Q: When would it be appropriate to report modifier -58 (staged or related procedure or service by the same physician during the postoperative period) for a procedure performed during the postoperative period?
Dee Jones, CFO, describes eight ways 340B covered entities can optimize their 340B programs to gain immediate operational efficiencies while accelerating cash flow and savings.
The final 2021 CPT, ICD-10-CM, and ICD-10-PCS code sets were released last week, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes. Read up on the changes, which will impact payment for hospital services in 2021.
Outpatient coders should be familiar with CPT reporting for knee surgeries based on information in the operative note. This article reviews the anatomy of the knee joint and CPT coding for arthroscopic and reconstructive procedures used to visualize and treat common knee conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Can modifier -59 (distinct procedural service) be used to bypass the NCCI edit that bundles CPT codes 11055 for lesion removal and 11721 for nail debridement?
The 2021 MPFS proposed rule, released August 3, introduces new policies under the Quality Payment Program (QPP) including plans to delay implementation of the Merit-based Incentive Payment System Value Payment (MVP) model and introduce 108 new quality measures.
Familiarize yourself with notable code updates in the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule, including new E/M reporting guidelines and CPT® codes for lung biopsies, auditory testing, and chronic care management.
Review ICD-10-CM codes for age-related macular degeneration and glaucoma and the 2021 updates to Chapter 7 of the ICD-10-CM manual, “Diseases of the Eye and Adnexa.” Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medicare’s rules for reporting blood products and applying the Part B blood deductible can be confusing. Judith L. Kares, JD , writes about unique HCPCS reporting and billing rules for blood products and related services reimbursed under the OPPS.
Familiarize yourself with proposed updates to the Medicare Physician Fee Schedule (MPFS), including plans to significantly revise the E/M coding guidelines and extend telehealth flexibilities beyond the COVID-19 public health emergency.
Bill Wagner, CHPS, CPCO , unpacks findings from a survey conducted by KIWI-TEK, a medical coding company in Indianapolis, that asked 157 coders how the novel coronavirus (COVID-19) pandemic has impacted their finances, workflow, and career prospects.
Review digestive anatomy and ICD-10-CM coding for common diseases of the digestive tract including diverticulitis, cholecystitis, and abdominal adhesions. Also look at new codes to be added to Chapter 11: Disease of the Digestive System of the ICD-10-CM manual on October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Would it be appropriate to use family psychotherapy CPT codes 90846-90849 to report therapy for the benefit of one person that involves input from family members?
CMS released the calendar year (CY) 2021 MPFS and OPPS proposed rules on August 3, introducing new CPT codes, reducing the PFS conversion factor by nearly 11%, and seeking commentary on how to gradually eliminate the inpatient only list.
Valerie Rinkle, MPA, CHRI , breaks down updated CMS guidance for reporting virtual clinic visits and other telehealth services rendered at on- and excepted off-campus provider-based departments.
Medicare Recovery Audit Contractors (RAC) reported that several outpatient claims did not meet medical necessity requirements for hyperbaric oxygen (HBO) therapy for diabetic wounds of the lower extremities, according to the July 2020 Medicare Quarterly Provider Compliance Newsletter .
Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS , describes simple actions you can take to show appreciation for providers and make education unobtrusive during the novel coronavirus (COVID-19) public health emergency.
CPT® coding for respiratory procedures can be challenging, given the structural complexity of the upper and lower respiratory tracts. Refresh your knowledge of respiratory anatomy and CPT reporting of angiographies, laryngoscopies, and endotracheal intubations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association (AMA) recently announced a new CPT® code for reporting antigen testing performed on patients suspected of being infected with the novel coronavirus (COVID-19). The new code is intended to improve reporting of antigen tests using an immunofluorescent or immunochromatographic technique for detection of COVID-19.
Coding managers: Take steps to effectively prepare staff for the transition to the new E/M guidelines, scheduled to take effect January 1. Review advice from coding experts on updating patient forms, medical record software, and rethinking your workflow to prepare staff for the changes to come.
Coders must apply modifiers to CPT codes for select services rendered during the novel coronavirus (COVID-19) public health emergency to ensure that providers are paid in full for documented work. This article details reporting of telehealth modifiers -95, -G0, and -GQ, and emergency modifiers -CR and -CS. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Recently published CMS guidance clarifies billing requirements for services rendered via telecommunications technology during the public health emergency. Valerie Rinkle, MPA, CHRI , breaks down the updated guidance as it applies to outpatient services provided at alternative care sites such as patient homes.
