Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Peggy Blue, MPH, CPC, CEMC, CCS-P, explain when to report the new codes introduced in the 2016 CPT Manual for genitourinary procedures.
The AMA introduced new CPT codes for 2016 to report intracranial therapeutic interventions. Stacie L. Buck, RHIA, CCS-P, CIRCC, RCC, reviews the changes and provides examples on how to use them in a variety of procedures.
Q: What can we report for the physician if circumcision is done during delivery? Do we bill that on a separate claim for the infant? Is this a covered procedure?
Perhaps recognizing the massive undertaking for coding and HIM departments in 2015 with the implementation of ICD-10, the latest CPT® update includes a relatively small 367 changes for 2016. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Peggy Blue, MPH, CPC, CEMC, CCS-P, review updates to the digestive system and E/M codes.
Before the new year begins, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, recommends taking a look at post-implementation risks CMS and third-party payers have identified. She also offers solutions on auditing and reviewing these risks. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
Physician office coders are likely familiar with coding for x-ray procedures, but may not have much experience coding ultrasound. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, and ICD-10-CM/PCS trainer, reviews how ultrasound procedure codes are categorized and offers tips on reporting them in office settings.
Primary care providers see patients for a wide variety of conditions, meaning coders in those settings may have to learn many of the new concepts and terms in ICD-10-CM. Annie Boynton, BS, RHIT, CPCO, CCS, CPC, CCS-P, COC, CPC-P, CPC-I, and Rhonda Buckholtz, CPC, CPC-I, CPMA, CRC, CHPSE, CGSC, CENTC, COBGC, CPEDC, discuss three common conditions seen in these settings and what information coders will need to look for in documentation to code them in ICD-10-CM.
Nearly 30% of Medicare patients are enrolled in Medicare Advantage (MA) programs, which come with specific coding and documentation challenges. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, and Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, highlight key requirements for reporting diagnoses that map to Hierarchical Condition Category codes, the basis of MA plans.
Evaluation and management (E/M) services are one of the top areas of review by federal auditors. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about common errors found in audits and how providers can take steps to correct them.
Hierarchical Condition Category (HCC) coding may be a foreign concept for some coders, but making sure documentation for Medicare Advantage patients supports it can be critical. Holly J. Cassano, CPC , discusses what criteria needs to be met for complete documentation.
While the digestive and integumentary sections had extensive edits in the latest CPT ® update, many sections were left relatively unchanged. Joanne Schade-Boyce, BSDH, MS, CPC, ACS , and Denise Williams, RN, CPC-H, review which sections only had minor updates and take a closer look at evaluation and management and chemodenervation changes in the 2014 CPT Manual.
Coders use the same CPT ® codes to report outpatient services whether they are coding physician or facility services. Jaci Johnson, CPC,CPC-H,CPMA,CEMC,CPC- I, and Judy Wilson, CPC, CPC-H, CPCO, CPC-P, CPPM, CPCI, CANPC, CMRS, examine the similarities and differences between coding in the two settings.
In the coding world, it’s a never-ending clash that can cause compliance concerns—facility vs. professional. Kimberly Anderwood Hoy, JD, CPC , and Peggy Blue, MPH, CPC, CCS-P, explain how coders in each setting use different codes for the exact same services based on the payment systems, the rules, and how each setting applies those rules.
Misusing modifier -25 (significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service) can be an expensive proposition. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, and Debbie Mackaman, RHIA, CHCO, explain how to determine when an E/M service is significant and separately identifiable.
The rules for coding for facilities and physicians are basically the same for most services, but coders follow different rules for appending certain modifiers. Christi Sarasin, CCS, CCDS, CPC-H, FCS , Kimberly Anderwood Hoy, JD, CPC , and Peggy Blue, MPH, CPC, CCS-P, separate physician and facility rules for using modifiers -26, -TC, and -79.
