Evaluation and management (E/M) coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G codes. Dave Fee, MBA, Peggy S. Blue, MPH, CCS-P, CPC, Jugna Shah, MPH, Kimberly Anderwood Hoy, JD, CPC, Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Valerie A. Rinkle discuss the possible impact if CMS finalizes its proposal.
Complete capture of procedure codes in ICD-9-CM helps to ensure accurate translation to ICD-10-PCS. Donna M. Smith and Patricia L. Belluomini, RHIA, reveal coding errors—including omission of procedure codes—that make the translation process more challenging.
Medical necessity is as simple as it sounds and it isn’t important just for inpatients. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the importance of establishing medical necessity for outpatient services.
When Paul Belton, RHIA, MBA, JD, LLM, speaks about the culture at Sharp HealthCare in San Diego, you can hear the pride and enthusiasm swelling in his voice. Having served as the vice president of corporate compliance for the past 15 years, Belton has led the ongoing effort to ensure that all employees "do the right thing" at all times.
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable). These G codes are to be reported in conjunction with therapy services (physical, occupational, and speech). CMS also introduced seven complexity/severity modifiers to be used with these G codes.
For coders, the summer months can be some of the busiest, particularly for those working in areas that attract tourists. Linda Schwab Messmer, RHIT, CCS, and Lori-Lynne A. Webb, CPC, COBGC, CCS-P, CCP, CHDA, review ICD-9-CM codes for common summer injuries and ailments.
CMS’ July update to the Integrated Outpatient Code Editor features new codes, new APCs, and a new modifier. Dave Fee, MBA, explains the most noteworthy changes for this quarter.
Facilities may be reluctant to charge for bedside services beyond the room rate because they fear double-dipping. Kimberly Anderwood Hoy, JC, CPC, and William L. Malm, ND, RN, CMAS, discuss what CMS does—and doesn’t—say about charging for ancillary services .
Ancillary department staff may think they don’t need ICD-10 training, but they’re wrong. Lori Purcell, RHIA, CCS, and Kathy DeVault, RHIA, CCS, CCS-P, offer tips for preparing ancillary department staff for ICD-10-CM.
