The intersection of CMS’ packaged payment policy and the increasing volume of Medically Unlikely Edits (MUE) can be likened to a car crash waiting to happen. Hospitals are having valid, medically necessary claim lines denied – including charges and units below MUE limits. Providers can help stop the crash by ensuring their claims, CPT coding, medical necessity, and the units are all correct.
The human eye may be small, but it’s one of the most complex organ systems in the body. Review the anatomy of the eye and how to code for conditions affecting the system, including new details for 2017.
Q: Facilities often have two charges for services performed in an operating room (OR) suite. For example, a facility performs a colonoscopy and an esophagogastroduodenoscopy, which took a total of 20 minutes in the procedure room. The facility charged two set-up fees plus an additional five minutes of OR time. Would this be considered a duplicate charge?
The ICD-10 Coordination and Maintenance Committee will meet March 7-8 to discuss new conditions, procedures, and expanded details that could appear in a future update of the code set.
With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
The codes in ICD-10-CM Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, cover diagnoses for conditions throughout the body. Due to the wide scope of conditions in the chapter, it had extensive updates for 2017. Review some of the most significant changes and the details required to accurately report the codes.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about the transition of the CPT code for reporting ablation of uterine fibroid tumors from a Category III to Category I code and the impact that could have on coding and billing.
Inpatient coding departments are likely familiar with integrating clinical documentation improvement (CDI) specialists into their processes. Crystal Stalter, CPC, CCS-P, CDIP, looks at how CDI techniques can benefit outpatient settings and what services and codes facilities should target.
Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly paying $137 million for these services, according to a study reported in the January 2016 Medicare Quarterly Compliance Newsletter .
Q: We have claims that are hitting an edit between a procedure HCPCS code and the new codes for moderate sedation (99151–99153). Since moderate sedation is no longer inherent in any procedure beginning January 1, why are these scenarios hitting an edit?
Coders have likely noticed that the 2017 CPT Manual features big changes for reporting moderate sedation. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes about how to define moderate sedation and includes tips on reporting the new codes appropriately.
Q: We just heard about a new add-on HCPCS code for 2017, C1842 (retinal prosthesis, includes all internal and external components; add-on to C1841) for the Argus Retinal Prosthesis, but are not sure how to report it along with C1841 (retinal prosthesis, includes all internal and external components). It has nearly the same description as C1841, so this is confusing.
A Comprehensive Error Rate Testing study showed insufficient documentation caused most improper payments for facet joint injections, according to the January 2016 Medicare Quarterly Compliance Newsletter .
Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, reviews when coders should report modifiers -76 and -77 and notes methods for auditing a facility’s accuracy when using these modifiers.
The 2017 ICD-10-CM updates included a significant number of additions to digestive system diagnoses, especially codes for pancreatitis and intestinal infections. These codes are largely focused in the lower gastrointestinal tract, and a review of the anatomy of this body system could help improve accurate documentation interpretation and code selection.
Coding managers cannot always monitor every guideline update or coding-related issue targeted by the Office of Inspector General. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, reviews what a coding manager can do during a coding audit and how to implement a plan.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about the challenges faced in OB hospitalist practices and which procedures and services to focus on for coding, billing, and documentation.
Q: We have an off-campus, provider-based department that is “non-excepted,” so we have to report modifier –PN (nonexcepted service provided at an off-campus outpatient, provider-based department of a hospital). Is that just for the services that would be paid under the OPPS if the department were “excepted”?
Insufficient documentation caused most improper payments for retinal photocoagulation payments reviewed in a Comprehensive Error Rate Testing study, according to the January 2016 Medicare Quarterly Compliance Newsletter.
Review the bones of the pelvic girdle, along with the differences in the bones between genders, and ICD-10-CM coding conventions to properly code fractures of the pelvis.
