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Using Correct Combinations – Modifier 50

One of the most frequent errors can result from the submission of invalid modifier combinations. In addition to​ the accurate coding of treatment, medical claims must be billed in combination with...

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Provisional Prior Authorization from Medicaid- Three State Approach

Beneficiaries who are dually eligible for Medicare and Medicaid often experience difficulties accessing durable medical equipment (DME), such as wheelchairs, in a timely manner. Whether Medicare or...

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Using Correct Combinations – Modifier 24 and 25

One of the most frequent errors can result from the submission of invalid modifier combinations. In addition to the accurate coding of treatment, medical claims must be billed in combination with codes...

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Using Correct Combinations – Modifier 59

One of the most frequent errors can result from using the wrong modifiers. In addition to the accurate coding of treatment, medical claims must be billed in combination with codes for additional...

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Coding Diabetes Mellitus in ICD-10-CM

Results of a recent coding and clinical documentation pilot study indicate that the ICD-10-CM coding classification changes made for diabetes mellitus have significantly improved coding for this...

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Medicare Coverage for DSMT Benefit

The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with...

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Official Guidelines for Diabetes Mellitus – 2019 Update

The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services...

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Reimbursement Tips and Documentation Requirements for DSMT

The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with...

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Basic Coding Guidelines for MNT

Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a ‘nutrition-based treatment provided by a registered dietitian nutritionist.’ It includes ‘a...

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Role of Primary Care Practitioner in DSMT

Diabetes self-management education/training (DSMET) is cost-effective and improves health outcomes as patients maintain better control of their A1C. Diabetes educators provide education/training...

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Christmas Time! ICD-10 Codes for this Festive Season

The most awaited time of the year is here! It is December, the time to celebrate and indulge in treats and sweets, family time and loads of gifts. With so much to be done, from baking and cooking to...

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Appropriate Use of CPT Code 99211

Working with a diabetes educator can reduce the time physicians need to spend with each patient and increase efficiency. The term ‘incident to a physician‘s professional services’ means that the...

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Preventing Type 2 Diabetes

Prediabetes means your blood glucose (also called blood sugar) levels are higher than normal. When your blood glucose levels reach a certain level, you have diabetes. This is a disease that occurs when...

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Medicare Reimbursement for Pre-Diabetes Screening

Pre-Diabetes Screening involves the testing of asymptomatic, high-risk individuals to assess whether they meet the criteria for either prediabetes or type 2 diabetes. Screening for prediabetes and...

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Medicare Coverage for Diabetics Shoes

Diabetes is a common disease that occurs when your blood sugar is too high. Type one diabetes is when the pancreas doesn’t make enough insulin, causing blood glucose levels to rise. Type two diabetes...

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ICD-10 Codes – Type 1 Diabetes Mellitus

Diabetes means your blood glucose or blood sugar is too high. With type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy....

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Diabetes and Chronic Kidney Disease (CKD)

If you have diabetes, get your urine tested every year to look for kidney disease. Your doctor should do a creatinine blood test to check how these organs are working. He’ll also check your blood...

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Diabetes, Pre-diabetes and DSMES Program

More than 30 million Americans have diabetes. Another 84 million US adults have prediabetes, a serious health condition in which blood sugar levels are higher than normal, but not high enough yet to be...

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ICD-10 Codes – Type 2 Diabetes Mellitus

With type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much...

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Controlling Gestational Diabetes

Gestational diabetes is diabetes that a woman can develop during pregnancy. When you have diabetes, your body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. As a...

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