In recent years, numerous pieces of legislation have been passed to limit healthcare spending, combat losses due to fraud, and ensure that dollars are being spent on quality care. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , describes different watchdog programs created to promote billing compliance and quality of care.
Drug abuse is a serious public health issue that affects millions of Americans. Familiarize yourself with diagnosis reporting for substance use disorders to ensure that ICD-10-CM-dependent administrative data accurately captures the social consequences of substance abuse. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our facility has attempted to use the -X{EPSU} modifiers on 2017 and 2018 claims but our Fiscal Intermediary Standard System (FISS) did not process the claims. I reverted to using modifier -59 (distinct procedural service). Do you have any knowledge of when these modifiers might go into use?
CMS released Transmittal 3950 on January 12 describing updates to a list of the HCPCS codes for Durable Medical Equipment Medicare Administrative Contractors and Part B Medicare Administrative Contractor jurisdictions.
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.
Medicare fee-for-service claims had a 90.5% accuracy rate and a 9.5% improper payment rate for all claims submitted between July 1, 2015- June 30, 2016, according to a recent CMS Comprehensive Error Rate Testing report.
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.
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.
Approximately 2%-3% of children between the ages of 6 and 12, and 6%-8% of adolescents in the U.S. may have serious depression. Debbie Jones, CPC, CCA details common symptoms of anxiety and depression in adolescence and provides advice for diagnostic coding of these conditions.
Q: What should we report if you have a compression dressing that was applied to the thigh, in addition to the lower leg, since CPT code 29582 (multi-level compression bandage application, thigh to foot) was deleted for 2018?
Complying with healthcare regulations within a coding department or physician practice involves promoting a positive attitude toward activities such as self-monitoring and staying up-to-date with healthcare regulations. Follow these steps to adhere to sound business ethics and set expectations for behavior across an organization. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Valerie A. Rinkle, MPA, offers guidance regarding the 340B drug discount program. She provides tips for accurate documentation of drug purchases and reviews frequently asked questions about billing for 340B-acquired drugs in 2018.
With providers continuing to expand clinical documentation improvement efforts into outpatient settings, ACDIS has published a position paper offering guidance to outpatient CDI departments for performing queries.
Q: Could you discuss or explain evaluating encounter billing vs. monthly billing for recurring outpatient services such as chemotherapy infusions or radiation oncology?
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.
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.
When faced with a claim denial, providers need to understand what is being denied and when an appeal is appropriate. This article outlines basic steps providers need to take before composing an appeal for a claim denial and helpful tips for successfully navigating through the appeals process.
The improper payment rate for hospital outpatient services was 5.4%, accounting for 7.5% of the Medicare Fee-For-Service improper payment rate, according to 2016 Medicare Fee-for-Service Improper Payments Report.
Q: Our coding department has been reviewing the AHIMA Standards of Ethical Coding but were interested in learning more about standard seven. I didn’t realize that continuing education credits help with ethical coding.
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.
