Q: When would it be appropriate to apply modifier -62 (two surgeons) on claims for spinal procedures performed by co-surgeons, and what effect would this have on physician reimbursement?
Changes to office E/M guidelines, effective January 1, 2021, will give providers the option to code based on the total time they spend on a patient’s care per date of service. Prepare for these changes by reviewing rules for time-based E/M documentation and code selection.
CMS recently published details on prior authorization requirements, established by the 2020 OPPS final rule, for select hospital outpatient department (HOPD) services, scheduled to go into effect July 1.
Outpatient coders must be able to assign E/M codes for the providers’ work and resources utilized by the facility during emergency visits. This article takes a close look at facility E/M coding and payment for visit services rendered in Type A and Type B emergency departments (ED). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS on April 30 released an interim final rule with regulatory relief for hospital outpatient departments. In this article, Kimberly A. Hoy, JD, CPC , reviews Medicare provisions that allow outpatient departments to bill services at alternate locations during the novel coronavirus (COVID-19) public health emergency.
Physician practices have started reopening to patients but are not expecting a return to normal anytime soon. They continue to struggle with staffing shortages and lost revenue due to COVID-19 restrictions.
Review up-to-date novel coronavirus (COVID-19) documentation tips, ICD-10-CM and CPT coding guidance, and advice for ensuring billing compliance during the public health emergency.
Coding audits are commonly used to determine the need for focused coder education and training. Learn about key considerations for conducting coding audits and summarizing significant audit findings.
The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for the novel coronavirus (COVID-19). This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities.
Determine the impact of new regulatory relief for hospitals regarding outpatient services and telehealth originating site services provided to patients at alternate locations, including their homes.
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.
Even experienced coders have difficulty adhering to CPT reporting guidelines for wound care procedures. Review Medicare’s medical necessity requirements for debridement procedures and CPT coding for wound care services delivered via interactive audio and video. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
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).
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