Q: A child presents to the ED with a closed fracture of his left hand. The physician performs a two-view hand x-ray that shows a small fracture. The physician reduces the fracture and performs a one-view x-ray to ensure alignment. Which CPT® codes and modifiers would be used to report the physician’s services?
Changes to office E/M guidelines, effective January 1, 2021, will give providers the option to code based on the total time they spend on a patient’s care per date of service. Prepare for these changes by reviewing rules for time-based E/M documentation and code selection.
Q: When would it be appropriate to apply modifier -62 (two surgeons) on claims for spinal procedures performed by co-surgeons, and what effect would this have on physician reimbursement?
CMS on April 30 released an interim final rule with regulatory relief for hospital outpatient departments. In this article, Kimberly A. Hoy, JD, CPC , reviews Medicare provisions that allow outpatient departments to bill services at alternate locations during the novel coronavirus (COVID-19) public health emergency.
Outpatient coders must be able to assign E/M codes for the providers’ work and resources utilized by the facility during emergency visits. This article takes a close look at facility E/M coding and payment for visit services rendered in Type A and Type B emergency departments (ED). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published details on prior authorization requirements, established by the 2020 OPPS final rule, for select hospital outpatient department (HOPD) services, scheduled to go into effect July 1.
Review up-to-date novel coronavirus (COVID-19) documentation tips, ICD-10-CM and CPT coding guidance, and advice for ensuring billing compliance during the public health emergency.
Physician practices have started reopening to patients but are not expecting a return to normal anytime soon. They continue to struggle with staffing shortages and lost revenue due to COVID-19 restrictions.
Coding audits are commonly used to determine the need for focused coder education and training. Learn about key considerations for conducting coding audits and summarizing significant audit findings.
Even experienced coders have difficulty adhering to CPT reporting guidelines for wound care procedures. Review Medicare’s medical necessity requirements for debridement procedures and CPT coding for wound care services delivered via interactive audio and video. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS issued the proposed lists of new, revised, and invalidated ICD-10-CM codes May 11 in conjunction with the fiscal year (FY) 2021 Inpatient Prospective Payment System proposed rule. The update will be significantly larger than the FY 2020 ICD-10-CM update if all the proposed changes are finalized.
Read up on new CMS policies that expand COVID-19 care, ramp up diagnostic testing, and loosen restrictions on billing for telehealth services during the public health emergency.
Diagnosis codes for neurologic disorders are widespread throughout the ICD-10-CM manual. In this article, Joel Moorhead, MD, PhD, CPC , breaks down ICD-10-CM code selection for cerebrovascular diseases, transient cerebral ischemic attacks, and peripheral neuropathies.
Practices that have experienced a shutdown or a near-shutdown during the COVID-19 national public health emergency need to adhere to state regulations for re-opening. In addition, they must consider the impact that re-opening would have on staff members and patients impacted by the pandemic.
To assign CPT codes for spinal procedures, coders need a solid understanding of spinal anatomy and procedural terminology. They must also be up to date on guidance from CMS and the American Medical Association for facility reporting of spinal surgeries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O , takes a closer look at the main topics addressed in a recently published Coding Clinic Advisor FAQ, including ICD-10-CM coding for antibody testing, virus signs and symptoms, and comorbidities related to the novel coronavirus (COVID-19).
CMS released an interim final rule with comment period on April 30 that grants organizations additional flexibilities to meet the challenges of the COVID-19 public health emergency, including permitting hospitals to bill for telehealth services and loosening restrictions on COVID-19 testing.
Q: Which ICD-10-CM codes would we use to report an emergency department (ED) encounter for a patient presumed to have COVID-19 who does not undergo diagnostic testing?
Providers have two new CPT codes to report for blood tests to check for the presence of COVID-19 antibodies. The codes, which allow for reporting of one- and two-step testing methods, took effect April 10, according to an American Medical Association (AMA) update.
The Office for Civil Rights’ (OCR) enforcement discretion statement seems to open a whole new world of options for providers and patients. However, experts have warned providers that they can still get in a lot of trouble if they are not careful about how they use technology.
In part two of this two-part series on modifier -22, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews documentation considerations for increased procedural services and tips for the appropriate CPT reporting of this commonly misused modifier.
Q: If laboratory results supporting a positive case of COVID-19 are included in the physician’s note for an emergency department visit, but the physician does not provide an interpretation of the laboratory results, would it be appropriate to report an ICD-10-CM code for a confirmed case of COVID-19?
