The AMA added a total of 60 new codes throughout the surgery section of the 2012 CPT ® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, and Christi Sarasin, CCS, CCDS, CPC-H, FCS, highlight the significant changes for 2012.
CMS added four new J codes for reporting drugs and biologicals that previously did not have specific codes available as part of the 2012 Outpatient Prospective Payment System updates ( Transmittal 2376 ).
QUESTION: The 2012 CPT ® Manual includes the typical time physicians spend at the bedside and on the patient’s hospital floor or unit for initial observation care codes 99218, 99219, and 99220. Do these codes only apply when the counseling and/or coordination of care support the respective 30/50/70 minutes of time? Do you know if CMS has published any new guidelines related to these times?
The 2012 ICD-10-CM updates include significant narrative changes for primary malignant neoplasms overlapping site boundaries and malignant neoplasm of ectopic tissue, as well as smaller narrative...
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS finalized for fiscal year (FY) 2012. However, it’s critical that providers also examine how these changes directly affect MS-DRG assignment. Robert Gold, MD, examines a number of these changes, including MS-DRG assignment related to cardiac-specific comorbidities, autologous bone marrow transplants, excisional debridement, and thoracic aneurysm repair.
Medicare Advantage plans rely on the Hierarchical Condition Categories (HCC) system for reimbursement. HCC payments are linked to the individual health risk profiles for the members in the plan. MA Plans use ICD-9-CM codes as the primary indicators of each member’s health status. Therefore, it is essential for MA plans to make sure that providers capture the complete diagnostic profile of patients through accurate and complete physician coding. Holly J. Cassano, CPC, explains why coders need to have a complete understanding of the HCC process and risk adjustment, as well as the effects on the provider, the member, the MA plan, and overall reimbursement.
Although the New Year marked the deadline for Version 5010 compliance, CMS recently reminded providers that it will not exercise enforcement until April 1, 2012. Despite the 90-day discretionary period, CMS urged providers that they should complete the transition to Version 5010 as soon as possible. This extension will not have any effect on the implementation date for ICD-10-CM/PCS, which remains set for October 1, 2013.
When Jim Brown, FHFMA, RHIA, CCS, started working at Jefferson Regional Medical Center in early November 2010, he quickly realized that there were a number of opportunities to improve their health information management operations and efficiencies. In this article, Brown shares strategies and tips for how he and his management team were able to identify areas that needed improvement and reduce department expenses and come in 9.5% ($149K) under budget for the end of fiscal year 2011.
QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end. Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?
Learn about CMS' bundled payment initiative, computer-assisted coding, the need to scrutinize physician documentation, and new Medicaid rules, and save the Briefings on Coding Compliance Strategies 2011 Index for future reference.
Our coding experts answer your questions about determining ED visit level, coding open reduction and internal fixation of a radius fracture, and coding image-guided minimally invasive lumbar decompression.
In this month's issue, you will find in-depth anaylsis of the OPPS Final Rule and a discussion on how to properly set charges to avoid payment reductions. In addition, we continue our occassional series of ICD-10 anatomy refreshers with the eye and our experts answer your coding questions.
Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator (CRT-D) procedures at the standardized inpatient rate. The agency announced its decision as part of the CY 2012 OPPS final rule released November 1, 2011.
Removal sounds like it should be an easy root operation in ICD-10-PCS. Removal means taking something out, right? Physicians remove things all the time—your appendix, a cyst, the toy your son stuck...
When a physician frees a body part from an abnormal physical constraint by cutting or by use of force, coders will use the root operation release (N) in ICD-10-PCS. Keep in mind, though, that you...
The Medicare Code Editor (MCE) is software that detects and reports errors in the coding on claims that are submitted for payment. All Part A inpatient discharges and transfers pass through the MCE...
