Updates

accounts receivables

Common Accounts Receivables Issues And How To Overcome Them

Are you suffering from recurring errors in your Medical Account Receivable processes? It’s important to know that you are not alone, as there are many common problems that trouble healthcare organizations and obstruct their financial goals. 

Unpaid accounts receivables can seriously damage your cash flow. It is the most critical process in any business. The main reason is poor AR management might result in unhealthy cash flow, and it is hard to manage AR.

In this way, you must employ the correct processes and tools for overcoming the challenges.

Throughout this guide, you’ll learn about 4 common challenges for accounts receivables and how to solve them. 

Let’s have a look!

Problems Relating To Accounts Receivables Management & Solutions

1. Knowledge Deficit

It is crucial to have a deep insight into the multiple reasons for claim denials or delays in payments. However, these problems must be corrected. Providing particular information regarding insurance claims, treatments, or delays is one way to help in implementing these measures. 

The lack of follow-up leads to countless requests for the same issue, which shows a lack of confidence in claims resolution. There is always a solution for any problem. Check out how you can resolve it below.

Solution

  • Train your calling team on a regular basis.
  • To prevent confusion in the protocols, assign callers to specific insurances or physicians.
  • You should make sure your callers pay heed to the call to prevent excessive repetitions.
  • Embedding denial reasoning can simplify call documentation.
  • Callers should review the claim and route it back to the web follow-up team for cases when the payer does not respond to initial claim requests by phone.
  • Audit the call notes your agents have written frequently.
  • Keeping an eye on your A/R data can help you better understand how efficient your team is.

2. Call Documentation Is Incomplete

It is best to document call notes in a structured manner, either during the call or immediately after. When A/R team members document call notes late, ineffective documentation is generated, and dialed numbers and insurance information are missed. These issues result in ineffective corrective actions that further delay the recovery and payment.

Solution

  • Through the use of objective questions, the caller is guided to gather the right information for specific denial coders (kick codes).
  • In order to standardize call documentation, operations leaders should consider automated documentation capabilities for each of the issues listed above. 
  • An excellent way to retrieve or cross-check missing information is using call recording technologies.
  • Make sure your callers consistently follow your company’s documentation protocol and billing process.
  • Your callers’ calls and collected information should be regularly audited.

3. Denied Insurance Claim

The healthcare organization’s cash flow is negatively impacted by this predictable and frequent AR problem. It is estimated that the denial rate for healthcare is between 10% and 25%. Despite this, MGMA recommends that the best healthcare organizations have a denial rate of only 4%.  

By making simple corrections, you can avoid the significant loss of revenue due to your hospital or organization.

Solution

  • The medical accounts receivable management team must carefully review each claim form before submission so that it meets the guidelines.
  • All denied claims must be investigated and any missing values must be determined and submitted.

4. Unnecessary Write-Offs 

There are some write-offs that are important, and others that do not. You should review each medical account receivable carefully. It is unlikely that the team emphasizes a lower payment amount, but some patients opt to pay in installments. 

Ultimately, these small payments will have a negative impact on your organization’s balance sheet if they are not managed properly. Consequently, you must remember that a quick review of the patient’s every overdue bill could lead to reimbursement for your organization.

 Solution

  • Determine which write-offs require managerial approval. These will help you to accelerate smaller accounts.
  • Monitoring and tracking write-offs will allow you to identify issues with your reimbursement policies and procedures. Using tracking, you can identify the problem associated with higher spikes. 
  • The first step towards reducing unnecessary write-offs is to identify and devise a plan. If you want to create a successful strategy, you need to examine the past data and determine an average write-off rate. Setting a limit for annual write-offs will give you control over them.

5. The Staff Is Unmotivated

Everyone in your organization, from medical providers to administrative staff, should love what they do and should strive to help your organization reach its mission and objectives. 

The bottom line is that if your organization is losing money both on the salary side as well as on the profit side because of a lazy staff, then you should observe the negative impact on the organization’s account.

 Solution

It is highly recommended that you outsource revenue cycle management and receivable management operations to a reliable outsourcing partner, who can diligently implement your requirements with the latest technology and dedicated staff. 

