Diagnosis codes for neurologic disorders are widespread throughout the ICD-10-CM manual. In this article, Joel Moorhead, MD, PhD, CPC , breaks down ICD-10-CM code selection for cerebrovascular diseases, transient cerebral ischemic attacks, and peripheral neuropathies.
CMS issued the proposed lists of new, revised, and invalidated ICD-10-CM codes May 11 in conjunction with the fiscal year (FY) 2021 Inpatient Prospective Payment System proposed rule. The update will be significantly larger than the FY 2020 ICD-10-CM update if all the proposed changes are finalized.
Read up on new CMS policies that expand COVID-19 care, ramp up diagnostic testing, and loosen restrictions on billing for telehealth services during the public health emergency.
CMS released an interim final rule with comment period on April 30 that grants organizations additional flexibilities to meet the challenges of the COVID-19 public health emergency, including permitting hospitals to bill for telehealth services and loosening restrictions on COVID-19 testing.
Practices that have experienced a shutdown or a near-shutdown during the COVID-19 national public health emergency need to adhere to state regulations for re-opening. In addition, they must consider the impact that re-opening would have on staff members and patients impacted by the pandemic.
To assign CPT codes for spinal procedures, coders need a solid understanding of spinal anatomy and procedural terminology. They must also be up to date on guidance from CMS and the American Medical Association for facility reporting of spinal surgeries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O , takes a closer look at the main topics addressed in a recently published Coding Clinic Advisor FAQ, including ICD-10-CM coding for antibody testing, virus signs and symptoms, and comorbidities related to the novel coronavirus (COVID-19).
Q: Which ICD-10-CM codes would we use to report an emergency department (ED) encounter for a patient presumed to have COVID-19 who does not undergo diagnostic testing?
Modifier -22 indicates that the procedural work performed by the provider or surgeon was substantially greater than what is typically required. The application of this modifier allows providers to receive additional reimbursement for a procedural service that was especially challenging, time-consuming, or unusual.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19.
Navigating Medicare’s rules for charging for ancillary services, bedside procedures, and supplies is no easy task. Get an expert perspective on how to apply the rules.
In part two of this two-part series on modifier -22, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews documentation considerations for increased procedural services and tips for the appropriate CPT reporting of this commonly misused modifier.
Q: If laboratory results supporting a positive case of COVID-19 are included in the physician’s note for an emergency department visit, but the physician does not provide an interpretation of the laboratory results, would it be appropriate to report an ICD-10-CM code for a confirmed case of COVID-19?
The Office for Civil Rights’ (OCR) enforcement discretion statement seems to open a whole new world of options for providers and patients. However, experts have warned providers that they can still get in a lot of trouble if they are not careful about how they use technology.
Providers have two new CPT codes to report for blood tests to check for the presence of COVID-19 antibodies. The codes, which allow for reporting of one- and two-step testing methods, took effect April 10, according to an American Medical Association (AMA) update.
Under the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS has broadened access to telemedicine services during the novel coronavirus (COVID-19) pandemic. Read about how the interim final rule impacts reporting of telehealth visits, virtual check-ins, and e-visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In its April update to the OPPS, CMS made effective new Proprietary Laboratory Analysis (PLA) codes for biochemical assays and billing codes for novel coronavirus (COVID-19) laboratory tests. Hospital coders should review these updates to ensure that they are selecting the most specific codes for these services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -22 frequently causes compliance headaches for revenue cycle professionals. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews CPT reporting requirements for this commonly misused modifier to ensure that your physicians are being appropriately reimbursed for increased procedural work.
On March 31, the CDC updated the 2020 ICD-10-CM Official Guidelines for Coding and Reporting to include guidance for reporting the novel coronavirus and associated respiratory illnesses, effective April 1 through September 30.
Over 330,000 cases of COVID-19 have been reported in the U.S., according to the Centers for Disease Control and Prevention. In this article, Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , writes about the virus’s etiology and how to effectively document and code for COVID-19 diagnoses.
Under both the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS is increasing access to Medicare’s telehealth services to allow beneficiaries to receive professional healthcare services without having to travel to a healthcare facility.
On January 1, 2021, hospitals will enter a new world of price transparency. CMS put hospitals on track to face expanded price transparency requirements with a final rule released November 15, 2019.
