I just started working for an ESRD facility, and I need to know how Medicare pays for hepatitis B vaccine and administration. Can you help?
Does Medicare offer guidance related to when unspecified diagnosis codes are appropriate?
Last week you said there were more than 80 new molecular pathology codes. Do you know why there are so many?
How does Medicare reimburse ventilation management provided during an observation stay?
This is a follow-up to the answer to last week’s (5-29-2018) cardiology question regarding claims for replacement ICDs (implantable cardioverter defibrillators) that were denied because they didn’t have a modifier. The provider asked whether they could request an adjustment for these, and you replied, “Yes, you may request an adjustment for claims for any date of service for which the replacement ICD was otherwise covered (as long as the claim was denied solely because it lacked a QR modifier).”
Don’t you mean a Q0 modifier (investigational clinical service provided in a clinical research study that is in an approved clinical research study)? We have been using Q0 per CMS direction for two years now—ever since our EP program began placing ICDs, and we have had no issues. Please clarify why you believe a QR still applies.
OMHA also announced that the SCF expansion will include a “fast track” process, or “SCF Express.” The Office of Medicare Hearings and Appeals (OMHA) hosted
CMS offers advice through its Medicare Learning Network Connects bulletin to avoid coding errors. Mistakes happen, and errors do occur in the coding industry. The
Improper use of extrapolation statistics is stunningly egregious, according to the author. Over the years, I have written extensively about the statistical extrapolations that are
The author responds to comments from readers of his recent RACmonitor article. The May 17, 2018 RACmonitor news article Two-midnight Rule Remains Confusing; Total Knee
In the case of Medicare, what is a SCOD?
Where can I find Medicare’s electronic clinical quality measures for next year?
Our sleep clinic manager wants to create a checklist to decrease Medicare denials for polysomnography (PSG) codes 95810 and 95811. Can you provide a few examples of reasons for denial that we can include on our list?
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This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
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