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: What are the documentation requirements for a continuous infusion for an observation patient, especially spanning the midnight hour? We often see rate change or rate verification notations during continuously running infusions, but would a start and stop time be required or expected for each bag change?
CMS released a change request April 28 which provides guidance for Medicare Administrative Contractors on how to ensure accurate program payment for moderate sedation services provided as part of screening colonoscopies.
Coding plays a large role in claims and therefore is a key factor in reimbursement compliance. As such, coders have a responsibility to be as accurate and up-to-date on coding practices as possible. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , explores some of the organizations and regulatory bodies available to assist coders.
As physicians and society debate the rising incidence and devastating effects of opioid dependency, neonatal abstinence syndrome, and the use and abuse of other mood-altering chemicals, James Kennedy, MD, CCS, CDIP , explains how providers must partner together to define, diagnose, document, and report drug-related events so that ICD-10-CM-dependent administrative data can accurately measure its epidemiology, responses to treatment, and consequences.
HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations, and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper, and that will hit reimbursement hard.
CMS released the fiscal year 2018 IPPS proposed rule April 14, and with it came a bevy of new potential ICD-10-CM codes. Explore the new additions to the ophthalmologic, non-pressure chronic ulcer, maternity and external cause codes ahead of implementation October 1.
April marks sexually transmitted infections month, and Peggy S. Blue, MPH, CPC, CCS-P, CEMC , gets in the spirit by breaking down the staging, diagnosis, and treatment of syphilis before examining how to code the disease in ICD-10-CM. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When reporting multiple separate infusions of the same substance or drug provided through the same IV site during one visit, should we add up the total time and then report the appropriate codes?
CMS released four new resources in early April on the Merit-based Incentive Payment System, one of two new payment options under the Quality Payment Program initiative created by the Medicare Access and CHIP Reauthorization Act.
Accurate clinical documentation is the bedrock of the legal medical record, billing, and coding. It is also the most complex and vulnerable part of revenue cycle because independent providers must document according to intricate and sometimes vague rules.
A benefit of the switch to ICD-10-CM is the ability to be as specific as possible about a patient’s condition, but the downside of this is that it can make coding fractures time-consuming and confusing. Knowledge of bone anatomy and how fracture codes work is therefore an invaluable asset in fracture coding.
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 ?
Audited hospitals generally applied modifier -59 (distinct procedural service) incorrectly when billing for outpatient right heart catheterizations and heart biopsies provided during the same encounter, leading to overpayments totaling approximately $7.6 million, according to a March report from the Office of Inspector General.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, discusses the use of unspecified codes after the ICD-10-CM grace period and advises providers on how to decrease the use of those codes.
In the second part of this two-part series on the Merit-based Incentive Payment System (MIPS), dive deeper into the four performance categories, their requirements, and their scoring parameters for the first year of MIPS reporting. This article also gives readers tips on what clinicians need to do to prepare for and participate in MIPS in 2017.
Q: We have trouble billing multiple units of injections and infusions – mostly CPT add-on codes 96375 and 96376–that are done during observation stays and exceed the medically unlikely edits number. What is the correct way to bill these and get paid?
CMS released a new educational initiative , Connected Care , on March 15 to help raise awareness of the benefits of chronic care management services, as Medicare has recently added and started paying for these services.
Glands located throughout the body are responsible producing hormones and releasing chemicals into the bloodstream as part of the endocrine system. These glands help maintain many important purposes of the body, including metabolism, growth, and reproductive functions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
In the first part of a two-part series on the Merit-based Incentive Payment System (MIPS), discover the basics of the MIPS program, understand who is eligible for 2017 participation, and navigate the scoring system for the first year of reporting.
