The beginning of March brought the release of the first quarter 2023 Coding Clinic . Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, summarizes key information provided in this publication, including analysis of ICD-10-CM guidelines , code changes, and coding Q&As.
The January 2023 update to the CPT manual had almost every chapter undergoing some form of change. In this article, Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, delves into some of the major changes to E/M coding and considerations for documentation integrity.
E/M coding guidelines for emergency department services (CPT codes 99281-99285) were recently updated for the first time in decades. Hamilton Lempert, MD, FACEP, CEDC, reviews these changes, along with coding requirements for many other E/M services.
Kathleen M. Romero, MSN, RN, EBP-C, Cynthia Beal, MBA-HCM, BSN, RN, and Renee Pate, MSOL, MSN Ed., RN, CCDS, explain how they implemented a CDI program in their facility’s emergency department and the how establishing this program improved coding accuracy and increased reimbursement.
Though outpatient settings have in some form been reviewed by CDI specialists practically since CDI itself started, this progress remains slow and steady for a reason.
CMS recently published its fourth quarter 2022 HCPCS Application Summaries and Coding Recommendations. The new codes will be used to report injections and skin substitutes and are scheduled to take effect April 1.
Limb girdle muscular dystrophy is a group of genetic disorders that cause myopathy of the proximal shoulder and hip girdle muscles. This article reviews the disease, 2023 ICD-10-CM code updates, and relevant coding guidance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
E/M coding guidelines for emergency department services (CPT codes 99281-99285) were recently updated for the first time in decades. Hamilton Lempert, MD, FACEP, CEDC, reviews these changes, along with coding requirements for many other E/M services.
The American Medical Association introduced E/M updates for 2023 and there are more E/M changes scheduled for 2024, according to the CPT Editorial Summary of Panel Actions. Julia Kyles, CPC, explains several 2023 and 2024 code revisions and additions that coders would benefit from making note of in their CPT manuals.
The CPT Editorial Panel made a handful of changes to codes for ocular and auditory system procedures as part of its 2023 update to the code set. This article reviews canaloplasty and auditory osseointegrated implant CPT code revisions and additions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Would a same date admission/discharge E/M code be used for a scenario in which a patient is admitted at 11 p.m. on a Monday, is seen by the provider at 4 a.m. on Tuesday, and discharged at 8 p.m. on Tuesday?
Kathleen M. Romero, MSN, RN, EBP-C , Cynthia Beal, MBA-HCM, BSN, RN, and Renee Pate, MSOL, MSN Ed., RN, CCDS, explain how they implemented a CDI program in their facility’s emergency department and the how establishing this program improved coding accuracy and increased reimbursement.
The HCPCS first quarter 2023 update, released in December, introduced several new codes and modifiers for medical products and procedural services. Most of the changes took effect January 1.
Pam Warren-Brooks, MHA, COC, CPC, explains different types of psychiatric healthcare providers, outpatient facilities, and best practices for reporting psychiatric services using CPT codes.
Remote therapeutic monitoring is one of the latest services to enter the virtual landscape since the COVID-19 public health emergency began. Debbie Jones, CPC, CCA, defines the services and reviews CPT guidance for reporting them.
Determine whether your facility needs to change E/M documentation habits and capture different details based on the revisions made by CMS to observation and inpatient reporting in the 2023 OPPS final rule.
Tonya Moton, RHIA, CCS, defines social determinants of health coding, explains the challenges of reporting these factors, and outlines how coders and providers can work together to create a positive impact in at-risk communities.
Tonya Moton, RHIA, CCS, defines social determinants of health coding, explains the challenges of reporting these factors, and outlines how coders and providers can work together to create a positive impact in at-risk communities.
This article outlines kidney anatomy, explains percutaneous nephrolithotomy and pyelolithotomy procedures, highlights relevant CPT guidance, and includes insight from experts. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What are the differences between remote therapeutic monitoring and remote physiologic monitoring and what details should we look for in documentation to report these services with CPT codes?
The 2023 Medicare Physician Fee Schedule (MPFS) final rule finalized major documentation and coding changes. This article summarizes new guidance for reporting E/M and telehealth services and a significant cut to physician payments.
CMS recently published an FAQ document on the use of drug waste modifiers. The resource addresses how the modifiers affect Medicare policy, to which products they can be appended, billing concerns, and more.
