A recent analysis of electronic health record data from 2015 to 2019 shows that providers underreported ICD-10-CM codes in categories Z55-Z65 for social determinants of health.
Bartholin’s gland cysts or abscesses develop in approximately 2% of women, according to the American Academy of Family Physicians. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about CPT and ICD-10-CM coding for the diagnosis and treatment of Bartholin’s gland cysts.
Review coronary anatomy and CPT coding for aortic and iliac repairs, as well as selective procedures used to treat vascular occlusions in the lower extremities. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The January 2021 quarterly update to the OPPS , released by CMS December 31, announces new HCPCS codes for vitrectomy, nasal endoscopy, and intravascular lithotripsy procedures. The update also...
In the 2021 Medicare Physician Fee Schedule final rule, CMS announced new HCPCS add-on code G2211 for visit complexity inherent to E/M services. Julia Kyles, CPC, describes when and how to report G2211 with E/M codes 99202-99215.
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, HCISPP , writes about CPT coding for total hip arthroplasty and autologous chondrocyte implantation: two orthopedic procedures that were recently removed from the inpatient-only (IPO) list for 2021.
The 2021 update to the ICD-10-CM code set introduced 43 new codes to Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. Review new codes for sickle-cell diseases, hemolytic anemias, and cytokine release syndrome. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.
Hospital coding for pregnancy-related services requires a detailed understanding of the CPT® global obstetric (OB) package and ICD-10-CM coding guidelines for maternal care management. This article details hospital coding for pregnancy and delivery complications and procedures used to treat them.
This article details 2021 updates to CPT® codes for medicine services including several new codes for continuous electrocardiogram (ECG) recordings and auditory-evoked potentials (AEP), as well as American Medical Association (AMA)-approved CPT codes for COVID-19 immunizations.
The calendar year 2021 Medicare Physician Fee Schedule (MPFS) final rule will have a significant impact on physician health systems. Review the implications of updated coding and payment policies that will boost payment for certain E/M services and cut the Medicare conversion factor by 10.2%.
Audit defense is a key strategy in protecting earned revenue and ensuring coding and billing compliance. Read about auditing trends during the COVID-19 public health emergency and internal processes that organizations are using to track audit activity.
The Medicine chapter of the CPT Manual covers a wide variety of services applicable to multiple specialties. Review calendar year 2021 updates to CPT® codes for medicine services including new codes for continuous electrocardiogram recordings and auditory-evoked potentials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When might it be appropriate to report computer-aided mapping of the cervix uteri using 2021 CPT add-on code 57465 (computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect)?
In this article, Laura Evans, CPC, reviews 2021 E/M coding for outpatient encounters based on provider documentation of medical decision-making (MDM). She breaks down the four levels of problems addressed and describes the types of conditions that would fall into each category.
Hospital coding for pregnancy-related services requires a detailed understanding of the CPT® global obstetric (OB) package and ICD-10-CM coding guidelines for maternal care management. This article details hospital coding for pregnancy and delivery complications and procedures used to treat them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS' new final rule prepares for vaccine coverage for Medicare, Medicaid, and commercial insurers without any out-of-pocket costs. CMS will pay for any coronavirus vaccine that receives FDA authorization either through an Emergency Use Authorization or via a license under a Biologics License Application.
Modifiers provide a means by which a physician or facility can flag a service that has been altered by a special circumstance but has not changed in definition or code. Break down CPT guidelines for reporting hospital modifiers -25, -50, -59, -LT, and RT.
The HIM department plays a critical role in the revenue cycle, but it’s often placed in a reactive position, limiting its effectiveness. Learn how to improve operations by enhancing the HIM department’s involvement across the revenue cycle.
The American Medical Association (AMA) on November 10 announced a handful of new CPT codes for reporting COVID-19 vaccine products and immunization administration.
A multi-organizational collaborative is proving further evidence of the growing interest in behavioral health integration with primary care. Read about organizational efforts to improve collaboration between primary care and mental health providers and enhance billing for behavioral health services.