Outsourcing RCM services has many advantages that your organization can compare to hiring in-house staff.

Managing various tasks at once in the healthcare industry is not easy. A top priority of today’s health organizations is to reduce costs and improve efficiency. So, if you are considering outsourcing your revenue cycle management and accounts receivable tasks then it is the best solution for all your healthcare needs.

We at Med-Miles LLC follow a strict audit process to improve your collection process. To learn more visit our Accounts receivable Management services

Read more...
Optometry Billing Collections

Improve Optometry Billing Collections In 6 Easy Steps

The growth and prosperity of an optometric practice depend on continuous revenue flow. A successful business is one that focuses on growing revenue while providing outstanding customer experiences. In healthcare, patients are customers.

It can be overwhelming to deal with Optometry Billing Collections. The hassles associated with optometry billing can often lead to errors or delays. 

A provider’s practice may still suffer losses despite providing the best possible care due to the complexity and varied policies of different payers. A well-defined payment collection process can prevent this problem.

Therefore, healthcare providers should improve optometry medical billing collection in order to maintain their financial stability. Because a healthy bottom line will help keep your eye care practice on a stronger financial path. 

Want To Improve Your Optometry Billing Collections? 

These 6 easy steps can boost your optometry practice’s collections. 

  • Make Sure The Insurance Payer Has Approved The Provider

In optometric health care billing, the first step is to verify that your provider holds a license from an insurance company.

You need to ensure that you file and follow up on claims as required by the insurance plan. You should take it one step further and contact insurance payers regularly to make sure the providers are registered in the network at the time enrollment is open.

  • Avoid Rejections By Using Correct Modifiers

Many optometrists use CPT® code 92133/92134 and fundus photography code CPT® 92250 for single visit billing. Note: When you do not code this correctly, Medicare can deny payment for both codes and only accept payment for the lowest reimbursement code.

There are three types or categories of five-character codes and two-character modifiers to describe any changes in a procedure and CPT® codes that are published by the American Medical Association®.

Although the NCCI revision allows the modifier to be used for OCT/GDX and fundus photography, you must be careful to use the modifier correctly otherwise this may lead to denials or rejection. 

  • Stay Up-To-Date With The Current Updates 

To make sure you are coding your eye care claims correctly and without error, you should closely monitor the local coverage determinations (LCDs) and Medicare Administrative Contractors (MACs) in your area and make sure you sign up to keep up to date in the payer list.

Optometrists and their staff must be prepared for significant changes in 2021 in the coding and documentation of evaluation and management (E/M) services in optometry. You will have to choose E/M codes depending on which is more appropriate: medical decision-making or overall time, rather than patient history and physical examination of the patient.

  • On-Time Settlement Of Patient Payments

Some patients’ insurance plans include copayments or deductibles. The perfect way to increase collections is to use online payment options from the patients at the time of enrollment.

Doing so will not only increase the speed of the admission process but also improve the patient experience. In this way, collecting payments at the time of enrollment makes the patient journey easier and assures timely payment to keep your practice’s revenue flowing healthily. It will also save lots of your time and effort while helping the collection process be hassle-free and more efficient.

  • Know When To Bill For Regular Vision & When To Bill For Health Insurance 

Many patients have insurance plans for both vision and health insurance. While the best billing practice is to choose a plan to bill based on the patient’s chief complaint and medical diagnosis, it is sometimes more difficult. It is very important to check both vision and medical plans before visiting the office.

  • Create An Efficient Collection Procedure

Most optometry providers are unable to maintain the optimal financial health of their practices in the absence of a well-defined collection process. 

Moreover, failure to properly collect patient information or verify addresses can lead to major losses for your practice.

For this reason, it is important to have efficient optometry billing and collection to create maximum reimbursements for your practice. 

As a healthcare provider, you must collect all the important patient details. You should also train your staff for each step in order to verify the patient’s address and contact information correctly which would be helpful for you to reach them in the future. 

If you collect co-pays and deductibles upfront, it will save your time and ultimately improve your optometry practice collections. 

Looking To Outsource Your Optometry Billing? 

