The 2018 OPPS proposed rule is one of the shortest—and latest—in recent memory, being released July 13 at only 663 pages, but it contains major proposed policy changes for the 340B drug discount program, incorporates new modifiers, and expands packaging to drug administration for the first time.
The words “endometriosis” and “endometrioma” look similar, but as Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes, these conditions vary greatly in terms of physiology and coding.
In the outpatient world, physicians are accustomed to seeing services as the key to reimbursement, but diagnoses and outcomes will increasingly factor into reimbursement as healthcare shifts toward value-based care. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Coding and billing for the transgender patient can be difficult even when society in general has become more aware of people who are transgender. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, covers some of the challenges coders may face when filing claims for transgender patients.
James S. Kennedy, MD, CCS, CDIP , discusses the new ICD-10-CM codes for FY 2018 and describes some of the changes that could be made to documentation and billing habits for these conditions.
With the increased focus on clinical documentation improvement in the outpatient arena, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, shares her tips for proving medical necessity on claims.
E/M services are some of the most frequently used CPT codes, and they are also some of the most frequent examples of incorrect coding. One of the problem areas in selecting the proper E/M code is distinguishing between new and established patients. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The Quality Payment Program proposed rule seems to bring relief to providers anticipating escalation of Medicare Access and CHIP Reauthorization Act (MACRA) requirements, but there are a plethora of reasons for coding professionals to start adapting their workflow for MACRA now. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The American College of Obstetricians and Gynecologists is encouraging providers to decrease the number of cesarean section deliveries. According to Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, this means coders should brush up on their knowledge of how to code fetal intervention procedures for babies who are in a breech position.
CMS Special Edition article 1609 was released in April to clarify CMS’ policy on prolonged drug and biological infusions using an external pump. Valerie A. Rinkle, MPA , breaks down that article and discusses its billing and reimbursement implications in the first of this two-part series.
In the second part of a two-part series on SE1609, Valerie A. Rinkle, MPA , distinguishes between CPT code 96416 and HCPCS code G0498 for billing and reimbursement purposes while outlining how practices can achieve compliance with CMS’ current external pump policy.
Modifier assignment can be a confusing task, and that work is sometimes made more difficult by encountering a set of modifiers which apply to the same circumstance with only one differentiating factor. A review of some of these modifiers, including modifiers -PO, -PN, -73, and -74, can be essential for accurate claims submissions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
May was a busy month for telehealth in the political world on both the federal and state levels. This action serves as a reminder that expanded access will mean an increase in telehealth coding, but navigating eligibility requirements and coding regulations can be a challenge. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Podiatry coding can become complicated quickly, as a number of procedures can be performed on the same site or region of the foot. This means codes could easily run into NCCI edits or denials. One way to ensure physicians are reimbursed properly for provided services is to review NCCI edits pertaining to podiatry.
CMS issued a change request to provide guidance to Medicare Administrative Contractors on the use of a new modifier to append to claims for dialysis treatments for end-stage renal disease exceeding the 13 or 14 monthly allowable treatments.
Wound care can be messy, but reimbursement and billing for wound care does not need to be as troublesome if coding and documentation are done correctly. One of the bedrocks in billing for wound care is ensuring medical necessity, and there are a few tricks and standards to learn about medical necessity in order to stay compliant. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: The CPT Assistant advice on how to apply modifier -59 to CPT code 29874 (knee arthroscopy with removal of loose/foreign body) seems to conflict with NCCI edits. Do the NCCI edits override the advice in CPT Assistant ?
With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
The intersection of CMS’ packaged payment policy and the increasing volume of Medically Unlikely Edits (MUE) can be likened to a car crash waiting to happen. Hospitals are having valid, medically necessary claim lines denied – including charges and units below MUE limits. Providers can help stop the crash by ensuring their claims, CPT coding, medical necessity, and the units are all correct.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about the transition of the CPT code for reporting ablation of uterine fibroid tumors from a Category III to Category I code and the impact that could have on coding and billing.