ICD-10-CM coding for genitourinary conditions requires careful attention to detail. Learn about genitourinary structures and their functions as well as new ICD-10-CM codes for glomerulonephritis, chronic kidney disease, and granulomatous mastitis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What place of service codes and modifiers should be reported on physician claims for wound care services performed via telehealth during the COVID-19 public health emergency?
CMS on October 28 released an interim final rule that ensures physician reimbursement for the administration of a COVID-19 vaccine and outpatient hospital reimbursement for COVID-19 drug services provided at the same time as a comprehensive APC service.
The COVID-19 public health emergency has not made it easy, but coders and medical practice staff have a lot to be proud of this year. Review key findings from a medical practice salary survey, including data to support medical staff pay increases and expanded job responsibilities.
Public comments on 2021 Medicare Physician Fee Schedule (MPFS) proposed rule offer insight into the policy preferences of the medical practice industry. Familiarize yourself with controversial proposed policies to restrict telehealth billing and reduce payment rates for audio-only E/M services.
Modifiers provide a means by which a physician or facility can flag a service that has been altered by a special circumstance but has not changed in definition or code. Break down CPT guidelines for reporting hospital modifiers -25, -50, -59, -LT, and RT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Outpatient coding for behavioral health services can be tricky given number of conditions that influence mental wellbeing. Review potentially confusing CPT coding guidelines for psychiatric evaluations, E/M visit services, and 2021 updates to ICD-10-CM codes for behavioral health. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association (AMA) released two new CPT codes October 7 for reporting antigen tests that detect the novel coronavirus (COVID-19) and influenza.
Valerie A. Rinkle, MPA, CHRI , reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.
In a recent National Correct Coding Initiative (NCCI) update, CMS rolled back many of the procedural edits that it temporarily extended in light of the novel coronavirus public health emergency. Read up on the changes, including 291,274 procedure-to-procedure edits, which took effect October 1.
Review significant updates to the musculoskeletal chapter of the ICD-10-CM manual including 57 new codes and updated guidelines for reporting arthritis, temporomandibular joint disorders, osteoporosis, and osteochondrosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A patient with a history of hypertension sees a cardiologist for chest discomfort during exercise. The cardiologist completes an office visit and performs a cardiac stress test the same day. Would it be appropriate to report the visit using an E/M code with modifier -25?
Baylor Scott & White-College Station didn't properly bill Medicare for supplemental outlier payments, according to a September Office of Inspector General (OIG) report. Reviewed claims contained errors due to overcharging and inaccurate coding, resulting in $189,276 in overpayments, said the report.
On January 1, new patient office visit code 99201 will be deleted from the CPT code set and coders will find revised descriptors for E/M codes 99202-99205 and 99211-99215. Read about how these changes will impact E/M leveling, medical decision-making (MDM), and code selection for outpatient visits.
Between 50-80% of pregnant women complain of back pain, according to the American College of Obstetricians and Gynecologists. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about ICD-10-CM documentation and coding for back pain during pregnancy.
Outpatient coders should be familiar with CPT reporting for knee surgeries based on information in the operative note. This article reviews the anatomy of the knee joint and CPT coding for arthroscopic and reconstructive procedures used to visualize and treat common knee conditions.
Valerie A. Rinkle, MPA, CHRI, reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.
The final 2021 CPT, ICD-10-CM, and ICD-10-PCS code sets were released in September, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes.
Q: During an outpatient visit, a nurse reviews the patient’s medical history and a physician performs an examination in the presence of the nurse. If you adhere to the 2021 E/M guidelines and use time as the controlling factor for code selection, can you report one E/M code for these shared services?
The American Medical Association (AMA) on September 8 published two new CPT codes for novel coronavirus (COVID-19)-related services, including one that accounts for additional supplies and clinical staff time used to mitigate the spread of the virus.
