Medical Billing

Modifier 58, Staged or related procedure or services by the same Physician or other Qualified Health care Professional during the postoperative period. When to Use modifier 58 Modifier 58 is used to identify those situations when a procedure or services may be staged(planned). While a return to the operating room for a related procedure may be commonplace, a staged (planned) procedure or services may not be as routine. I will try to clarify the intent when to exactly use modifier 58 with the procedure code. As per the CPT coding guidelines, Modifier 58 is assigned for any subsequent procedure, Which is planned or has to be performed with the related original procedure. Following three key points should be remembered before appending modifier 58 to the procedure codes. Modifier 78 Unplanned return to the operating / procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative pe...

Effective with services rendered October 1, 2015 and later,  ALL  ambulance transports require dual diagnoses.  Providers should report the primary diagnosis as the most appropriate ICD-10 code that adequately describes the patient’s medical condition at the time of transport.   In addition, a secondary diagnosis must be reported which reflects the patient’s need for the ambulance service and ambulance personnel at the time of transport.   In order for claims to be processed and paid in a timely manner it is important that claims submitted for ambulance services contain both the primary and secondary diagnosis. Please refer to the Ambulance Local Coverage Article A54574 for a list of “suggested” ICD-10 codes that may be reported as a primary diagnosis. Please note that the list of diagnosis codes provided in A54574 is not an all-inclusive list. Other valid ICD-10 diagnoses codes that accurately describe the patient’s cond...

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act, 2016 On Friday, December 18, 2015, President Obama signed into law the Consolidated Appropriations Act, 2016.  Section 601, Modification of Medicare Inpatient Hospital Payment Rate for Puerto Rico Hospitals modifies the payment calculation with respect to operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for discharges on or after January 1, 2016. CMS is currently revising the Inpatient Prospective Payment System (IPPS) FY 2016 Pricer to reflect the new payment calculation requirement.  The amount of the payment with respect to the operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for inpatient hospital discharges on or after January 1, 2016, will be based on 0 percent of the applicable Puerto Rico percentage and 100 percent of the applicable Federal percentage. In addition, the IPPS FY 2016 Pricer will include conformin...

Provider Enrollment Application Fee Amount for CY 2016 On December 3, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2016 [CMS–6066–N] ( http://go.usa.gov/ckj8Z ). Effective January 1, 2016, the CY 2016 application fee is $554 for institutional providers that are: Initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP)Revalidating their Medicare, Medicaid, or CHIP enrollmentAdding a new Medicare practice location This fee is required with any enrollment application submitted from January 1 through December 31, 2016.

New place of service 19 Effective 1st January 2016, a new place of service 19 is available to use. A portion of an off-compus hospital provider based department which provides diagnostic, therapeutic ( Both surgery and nonsurgical), and rehabilitation services to sick or injured persons who don't require hospitalization or institutionalization .

US Federal Holidays list 2016 Friday, January 1New Year’s Day Monday, January 18Birthday of Martin Luther King, Jr. Monday, February 15*Washington’s Birthday Monday, May 30Memorial Day Monday, July 4Independence Day Monday, September 5Labor Day Monday, October 10Columbus DayFriday, November 11Veterans Day Thursday, November 24Thanksgiving Day Monday, December 26 Christmas Day

2016 USPS Holidays list Friday, January 1  New Year’s Day Monday, January 18  Birthday of Martin Luther King, Jr. Monday, February 15  Washington’s Birthday Monday, May 30  Memorial Day Monday, July 4  Independence Day Monday, September 5  Labor Day Monday, October 10  Columbus Day Friday, November 11  Veterans Day Thursday, November 24  Thanksgiving Day Monday, December 26  Christmas Day