The Centers for Disease Control and Prevention reports that approximately 15 million people in the U.S. report experiencing acute joint pain due to arthritis. Shelley C. Safian, Ph.D., RHIA, CCS-P, reviews ICD-10-CM and CPT coding for lower extremity arthritis and procedures used to treat it.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
Essential newborn care includes services provided at the time of birth and over the first hours of life. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about E/M coding for these routine obstetric services.
Medicare auditors have identified failure to document time as a key flaw in claims for advance care planning (ACP), and the Office of Inspector General plans to conduct an audit of these services. Read up on documentation requirements and CPT coding for ACP to prevent claim denials.
Corneal dystrophies are a group of genetic, often progressive, eye disorders that alter functioning of the cornea. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for corneal dystrophies and CPT coding for procedures used to treat them.
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.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, CCDS-O, analyzes confusing E/M guidelines for time-based visits and prolonged services provided before or after a face-to face encounter.
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.
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.
A vaginal cuff tear, also known as vaginal cuff dehiscence, is a severe complication of a hysterectomy . Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about CPT coding for transvaginal and laparoscopic vaginal cuff repairs.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In its February MLN Connects newsletter, CMS reminds providers that HCPCS add-on code G2211 for visit complexity is a bundled service under the Medicare Physician Fee Schedule, meaning the application of this code will not result in additional payment for a billed E/M visit service.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, HCISPP , writes about CPT coding for total hip arthroplasty and autologous chondrocyte implantation: two orthopedic procedures that were recently removed from the inpatient-only (IPO) list for 2021.
In the 2021 Medicare Physician Fee Schedule final rule, CMS announced new HCPCS add-on code G2211 for visit complexity inherent to E/M services. Julia Kyles, CPC, describes when and how to report G2211 with E/M codes 99202-99215.
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.
Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.
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.
The Medicine chapter of the CPT Manual covers a wide variety of services applicable to multiple specialties. Review calendar year 2021 updates to CPT® codes for medicine services including new codes for continuous electrocardiogram recordings and auditory-evoked potentials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
CMS' new final rule prepares for vaccine coverage for Medicare, Medicaid, and commercial insurers without any out-of-pocket costs. CMS will pay for any coronavirus vaccine that receives FDA authorization either through an Emergency Use Authorization or via a license under a Biologics License Application.
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.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Outpatient coding for behavioral health services can be tricky given number of conditions that influence mental wellbeing. Review potentially confusing CPT coding guidelines for psychiatric evaluations, E/M visit services, and 2021 updates to ICD-10-CM codes for behavioral health. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association (AMA) released two new CPT codes October 7 for reporting antigen tests that detect the novel coronavirus (COVID-19) and influenza.
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.
The final 2021 CPT, ICD-10-CM, and ICD-10-PCS code sets were released in September, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes.
Valerie A. Rinkle, MPA, CHRI, reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.
Strabismus is one of the most common eye problems in children, according to Stanford Children’s Health. In this article, Debbie Jones, CPC, CCA , details ICD-10-CM coding for strabismus and CPT coding for surgical treatments used to correct eye misalignment.
CMS continues to focus on site-neutral payment policies and keeping payments down for 340B-acquired drugs in the 2021 OPPS proposed rule, released in early August. Read about these proposals which if finalized, will impact hospital billing and payment starting January 1.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The final 2021 CPT, ICD-10-CM, and ICD-10-PCS code sets were released last week, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes. Read up on the changes, which will impact payment for hospital services in 2021.
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.
CMS continues to focus on site-neutral payment policies and keeping payments down for 340B-acquired drugs in the 2021 OPPS proposed rule, released in early August.
CMS released the calendar year (CY) 2021 MPFS and OPPS proposed rules on August 3, introducing new CPT codes, reducing the PFS conversion factor by nearly 11%, and seeking commentary on how to gradually eliminate the inpatient only list.
This article details CDI quality review processes from various hospitals, some of which zero in on patient safety indicator and mortality cases to improve their facility’s severity of illness and rate of mortality scores.
Judith L. Kares, JD, writes about the unique coverage, billing, and payment rules that apply to these blood products and related services under Part B.
In response to the novel coronavirus (COVID-19) public health emergency, CMS has expanded patient access to telehealth services, allowing beneficiaries to receive a wide range of services without having to visit a healthcare facility.
CPT® coding for respiratory procedures can be challenging, given the structural complexity of the upper and lower respiratory tracts. Refresh your knowledge of respiratory anatomy and CPT reporting of angiographies, laryngoscopies, and endotracheal intubations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
Physicians and facilities use the same codes to report E/M levels for ED services, but follow different rules. Outpatient coders must be able to assign E/M codes for both physicians’ work and resources utilized by the facility during emergency visits.
CMS recently issued a major update to frequently asked questions (FAQ) on COVID-19 fee-for-service billing issues. The bulk of the new FAQs concerns hospitals and the ability to invoke various waivers in order to deliver services to patients in their homes using telecommunications technologies.
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.
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.
Review up-to-date novel coronavirus (COVID-19) documentation tips, ICD-10-CM and CPT coding guidance, and advice for ensuring billing compliance during the public health emergency.
The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for the novel coronavirus (COVID-19). This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities.
Determine the impact of new regulatory relief for hospitals regarding outpatient services and telehealth originating site services provided to patients at alternate locations, including their homes.
