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.

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.

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.

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.