The end of the public health emergency (PHE) will bring the expiration of many Medicare waivers issued since 2020. Ronald Hirsch, MD, FACP, CHCQM, CHRI, explains how facilities can maintain their compliance in this new era.
This article outlines when and how to report new and revised 2023 CPT codes for arthroplasty and arthrodesis procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The CPT Editorial Panel released 20 new Category III CPT codes. These new codes, along with two revisions, are mainly for cardiovascular procedures and take effect July 1.
Q: When is it permissible under Medicare to assign CPT add-on code 37186 for a secondary thrombectomy when an atherectomy is performed in the same vascular territory?
Remote therapeutic monitoring is one of the latest services to enter the virtual landscape since the COVID-19 public health emergency began. Debbie Jones, CPC, CCA, defines the services and reviews CPT guidance for reporting them.
Alysia Minott, CIRCC, CCS, CDIP, explains that CPT coding for complex procedures performed using interventional radiology (IR) can be mastered; the first step is learning how to interpret applicable coding guidelines.
With reimbursement gains whittled down by CMS' attempt to remedy unlawful cuts to 340B drug payments, complying with updated Outpatient Prospective Payment System (OPPS) policies is key to protecting reimbursement. Take a closer look at CMS' latest policies and ensure your organization is in compliance.
CMS developed the National Correct Coding Initiative (NCCI) to control improper coding and potentially inappropriate payment of Part B services. Review NCCI basics to ensure compliance with the latest coding policies.
The American Medical Association's update to the 2023 CPT code set has brought three code additions, one revision, and one deletion to the integumentary chapter (CPT codes 10030-19499). This article provides procedure descriptions and coding guidance for the new and revised codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alysia Minott, CIRCC, CCS, CDIP, explains that CPT coding for complex procedures performed using interventional radiology (IR) can be mastered; the first step is learning how to interpret applicable coding guidelines.
The Centers for Disease Control and Prevention and the National Center for Health Statistics published updates to the ICD-10-CM coding guidelines and files, which take effect April 1. The updates include 42 new diagnosis codes, seven deletions, and one revision.
The new batch of diagnosis codes and revised guidelines for social determinants of health (SDOH) that will go into effect April 1 highlight the importance policymakers place on collecting this data. Julia Kyles, CPC, provides tips for capturing the SDOH using these new codes.
CMS recently released Transmittal 11737, detailing January 2023 updates to the OPPS. The transmittal offers information on new COVID-19 vaccine and administration codes, dental coding updates, coding clarification, and remote behavioral health service codes.
Coders can reinforce their understanding of the 2023 CPT E/M medical decision-making (MDM) requirements with tips from Peter Hollman, MD , who oversaw the changes.
A urinary tract infection (UTI) is a common bacterial disease that affects the bladder and urethra. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews urinary anatomy as well as diagnostic considerations and ICD-10-CM coding for UTIs.
The 2023 CPT code update introduced numerous code additions, revisions, and deletions that took effect January 1. This article covers new and revised codes in the respiratory and nervous system chapters of the CPT Manual. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
As of November 16, the CPT Editorial Panel has approved 56 Category I codes for severe acute respiratory syndrome coronavirus 2 vaccines and immunization administration. In this article, Kimberly Lee, M.Ed., RHIA, CCS-P, addresses some of the new COVID-19 product and administration codes.
The 2023 CPT code update introduced an option for reporting nasal valve collapse repairs, as well as revisions to certain injection codes to include imaging guidance.
Peter Hollman, MD , breaks down 2023 CPT guidance in a new section of the manual for initial and subsequent E/M services, which will impact reporting of hospital inpatient and observation care services beginning January 1.
CMS developed the National Correct Coding Initiative (NCCI) to control improper coding and potentially inappropriate payment of Part B services. Review NCCI basics to ensure compliance with the latest coding policies.
The CPT Editorial Panel recently announced that it approved new CPT codes for Pfizer’s bivalent COVID-19 vaccine booster and its administration for children six months to 4 years old after they have received administration of the first and second doses of the product.
Q: What is the difference between “normal” and “abnormal” native connections in the descriptors for new 2023 CPT codes 33900-33903 describing percutaneous pulmonary artery revascularization by stent placement?
The 2023 CPT code set takes effect on January 1, 2023. This article covers code changes for bariatric gastric balloon procedures, hernia repairs, and other updates within the digestive system chapter. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medicare finalized a care management service for chronic pain management (CPM). Effective January 1, CPM services can be reported by a wide range of providers, including primary care practitioners.