Look no further! We are here to help you optimize all your optometry billing processes. Our team will handle everything from claim denials to maximum reimbursements. Contact us today for a successful optometry practice.

Read more...
Virtual Care

Virtual Care Challenges In 2021

The year 2020, also known as the “year of the pandemic,” had been remarkable in terms of the extent and degree of change taking place around us, in all industries, regions, and organizations.

As COVID-19 had a bad impact on the health care system in 2020, which is why there is a huge opportunity for payers and stakeholders to reconstruct the health care system into a more effective and consumer-driven system in 2021.

Telemedicine has taken a dramatic leap forward in response to the COVID-19 pandemic, as organizations have looked for rapid implementation so that they can continue providing services among isolated groups and social distancing protocols.

While the move from in-person visits to virtual care – both by phone and video – provides several conveniences, there are unavoidable difficulties for health systems, and challenges continue to arise as telemedicine becomes more prevalent.

Before understanding the challenges, let’s know about virtual care!

What Is Virtual Care?

Now many health care providers and health care systems are looking for ways to increase access to care for their patients along with a decrease in overall health care costs, which has made the health care industry grow at a faster pace. 

It is fortunate that digital technology acts as a means for health care providers to communicate with their patients while breaking down barriers that can hinder a patient’s access to care. This is how virtual care is an important role.

To define virtual care- “it is the comprehensive term that consists of the ways that most healthcare providers are using to interact with their patients remotely” one of them is Telemedicine. Providers typically use video, audio and real-time instant messaging to communicate remotely with their patients.”

Moreover, there are many benefits of telehealth and virtual care which are comprehended because of the pandemic, but it still contains many difficulties. As it has said in the report that there are a lot of difficulties in telehealth and patient experience of virtual care. Let’s understand them!

Challenges of Virtual Care

  • Technology & Connectivity 

Wi-Fi connectivity and different software with application platforms present technical difficulties. Even though laptops having basic hardware also don’t have enough sufficient video capabilities which will affect provider and patient communication. 

Also, many patients who belong to remote areas don’t have access, affinity, or skills to use the virtual platforms and medical groups also don’t have enough time to train patients that required for virtual treatment. 

  • Correct Use

It is important for healthcare providers and patients to use virtual care appropriately. There are certain conditions that might not safe and appropriate for virtual care. 

For Example – Metabolic conditions and behavioral health may be appropriate for virtual visits but exam dependents are not fit for this. 

  • Ongoing Personal Connection

 The third challenge is a personal connection. Healthcare providers are finding ways to make a personal connection with patients especially for those who are using digital health as use cases tend to be one-off visits (for acute needs like a sore throat) or care that’s not connected to a patient’s usual doctor (such as mental health).

  •  Reimbursement

Most of the providers are facing transition problems to virtual care and telehealth. Due to pandemic, virtual care and telehealth reimbursement arguments are highlighted. 

It is important for health insurance companies to learn that provider satisfaction is necessary for strong virtual care. Their primary concern is to get paid faster for the services they provided. Whether it is face-to-face visits or virtual care, reimbursements are essential. 

If you need help then outsource your virtual care billing to our safe hands. The dedicated team at Med-Miles will assist you in all virtual Care billing requirements and help you to get paid faster. Call our experts at +1 888-598-9181.

  • Limitations For Physical Examination 

In today’s technological world, many providers and patients have access to high-quality video conferencing but it is not easy for some providers to diagnose or treat a patient virtually. 

Moreover, the conditions that are not serious can be effective for virtual care. In some conditions, providers may not feel comfortable conducting an examination over video chat. This is the reason patients prefer in-person visits over virtual appointments. 

  • Awareness About Virtual Care

Some of the virtual care services such as chronic patient monitoring, therapy appointment, and post-operative care are specifically run on the software and hardware which are more costly that requires additional IT training, more staff, and purchase of different servers and supplementary equipment. 

Patients who are not computer-literate or don’t have a budget to purchase equipment and software have faced many problems in virtual care treatment. For this reason, it is necessary to aware of the patients of all the required needs of virtual treatment. So, he/she can plan accordingly. 

Want to know more about virtual care? Contact Med-Miles LLC!