In this article, Joel Moorhead, MD, PhD, CPC , breaks down ICD-10-CM code selection for cerebrovascular diseases, transient cerebral ischemic attacks, and peripheral neuropathies.
Even experienced coders have difficulty adhering to CPT reporting guidelines for wound care procedures. Review Medicare’s medical necessity requirements for debridement procedures and CPT coding for wound care services delivered via interactive audio and video. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To assign CPT codes for spinal procedures, coders need a solid understanding of spinal anatomy and procedural terminology. They must also be up to date on guidance from CMS and the American Medical Association for facility reporting of spinal surgeries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19.
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.
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.
In its April update to the OPPS, CMS made effective new Proprietary Laboratory Analysis (PLA) codes for biochemical assays and billing codes for novel coronavirus (COVID-19) laboratory tests. Hospital coders should review these updates to ensure that they are selecting the most specific codes for these services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To code for spinal excisions and decompression procedures, coders must break down provider documentation to determine the surgical approach utilized and surgical specialists involved, and in some cases, visualize how the procedure was performed across multiple levels of the spinal column.
Providers will find immediate opportunity to provide virtual visits to patients enrolled in Medicare and Medicare Advantage plans as CMS seeks to facilitate screening and treatment of novel coronavirus (COVID-19) cases.
Given the frequency with which wound procedures are performed, and the expenses associated with their performance, it’s essential that coders have a clear understanding of how to accurately report CPT codes for these services. Review 2020 CPT codes for wound repairs and grafting procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hemorrhoids are the third most common outpatient gastrointestinal diagnosis in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases. Debbie Jones, CPC, CCA , writes about symptoms of hemorrhoids and CPT coding for treatment.
When reporting CPT codes for spinal excisions and decompression procedures, coders must consider the approach used, spinal levels operated on, number of providers involved, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders will find a wide range of CPT and HCPCS Level II codes that have been assigned medically unlikely edits (MUE) this year. Review new MUE values that went live January 1 for codes involving drug injections as well as E/M, radiology, and therapy services.
Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.
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.
More than 34 million people in the U.S. have diabetes and one in five don’t know they have it, according to the Centers for Disease Control and Prevention. In this article, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about E/M coding for diabetes management and HCPCS Level II coding for external insulin infusion pumps.
The Medicine section of the CPT Manual includes codes for a variety of services including acupuncture, vaccinations, and behavioral health assessments and is divided into 33 subsections that can make it challenging to navigate.
The Medicine section of the CPT Manual includes codes for a variety of services and is divided into 33 subsections that can be challenging to navigate. Review guidance for reporting 47 new codes within this section of the manual including those for vaccines, behavioral assessments, ocular examinations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association introduced new CPT codes for long-term electroencephalogram (EEG) monitoring sessions that went into effect on January 1. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how to accurately apply these codes based on details in provider documentation.
The 2020 edition of the National Correct Coding Initiative (NCCI) Policy Manual features new guidance and clinical examples to help coders appropriately apply the -X{EPSU} modifiers debuted by CMS several years ago.
Modifier -25 can cause frustration as it is not recognized by many payers, including Medicaid. When applying this modifier, coders must consider CPT reporting rules and adhere to potentially restrictive billing rules followed by payers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The flu vaccine is changed each year based on the virus types that the Centers for Disease Control and Prevention estimates will be the most prevalent. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews CPT and ICD-10-CM coding for this year’s flu vaccine and its administration.
The 2020 update to the CPT Manua l includes extensive updates to cardiovascular codes, including new codes for pericardiocentesis and pericardial drainage, aortic grafting, and endovascular repair procedures.
Although the dollar figures aren’t big, the Office of Inspector General’s (OIG) report on faulty chronic care management (CCM) billing should be concerning for physician practices billing these codes.
Because the cardiovascular system circulates oxygen and nutrients to all body parts, procedures of the cardiovascular system can be complex and challenging to accurately report. This article reviews CPT guidelines for reporting ECMO procedures and endovascular interventions in the lower extremities. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , writes about new E/M codes, effective January 1, for patient-initiated services administered by a physician or other qualified healthcare provider.
In the 2020 Medicare Physician Fee Schedule (MPFS) final rule, CMS put a stamp of approval on its previous proposals to overhaul how medical practices will report office and outpatient E/M services in 2021.
CPT reporting for surgical heart procedures requires an in-depth understanding of cardiovascular anatomy and terminology. This article reviews CPT reporting for procedures involving cardiac pacemakers and implantable cardioverter-defibrillators based on key details in provider documentation.
CPT reporting for surgical heart procedures requires an in-depth understanding of cardiovascular anatomy and terminology. This article reviews CPT reporting for procedures involving cardiac pacemakers and implantable cardioverter-defibrillators based on key details in provider documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Review finalized changes to relative value units for office visits, new HCPCS codes for chronic care management and opioid treatment services, and future updates to the E/M reporting guidelines.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews the appropriate application of 14 new HCPCS codes that will allow opioid treatment programs to report medication-assisted treatments beginning January 1, 2020.
Advances in technology have made it easier for providers to administer remote physiologic monitoring services. However, because these services are relatively new, they remain underutilized and Part B providers have questions on how to accurately report and bill for them.