As of November 16, the CPT Editorial Panel has approved 56 Category I codes for severe acute respiratory syndrome coronavirus 2 vaccines and immunization administration. In this article, Kimberly Lee, M.Ed., RHIA, CCS-P, addresses some of the new COVID-19 product and administration codes.
The Office of Inspector General (OIG) recently released a report investigating instances of incorrect co-surgery and assistant-at-surgery modifier usage, which found that 69 of 100 sampled procedural services did not meet federal requirements.
The American Medical Association recently published CPT codes for 2023, including 103 code additions, 88 revisions, and 69 deletions. This article covers new codes and the single revision made to the cardiovascular system chapter. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding and billing professionals must ensure that medical record information is accurate, up to date, and compliant. In this article, Holly Cassano, CPC, CRC , defines late entries, corrections, and addendums, and explains the proper methods used to alter health records while maintaining Medicare compliance.
CMS released its 2023 OPPS final rule on November 1. The document finalizes most proposed policies, including a new provider type for rural emergency hospitals (REH), continued coverage of telehealth services, and implementation of new skin substitute HCPCS codes, among other changes, which largely take effect January 1, 2023.
The 2023 ICD-10-CM update brought many new codes to report injuries sustained from collisions between motorcycles or electric-assisted bicycles and other vehicles, entities, or objects. This article reviews external cause codes and examines the new additions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS confirmed in the 2023 Medicare Physician Fee Schedule final rule that it will adopt the framework of the revised AMA E/M guidelines, including payment based on medical decision-making (MDM) or time, effective January 1, 2023. Laura Evans, CPC, explains how the agency will diverge from the AMA on some points, however.
Diabetes mellitus is a chronic disease that causes elevated levels of glucose in the blood. It invades the body in many different ways. Shelley Safian PhD, RHIA, CCS-P, COC, CPC-I describes the types, manifestations, and treatment methods for diabetes mellitus and how to report them accurately in ICD-10-CM.
The Office of Inspector General (OIG) released a report in October to assess the results of 12 Medicare hospital and identify CMS’ actions as a result of OIG recommendations made in those audits.
Coding and billing professionals must ensure that medical record information is accurate, up to date, and compliant. In this article, Holly Cassano, CPC, CRC , defines late entries, corrections, and addendums, and explains the proper methods used to alter health records while maintaining Medicare compliance.
Despite CMS’ long-anticipated change in method for selecting E/M visit codes, some physicians and healthcare providers have continued to review 10 or more body systems for every patient. Julia Kyles, CPC explains how this action has some coding professionals wondering if it will prove to be a problem in the long run.
Traumatic brain injuries (TBI) occur after blows, bumps, or jolts to the head disrupt normal brain function. This article covers new codes from the 2023 ICD-10-CM update that pertain to TBIs involving the skull and meninges. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2023 update to the ICD-10-CM code set includes over 60 new codes for intracranial injuries with loss of consciousness, status known. This article covers codes from the 2023 ICD-10-CM update that pertain to traumatic injuries of the brain, specifically the cerebrum, cerebellum, and brainstem.
The ICD-10-CM Official Guidelines for Coding and Reporting provide a roadmap for accurate diagnosis coding. Kimberly Lee, M.Ed., RHIA, CCS-P, unpacks fundamental ICD-10-CM coding concepts.
The 2023 update to the ICD-10-CM code set includes over 60 new codes for intracranial injuries with loss of consciousness, status known. This article covers codes from the 2023 ICD-10-CM update that pertain to traumatic injuries of the brain, specifically the cerebrum, cerebellum, and brainstem. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A coder’s practice should check its telehealth claims against the information in the recent Office of Inspector General data brief on telehealth services, healthcare attorneys advise. Julia Kyles, CPC, reviews the September 2 report, which contains findings and program integrity measures for telehealth services.
Flail chest is the most severe type of blunt traumatic chest injury and is likely the most common serious thoracic injury. Debbie Jones, CPC, CCA, explains the symptoms, diagnostic process, and guidelines associated with reporting flail chest.
CMS recently published Transmittal 11594 , outlining HCPCS codes for drugs that received pass-through status, new proprietary laboratory analysis (PLA) codes for tests, code revisions for pharmaceutical drugs, and skin substitute product codes, all of which became effective October 1.
