Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the 2023 Medicare Physician Fee Schedule proposed rule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
Effective October 1, the ICD-10-CM code set will be updated to include over 1,100 new codes before counting code revisions and deletions. This article covers new codes for musculoskeletal and genitourinary conditions including muscle wasting, rib and sternal fractures, drug-induced neuropathy, and endometriosis.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, writes about the 2023 updates coders will find in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.
In part two of this series, expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, addresses the “nuts and bolts” of ICD-10-CM coding for anesthesia services, including how and when to append modifiers.
A broken nose is a break in the bone or cartilage over the bridge of the nose or over the septum—the structure that separates the nostrils. Debbie Jones, CPC, CCA , explains how to select the most specific CPT codes for nasal fracture and dislocation treatments.
Most coders never have the opportunity to code for anesthesia. Expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains that ICD-10-CM coding for anesthesia services is interesting and straightforward, but can be confusing if an individual is unfamiliar with coding guidelines and terminology for anesthesia administration.
The 2023 CPT update will shift provider consults, facility, and home-based E/M visits to a coding model based on medical decision-making (MDM) or time, according to the AMA.
The Centers for Disease Control and Prevention recently released the 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting. Review key ICD-10-CM updates including new codes for dementia, head injuries, and long-term drug therapy.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting. Review key ICD-10-CM updates including new codes for dementia, head injuries, and long-term drug therapy.
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.
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.
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.
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 .
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.
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.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how to use Office of Inspector General audit reports to identify areas at risk for noncompliance and how to organize targeted internal reviews.
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.
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.
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.
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.
Review new CPT codes 98975-98981 for the monitoring of non-physiologic patient data such as musculoskeletal system status, respiratory system status, and medication adherence.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
Review documentation requirements and CPT coding for radiology services including computed tomography and x-ray scans, breast mammography, and bone length studies.
Medical practices in the U.S. are expanding treatment options for major depressive disorder to include transcranial magnetic stimulation (TMS). Laurie Bouzarelos, MHA, CPC, reviews the basics of TMS, types of providers who can deliver TMS, and ICD-10-CM/CPT coding for TMS delivery and management.
CMS recently released the 2022 National Correct Coding Initiative Policy Manual for Medicare Services . Julia Kyles, CPC , breaks down procedure-to-procedure and medically unlikely edits for a selection of new provider-based services.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
The 2022 CPT code set includes 249 new codes that went into effect January 1. Review new CPT codes for spinal decompressions, cataract removals, auditory implantations, and more.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT.
Four new CPT codes for principal care management services take effect January 1, 2022. Review documentation requirements and billing edits that will affect reporting of these new codes.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CACO, CAC, reviews findings from a recent Office of Inspector General audit of claims for neurostimulator implantation surgeries and their implications for coders.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia.
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries.
Kimberly A. Hoy, JD, CPC , summarizes proposed changes to physician coding and billing for therapy assistant services in the 2022 Medicare Physician Fee Schedule proposed rule.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The latest quarterly National Correct Coding Initiative (NCCI) update includes a reversal of procedure-to-procedure (PTP) edits that involve E/M codes along with new medically unlikely edits (MUE) for a series of COVID-19 vaccination codes. Review the changes, which went into effect on October 1.
ICD-10-CM coding for neuropathies can be challenging given the complexity of these diagnoses and associated complications. Demystify documentation requirements and ICD-10-CM coding for ischemic and hemorrhagic strokes, migraine headaches, and paralysis.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for diagnostic services performed during the second and third trimesters, and provides an overview of an obstetric (OB) hospitalist's role in caring for high-risk maternity patients.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for diagnostic services performed during the second and third trimesters, and provides an overview of an obstetric (OB) hospitalist's role in caring for high-risk maternity patients.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for ancillary services provided by obstetric providers including targeted ultrasound services and maternal serum tests used to screen for fetal abnormalities.
CMS recently released the 2022 Medicare Physician Fee Schedule proposed rule, which introduces new guidelines for reporting split/shared visit services. Julia Kyles, CPC , analyzes how the changes would impact physician practices.
Review proposed updates to the CPT set for 2022, including new codes for chronic care management, laser interstitial thermal therapy, spinal anesthesia, and more.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
CPT coding for vaginal and cesarean deliveries and postpartum care requires strong attention to detail. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down stages of delivery and CPT coding guidance for childbirth.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
Read up on ICD-10-CM code updates for fiscal year 2022, including new codes for post-COVID-19 symptoms, social determinants of health, and poisonings by cannabis and synthetic cannabinoids.
