Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC, discusses how modifiers -59 and -91 differ and what coders need to know to use them when reporting laboratory services.
In addition to updated procedure codes in 2015, ICD-10-CM added new codes for reporting mammography and breast MRIs and ultrasounds. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about how to identify which codes to use to meet Medicare requirements and where third-party payer requirements may diverge.
ICD-10 is undoubtedly affecting coder productivity, but Bonnie S. Cassidy, FAHIMA, RHIA, FHIMSS, CPUR, NAHQ, and Reid Conant, MD, FACEP, provide strategies for increasing proficiency and leveraging technology to reduce the effects of changing to a new code set.
Recovery Auditors have identified numerous potential duplicate claims from Medicare Part B providers, according to the October 2015 Medicare Quarterly Compliance Newsletter . These claims are send to MACs for further action, which could include overpayment recovery.
Q: Our business office wants us to start using modifier -PO (services, procedures, and/or surgeries furnished at off-campus, provider-based outpatient departments) for services that are provided in some of our outpatient departments, but not all. We want to hard code this to our charge description master but are not sure why some services will get this modifier and some won't.
The 2016 IPPS final rule includes many new claims-based measures for 2018 and 2019 payment determination. Shannon Newell, RHIA, CCS, provides an overview of those measures and additional changes to theHospital Value-Based Purchasing and Hospital-Acquired Conditions Reduction programs.
In the first three years after implementation, incentives and penalties tied to the Hospital Value-Based Purchasing (HVBP) Program had a minimal effect on Medicare, while doing little to improve quality trends, according to a recent Government Accountability Office (GAO) report.
Q: I am having trouble with ICD-10-PCS coding for a perineal laceration repair. Some sources state that the correct code uses the perineal anatomic region, not muscle repair. Could you please clarify the correct ICD-10-PCS code for a second-degree obstetrical (perineum) laceration that includes muscle?
Dual coding. Reformatting queries. Educating physicians. Let's face it?the to-do list for ICD-10 preparation is pretty long, and can be a bit daunting. With ICD-10 implementation happening this month, there's one thing your facility should do: prioritize.
When a patient suffers a traumatic injury or poisoning, we need to report how they became injured and where they were when it happened. You already know this from ICD-9-CM.
Heart disease is the most common cause of death for both men and women in the U.S., according to the Centers for Disease Control and Prevention (CDC). The most common type is coronary artery disease (CAD), which can lead to heart attacks, heart failure, angina, and arrhythmias, according to the CDC.
A 12-year-old male developed umbilical discomfort Monday and didn't eat much dinner. On Tuesday, he started vomiting at school and the pain shifted to his right lower quadrant. His parents brought him to the ED, where his vital signs showed:
A 12-year-old male developed umbilical discomfort Monday and didn't eat much dinner. On Tuesday, he started vomiting at school and the pain shifted to his right lower quadrant. His parents brought him to the ED, where his vital signs showed:
Heart disease is the most common cause of death for both men and women in the U.S., according to the Centers for Disease Control and Prevention (CDC). The most common type is coronary artery disease (CAD), which can lead to heart attacks, heart failure, angina, and arrhythmias, according to the CDC.
Each new CMS fiscal year, MS-DRG weight and classification changes in the CMS IPPS final rule are closely scrutinized by coders and CDI specialists to identify any potential impact on documentation capture and code assignment processes.
Sometimes people do their homework with setting up a new system, and sometimes they don't. Sometimes they do their homework, but not enough of it, and billions of dollars of wasteful spending occurs that could be avoided. But "they" won't listen.
Because CMS has not created any national ED E/M guidelines, providers must create their own criteria for each visit level. CMS has developed a list of 11 criteria that it uses when auditing facility E/M criteria.
Providers have to create their own ED E/M guidelines, which can present a variety of challenges for facilities. For coders, this means an understanding of how to calculate critical care and other factors in order to report the correct visit level.
