Medical Billing

Difference Between ICD 9 - ICD 10 Basic Information about ICD 9: The United States Implemented ICD 9 in 1979. But most of the countries moved to ICD 10 several years ago, it’s time for United States medical history to reflect modern Medical terms.  Difference between ICD 9 – ICD 10 Code set differences ICD-9-CM codes are very different than ICD-10-CM/PCS code sets: There are nearly 19 times as many procedure codes in ICD-10-PCS than in ICD-9-CM volume 3 There are nearly 5 times as many diagnosis codes in ICD-10-CM than in ICD-9-CM ICD-10 has alphanumeric categories instead of numeric ones The order of some chapters have changed, some titles have been renamed, and conditions have been grouped differently ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes No Laterality Laterality – Right or Left account for >40% of codes 3-5 digits First digit is alpha (E or V) ...

When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of his terminal illness during the period his hospice benefit election is in force, except for professional services of an “attending physician” who is not an employee of the designated hospice and does not receive compensation from the hospice for those services. Professional services of an “attending physician” are submitted with the GV modifier if all conditions are met (description below). Any services provided to a patient enrolled in hospice that are not related to the treatment and management of the patient’s terminal illness are submitted with the GW modifier (description below). For purposes of administering the hospice benefit provisions an “attending physician” is defined as follows (must meet all requirements): An individual who is a doctor of medicine, doctor of osteopathy or a nurse practitioner. Is identi...

Recently, Novitas Solutions has received numerous requests to provide pre-authorization for surgery scheduled to occur within days. Traditional Medicare does not provide pre-certification or pre-authorization of a surgery. Medically necessary services should not be withheld or delayed. Medically necessary services that have been provided to the patient are billed to Medicare for consideration and processing. If a service is denied, the provider and the patient have a right to request a redetermination of the denial. Title XVIII of the Social Security Act, Section 1862(a)(1)(A) allows coverage and payment for items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member. Section 1862(a)(1)(A) of the Social Security Act is the basis for denying payment for types of care, specific items, services, or procedures, not excluded by any other statutory clause, meet all technical requiremen...