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.
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.
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.
Prader-Willi syndrome (PWS) is a rare genetic disorder that causes significant physical and intellectual abnormalities. Debbie Jones, CPC, CCA , writes about signs and symptoms of PWS and diagnostic and CPT coding for the disorder.
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.
CPT coding for behavioral health can be challenging given the multitude of factors that influence code selection. Review procedural coding for psychiatric diagnostic assessments, psychotherapy, and other mental health services commonly performed in the office setting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A wide range of diagnostic tests may be used by hospital providers to examine respiratory functioning. In this article, Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, CPC-I , interprets CPT guidance for reporting pulmonary functioning tests used to diagnose patients with asthma and chronic obstructive pulmonary disease.
As Medicare Advantage makes strides to becoming the new norm, organizations need to establish new processes, educate staff, and advocate for patients. Learn how your organization can keep pace with change before it’s too late to catch up.
Device-dependent edits require reporting a device code with procedures CMS has designated to be device intensive, and they are meant to ensure that device costs are accounted for in Medicare rates for device-intensive procedures.
Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC , reviews 2021 proposals to E/M codes for office visits and other outpatient services and draft guidelines for the implementation of these changes.
Gastrointestinal cancer is the fourth most common cancer in the U.S., according to the National Cancer Institute. Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, COC , writes about ICD-10-CM coding for colon cancer screening and CPT coding for diagnostic colonoscopies.
The 2020 CPT update added new codes for the preparation and insertion of drug delivery devices, dry needling, and anesthetic nerve injection administration. Familiarize yourself with these and other updates before they go into effect January 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
If payment updates in the 2020 Medicare Physician Fee Schedule proposed rule are finalized, they will significantly impact physician reimbursement for x-ray and E/M CPT codes, among others. Review payment proposals and the specialties that would see the greatest impact.
Your heart may flutter when you’re nervous, but if this happens on a regular basis, it could be a sign of a serious heart condition. Atrial fibrillation (AF), a common and potentially fatal cardiovascular condition, is an irregular heartrate that can cause blood clots, stroke, and other heart-related complications.
Perhaps the most momentous Quality Payment Program (QPP) news in the proposed 2020 Medicare physician fee schedule is the Pathways (MVP) version of the Merit-based Incentive Payment System (MIPS) — but that’s not happening until 2021.
When applying CPT modifiers -80, -81, and -82, physician coders must carefully consider details in the operative note. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about the correct application of modifiers used to identify services performed by surgical assistants.
Drug administration is one of the most commonly performed procedures in outpatient departments; however, this topic continues to generate confusion for coders and providers alike. Brush up on CPT coding rules for intravenous (IV) injections, infusions, and hydration services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2020 Medicare Physician Fee Schedule proposed rule includes significant documentation and payment changes for outpatient office visits reporting using E/M codes 99202-99215. Beginning in 2021, these proposed updates could add billions of dollars to the national E/M revenue stream.
Behavioral health is a highly specialized area of coding that many coders and billers are unfamiliar with. There are hundreds of ICD-10-CM codes for mental disorders with unique characters to specify symptoms and complications.
Even if a hospital is not a teaching hospital, it may have services that require National Clinical Trial (NCT) reporting. It is logical for revenue integrity leadership to own this issue, but an explanation of the requirements for NCT reporting should be shared with all staff within the revenue cycle so there is a better appreciation of the fact that clinical trial billing rules apply more broadly than merely just to research or clinical trial studies.
Several surgical techniques can be used to excise or slow the growth of a paratubal cyst. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the etiology of paratubal cysts and CPT coding for their treatment.
CMS recently released two quarterly updates effective July 1: Medicare Claims Processing Transmittal 4313 , which is the July update to the OPPS, and Medicare Claims Processing Transmittal 4314 , which is the related July update to the Integrated Outpatient Code Editor (I/OCE) Specifications, Attachment B.
ED physicians commonly treat fractures. A fracture can be the result of a traumatic injury, such as a fall, or may be pathologic (i.e., due to a disease process). In general, fractures can be classified as open or closed, displaced or nondisplaced.
CMS recently released quarterly updates to the OPPS and Integrated Outpatient Code Editor (I/OCE), effective July 1. Judith Kares, JD , summarizes key coding and billing policy updates, including changes to APCs, status indicators, revenue code changes, and more.
The skin maintains homeostasis by generating new tissue in response disease or damage. Sometimes, however, surgical interventions are used lessen the severity of the wound and prevent infection. Review integumentary system anatomy and CPT coding for removals and repairs used to facilitate wound healing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The use of ultrasound at the bedside, or within the office practice, has become more common in provider-based clinic settings. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , details documentation requirements and CPT and ICD-10-CM coding for diagnostic ultrasound services.
Because lower extremity diagnoses are often associated with issues in other parts of the body, assessing the severity of a patient’s podiatric condition can be challenging. Shelley Safian, PhD, RHIA, HCISPP, COC, CPC-I , reviews physician E/M coding for patients seeking treatment for foot and lower leg problems.
