With the expansion of telehealth services, providers for both the originating site and distant site can also count on the expansion of Medicare contractor audits.
Valerie Rinkle, MPA, writes about CMS’ hospital prohibition of unbundling rules and a new outpatient date of service exception for molecular pathology and advanced diagnostic laboratory tests.
Even experienced coding professionals find injection and infusion coding confusing because CPT guidelines for these services differ from the guidelines for most other services. Review the drug administration hierarchy and guidelines for reporting therapeutic, prophylactic, and diagnostic injections and infusions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Stress urinary incontinence is a common problem induced by minor physical stressors such as laughing, coughing, or sneezing. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about CPT coding for procedures such as sling operations and laparoscopies, used to treat urinary stress incontinence.
Medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. This article describes how medical necessity impacts third-party payers and those who work in billing and reimbursement services.
Wound care coding can be challenging as wound size, depth, and severity must be properly documented to report the most accurate codes. Review coding for pressure ulcers in ICD-10-CM and wound debridement in CPT to avoid common documentation and reporting errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
One of the most memorable sessions at the AMA CPT Symposium in November 2017 involved an impromptu open mic feedback session facilitated by CMS’ Marge Watchorn, deputy director of the Division of Practitioner Services. The focus of this session was the applicability of the current CMS documentation guidelines for E/M services.
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about discussions at the AMA CPT Symposium that could impact coders, including the need for updates to CMS’ E/M Documentation Guidelines and how medical decision making is used as a key component for E/M reporting.
Bundled Payments for Care Improvement Advanced, a new voluntary bundled payment model launched by CMS in January, includes 32 clinical episodes encompassing both inpatient admissions and outpatient procedures. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , writes about participation criteria, payment calculations, and quality measures for this program.
The skin is the largest organ in the human body and plays a vital role in protecting the body from injury and illness. This article reviews integumentary anatomy and provides guidance to aid in accurate ICD-10-CM and CPT code assignment for complex integumentary diagnoses and procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CPT modifier -22 for an increased procedural service is frequently reported incorrectly. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the circumstances under which it would be appropriate to report modifier -22, and provides tips for accurate documentation to support use of the modifier.
Drug abuse is a serious public health issue that affects millions of Americans. Familiarize yourself with diagnosis reporting for substance use disorders to ensure that ICD-10-CM-dependent administrative data accurately captures the social consequences of substance abuse. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS' Bundled Payments for Care Improvement Advanced model will qualify as an Advanced Alternative Payment Model under the Quality Payment Program and include outpatient episodes.
A recent report released by the Centers for Disease Control and Prevention revealed that almost 70% of Americans are considered overweight or obese. This epidemic costs American healthcare systems approximately $190 billion per year in treatment of weight-related conditions.
The advancement of accurate and compliant coding efforts brings unique challenges. As benevolent as a health information management (HIM) department’s mission may seem to be, for many facilities, the focus of physician queries continues to be “optimizing” information in the medical record to increase reimbursement.
Updates to the 2018 CPT Manual particularly effect coding for cardiovascular and laboratory procedures. Stay-up-to-date with these changes and take time to understand complex procedures to prevent interruptions to claims processing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Approximately 2%-3% of children between the ages of 6 and 12, and 6%-8% of adolescents in the U.S. may have serious depression. Debbie Jones, CPC, CCA details common symptoms of anxiety and depression in adolescence and provides advice for diagnostic coding of these conditions.
New ICD-10-CM/PCS codes provide additional specificity to describe the condition of and care afforded to a given patient. This article takes a closer look at these code updates as well as guidelines for reporting codes under new payment models.
In this article, Valerie A. Rinkle, MPA, offers guidance regarding the 340B drug discount program. She provides tips for accurate documentation of drug purchases and reviews frequently asked questions about billing for 340B-acquired drugs in 2018.
Coding for damage control surgery and acute blood loss anemia can be difficult when clear provider documentation is not found within the medical record. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, outlines best practices for identifying anemia and ensuring more accurate documentation.
Complying with healthcare regulations within a coding department or physician practice involves promoting a positive attitude toward activities such as self-monitoring and staying up-to-date with healthcare regulations. Follow these steps to adhere to sound business ethics and set expectations for behavior across an organization. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CMS' 340B FAQ reviews modifiers -JG (drug or biological acquired with 340B drug pricing program discount) and -TB (drug or biological acquired with 340B drug pricing program discount, reported for informational purposes) and requires 340B hospitals to report modifiers even on drugs that are not subject to the discount policy.
If ICD-10-CM/PCS is used to its full potential, it will provide greater detail and a more accurate depiction of patient severity. This level of detail is expected to provide more information about the relationship between a provider’s performance and the patient’s condition.
