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Supporting Medical Necessity of CPT Code 97016

On December 14, 2018, Noridian provided an update within their “Fees and News Update,” which was published on December 17, 2018 regarding billing of CPT code 97016 for Vasopnuematic devices. Noridian reported multiple outpatient reviews have noted insufficient documentation to support use and billing for the use of vasopnuematic devices to apply pressure to an extremity to reduce swelling.Noridian provided informational guidelines and documentation expectations to meet Medicare’s coverage to support 97016.  Here are the findings/guidelines from…

PDPM ICD-10 Code Mappings Fiscal Year 2023: What’s New?

The Patient-Driven Payment Model (PDPM) has been the reimbursement methodology for Medicare Part A in the Skilled Nursing Facility (SNF) since October 1, 2019, with updated regulations effective every October 1st. Each fiscal year, the Centers for Medicare & Medicaid Services (CMS) releases the updated ICD-10 CM guidance for the new fiscal year, the ICD-10-CM Official Guidelines for Coding and Reporting. In addition to these ICD-10 coding changes or updates, SNFs must be aware of the changes in…

10 Factors that Could Trigger an Audit of Your Medical Records

With the ever-increasing litigious environment and mandatory Congressional oversight of commercial and government payers, physician supporting documentation should emphasize and include the type of service(s) provided, the time involved, special technology and equipment used, as well as any other complications encountered.Furthermore, because the government and insurance carriers routinely perform audits as mandated through the Fraud, Waste and Abuse program, it’s important for providers to be aware of problems that could cause them to come under…