Cardiovascular conditions affect the structure and function of the heart and are a leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. This article details ICD-10-CM coding for common heart conditions and CPT coding for cardiac catheterization procedures.
The 2022 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant policy updates affecting physician coding and billing. Review proposals to decrease to the Medicare conversion factor, revise guidelines for critical care services, and loosen telehealth coverage requirements.
The 2022 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant policy updates affecting physician coding and billing. Review proposals to decrease to the Medicare conversion factor, revise guidelines for critical care services, and loosen telehealth coverage requirements.
Approximately 34.2 million Americans, or 10.5% of the U.S. population, were diagnosed with diabetes in 2018, according to the Centers for Disease Control and Prevention. Review signs and symptoms of diabetes mellitus types 1 and 2 and ICD-10-CM coding for these conditions.
Refresh your knowledge of dysphagia, esophagitis, gastroesophageal reflux disease, and Barrett’s esophagus, and review guidance for reporting these conditions in ICD-10-CM.
Laura Evans, CPC, and Julia Kyles, CPC, break down potentially confusing updates to the 2021 E/M guidelines, including new definitions for technical terms and revised guidance for reporting diagnostic laboratory testing with interpretation.
Laura Evans, CPC , and Julia Kyles, CPC , break down potentially confusing updates to the 2021 E/M guidelines, including new definitions for technical terms and revised guidance for reporting diagnostic laboratory testing with interpretation.
Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how facilities can create internal guidelines and point systems for determining E/M level section.
The most impactful overhaul to the E/M coding and documentation guidelines in 25 years went live January 1. The updated guidelines eliminate medical history and physical examination as required elements for reporting E/M codes 99202-99215. E/M coding for outpatient visits is now based on documentation of medical decision-making (MDM) or time spent on the encounter.
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures.
The mid-revenue cycle is rife with possibilities to lose earned, appropriate revenue. Learn how to identify common weaknesses and deploy coding and technology to avoid revenue loss.
CPT neurology codes describe advanced techniques to evaluate and treat conditions of the brain, spinal cord, and nerves. This article details CPT coding for three procedural services used to assess neurological symptoms: electroencephalogram, electromyography, and auditory-evoked potentials testing.
Arthroscopic surgical procedures involve the insertion of a small scope into the interior of a joint, allowing the physician to view the joint without making a large incision through the skin. Review CPT coding for arthroscopic procedures of the hip and knee joints.
Coding managers use risk assessments to measure their level of compliance with laws, regulations, and internal policies and procedures. Learn about the steps involved in E/M risk assessments and practices used to address E/M coding and billing errors.
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.
In a year of unprecedented disruption and uncertainty, coding productivity managed to hold steady, according to the results of our 2020 Coding Productivity Survey. Learn how facilities adapted and how yours compares.
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.
Read about regulatory updates in the 2021 Medicare Physician Fee Schedule final rule impacting CPT coding for chronic and transitional care management services, and billing for COVID-19-related services.
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.
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.
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%.
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.
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.
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.
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.
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.
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.
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.
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.
Q: When would it be appropriate to report modifier -58 (staged or related procedure or service by the same physician during the postoperative period) for a procedure performed during the postoperative period?
CMS is moving forward for E/M changes for physician billing according to the 2021 Medicare Physician Fee Schedule. Read about those changes, as long as a preview of new CPT codes that will be added for 2021.
Familiarize yourself with notable code updates in the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule, including new E/M reporting guidelines and CPT® codes for lung biopsies, auditory testing, and chronic care management.
Familiarize yourself with proposed updates to the Medicare Physician Fee Schedule (MPFS), including plans to significantly revise the E/M coding guidelines and extend telehealth flexibilities beyond the COVID-19 public health emergency.
Coders must apply modifiers to CPT codes for select services rendered during the novel coronavirus (COVID-19) public health emergency to ensure that providers are paid in full for documented work. This article details reporting of telehealth modifiers -95, -G0, and -GQ, and emergency modifiers -CR and -CS. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding managers: Take steps to effectively prepare staff for the transition to the new E/M guidelines, scheduled to take effect January 1. Review advice from coding experts on updating patient forms, medical record software, and rethinking your workflow to prepare staff for the changes to come.
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.
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.
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.
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.
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.
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.
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.
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.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. On January 30, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern due to its sustained person-to-person spread within countries and across continental borders.
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.
CMS recently announced that it will cover acupuncture therapy sessions for Medicare patients with chronic low back pain. Read about how this change will impact physician coding and billing for acupuncture services.