To code for spinal excisions and decompression procedures, coders must break down provider documentation to determine the surgical approach utilized and surgical specialists involved, and in some cases, visualize how the procedure was performed across multiple levels of the spinal column.
The AMA announced that its CPT® editorial panel expedited approval of a unique CPT code to report laboratory testing services for COVID-19. The new code supports the urgent public health need for streamlined reporting of testing for the virus.
Providers will find immediate opportunity to provide virtual visits to patients enrolled in Medicare and Medicare Advantage plans as CMS seeks to facilitate screening and treatment of novel coronavirus (COVID-19) cases.
Given the frequency with which wound procedures are performed, and the expenses associated with their performance, it’s essential that coders have a clear understanding of how to accurately report CPT codes for these services. Review 2020 CPT codes for wound repairs and grafting procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hemorrhoids are the third most common outpatient gastrointestinal diagnosis in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases. Debbie Jones, CPC, CCA , writes about symptoms of hemorrhoids and CPT coding for treatment.
Coders will find a wide range of CPT and HCPCS Level II codes that have been assigned medically unlikely edits (MUE) this year. Review new MUE values that went live January 1 for codes involving drug injections as well as E/M, radiology, and therapy services.
Providers need to clean up coding for electro-acupuncture devices, according to CMS. In Special Edition MLN Matters 20001, the agency noted that some providers are incorrectly coding these devices using HCPCS Level II code L8679 (implantable neurostimulator, pulse generator, any type).
When reporting CPT codes for spinal excisions and decompression procedures, coders must consider the approach used, spinal levels operated on, number of providers involved, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To enhance efforts to combat the opioid crisis in America, CMS policy allows for a new benefit under Medicare Part B concerning Opioid Treatment Programs.
Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. On January 30, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern due to its sustained person-to-person spread within countries and across continental borders.
CMS recently announced that it will cover acupuncture therapy sessions for Medicare patients with chronic low back pain. Read about how this change will impact physician coding and billing for acupuncture services.
More than 34 million people in the U.S. have diabetes and one in five don’t know they have it, according to the Centers for Disease Control and Prevention. In this article, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about E/M coding for diabetes management and HCPCS Level II coding for external insulin infusion pumps.
The Centers for Disease Control and Prevention is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. Learn about signs, symptoms, and ICD-10-CM coding for the virus. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Nationwide studies show increases in rates of alcohol-related emergency department visits and hospitalizations over the past decade. Review ICD-10-CM documentation and reporting for alcohol abuse and related complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Centers for Disease Control and Prevention (CDC) recently published an ICD-10-CM index and tabular addenda with reporting criteria for new ICD-10-CM code U07.0 (vaping-related disorders). The agency also updated its MS-DRG grouper software package to accommodate the new code.
As with any new clinical documentation integrity (CDI) initiative, there are many possible starting points for outpatient CDI. Review advice from healthcare professionals at Trinity Health on how to successfully implement an outpatient CDI program.
The Centers for Disease Control and Prevention estimates that over 30 million people in the U.S. have diabetes mellitus and 25% don’t know they have it. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about characteristics of the diabetes and ICD-10-CM coding for the disease.
The Medicine section of the CPT Manual includes codes for a variety of services including acupuncture, vaccinations, and behavioral health assessments and is divided into 33 subsections that can make it challenging to navigate.
Coding productivity held steady, but missing documentation and unanswered queries bog down coders, according to the results of our 2019 coding productivity survey
The American Medical Association introduced new CPT codes for long-term electroencephalogram (EEG) monitoring sessions that went into effect on January 1. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how to accurately apply these codes based on details in provider documentation.
HCPro’s 2019 coding productivity survey showed that coding productivity held steady for 2019, but facilities continue to struggle with miscommunications between coding and CDI staff and unanswered physician queries.
The Medicine section of the CPT Manual includes codes for a variety of services and is divided into 33 subsections that can be challenging to navigate. Review guidance for reporting 47 new codes within this section of the manual including those for vaccines, behavioral assessments, ocular examinations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently rescinded Transmittal 4880, January 2020 Update of the OPPS, and replaced it with Transmittal 4494 to include updated language on the removal of procedures from the inpatient-only list and new information on out-of-pocket costs for screenings with electrocardiography. All other information remains the same.