If you only bill using the CMS-1500 claim form, then you’ve probably never seen a revenue code. But if you need to bill for facilities, you know revenue codes play an important communicative role between providers and insurers. UB-04 claim forms sent to an insurance company without a revenue code associated with each charge will be rejected.
With the addition of the two new telehealth service codes for 2019, providers now have 98 CMS-approved telehealth services to report. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , describes the two newest telehealth HCPCS codes and breaks down 2019 billing regulations surrounding telehealth.
The month of May is designated Skin Cancer Awareness Month by the American Academy of Dermatology. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D , writes about ICD-10-CM/CPT coding for common types of skin cancer and their treatments.
Reduced and discontinued service modifiers indicate to the payer when service is either less than the HCPCS code indicates (reduced) or the procedure was stopped before completion (discontinued).
Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, writes about E/M code changes implemented this year and changes for implementation over the next two years.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS , writes about E/M code changes implemented this year and changes for implementation over the next two years.
A spinal fusion is a major surgery used to fuse together two or more vertebrae so they can heal into a single bone. This article breaks down spinal anatomy and simplifies CPT and NCCI guidance for reporting spinal fusions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Vestibular migraine is a common visual and neurological disorder that can be difficult to diagnose as symptoms of the disorder resemble those of other conditions such as vestibular neuritis and Meniere’s disorder. In this article, Debbie Jones, CPC , reviews clinical indications of vestibular migraine disorder and CPT coding for diagnostic tests used to assess vestibular functioning.
Providers will find significant leeway in how they can approach and report advance care planning services for physicians given CMS’ open-ended coding requirements, which should push the already strong growth of the codes to new heights.
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. In addition, because ED coding encompasses professional and facility billing, they may need to scour provider documentation to determine the correct E/M service level for both bill types.
Telehealth services are likely to promote health, wellness, and disease management, providing an avenue to offer efficient, high-quality care while supporting value-based care in a cost-effective manner. Although the benefit of telehealth is obvious and its value is continually highlighted by CMS, it appears the services are underutilized.
Wound care coding is frequently a target of payer and Office of Inspector General audits. This article provides coders with step-by-step instructions for interpreting provider documentation and assigning CPT codes for excisional, selective, and non-selective debridement, based on the depth of the tissue removed and the total surface area debrided. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published One Time Notification Transmittal 2259 and MLN Matters 11168 , which outline changes to the processing of NCCI procedure-to-procedure edits associated with modifiers -59 and -X{EPSU}. Read about these updates and how they will impact CPT coding and for select surgical procedures.
According to the U.S. Department of Health and Human Services, endometriosis affects 11% of women between the ages of 15 and 44. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about diagnosing and treating endometriosis as well as ICD-10-CM and CPT coding for the condition.
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. Review expert advice on accurate documentation and coding for outpatient ED visits and for developing detailed E/M guidelines. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status
Coding for knee arthroscopies can be challenging, especially when procedures are performed in multiple compartments of the same knee. Read about anatomy and coding details required to accurately report these procedures.
Outpatient coders and billers must be able to interpret potentially confusing documentation elements for drug administration services and know what to do when key elements, such as infusion time, are missing from an order. Review CMS guidance on the accurate reporting and billing of intravenous drug administration services for calendar year 2019. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Prostate cancer is the second most common form of cancer in American men, according to the American Cancer Society. Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I , writes about CPT coding for rectal exams and a new prostate specific antigen (PSA) immunoassay test used to detect early indications of prostate cancer, as well as ICD-10-CM codes used to support medical necessity for these services.
CMS added new guidance to the CPT Manual to clarify imaging documentation for codes that include both procedural and imaging guidance. This article outlines these regulatory changes and implications for outpatient coders and providers.
Review advice from experts on accurate documentation and CPT coding for chronic care management, knee injection services, and health and behavior assessments.
Arthroscopic procedures allow surgeons to use minimally invasive arthroscopic techniques to treat conditions which previously required more intensive, open surgery. Learn about orthopedic anatomy and terminology and CPT guidelines for reporting arthroscopic hip and knee procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In 2018, most organizations held the line on coder productivity, according to the results of sister publication HIM Briefings’ 2018 coding productivity survey.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. This does not reduce the payment for the drugs, so this is an informational modifier, but it is a mandatory modifier.
Pay close attention to new CPT documentation and coding guidance for reporting radiological imaging. For example, a new paragraph titled “Imaging Guidance” in both the surgery and medicine guidelines advises that even when imaging guidance or supervision are included in a surgical procedure code, you must still follow the radiology documentation requirements in the CPT manual.
The beginning of a new year typically brings new resolutions to deal with weight-related issues. Shelley C. Safian, PhD, RHIA, HCISPP , writes about ICD-10-CM coding for common weight-related diagnoses such as obesity and anorexia, and CPT coding for interventions used to treat them.
In the current healthcare climate the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. Review medical necessity guidance from CMS and learn how to prevent repeated denials due to improper documentation of medical necessity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS has downgraded the supervision requirements for services performed by radiologist assistants working in medical practices, imaging centers, and radiology offices. Read about these 2019 changes to ensure accurate documentation and reporting for radiology services.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews common CPT and ICD-10-CM coding and documentation errors, such as unbundling, inappropriate modifier usage, and missing information, to help coders reduce their risk from audits.
