Help your doctors code properly.
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Payment for IMRT planning bundles, or includes, many services represented by other procedure codes when performed on the same date. As a result, radiation therapy providers must maintain an awareness of bundling edits and coding guidelines to ensure complete and accurate reimbursement for this advanced technology.
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Internal chart reviews are useful tools for practices to determine the accuracy of their coding when billing for services, especially to governmental payers. They can also boomerang, however, and be used as evidence against a practice when their results are not fully understood or implemented. This article provides some guidance to help practitioners realize the fuller value of chart reviews in terms of over- and under-coding, adequacy of documentation, and attorney-client privilege.
Before reporting the new Category III CPT codes, contact payors to determine both acceptance of these temporary codes and reimbursement allowances. Documentation must clearly support all services performed, and the requirements for an online medical evaluation should be followed, with the encounter recorded in the individual patient medical record. Hospitals should also review the quarterly changes to OPPS codes and descriptors and ensure that Charge Description Masters are updated as new codes become effective.
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