The flu vaccine is changed each year based on the virus types that the Centers for Disease Control and Prevention estimates will be the most prevalent. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews CPT and ICD-10-CM coding for this year’s flu vaccine and its administration.
The 2020 edition of the National Correct Coding Initiative (NCCI) Policy Manual features new guidance and clinical examples to help coders appropriately apply the -X{EPSU} modifiers debuted by CMS several years ago.
Q: A physician performed a pleural catheter flush using saline with manual clearance of clots under ultrasound guidance. Should we bill an E/M code for an outpatient office visit or report this using other CPT codes?
Modifier -25 can cause frustration as it is not recognized by many payers, including Medicaid. When applying this modifier, coders must consider CPT reporting rules and adhere to potentially restrictive billing rules followed by payers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2020 update to the CPT Manua l includes extensive updates to cardiovascular codes, including new codes for pericardiocentesis and pericardial drainage, aortic grafting, and endovascular repair procedures.
One of the most vexing challenges that CDI specialists have is how to engage physicians to completely and precisely document their patients’ conditions and treatments in the language required by ICD-10-CM, which is essential to risk adjustment.
If you aren’t yet confused by the site-neutral payment policy changes prompted by CMS apparently ignoring both Congressional intent and the American Hospital Association (AHA) and other impacted hospitals filing suit, you are likely to become so now.
Although the dollar figures aren’t big, the Office of Inspector General’s (OIG) report on faulty chronic care management (CCM) billing should be concerning for physician practices billing these codes.
The American Medical Association released its annual update to the CPT code set in September, introducing several new codes for cardiovascular and digestive procedures. Review the new 2020 CPT codes for preperitoneal pelvic packing, hemorrhoidectomy procedures, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP, CCDS , reviews updated policies in the 2020 Medicare Physician Fee Schedule final rule that will affect ICD-10-CM risk-adjustment reporting and documentation for facilities.
In the 2020 Medicare Physician Fee Schedule final rule, CMS proposes to adopt four new time-based HCPCS codes to be used in place of existing CPT codes for complex and non-complex chronic care management (CCM) services.
Because the cardiovascular system circulates oxygen and nutrients to all body parts, procedures of the cardiovascular system can be complex and challenging to accurately report. This article reviews CPT guidelines for reporting ECMO procedures and endovascular interventions in the lower extremities. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , writes about new E/M codes, effective January 1, for patient-initiated services administered by a physician or other qualified healthcare provider.
JustCoding’s sister publication, HIM Briefings, conducted a benchmarking survey to shed light on edit and denial management processes across the industry. Review findings from the survey to see how your organization compares to those across the industry.
CPT reporting for surgical heart procedures requires an in-depth understanding of cardiovascular anatomy and terminology. This article reviews CPT reporting for procedures involving cardiac pacemakers and implantable cardioverter-defibrillators based on key details in provider documentation.
In the 2020 Medicare Physician Fee Schedule (MPFS) final rule, CMS put a stamp of approval on its previous proposals to overhaul how medical practices will report office and outpatient E/M services in 2021.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews the appropriate application of 14 new HCPCS codes that will allow opioid treatment programs to report medication-assisted treatments beginning January 1, 2020.
In the 2020 Medicare Physician Fee Schedule final rule, CMS increased the performance threshold for Merit-based Incentive Payment System (MIPS) eligible providers and finalized its proposal to implement the MIPS Value Pathways (MVP) framework in calendar year 2021.
CPT reporting for surgical heart procedures requires an in-depth understanding of cardiovascular anatomy and terminology. This article reviews CPT reporting for procedures involving cardiac pacemakers and implantable cardioverter-defibrillators based on key details in provider documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A patient presents for routine obstetrical (OB) care following a vaginal delivery. During the visit, the provider performs a postpartum depression screening. Should the depression screening be charged separately from the global OB visit service?
Review finalized changes to relative value units for office visits, new HCPCS codes for chronic care management and opioid treatment services, and future updates to the E/M reporting guidelines.
CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule and OPPS final rules approving changes to E/M documentation guidelines, introducing new HCPCS codes, and continuing its potentially unlawful payment policy for drugs purchased through the 340B drug discount program.
