Payment Rules for Multiple Scope Procedures
Related Scope Procedures: Scope surgeries are related procedures (same code family) performed during the same operative session and through the same body orifice/incision on the same day.The scope with...
View ArticleMedical Record Signature policy
Signature RequirementsIn the content of health records, each entry must be authenticated by the author. Authentication is the process of providing proof of the authorship signifying knowledge,...
View ArticleInsurance requests for medical records
1. Insurance staff members conduct medical review of claims and seek the advice of qualified and, typically, practicing professionals when necessary. Contracting providers agree to accept the...
View ArticleCPT CODE 81479, 81403, 81311 -Metastatic Melanoma
Procedure Codes and DescriptionGroup 1 Codes:81311NRAS (NEUROBLASTOMA RAS VIRAL [V-RAS] ONCOGENE HOMOLOG) (EG, COLORECTAL CARCINOMA), GENE ANALYSIS, VARIANTS IN EXON 2 (EG, CODONS 12 AND 13) AND EXON 3...
View Articlecpt code 22510, 22514, 22515
Procedure Codes And DescriptionGroup 1 Paragraph: N/AGroup 1 Codes:22510PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE...
View ArticleCPT 43257, 43499, 49999 - Endoscopic treatment of GERD
Procedure Codes and DescriptionGroup 1 Codes:43257ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DELIVERY OF THERMAL ENERGY TO THE MUSCLE OF LOWER ESOPHAGEAL SPHINCTER AND/OR GASTRIC CARDIA,...
View ArticleCPT 43210, 43499, 43999 - TIF procedures
CPT/HCPCS Codes43210ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ESOPHAGOGASTRIC FUNDOPLASTY, PARTIAL OR COMPLETE, INCLUDES DUODENOSCOPY WHEN PERFORMED43499UNLISTED PROCEDURE,...
View ArticleVertebral augmentation procedures VAPs 22514, 22510
CPT/HCPCS CodesGroup 1 Codes:22510Perq cervicothoracic inject22511Perq lumbosacral injection22512Vertebroplasty addl inject22513Perq vertebral augmentation22514Perq vertebral augmentation22515Perq...
View Articlecpt 22514, 22510 , 22515 - Vertebral augmentation , balloon reduction
Coverage Indications, Limitations, and/or Medical NecessityThis LCD applies to all types of and methods involving any procedure affecting vertebral augmentation, such as balloon reduction and...
View ArticlePayment for hospital, Therapeutic leave days - revenue code 0185, 0813
HOSPITAL LEAVE DAYSFor Hospital Leave Days, Medicaid will pay to hold a beneficiary’s bed only when the facility’s total available bed occupancy is at 98 percent or more on the day the beneficiary...
View ArticleCHILDREN IN FOSTER CARE Coverage
Medical interventions, screenings, and various preventive health care services are to be up-to-date for all children in foster care. For purposes of this section, any reference to “child” or “children”...
View ArticleCoverage BLOOD LEAD NURSING ASSESSMENT VISITS
MDHHS covers up to two blood lead nursing assessment visits and in-home education visits for children determined to be lead burdened. If more than one child in the home has blood lead poisoning, the...
View ArticleCPT 81229, 81313, 81539, 81541 - Oncology, cytogenomic - Prostate cancer
Code Description CPT81229 Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for...
View ArticleCPT 81403, 81405, 81406, 81047 - Molecular Pathology, Gnetic Testing dilated...
Code Description CPT81403 Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent...
View Articlecpt 43201, 43210, 43236,43257 -Transesophageal Endoscopic Therapies
CPT Coding - Code Description 43201 Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance43210 Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric...
View ArticleCPT 43647,43648, 43881, 43882, E0765 - laparoscopy gastric nerostimulaor
Coding Code Description CPT43647 Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum43648 Laparoscopy, surgical; revision or removal of gastric...
View ArticleCPT 37243, 75894, 79445, S2095 - Metastatic Tumors of the Liver
Code Description CPT 37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the...
View ArticleCPT 0008M, 81460, 81465, 81504, 81520 , S3854 - Patients with Breast Cancer
Code Description CPT 0008M Oncology (breast), mRNA analysis of 58 genes using hybrid capture, on formalin-fixed paraffin-embedded (FFPE) tissue, prognostic algorithm reported as a risk score...
View ArticleCPT S0390, 11055, 11056, 11057, 11719, 11721, G0127, - Routine Foot Care...
Coding code Description CPT 11055 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion 11056 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2...
View ArticleCPT T1016, T1017 - Targeted case Managment services
CPT Code DefinitionT1016 Case management, each 15 minutesT1017 Targeted case management, each 15 minutesDESCRIPTION OF SERVICES Targeted case management (TCM) programs are available to assist...
View ArticleCPT 81504, 81540, 81599 - Oncology (tissue of origin)
Coding Code Description CPT 81479 Unlisted molecular pathology procedure 81504 Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin...
View ArticleCPT 81225, 81226, 81227 - Genotype-Guided Tamoxifen Treatment
Code Description CPT 81225 CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17) 81226 CYP2D6 (cytochrome...
View ArticleCPT 0030U, G9143 - Genotype-Guided Warfarin Dosing
Code Description CPT 0030U Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823) (new code effective 1/1/18) G9143 Warfarin responsiveness...
View ArticlePECOS - contact details and FAQ
PECOS TECHNICAL ASSISTANCECONTACT INFORMATIONICN 903766 January 2019PRINT-FRIENDLY VERSIONTarget Audience: Medicare Fee-For-Service ProvidersThe Hyperlink Table, at the end of this document, provides...
View ArticleCPT code 99241, 99242, 99243, 99244, 99245
CPT code and Description99241, Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and...
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