The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant potential updates to E/M coding and reporting. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS , reviews the proposed changes and their potential impact on coding and billing for office visits and other outpatient services in 2019.
This second article in a series reviews common procedures used to isolate back pain and reduce inflammation including nerve block injections, facet joint injections, and facet denervation. CPT coding for these procedures is complex and requires a detailed understanding of spinal anatomy and terminology as well as coding guidelines. Note : To access this article, you must first register here if you do not have a paid subscription.
A July 2018 update to the OPPS clarifies that coders can report HCPCS code C9749 for an inherently bilateral procedure with modifiers -73 or -74 to indicate that the procedure was unilateral. Debbie Mackaman, RHIA, CPCO, CCDS, unpacks this seemingly contradictory guidance and addresses implications for coding and billing professionals.
Coding for pain management requires a detailed understanding of medical anatomy and terminology as well as the guidelines for reporting complex surgical procedures. Review ICD-10-CM coding for chronic and acute pain diagnoses and CPT coding for trigger point, joint, and epidural steroid injections. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In the April 2018 OPPS update transmittal, CMS announced new HCPCS code C9749 (repair of nasal vestibular lateral wall stenosis with implant[s]), effective April 1, 2018.
Understanding when and how to report hospital modifiers is critical to ensuring compliant billing. Review CPT guidelines for modifiers -25, -50, and -59, as well as case studies and denial numbers by specialty, to reduce your risk from audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Cognitive impairment ranges from mild to severe and can impact a person’s ability to perform everyday functions such as talking, remembering, and comprehending information. Debbie Jones, CPC, CCA , reviews CPT and ICD-10-CM coding, and care planning for patients living with cognitive impairment.
Cancer is the second most common form of death in the U.S., according to the Centers for Disease Control. To accurately report CPT and ICD-10-CM codes for skin and breast cancer, coders need a thorough understanding of symptoms of malignancies and treatments used to prevent them from spreading. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Predicting CMS policies can be a foolhardy exercise, especially with a relatively new administration and frequent turnover at the highest levels of HHS over the last year. But it’s safe to say drug payment policy has been and will continue to be a focus of the current regime.
Pelvic congestion syndrome is a chronic medical condition affecting millions of women between the ages of 20 and 45. Lori-Lynne Webb CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS , reviews symptoms of the condition and reporting using CPT and ICD-10-CM codes.
A recent report from the Office of Inspector General focuses on improper payments for specimen validity tests billed in combination with urine drug tests. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I, reviews Medicare instructions and coding guidance for presumptive and definitive drug testing.
Every year, more than 30 million people in the United States are diagnosed with sinusitis, otherwise known as a sinus infection. Debbie Jones, CPC, CCA, reviews signs and symptoms of sinusitis and CPT coding for procedures used to treat the infection.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), it is estimated that more than half a million people in the U.S. have Crohn’s disease. For unknown reasons, the disease has become more widespread in both the U.S. and other parts of the world.
CMS recently released MLN Matters SE18001 to provide healthcare practitioners with instructions and coding guidance for specimen validity when performed and billed in combination with drug testing. The article was issued to remind laboratories and other providers performing urine drug testing that specimen validity testing (SVT) is not separately billable.
A coding audit may be conducted by internal staff or external entities, typically representing the insurers paying for the care. When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration.
Coding for hydration and chemotherapy administration can be a daunting task for both beginner and experienced coders, who may not understand the hierarchy rules and gray areas in the CPT guidelines. Review correct coding for these services and how they fit into the hierarchy. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Providers should be preparing for another rulemaking cycle from CMS as we hit April, with the IPPS rule expected to include a discussion on how the existing payment system can address new and emerging cellular and gene therapies.
The shift from fee-for-service to value-based programs for outpatient payment systems has increased the need for outpatient CDI staff to review documentation for pertinent clinical factors.
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.
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.
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.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about discussions at the 2017 AMA CPT Symposium that could impact coders, including issues with the Table of Risk for E/M office visit codes and suggestions for E/M guideline revisions. This article is part two in a series.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
Outpatient coding’s impact on reimbursement is evolving as healthcare continues its march toward value-based care. Kim Miller, CPC, CHC , and Kerri Wing, RN, MS , detail how coders play a central role in this shift.
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one Medicare administrative contractor tightened up physician supervision requirements.
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one MAC tightened up physician supervision requirements.
In the 2018 OPPS proposed rule, CMS proposed a change to the current clinical laboratory date-of-service policies for molecular pathology tests and for Advanced Diagnostic Laboratory Tests.
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.
The urinary system might not be one of the body systems people are most eager to discuss, but learning the anatomy of the urinary system is key in coding certain procedures, especially in the surgical and interventional radiology specialties. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
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.