CPT coding for behavioral health can be challenging given the multitude of factors that influence code selection. Review procedural coding for psychiatric diagnostic assessments, psychotherapy, and other mental health services commonly performed in the office setting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Prader-Willi syndrome (PWS) is a rare genetic disorder that causes significant physical and intellectual abnormalities. Debbie Jones, CPC, CCA , writes about signs and symptoms of PWS and diagnostic and CPT coding for the disorder.
Advances in technology have made it easier for providers to administer remote physiologic monitoring services. However, because these services are relatively new, they remain underutilized and Part B providers have questions on how to accurately report and bill for them.
Q: Does a psychiatrist need to document a physical examination and a review of prescriptions in order to support the reporting of CPT code 90792 (psychiatric diagnostic evaluation with medical services)?
The fiscal year (FY) 2020 ICD-10-CM Official Guidelines for Coding and Reporting, released shortly after the FY 2020 ICD-10-CM code release, provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Coders should take time to review these changes that were implemented October 1.
As of October 1, approximately 1,080 cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S., according to the U.S. Centers for Disease Control and Prevention (CDC). Despite continued research into these cases by the CDC and the U.S. Food and Drug Administration (FDA), the specific cause of these illnesses remains unknown.
In today’s virtual environment, with its focus on flexible schedules, organizing the coding function requires consideration of time zones, team member skills, volume of work, and claim-processing schedules.
Q: If a patient comes in twice a day over the course of a week to receive an IV infusion of Vancomycin and the same line is used daily, would the coder report one initial infusion CPT code per day?
The Centers for Disease Control and Prevention (CDC) recently released documentation guidance for providers who evaluate patients with symptoms of e-cigarette- or vaping-associated lung injury, as well as official ICD-10-CM coding guidance for reporting these encounters.
Every day, more than 130 people in the U.S. die after overdosing on opioids, according to the National Institute on Drug Abuse. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about accurate documentation and ICD-10-CM coding for opioid use, abuse, and dependence.
By selecting the most specific codes for cancer diagnoses, coders can help epidemiologists track disease trends and measure the efficacy of drug therapies and radiation oncology treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A wide range of diagnostic tests may be used by hospital providers to examine respiratory functioning. In this article, Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, CPC-I , interprets CPT guidance for reporting pulmonary functioning tests used to diagnose patients with asthma and chronic obstructive pulmonary disease.
Perhaps the most momentous Quality Payment Program (QPP) news in the 2020 Medicare Physician Fee Schedule proposed rule is the Pathways version of the Merit-based Incentive Payment System (MIPS)—but that’s not happening until 2021.
One thousand eighty cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S. as of October 1, according to the Centers for Disease Control and Prevention. Review provider documentation and ICD-10-CM reporting for vaping-induced illnesses. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
As Medicare Advantage makes strides to becoming the new norm, organizations need to establish new processes, educate staff, and advocate for patients. Learn how your organization can keep pace with change before it’s too late to catch up.
Device-dependent edits require reporting a device code with procedures CMS has designated to be device intensive, and they are meant to ensure that device costs are accounted for in Medicare rates for device-intensive procedures.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC , reviews 2021 proposals to E/M codes for office visits and other outpatient services and draft guidelines for the implementation of these changes.
The fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about significant guideline updates that will impact facilities starting October 1.
Internal audits can reveal inconsistencies in provider documentation and coding, reporting errors, and fraudulent billing practices. Review internal auditing basics and advice from regulatory experts on how to effectively educate providers on audit findings. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: The 2020 ICD-10-CM update added several new codes for legal interventions. What are these codes, and can they be assigned based on nonphysician documentation?
U.S. District Judge Rosemary M. Collyer recently ruled that CMS exceeded its authority when it expanded a site-neutral payment policy that cut reimbursement for certain E/M services provided in previously excepted off-campus hospital clinics.
The 2020 CPT update added new codes for the preparation and insertion of drug delivery devices, dry needling, and anesthetic nerve injection administration. Familiarize yourself with these and other updates before they go into effect January 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
If payment updates in the 2020 Medicare Physician Fee Schedule proposed rule are finalized, they will significantly impact physician reimbursement for x-ray and E/M CPT codes, among others. Review payment proposals and the specialties that would see the greatest impact.