The ICD-10-CM Official Guidelines for Coding and Reporting provide a roadmap for accurate diagnosis coding. Kimberly Lee, M.Ed., RHIA, CCS-P, unpacks fundamental ICD-10-CM coding concepts.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic. Julia Kyles, CPC, explains the significance of using the OIG’s data brief and offers tips to adhere to compliance guidelines.
The American Medical Association (AMA) released the calendar year 2023 CPT code set on September 9. Learn about new codes pertaining to virtual reality technology, cognitive behavioral therapy, and abdominal hernia procedures.
The 2023 ICD-10-CM update, which took effect on October 1, includes almost 1,500 code changes. This article focuses on new codes in Chapter 9, Diseases of the Circulatory System. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: For colonoscopies, is it appropriate in CPT coding to report the excision of several lesions in the same portion of colon separately if they are removed by the same technique?
Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic.
Many healthcare systems are looking at how to expand their CDI program to include outpatient and ambulatory settings. Jennifer Boles, BS, COC, CRC, CCDS-O, explores her ambulatory CDI program’s success and offers advice for those looking to expand.
The 2023 ICD-10-CM update features many new, revised, and deleted codes. This article focuses on code changes pertaining to blood/blood-forming organs including new codes for von Willebrand disease, heparin-induced thrombocytopenia, and platelet-activating anti-PF4 disorders.
Q: How do CPT codes 28295 (correction, hallux valgus, with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method) and 28298 (…; with proximal phalanx osteotomy, any method) differ?
Many healthcare systems are looking at how to expand their CDI program to include outpatient and ambulatory settings. Jennifer Boles, BS, COC, CRC, CCDS-O, explores her ambulatory CDI program’s success and offers advice for those looking to expand.
On August 31, the American Medical Association (AMA) announced eight new CPT codes for bivalent COVID-19 vaccine booster doses. The vaccine boosters are designed to combat both the original COVID-19 strain and omicron subvariants BA.4 and BA.5. Of the eight new CPT codes, four are to be used for Moderna booster vaccines and four are to be used for Pfizer-BioNTech boosters.
Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
Effective October 1, the ICD-10-CM code set will be updated to include over 1,100 new codes before counting code revisions and deletions. This article covers new codes for musculoskeletal and genitourinary conditions including muscle wasting, rib and sternal fractures, drug-induced neuropathy, and endometriosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent Medicare Provider Compliance Newsletter highlights accurate documentation and CPT coding for total hip arthroplasty (THA) surgery. This newsletter explains relevant codes and reminders when reporting these procedures.
Q: New ICD-10-CM codes for unspecified vascular dementia with behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety take effect October 1. Do these new codes require linkage and specific documentation by the provider that the conditions are related?
Streamlined coding and shorter time requirements for prolonged services are on the horizon for physicians and qualified healthcare professionals. The pending update to the E/M chapter of the CPT Manual , effective January 1, 2023, will replace four prolonged services with two 15-minute codes.
Effective October 1, the ICD-10-CM code set will be updated to include over 1,100 new codes before counting code revisions and deletions. This article covers new codes for musculoskeletal and genitourinary conditions including muscle wasting, rib and sternal fractures, drug-induced neuropathy, and endometriosis.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, writes about the 2023 updates coders will find in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the 2023 Medicare Physician Fee Schedule proposed rule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
Each year, coders must review updates to the ICD-10-CM code set including new, revised, and deleted codes and reporting guidelines. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, explains that for 2023, coders will find several new codes in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.
Revenue erosion and denials are often easily prevented, but simple errors may evade traditional, reactive denials management processes. Coders are encouraged to shift focus to take a proactive approach that targets common errors in claim submission and charge capture and eliminates resource-intensive rework.
CMS published a notice in the Federal Register on August 9 stating that it will be suspending prior authorization requirements for specific durable medical equipment, prosthetics/orthotics, and supply (DMEPOS) codes under certain circumstances, beginning January 1, 2023. All claims submitted before that date will require prior authorization documentation.
Arthroscopic procedures have been the topic of controversy and confusion in the coding community. This article covers relevant anatomy, common shoulder arthroscopy and arthroplasty procedures, and National Correct Coding Initiative edits to keep in mind. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the proposed 2023 Medicare Physician Fee Schedule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
In part two of this series, expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, addresses the “nuts and bolts” of ICD-10-CM coding for anesthesia services, including how and when to append modifiers.