Read more...
Coding Guideline For Low Vision and Blindness

ICD-10 Update: Coding Guidelines For Low Vision And Blindness

Low vision is a chronic eye disorder that a person cannot treat with glasses, contact lenses, or medical or surgical treatment. It includes varying levels of vision loss, blind spots, poor night vision, and trouble with blindness to almost total loss of vision.

It is important to know that blindness and low vision are not the same 

Blindness and low vision are not the same, because limited visibility remains in the latter state. 

Eye and vision doctors and optometrists measure low vision by having patients read letters on a visual chart called visual acuity. 

For an accurate claim submission, ophthalmologists and optometrists are treating his eye condition and can take the help of professional medical billing services. 

Categories of Low Vision 

There are two categories of low vision- one is partially sighted and the other one is legally blind. Moreover, partially sighted mentions the visual activity between 20/70 and 20/200 along with conventional prescription lenses. 

On the other hand legally blind mentions the visual activity no better than 20/200 along with conventional correction or a restricted field of vision less than 20 degrees wide. 

Visual aids can be helpful for people having low vision. Most popular low vision aids include telescopic glasses, lenses that filter light, hand magnifiers, magnifying glasses, and closed-circuit television and reading prisms. 

As ophthalmologists, we understand that it is difficult to manage billing and coding besides their treatment. This is why, in this blog, we cover the updated ICD-10 codes for low vision and blindness. Just continue reading to know them!

Whether you do in-house or outsource, it is necessary to know the updated ICD-10 codes for efficient practice performance.  

Before we move towards codes, let’s take a look at a new passage in the ICD-10-CM Official Guidelines for Coding and Reporting, which contains general instructions for how to code for blindness and low vision.

“If ‘blindness’ or ‘low vision’ of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes. 

If “blindness” or “low vision” in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, unqualified visual loss, one eye.

 If “blindness” or “visual loss” is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.”

With the help of these guidelines, it is easy for coders to tackle the challenge of both eyes. Blindness and low visions codes are not the same.   When blindness or low vision isn’t bilateral or isn’t the same category for each eye, you should use your new code options to describe them separately. 

The new codes allow you to signify whether right eye blindness is a different category than left eye blindness. 

To choose the correct code from this series, first, find the category of the right eye and then choose a subcode based on the category of the left eye. 

H54 ICD-10 Codes to Report Blindness and Low Vision

  • H54 Blindness and low vision
  • H54.0 Blindness, both eyes
  • H54.0X Blindness, both eyes, different category levels
  • H54.0X3 Blindness right eye, category 3
  • H54.0X33 Blindness right eye category 3, blindness left eye category 3
  • H54.0X34 Blindness right eye category 3, blindness left eye category 4
  • H54.0X35 Blindness right eye category 3, blindness left eye category 5
  • H54.0X4 Blindness right eye, category 4
  • H54.0X43 Blindness right eye category 4, blindness left eye category 3
  • H54.0X44 Blindness right eye category 4, blindness left eye category 4
  • H54.0X45 Blindness right eye category 4, blindness left eye category 5

 

  • H54.0X5 Blindness right eye, category 5
  • H54.0X53 Blindness right eye category 5, blindness left eye category 3
  • H54.0X54 Blindness right eye category 5, blindness left eye category 4
  • H54.0X55 Blindness right eye category 5, blindness left eye category 5
  • H54.1 Blindness, one eye, low vision another eye
  • H54.10 …… unspecified eyes
  • H54.11 Blindness, right eye, low vision left eye
  • H54.113 Blindness right eye category 3, low vision left eye
  • H54.1131 …… category 1
  • H54.1132 …… category 2
  • H54.114 Blindness right eye category 4, low vision left eye
  • H54.1141 …… category 1
  • H54.1142 …… category 2
  • H54.115 Blindness right eye category 5, low vision left eye
  • H54.1151 …… category 1
  • H54.1152 …… category 2
  • H54.12 Blindness, left eye, low vision right eye
  • H54.121 Low vision right eye category 1, blindness left eye
  • H54.1213 …… category 3
  • H54.1214 …… category 4
  • H54.1215 …… category 5
  • H54.122 Low vision right eye category 2, blindness left eye
  • H54.1223 …… category 3
  • H54.1224 …… category 4
  • H54.1225 …… category 5

