Coding | EmblemHealth

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The proper coding of procedure and diagnosis for billing purposes. 



Date Issued (YYYY/MM/DD) Title
2021/01/01 EmblemHealth Preventive Care/Screening Services Coverage (Revised)
2021/02/04 EmblemHealth Guide for NPIs and Taxonomy Codes
2021/02/04 Gender Rules and ICD 10-CM F64.0
2021/02/04 Additions to the Self-Referral Payment Policy List
2021/01/11 National Drug Code (NDC) Requirements for Drug Claims
2020/11/06 Coding updates for Medical Policies
2020/10/19 Denial of CPT Codes Billed With Bariatric Surgery
2020/10/14 Future Steps Pregnancy App
2020/08/20 EmblemHealth 5010 HIPAA Transaction Standard Companion Guides
2020/06/25 New CPT Codes
2018/12/18 Emergency Ground Ambulance Destination Modifier
2016/12/27 2017 ClaimsXten Edits
2016/01/28 New and Revised Place of Service Codes (POS) for Outpatient Hospital
2020/06/12 Anesthesia for Pain Management Injections –Commercial (Updated)
2018/07/16 Anesthesia Modifier Reporting
2020/06/12 APG Rate Codes
2017/02/03 Billing Instructions for Long Acting Injectable Antipsychotics, Vivitrol and Injectable Naloxone
2018/07/19 Canalith Repositioning Therapy – CPT 95992
2018/07/16 Cardiovascular Evaluation with Tilt Table Testing –CPT code 93660
2018/07/16 Care Management Services
2012/05/22 Category II CPT Codes
2014/09/30 Change in CPT Codes for Qualitative Drug Screen Testing
2014/11/12 Changes to HCPCS Modifier 59
2018/03/23 Chest X-Rays for Lung Cancer Screening
2015/06/26 ClaimsXten® — Claims Audit Software
2019/05/03 Clinical Laboratory Improvement Amendment Waived Tests
2018/09/07 Clinical Trial Billing Requirements
2014/07/17 CMS Requires HIPPS and Rate Codes for SNF and HHA Claims
2018/11/12 Code J7313, Brand Name: Iluvien
2018/05/23 Coding Antepartum Care by Different Provider Groups
2015/06/23 Coding—New Oral Antiemetic Drug Akynzeo®
2018/02/26 Colonoscopy Procedures
2014/04/04 Complete and Accurate Medical Record Documentation and Coding Critical to Patient Care
2018/07/16 Corneal Pachymetry –CPT Code 76514
2015/10/08 Correct Bundling of Urinalysis CPT Codes 81002 and 81003 With Evaluation and Management CPT Codes
2018/10/01 Correct Laterality ICD-10-CM Diagnosis Coding Policy
2015/08/27 Correct Usage of Modifier 25
2014/11/07 Correct Usage of Modifier 50 and Modifiers LT and RT for Bilateral Procedures
2016/01/14 CPT Code 31634 Considered Unproven Technology
2020/06/12 CPT Codes 69209, 69210, G0268
2016/07/22 CPT ICD Diagnosis Code Changes
2020/06/12 Daily Max Units Regardless of Modifier
2018/07/16 Definitive Drug Testing Frequency
2012/05/09 Discontinue Use of CPT Codes Retired January 1, 2012
2016/01/01 Drug Testing and Screening Code Updates
2018/03/23 Dual Energy X-Ray Absorptiometry
2019/05/03 Duplicate Claims from a Non-Physician Practitioner
2018/07/16 Duplicate Initial Observation Service
2014/08/05 Effective Coding of Evaluation and Management Services
2019/07/30 Electroencephalogram
2018/12/18 Emergency Ground Ambulance Destination Modifier
2010/08/19 Evaluation and Management Codes Not Payable to Audiology and Speech Language Pathology Specialties
2014/11/11 Expanded Coverage for Fragile X Syndrome - Prenatal Carrier Testing
2014/11/25 Expanded Coverage for Spinal Muscular Atrophy - Prenatal Carrier Testing
