Tagged with CPT Coding
Anthem – Enhanced Automated Claim Edits
Anthem is updating its editing systems to automate edits supported by correct coding guidelines, as documented in industry sources such as CPT®, HCPCS Level II, and ICD-10. Anthem states the enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.
Cigna Clinical, Reimbursement, Admin and Preventive Care Updates
Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for Infusion and Injection Administration Services with Emergency Department as Place of Service and precertification changes for Cardiac Electrophysiological Studies.
Humana Updated Claim Payment Policies
Humana recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.
CY 2019 OPPS and ASC Payment System Final Rule Released
CMS has released its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule for the next calendar year. According to the agency, the policies adopted in the CY 2019 final rule will help lay the foundation for a patient-driven healthcare system and will also strengthen the Medicare program by providing more choices and lower cost options.
Fourth Quarter ASC Payment Rate Updates Released
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
Humana Policy and Claims Payment System Updates
Humana has posted a number of policy and claims payment system updates, that will become effective in October.
Cigna Issues 34 New Precertification Codes
Cigna has updated their precertification list to include 27 new CPT® codes and seven new HCPCS codes to its precertification list.
Florida Blue Billing Laterality Modifiers
Florida Blue issued a notice to providers stating the insurer will implement edits for several spinal surgery procedures when billed in conjunction with lumber spinal fusion codes, including spinal cord decompression and laminectomy, facetectomy and foraminotomy procedures.
BCBS Vermont New, Revised and Deleted Codes Released
Following Blue Cross and Blue Shield of Vermont’s (BCBSVT) review of the CPT® and HCPCS additions, deletions and revisions for October 1, the insurer has made several changes involving prior approval, investigational services, and unit designation.
Humana Claim Processing Edits
Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.
CMS Removes Prior Authorization Requirement for DMEPOS
CMS will remove the prior authorization (PA) requirement for certain types of medical equipment that no longer meet standards set forth in a 2015 final rule.
Harvard Pilgrim Anesthesia for GI Endoscopic Procedures Policy Update
Harvard Pilgrim is implementing updates to its policy for Monitored Anesthesia Care for Gastrointestinal (GI) Endoscopic Procedures to include the appropriate 2018 CPT codes and to expand coverage of monitored anesthesia care to include patients at risk of complication due to mild systemic disease.
UnitedHealthcare Redesigns Emergency Department Reimbursement Policy
UnitedHealth Group has announced plans to introduce a new payment policy intended to reduce its emergency department claims cost.
Aetna NPL, Clinical Payment and Coding Policy Changes
Effective July 1, Aetna will implement changes to its clinical payment and coding policies as well as several changes to its National Precertification List (NPL).
UnitedHealthcare Medicare Advantage Notification for Outpatient Injectable Chemotherapy
As of March 1 for UnitedHealthcare (UHC) Medicare Advantage (MA) members in Florida and Georgia and April 1 for plans in Wisconsin, UHC will require care providers to submit a notification for injectable chemotherapy when administrated in an outpatient setting for UHC MA members with a cancer diagnosis.
UnitedHealthcare – Changes in Advance Notification and Prior Authorization Requirements
Effective for dates of service on or after April 1st, several new codes will be added to UHC’s prior authorization list as a result of the American Medical Association (AMA) 2018 annual CPT® update.
2018 Guideline Updates for Emergency Department Coding and Documentation
As of January 1st, several CPT® code updates for emergency medicine took effect, including changes to chest x-ray and abdominal x-rays codes, lab test and needle introduction codes, observation codes, and an updated ultrasound of extremities descriptor.
2018 CPT Changes for Orthopaedic Surgery
This year, CPT® coding updates for orthopaedic surgery includes the removal of two codes and adds one new code, as well as a number of instructional notes to clarify proper reporting of certain codes.
2018 Payment Policy for Blue Light Cystoscopy
In the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, CMS adopted a number of policies, recommended by the American Urological Association (AUA), to support urologic services such as cystoscopy.
Aetna Clinical Payment, Coding and Policy Updates
Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.
