CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them from line-item edits to date-of-service edits, effective April 1. Jugna Shah, MPH, Kathy Dorale, RHIA, CCS, CCS-P, John Settlemyer, MBA/MHA, and Valerie Rinkle, MPA, explain how the change could affect coding and reimbursement.
CMS added numerous device/procedure edits as part of the April update to the Integrated Outpatient Code Editor . To avoid triggering the edits, coders must report particular procedure codes and device codes together on the claim form.
With no national guidelines in place for facilities to use to determine evaluation and management (E/M) level, coders must apply their facility’s guidelines when coding an outpatient visit. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, and Joanne M. Becker, RHIT, CCS, CCS-P, CPC, CPC-I, use three ED case studies to highlight potential pitfalls for ED E/M leveling.
Breast biopsies should be easy to code because coders have so few codes to assign, but it is one area where documentation is lacking. Stacie L. Buck, RHIA, CCS-P, RCC, CIC, reveals what key elements coders should look for in a breast biopsy note.
Although coders and billers don't play a role in determining whether condition code 44 is appropriate, they most certainly ensure correct billing of the code.
In this month's issue, we discuss the upcoming changes to the Medically Unlikley Edits, review current coding for molecular pathology coding, and offer tips for auditing records. In addition, our experts answer your questions.
DRGs for procedures unrelated to the principal diagnosis shouldn't occur frequently. If they do, coding managers should take a closer look at coding compliance efforts to ensure accuracy and avoid costly audits.
DRGs for procedures unrelated to the principal diagnosis shouldn't occur frequently. If they do, coding managers should take a closer look at coding compliance efforts to ensure accuracy and avoid costly audits.
Being audited is rarely fun. After all, you're probably going to lose money, face a fine, or both. More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on.
CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them from line-item edits to date-of-service (DOS) edits, effective April 1.
Editor's note: Facilities need to address coding, payment, and coverage issues for molecular pathology. This article is the first in a series and discusses molecular pathology coding.
Our experts answer questions about, modifier -25, cardioversion performed during an ED code, denials for multiple port film line items, and procedure discontinued after administration of anesthesia.
When Lori Belanger, RN, BSN, RHIT, inpatient coder and CDI specialist at Northern Maine Medical Center in Fort Kent, Maine, began to practice coding charts using ICD-10-CM/PCS, she was a bit surprised by how much her productivity decreased.
CMS Transmittal 1199 updates the national coverage determination (NCD) hard-coded shared system edits to include ICD-10-CM codes. CMS included 30 spreadsheets with the transmittal. The spreadsheets...
Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the four Recovery Auditors in FY 2013 first quarter (October 2012–December 2012), according to the most recent release of improper payment statistics .
Office politics are a fact of life, but can lead to poor or unjust outcomes. Lois Mazza, CPC, offers tips to help coders navigate the political waters in the office.
Coded data is incredibly important to a wide range of people. Bill Rudman, PhD, RHIA, Roxanne Andrews, PhD, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Susan Beever, RHIT, CCS, reveal how accurate coding aids research and law enforcement and improves quality of care.
Q: Can you clarify the requirements surrounding the use of E codes? We have been working on documentation concerns related to patient safety indicator (PSI) 15 and wonder if E codes are required. Can a facility simply decide not to use them?
The OIG is taking a closer look at mechanical ventilation, according to its FY 2013 Work Plan. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explain why your facility should do the same.
When last we left our intrepid hero, Luke Skywalker, he was well on the road to recovery after being bashed by a wampa and spending the night in the belly of a Tauntaun. Now he’s off to the Dagobah...
