CMS administers the Medicare program and it is currently the single largest payer for healthcare in the United States. Medicare Part A, B, C, and D, all encompass a wide variety of services, all of which providers need to understand to determine which services are covered for patients.
CMS recently announced a delay in the anticipated system release of outpatient and inpatient quality reporting data due to the relocation of the Health Care Quality Information System Data Center responsible for the Hospital Quality Reporting programs.
Q: If a physician orders a consultation for a patient who is experiencing a headache due to hypertension, which ICD-10-CM codes would be assigned? Would hypertension be coded since headache is a common sign and symptom of hypertension, or would both the headache and hypertension be coded?
CPT codes for drug administration follow a hierarchy that is unique to those procedures. Review the hierarchy in order to understand how to apply codes for any type of scenario.
Accurate coding and billing data is important for both providers and CMS. Jugna Shah, MPH, writes about challenges providers have faced with providing that data to CMS and what the agency can do to ease provider burden.
Specialty groups are often able to move faster on creating guidelines for new procedures and codes than other ruling bodies. But sometimes this guidance can create conflicts between physician and facility coders. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about how to avoid these scenarios and come to the best resolution for providers, payers, and patients.
Beginning April 1, approximately 800 hospitals will be required to participate in CMS’ new joint replacement payment model. Shannon Newell, RHIA, CCS, outlines the requirements and what providers need to do in order to prepare.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, reviews anatomic details related to hernias and how to use operative report details to report the appropriate procedure codes for hernia surgeries.
Q: Our facility is developing clinical definitions regarding types of atrial fibrillation (afib) given the specificity changes in ICD-10. Could you provide suggestions for these definitions? Do you think it is appropriate to query for persistent atrial fibrillation for the period of more than seven days and chronic afib sustained for more than 12 months Are you aware of any strategies other institutions are using when querying regarding afib?
CMS is reporting that the Quality Improvement and Evaluation System (QIES) will be down for five days in March due to extended systems maintenance. The QIES will be unavailable starting at 8 p.m. Eastern on March 16, and returning March 21 at 11:59 p.m., according to CMS.
