Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services is used to control improper coding leading to inappropriate payment for Part B services. This article provides an in-depth overview of 2022 updates to the NCCI Manual including new and revised reporting guidance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Many factors influence the identification of a primary diagnosis, including varying provider documentation styles and health record nuances. Holly Cassano CPC, CRC, navigates challenges that come with selecting an appropriate primary diagnosis code.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
Coding managers should not assume that they can review every coding guideline, Coding Clinic , or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits.
Ongoing labor shortages and a competitive hiring market are putting a strain on HIM departments. As competition for qualified staff increases, learn how HIM leaders can turn to a variety of short- and long-term fixes and even find opportunities for improvement.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Although many provisions of the 2022 OPPS final rule are a light lift for hospitals, several have far-reaching implications. Apply these expert tips to ensure you're up to speed and aware of compliance pitfalls.
Medication Therapy Management (MTM) is a group of services provided by pharmacists that involve active management of drug therapy. Review CPT coding, the role of pharmacists, and documentation tips associated with MTM.
The American Medical Association (AMA) recently announced an editorial update to the CPT code set for COVID-19 vaccines that includes new codes for Pfizer-BioNTech’s booster vaccine and Sanofi-GlaxoSmithKline’s (Sanofi-GSK) vaccine candidate.
Q: What is the best way to determine if an E/M service is above and beyond the physician work normally associated with a procedure to justify the use of modifier -25?
Sometimes even the most seasoned revenue integrity professionals get stumped trying to navigate the maze of billing, charging, and coding rules that govern chargemaster structure. Review expert answers to perplexing chargemaster questions.
CMS’ recently released fiscal year (FY) 2023 IPPS proposed rule includes 1,179 proposed ICD-10-CM code additions, mainly affecting reporting for dementia, concussions, and injuries due to motor vehicle collisions. The code changes, if finalized, would take effect October 1, 2022.
Podiatry is the study, diagnosis, and treatment of disorders or deformities of the foot and ankle. Read up on foot and ankle anatomy and CPT coding for hallux valgus and rigidus corrections, cock-up fifth toe repairs, toe amputations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Determination of what is medically necessary for any given diagnosis is set forth by the healthcare industry’s Standard of Care. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation .
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation .
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the difference between an implant and a foreign body removal and outlines CPT coding for these procedures.
A New York City provider received an estimated $1.1 million in Medicare overpayments for behavioral health services that did not comply with billing requirements, according to a recent Office of Inspector General (OIG) report.
Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Although most organizations do a good job of tracking denials by reason, payer, and volume, they miss the mark when communicating information about appeals, according to the results of HIM Briefings’ 2022 Denials Management Survey.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the difference between an implant and a foreign body removal and outlines CPT coding for these procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Physician service modifier -FT for unrelated E/M visits provided on the same day has been a source of confusion for many coding and billing professionals. Review the latest coding and billing guidance for reporting this modifier.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Bruxism, or excessive teeth grinding, is a common condition that is often brought on by stress and anxiety . Debbie Jones, CPC, CCA , describes the causes and symptoms of bruxism and ICD-10-CM coding for the condition.
CMS recently released an update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edit files, introducing more than 4,000 new CPT code pairs. The PTP edits took effect April 1 and primarily involve codes found in the pathology and laboratory section of the CPT Manual .
Anxiety disorders are the most common mental illness in the U.S., according to the National Institute of Mental Health Statistics. Shelley Safian, PhD, RHIA, CCS-P, COC, CIC , breaks down ICD-10-CM coding for common types of anxiety disorders and psychotherapy treatments used to manage them.
Electronic health records (EHR) hold all the important information about patients’ medical histories and demographics. Historically, however, they have tended to only include one indication of gender: the gender a patient was assigned at birth.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality.
Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Arterial embolization is less invasive than open surgery and is often performed as an outpatient procedure in a hospital setting. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, evaluates medical necessity and CPT coding for uterine artery embolization.
Providers can now code for E/M visits based solely on medical decision-making. Julia Kyles, CPC , outlines how to use the first column of the medical decision-making chart in the CPT Manual to determine E/M level selection.
Following the release of the Medicare Payment Advisory Commission’s March report to Congress, the American Medical Association (AMA) urged Congress to revise the Medicare Physician Fee Schedule (MPFS) to include stable, annual payment updates that keep up with inflation and practice costs.
Anxiety disorders are the most common mental illness in the U.S., according to the National Institute of Mental Health Statistics. Shelley Safian, PhD, RHIA, CCS-P, COC, CIC , breaks down ICD-10-CM coding for common types of anxiety disorders and psychotherapy treatments used to manage them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released new HCPCS modifiers -FR, -FQ, -FS, and -FT for telehealth visits. Julia Kyles, CPC , breaks down reporting guidance for these new physician modifiers that took effect January 1.
To assign the most specific CPT codes for spinal procedures, coders need a solid understanding of spinal anatomy and surgical terminology. Review spinal anatomy and CPT coding for vertebral corpectomies, discectomies, laminectomies, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
CMS recently announced a new HCPCS Level II code for COVID-19 convalescent plasma administered in the outpatient setting, effective for claims submitted on or after December 28, 2021.
Organizations may opt to measure productivity using several methods, such as number of charts coded per day or per month, based on their needs, service lines, and other considerations. Some organizations use different productivity metrics for specific settings or account types.
The 2022 ICD-10-CM manual includes new codes for thrombotic microangiopathy (TMA)—a rare clinical syndrome defined by the presence of hemolytic anemia, organ dysfunction, and low platelets. Read up on TMA pathophysiology and diagnosis coding.
Chapter 19 of ICD-10-CM includes codes for various types of injuries, poisonings, and other consequences of external causes. Review integumentary anatomy and ICD-10-CM coding for burns and superficial injuries.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
Q: What is the difference between anterior and posterior approaches to spinal surgery, and when might a physician use a combined (anterior and posterior) approach?