2018/09/07 Extracorporeal Photopheresis (CPT code 36522)
2020/06/12 Frequency of Routine Foot Care
2019/05/03 Fundus Photography
2015/04/24 Global Surgery Reimbursement Policy Concerning an Unplanned Return to the Operating Room; Modifier 78 will receive a 20% Fee Reduction*
2018/11/12 HCPCS code J9357
2014/04/04 HIPPS and Rate Codes for SNF and HHA Claims Required/ Keeping Accurate Documentation and Coding - Critical to Patient Care
2020/06/12 Hospital Discharge Services
2018/12/06 ICD-10-CM Excludes 1 Notes Policy
2020/06/12 ICD-10-CM Secondary Diagnosis Codes
2015/03/25 Important Coding Information with Regard to DME Modifiers
2014/01/17 Limitations to Pain Management Services
2018/07/16 Lung Cancer Screening with Low Dose Computed Tomography Frequency
2014/12/02 Maternity Claims: Multiple Birth Reimbursement
2016/12/14 Moderate (Conscious) Sedation
2018/09/07 Modifier 24 with E/M Services During the Major and Minor Procedures Postoperative Period
2018/07/19 Modifier 25 with Evaluation and Management Services Reported with Procedures
2020/06/12 Modifiers for Services and Procedures During the Postoperative Period
2016/06/30 New ClaimsXten Edits -Effective August 14, 2016
2016/03/01 New ClaimsXten® Edits for Facility-Based Services
2018/01/12 New Reporting Instructions for Colon Cancer Screening Anesthesia Services and New 2018 CPT Code Updates to the EmblemHealth Preventive Care/Screening Services Exempt from Cost-Share
2016/03/29 New York State Medicaid Expansion of Coverage of Group A Streptococcus Testing for Practitioners
2018/05/22 Noninvasive Vascular Diagnostic Studies
2018/07/19 Tumor Antigen by Immunoassay CA 15-3/CA 27.29 – CPT 86300
2014/03/25 Update on Denial of CPT Codes Billed With Bariatric Surgery
2019/08/19 Update to ClaimsXten Software
2016/08/30 Upper Eyelid Blepharoplasty and Blepharoptosis Repair
2016/01/28 Use of Modifier 25 and Pulmonary Function Testing
2018/08/01 Use of Modifier 79
2020/06/12 Use of Sequela (7th character "S") Diagnosis Codes
2020/06/12 Using and Documenting CPT Code 99211 Services Correctly
2020/06/12 Vaccines for Children (VFC) Program Update: Fee Schedule Code Revisions
2020/06/10 Reporting Multiple Office Visits and Modifier - 25
2020/06/01 Quality Reporting for MACRA (Reporting only Codes)
2020/06/09 Cytogenetic Studies
2020/03/25 New Outpatient Facility Policy Enhancements
2020/03/18 Coding updates for Medical Policies
2019/10/01 Screening Electrocardiogram for Coronary Disease
2019/10/01 Shingles Vaccination Covered Under Medicare Part D
2019/10/01 Ophthalmic Ultrasound CPT Code 76513
2019/09/29 Pilonidal Cyst and Sinus Procedures
2019/09/29 POA Indicator
2019/09/29 Postpartum Maternal Depression Screening: Updated Billing Guidance
2019/09/29 Proper Coding for Accurate Reimbursement
2019/09/29 Required Use of Occurrence Codes 40 and 41 for Presurgical and Preadmission Testing
2019/09/27 Ocular Blood Flow Testing
2019/09/27 Pain Management -Trigger Point Injections -CPT codes 20552 and 20553
2019/09/13 Pelvic Ring Fractures
2021/06/16 NY State Medicaid: Smoking and Tobacco Use Cessation
2021/06/16 Diagnosis Code Guideline Policies: Manifestation and Secondary Codes
2021/06/16 Duplicate Claims for Drugs
2021/06/16 NY State Medicaid: Allergy Testing