 

  • H54.2 Low vision, both eyes
  • H54.2X Low vision, both eyes, different category levels
  • H54.2X1 Low vision, right eye, category 1
  • H54.2X11 Low vision right eye category 1, low vision left eye category 1
  • H54.2X12 Low vision right eye category 1, low vision left eye category 2
  • H54.2X2 Low vision, right eye, category 2
  • H54.2X21 Low vision right eye category 2, low vision left eye category 1
  • H54.2X22 Low vision right eye category 2, low vision left eye category 2

 

  • H54.3 Unqualified visual loss, both eyes
  • H54.4 Blindness, one eye
  • H54.40 …… unspecified eye
  • H54.41 Blindness, right eye, normal vision left eye
  • H54.413 Blindness, right eye, category 3
  • H54.413A Blindness right eye category 3, normal vision left eye

 

  • H54.414 Blindness, right eye, category 4
  • H54.414A Blindness right eye category 4, normal vision left eye

 

  • H54.415 Blindness, right eye, category 5
  • H54.415A Blindness right eye category 5, normal vision left eye

 

  • H54.42 Blindness, left eye, normal vision right eye
  • H54.42A Blindness, left eye, category 3-5
  • H54.42A3 Blindness left eye category 3, normal vision right eye
  • H54.42A4 Blindness left eye category 4, normal vision right eye
  • H54.42A5 Blindness left eye category 5, normal vision right eye
  • H54.5 Low vision, one eye
  • H54.50 …… unspecified eye
  • H54.51 Low vision, right eye, normal vision left eye
  • H54.511 Low vision, right eye, category 1-2
  • H54.511A Low vision right eye category 1, normal vision left eye
  • H54.512A Low vision right eye category 2, normal vision left eye
  • H54.52 Low vision, left eye, normal vision right eye
  • H54.52A Low vision, left eye, category 1-2
  • H54.52A1 Low vision left eye category 1, normal vision right eye
  • H54.52A2 Low vision left eye category 2, normal vision right eye

 

  • H54.6 Unqualified visual loss, one eye
  • H54.60 …… unspecified
  • H54.61 Unqualified visual loss, right eye, normal vision left eye
  • H54.62 Unqualified visual loss, left eye, normal vision right eye
  • H54.7 Unspecified visual loss
  • H54.8 Legal blindness, as defined in the USA

To avoid claim rejections, the coding and billing staff needs to be very careful in choosing specific codes. If you find difficulty in choosing the right code then outsource your ophthalmology medical coding services to us can be the right solution. With our medical coding services, you can submit medical claims accurately and will receive timely reimbursements. Get our Medical coding services today!

Read more...
Importance of Patient Compliance In The Healthcare

Importance of Patient Compliance In The Healthcare

All over the world, it has been noted that patient compliance is a multifaceted and complex health care problem. 

There is no secret that most patients with chronic conditions have a hard time adhering to medical recommendations and treatment plans. No one likes to go to the doctor, but there are occasions when we don’t have a choice because our bodies eventually need some kind of repair. But, what is the actual problem? 

The problem is that a lot of people go to the doctor with health problems but they don’t take their medications as scheduled, skip their appointments, and/or ignore suggested lifestyle changes and health dietary recommendations.

There are two types of non-compliance- one is primary non-compliance and the other one is secondary non-compliance. A primary non-compliance happens when a patient fails to fill a prescription.

Around a third of noncompliant patients fall into this category. There are several ways a secondary mismatch can occur, and these include missing a dose, stopping the medication altogether, taking the medication at the wrong time, and medication misuse

According to the research study, approximately 50% of patients do not take their medications as prescribed and about 75% of patients are non-compliant in one way or another. 

Importance of Patient Compliance In Healthcare

Patient compliance is defined as the extent to which the patient follows the prescribed diet or treatment, and whether the patient returns for follow-up, observation, or treatment.

This non-compliance behavior costs more than $100 billion to $289 billion a year to the U.S. health care system, and this figure is expected to rise more in the future.

