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CMS adds flexibilities to final Aduhelm NCD, but usage could be rare

05/02/2022

CMS’ final national coverage determination (NCD) on the Alzheimer’s drug Aduhelm may provide a clearer path to use, but critics warn the way CMS handled the approval issues could presage problems with other big-ticket drug decisions down the line.

ABN guide: How to apply HCPCS modifiers for non-covered services

05/02/2022

by: Sarah Gould, CPC

When you know a service will not be covered under Medicare, you are required to issue an advance beneficiary notice of non-coverage (ABN). Sharpen your modifier know-how so that you can accurately report claims when an ABN is involved.

T is for telephone: Appendix T lists 38 audio-only CPT codes

05/02/2022

by: Julia Kyles, CPC

You won’t find the new appendix for audio-only services in the print version of your CPT manual until the 2023 edition. But Appendix T (CPT codes that may be used for synchronous real-time interactive audio-only telemedicine services) went into effect April 1 and was added to the electronic version of the CPT manual in March.

CMS releases Moderna booster codes after FDA approval

05/02/2022

by: Richard Scott

As the COVID public health emergency endures, you’ll find a new code that you can report when providing a Moderna booster shot, along with a complementary administration code.

Didn’t get discharge data? Sorry, you can’t charge TCM

05/02/2022

by: Roy Edroso

Question: We performed transitional care management (TCM) on a patient who had been discharged as an inpatient by a provider from a different practice. When our claim went in, the payer did not have the discharge summary on file and denied our claim. What can we do?

Turn to Q codes, modifier JW for discarded CTP products

05/02/2022

by: Sarah Gould, CPC

Question: How do you code and bill for wound debridement involving the disposal of unused cellular-based tissue product (CTP)?

Behavioral health services continue to climb, revenue jumps

05/02/2022

by: Richard Scott

The growth of two services that Medicare has approved in recent years — cognitive assessment service 99483 and behavioral health care management code 99484 — signals that practices are spending more time addressing their patients’ behavioral health needs.

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