPT for FAQs. FAQs are separated into ‘categories.’ I need the name of the ‘category’ then a every post within that ‘category.’
Example:
Category 1
Title of Post 1 within Category 1
Content of Post 1 within Category 1
Title of Post 2 within Category 1
Content of Post 2 within Category 1
Category 2
Title of Post 1 within Category 2
Content of Post 1 within Category 2
Title of Post 2 within Category 2
Content of Post 2 within Category 2
The code that I now have is:
<?// for a given post type, return all except 'uncategorized'
$post_type = 'faq';
$tax = 'category';
$tax_terms = get_terms($tax, array('orderby' => 'id', 'order' => 'ASC', 'exclude' => '1'));
if ($tax_terms) {
foreach ($tax_terms as $tax_term) {
$args = array(
'post_type' => $post_type,
"$tax" => $tax_term->slug,
'post_status' => 'publish',
'posts_per_page' => - 1,
'orderby' => 'title',
'order' => 'ASC',
'caller_get_posts' => 1
); // END $args
$my_query = null;
$my_query = new WP_Query($args);
if ($my_query->have_posts()) {
echo '<div class="aro"><div class="wrap"><h2>' . $tax_term->name . '</h2></div><div class="details"><div class="wrap">';
while ($my_query->have_posts()) : $my_query->the_post(); ?>
<div class="info">
<h3><?php the_title(); ?></h3>
<?php the_content(); ?>
</div>
<?php
endwhile; } // END if have_posts loop
echo '</div></div></div>'; // Close 'details', 'wrap', & 'aro' DIVs
wp_reset_query(); } // END foreach $tax_terms
} // END if $tax_terms
?>
This code does list every ‘category’ individually, which I do want. However, every post within FAQs is listed under every ‘category,’ which is not what I want. Any ideas what I’m doing wrong?
DESCARGAR MIDTOWN MADNESS 1 – I've go tthe torrent
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