b'2021 Medicare Fee Schedule [ CODING CONTINUED FROM PAGE 9 ]Deductible: $203.00 response. For example: According to The American AreaCodeParNon-ParLimiting Charge Medical Association (AMA), the Current Procedural Terminology (CPT) Editorial panel on September 8, 2020 0198940$31.40$29.83$34.30 approved and released CPT code 99072 in response to 01*98940$24.28$23.07$26.53 the COVID-19 pandemic. New code 99072 was estab-0198941$44.73$42.49$48.86 lished to report additional practice expenses incurred during a Public Health Emergency (PHE), including 01*98941$37.20$35.34$40.64 supplies and additional clinical staff time. If you can, 0198942$58.40$55.48$63.80 include specific citations, including page numbers, etc. 01*98942$50.87$48.33$55.58 9. You can also point out that CPT codes, HCPCS codes 9998940$30.52$28.99$33.34 and ICD-10 codes have all been adopted as federal law: these codes and their definitions must be acknowledged 99*98940$23.75$22.56$25.94 by all HIPAA covered entities, which of course includes 9998941$43.54$41.36$47.56 insurance companies. For example: Under the HIPAA 99*98941$36.38$34.56$39.7 Transaction and Code Set standards, [Insurance Company Name] is obligated to utilize the AMAs 9998942$56.91$54.06$62.17 Current Procedural Terminology (CPT) codes when 99*98942$49.74$47.25$54.34 adjusting health care service claims of its insureds. See, 45 C.F.R.162.925(c)(1) which requires health plans such * Represents all services in any facility other than office. as [Insurance Company Name] to accept and promptly Area 01 = Sussex, Warren, Passaic, Bergen, Morris, Essex, process standard transactions containing the restricted Hudson, Union, Middlesex, Somerset, Hunterdon Counties code sets. Area 99 = All other Counties 10. Always provide a conclusion that outlines your LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS request, for example: Based on the above, please BY NON-PARTICIPATING PROVIDERS. reprocess claim#dated / /2020 for the above-named patient with the correctly submitted CPT code 99072.11.Make sure to leave your contact information and telephone number where someone can reach you with questions or follow up.12. Create Templates: For every appeal, try to determine if it can be used again as a template and build an appeals library. Make sure to keep the appeals that are successful and note ones that are not. This will help increase efficiency, accuracy when doing appeals. Persistence is key, you will not win all appeals and WELCOME! remember, while payers must follow coding rules, they are at liberty to make up their own reimbursement policies. For this reason, when payer rules allow, you Dr. Dana Barry might want to notify your patients that they will be Dr. Richard Curcio responsible for any fees not covered by the payer and get this in writing, similar to a Medicare ABN form. Dr. Barbara EmanuelDr. Richard Guma David Klein, CPC, CPMA, CHC, is co-founder of PayDC www.paydc.com, a web-based fully certified EHR system Dr. Allison Heffron that focuses on compliance and reimbursement. He is a certified professional coder and certified professional Dr. John King medical auditor through the American Academy of Professional Coders (AAPC), and is certified in healthcare Dr. John McHugh compliance through the Health Care Compliance Board (HCCB). He is the Founder and President of DK Coding & Compliance, Inc. a healthcare consulting firm that focuses on audit defense, education, compliance and reimburse-ment issues. He can be reached at dave@paydc.com www.njchiropractors.com I 11'