The ICD-10-CM Manual was recently updated with new codes for peritonitis in association with acute appendicitis and the CPT Manual now includes new codes for gastrostomy tube replacements. Familiarize yourself with these changes to ensure accurate reporting of digestive diagnoses and treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2019 CPT code update includes 19 code additions and three revisions to the cardiovascular section of the CPT Manual. These changes reflect advances in surgical treatment for cardiovascular conditions such as heart failure and aortic stenosis.
Reporting and billing hospital observation services can be confusing, particularly when the observation stay lasts more than one day. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about CPT coding for observation services based on time and the key components of the history, exam, and medical decision making of a patient.
A variety of therapeutic services can be used to treat patients suffering from debilitating mental health conditions. Clear up confusion surrounding CPT coding for these initial office visits, psychiatric diagnostic evaluations, and psychotherapy visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Take cues from the revised NCCI Policy Manual for Medicare Services to polish your coding and billing efforts in 2019 and avoid common infractions tied to modifier -50 (bilateral procedure).
The 2019 CPT code update will impact reporting for dermatologic biopsies. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , reviews updated reporting guidance and CPT codes for these common types of biopsies.
CMS hit the brakes on making imminent changes to the oft-used E/M code set that’s tied to billions of dollars in medical practice revenue. Review updates to E/M payment and documentation requirements effective January 1 and the extensive changes planned for implementation in 2021 under the 2019 Medicare Physician Fee Schedule final rule.
The AMA updated the cardiovascular section of the 2019 CPT Manual to reflect advances in surgical treatment for cardiovascular conditions such as heart failure and aortic stenosis. Read about new and revised codes for the implantation and removal of leadless pacemakers, cardiac rhythm monitors, and other surgical devices commonly used to treat chronic heart conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Along with E/M changes for 2019 and beyond , the 2019 Medicare Physician Fee Schedule final rule contains a plethora of regulations impacting reimbursement, including new modifiers for therapists.
Beginning in 2018, total knee arthroplasty (TKA) was removed from the Inpatient Only List and assigned a comprehensive APC payment. Outpatient coders need to ensure they are assigning the correct CPT codes for TKA to reduce their hospital’s risk of audits.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
Coders must have a solid understanding of complex terminology and CPT and ICD-10-CM coding guidelines to select the most specific codes for traumatic fractures and their treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Remittance processing and appeals are integral parts of the revenue cycle. When facilities submit a claim to Medicare, the hope is that the claim will be paid in full and in a timely manner, but that does not always happen.
According to the National Center for Chronic Diseases Prevention and Health Promotion, an estimated 5.7 million adults throughout the U.S. have heart failure. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, writes about ICD-10-CM coding for heart failure diagnoses and CPT coding for procedures used to treat the disease.
Modifier -25 is frequently a target of payer and Office of Inspector General audits. Susan E. Garrison, CHCA, CPC, CPC-H, reviews CMS and NCCI guidance for reporting modifier -25.
Patients determined to have a tubo-ovarian abscess (TOA) require immediate and aggressive surgical therapy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews clinical documentation and ICD-10-CM coding for TOAs as well as CPT coding for surgical interventions used to treat them.
Before radiation therapy can be administered, several steps must be taken prepare the patient for treatment. Review CPT coding and documentation for the first two steps in the process: the initial consultation and preparation for radiation treatment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released updated guidance on billing intensity-modulated radiation therapy (IMRT) after an OIG audit found a 100% error rate in billing certain IMRT planning services.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
Medicare guidelines for reporting arthroscopic shoulder surgeries have changed significantly over the past decade. Review updated guidance and CPT coding for SLAP repairs as well as biceps tenotomy and tenodesis procedures to reduce audit risk. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews the key characteristics of physician visits administered to patients in skilled nursing facilities and E/M coding for these services.
According to the American Academy of Orthopedic Surgeons, in 2013, 2 million people in the U.S. saw a physician for a rotator cuff problem. Review shoulder anatomy and CPT coding for rotator cuff repairs to improve coding accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Age-related macular degeneration (AMD) is a leading cause of vision loss among people age 50 and older, according to the National Eye Institute. Debbie Jones, CPC, CCA , reviews ICD-10-CM coding for AMD and CPT coding for treatments used to slow the disease’s progression.
E/M code assignment for hospital admissions based solely on the provider’s documentation of face-to-face-time spent with a patient can be confusing and requires a detailed understanding of CPT guidelines. Lori-Lynne A. Webb , CPC, CCS-P, CCP, CHDA, COBGC , reviews reporting requirements for E/M visit levels based on the provider’s documentation of time and CPT coding for hospital admissions.
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.
ICD-10-CM and CPT coding for glaucoma and retinal detachment requires a detailed understanding of coding guidelines as well as ocular anatomy and terminology. Explore the anatomy of the eye and review coding guidance for conditions that affect our view of the outside world. Note : To access this article, you must first register here if you do not have a paid subscription.
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.
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.
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.
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.
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.
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.