If there is a mismatch between the patient’s willingness to take the health care plan and the physician’s attempt to initiate an intervention, noncompliance with the plan is likely to follow. In the end, the patient suffers. 

Nevertheless, some solutions exist to help physicians adapt treatment plans to the individual patient that will provide them with the motivation to work together in their care and lead to better health, shorter hospital stays, and stronger health systems. 

Let’s look at the strategies to boost Medication Compliance!

Strategies to Boost Medication Compliance

  • Involvement In The Process

Many non-compliant patients feel they don’t have the proper support system to help them keep track of their daily medication usage or feel they are not involved in their own care process.

Patients who are not compliant usually feel that they don’t have the proper support system for tracking their daily medication usage. They also feel that they are not involved in their own process care. 

However, it is important to involve patients in their treatment process to get a high level of patient satisfaction. 

The research study also shows that providers who actively involved their patients in a diagnosis or treatment plan will get positive results in terms of patient satisfaction.

It has also been said in the study that when patients view their physician as honorable and trustworthy, chances that they will obey the following recommendations.

  • Compliance Reminders

With the help of compliance reminders, it is easy for patients to get to know when it’s time to take their medications. This will also help patients because it has been shown to increase compliance substantially, which will lead to better results. 

Also, 73 percent of test participants reported being satisfied with the program, while 88 percent claimed that interaction with health professionals plays a big role in their engagement.

  • Understand Patient Behavior

One of the most important things that providers should consider is the understanding of patient behaviors. Moreover, providers need to understand all the problems that patients have to face more often such as problems in filing, taking, or affording medications. 

For this reason, create motivating environments for patients is necessary to make patients feel comfortable in speaking openly and honestly. 

  • Create Awareness About Side Effects

In order to create awareness providers should talk about side effects with patients to let them know about the serious adverse drug reaction. Also, tell them how to prevent them. How treatment pan will be changed if they don’t resolve? Are they typically resolve without intervention? Providers should have answered these questions. 

  • Understand Patient’s Financial Condition 

It is also important for providers to understand the patient’s financial condition. Whether they can afford the medications or not, providers should actively involve in this process to boost patient compliance.

If you want to make your patients compliant then it’s time to make your patient’s aware of pharma company-based assistance plans, state-based assistance plans, and pharmacies that arrange for 30-day supplies of broadly suggested medications.

  • Decrease The Complexity

Reducing the complexity of the drug regimen will help patients to follow through with taking medications correctly. Some ways to reduce complexity are providing combination products and prescribe medications with once-daily dosing instead of multiple doses per day etc. 

  • Use Technology 

Patient medication compliance may improve with the help of technology such as automatic pill dispensers, pillboxes and timers, and alarm watches. A Bluetooth pillbox can provide physicians the information they can use to detect adherence issues.

  • Follow-Up With Patients 

Use medication reminders via text, email, or direct mail or during time allotted for chronic care management services. Also, schedule follow-up appointments to discuss medication compliance. You should tell your patients why they need their medication as prescribed even they are symptom-free. 

Considering that patient non-compliance is an issue in the U.S. that costs billions of dollars each year, the number of preventable deaths has occurred already. For this reason, it is important to find out the root cause of the problem and then address it with a proper solution. Hopefully, the above strategies will help you improve patient compliance while we help you with medical billing and coding.

Leave your billing and codding worries to Med-Miles LLC so you can focus more on what you love the most!

Read more...
CMS

HCPCS Level II Quarterly Updates

The Centers for Medicare & Medicaid Services (CMS) has updated its HCPCS (Common Procedural Coding System) Level II coding procedures to allow for shorter and more frequent HCPCS code cycles. 

HCPCS or Common Procedure Coding System for Health Care represents medical procedures, supplies, products, and services and is used to help Medicare and other insurance companies process health insurance claims.

In these updates, there is a significant change in comparison to the previous framework, in which there was only one submission deadline and coding cycle for each calendar year. 

In addition, these updates are part of CMS’s “innovation relief” initiative and provide manufacturers and other stakeholders the opportunity to take advantage of more frequent coding filing opportunities.