The first week of December was National Influenza Vaccination Week, a week highlighting the importance of continuing flu vaccination, particularly through the holiday season. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes about CPT coding for vaccinations and immunization administration.
Updates to the 2018 CPT Manual , set to go into effect January 1, include several additions, revisions, and deletions to E/M and anesthesia procedural code sets. Familiarize yourself with these coding changes to aid in accurate reporting and prevent disruptions to the claims process. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
When faced with a claim denial, providers need to understand what is being denied and when an appeal is appropriate. This article outlines basic steps providers need to take before composing an appeal for a claim denial and helpful tips for successfully navigating through the appeals process.
The improper payment rate for hospital outpatient services was 5.4%, accounting for 7.5% of the Medicare Fee-For-Service improper payment rate, according to 2016 Medicare Fee-for-Service Improper Payments Report.
Coding for respiratory conditions can be challenging, given the structural complexity of the upper and lower respiratory tracts. Refresh your knowledge of respiratory anatomy to aid in the accurate reporting of common respiratory diagnoses such as emphysema, asthma, and chronic bronchitis. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
HCCs aren’t new, but for many organizations, their impact hasn’t been apparent until recently. Organizations must educate staff on HCCs to ensure success under reimbursement methodologies such as the Quality Payment Program and Merit-based Incentive Payment System reimbursement.
Each year, more than 2,000 Americans are diagnosed with mesothelioma— an aggressive and deadly type of cancer that develops in the lining of the lungs, abdomen, or heart. Debbie Jones CPC, CCA , writes about different types of mesothelioma and how they should be reported in ICD-10-CM.
CMS is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released in November.
CMS’ policy in the 2018 OPPS final rule to cut reimbursement for drugs purchased through the 340B drug discount program by nearly 30%, accounting for the decrease from average sales price plus 6% to minus 22.5%, is getting a lot of attention from the provider community—and with good reason.
November, a month associated with the pleasure of eating, is also Stomach Cancer Awareness Month. In this article, Yvette M DeVay, MHA, CPC, CPMA, CIC, CPC-I, describes signs and symptoms of stomach cancer, and outlines best practices when assigning diagnostic and procedural codes for this disease.
Review vascular anatomy and terminology in order to aid in accurately assign codes for interventional radiology procedures such as angioplasties, atherectomies, and lower extremity revascularizations. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
A new private payer rate-based Clinical Laboratory Fee Schedule (CLFS) system is estimated to drastically reduce Medicare Part B lab payments in 2018. Valerie A. Rinkle, MPA, details how this revision will impact providers in outpatient settings and payers tied to the Medicare CLFS.
More and more, hospitals are experiencing a shift of services from inpatient to outpatient settings. In this article, Laura Jacquin, RN, MBA , describes common challenges healthcare workers face when providing comprehensive documentation for services across the care continuum.
In order to accurately code for complex diseases and procedures of the brain, spinal cord, and sense organs, coders need a basic understanding of nervous system functionality. This article provides detailed information on nervous system anatomy and terminology, common brain and nervous system disorders, and recently introduced 2018 ICD-10-CM codes related to nervous system conditions.
Ovarian cysts may develop at any point in a woman's life and frequently occur with other medical diseases. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, details best practices when assigning ICD-10-CM/CPT codes for ovarian cyst diagnoses and procedures.
Patient care continues to move from the inpatient setting to outpatient. With this change, the challenge of securing comprehensive documentation that articulates the services rendered and the patient care provided now needs to extend across the care continuum.
Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) added a requirement that will dramatically revise the Medicare Clinical Laboratory Fee Schedule (CLFS) effective January 1, 2018.
In July, Utah pain doctor Jahan Imani, MD, and Intermountain Medical Management, P.C., entered into a nearly $400,000 settlement with the OIG to resolve allegations that Imani’s practice submitted false or fraudulent claims due to improper modifier use for payment by improperly using modifier -59 with HCPCS code G0431.
A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter .
The new ICD-10-CM codes for FY 2018, effective October 1, represent significant changes in some hospital documentation and coding practices. James S. Kennedy, MD, CCS, CDIP, CCDS , reviews some of the most significant revisions to the ICD-10-CM guidelines for 2018.
Whether big or small, crooked or straight, the nose is a vital component of the human respiratory system. There will be extra focus on nasal anatomy in 2018, as the CPT® codes for nasal endoscopies were revised. Brush up on nasal anatomy to prepare for reporting these new codes. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The best time to determine code edits is when the account is coded, meaning coding professionals play a key role in establishing overarching principles and best practices for edit management.