In a second-quarter update, 23 codes are added to these categories, six codes are revised and 12 codes are discontinued. 

Let’s have a look at HCPCS level II Code Updates;

HCPCS Level II Code Updates

Here you can see a list of newly added codes;

  • A9592 Copper cu-64, dotatate, diagnostic, 1 millicurie
  • C9074 Injection, lumasiran, 0.5 mg
  • C9777 Esophageal mucosal integrity testing by electrical impedance, transoral (list separately in addition to code for primary procedure)
  • G2020 High-intensity clinical services related to primary engagement and coverage of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes). CMS advises that G2020 services should be provided and billed at least one day before all other services covered by the home visit fee are reimbursed.
  • G2172 Payment for services associated with highly comprehensive and fully coordinated opioid use disorder (OUD) treatment services provided as part of a demonstration project, inclusive.
  • J1427 Injection, viltolarsen, 10 mg
  • J1554 Injection, immune globulin (asceniv), 500 mg
  • J7402 Mometasone furoate sinus implant, (sinuva), 10 micrograms
  • J9037 Injection, belantamab mafodotin-blmf, 0.5 mg
  • J9349 Injection, tafasitamab-cxix, 2 mg
  • K1013 Enema tube, any type, replacement only, each
  • K1014 Adduct, endoskeletal knee corrugator system, 4-bar attachment or multiaxial, fluid swing system and positioning phase control
  • K1015 Foot, adductor positioning device, customizable
  • K1016 Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve.
  • K1017 Monthly supplies for using a k1016 coded device
  • K1018 External upper extremity peripheral wrist nerve tremor stimulator
  • K1019 Monthly supplies for using a k1018 coded device.
  • K1020 Non-invasive vagus nerve stimulator
  • M0245 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post-administration monitoring
  • Q0245 Injection, bamlanivimab and etesevimab, 2100 mg
  • Q2053 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • S1091 Stent, non-coronary, temporary, with a delivery system (propel)

These codes, such as K1013, K1014, K1015, K1016, K1017, K1018, K1019, and K1020, were the result of stakeholder requests received at the HCPCS PBC public meeting. Code K1019 replaces A4595 for reporting wrist connector component replacements.

Revised Codes

Several code descriptor changes are updated in April 2021, which are listed here;

  • C9761 Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for controlled vacuum aspiration of the kidney, collection system, ureter, bladder and urethra, if valid.
  • G9868 Remote, asynchronous image acquisition and analysis for dermatologic and/or ophthalmologic evaluation, for use only in Medicare-approved cmmi model, less than 10 min.
  • G9869 Remote, asynchronous image acquisition, and analysis for dermatologic and/or ophthalmologic evaluation, for use only in Medicare-approved CMMI model, for 10-20 minutes.
  • G9870 Remote, asynchronous image acquisition and analysis for dermatologic and/or ophthalmologic evaluation, for use only in Medicare-approved cmmi model, for more than 20 minutes.
  • J7321 Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose

Deleted HCPCS Level II Codes

On April 1, 21, the following codes are discontinued:

  • C9068 Copper cu-64, dotatate, diagnostic, 1 millicurie
  • C9069 Injection, belantamab mafodotin-blmf, 0.5 mg
  • C9070 Injection, tafasitamab-cxix, 2 mg
  • C9071 Injection, viltolarsen, 10 mg
  • C9072 Injection, immune globulin (asceniv), 500 mg
  • C9073 Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
  • C9122 Mometasone furoate sinus implant, 10 micrograms (sinuva)
  • J7333 Hyaluronan or derivative, visco-3, for intra-articular injection, per dose
  • J7401 Mometasone furoate sinus implant, 10 micrograms
  • K1010 Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
  • K1011 Activation device for intraurethral drainage device with valve, replacement only, each

K1012 Charger and base station for intraurethral activation device replacement only.

Each year HCPCS coding changes. This is why healthcare providers should ensure that their coders are aware of these changing billing and coding standards or not. 

Need a professional and skilled coder? Partner with Med-Miles LLC. Our trained coders and billing specialists fulfill all your coding needs and get you paid faster for the services provided. Call our experts at +1 888-598-9181.

Read more...