Under the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS has broadened access to telemedicine services during the novel coronavirus (COVID-19) pandemic. Read about how the interim final rule impacts reporting of telehealth visits, virtual check-ins, and e-visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
On March 31, the CDC updated the 2020 ICD-10-CM Official Guidelines for Coding and Reporting to include guidance for reporting the novel coronavirus and associated respiratory illnesses, effective April 1 through September 30.
Over 330,000 cases of COVID-19 have been reported in the U.S., according to the Centers for Disease Control and Prevention. In this article, Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , writes about the virus’s etiology and how to effectively document and code for COVID-19 diagnoses.
Modifier -22 frequently causes compliance headaches for revenue cycle professionals. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews CPT reporting requirements for this commonly misused modifier to ensure that your physicians are being appropriately reimbursed for increased procedural work.
In its April update to the OPPS, CMS made effective new Proprietary Laboratory Analysis (PLA) codes for biochemical assays and billing codes for novel coronavirus (COVID-19) laboratory tests. Hospital coders should review these updates to ensure that they are selecting the most specific codes for these services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The AMA announced that its CPT® editorial panel expedited approval of a unique CPT code to report laboratory testing services for COVID-19. The new code supports the urgent public health need for streamlined reporting of testing for the virus.
Providers will find immediate opportunity to provide virtual visits to patients enrolled in Medicare and Medicare Advantage plans as CMS seeks to facilitate screening and treatment of novel coronavirus (COVID-19) cases.
Approximately 12% of Americans suffer from migraine headaches, according to the Migraine Research Foundation. In this article, Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, reviews coding for migraine headaches and their treatment, including CPT reporting of drug-free alternative treatment options.
Given the frequency with which wound procedures are performed, and the expenses associated with their performance, it’s essential that coders have a clear understanding of how to accurately report CPT codes for these services. Review 2020 CPT codes for wound repairs and grafting procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
When reporting CPT codes for spinal excisions and decompression procedures, coders must consider the approach used, spinal levels operated on, number of providers involved, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Providers need to clean up coding for electro-acupuncture devices, according to CMS. In Special Edition MLN Matters 20001, the agency noted that some providers are incorrectly coding these devices using HCPCS Level II code L8679 (implantable neurostimulator, pulse generator, any type).
Coders will find a wide range of CPT and HCPCS Level II codes that have been assigned medically unlikely edits (MUE) this year. Review new MUE values that went live January 1 for codes involving drug injections as well as E/M, radiology, and therapy services.
Hemorrhoids are the third most common outpatient gastrointestinal diagnosis in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases. Debbie Jones, CPC, CCA , writes about symptoms of hemorrhoids and CPT coding for treatment.
The Centers for Disease Control and Prevention is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. Learn about signs, symptoms, and ICD-10-CM coding for the virus. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS announced on February 13 that it created a new HCPCS code U0001 to report laboratory testing for the 2019 novel coronavirus (COVID-19). Medicare’s claims processing system will be able to accept this code on April 1 for dates of service on or after February 4.
CMS recently announced that it will cover acupuncture therapy sessions for Medicare patients with chronic low back pain. Read about how this change will impact physician coding and billing for acupuncture services.
More than 34 million people in the U.S. have diabetes and one in five don’t know they have it, according to the Centers for Disease Control and Prevention. In this article, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about E/M coding for diabetes management and HCPCS Level II coding for external insulin infusion pumps.
As with any new clinical documentation integrity (CDI) initiative, there are many possible starting points for outpatient CDI. Review advice from healthcare professionals at Trinity Health on how to successfully implement an outpatient CDI program.
The Centers for Disease Control and Prevention (CDC) recently published an ICD-10-CM index and tabular addenda with reporting criteria for new ICD-10-CM code U07.0 (vaping-related disorders). The agency also updated its MS-DRG grouper software package to accommodate the new code.
The Centers for Disease Control and Prevention estimates that over 30 million people in the U.S. have diabetes mellitus and 25% don’t know they have it. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about characteristics of the diabetes and ICD-10-CM coding for the disease.
Nationwide studies show increases in rates of alcohol-related emergency department visits and hospitalizations over the past decade. Review ICD-10-CM documentation and reporting for alcohol abuse and related complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Medicine section of the CPT Manual includes codes for a variety of services and is divided into 33 subsections that can be challenging to navigate. Review guidance for reporting 47 new codes within this section of the manual including those for vaccines, behavioral assessments, ocular examinations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently rescinded Transmittal 4880, January 2020 Update of the OPPS, and replaced it with Transmittal 4494 to include updated language on the removal of procedures from the inpatient-only list and new information on out-of-pocket costs for screenings with electrocardiography. All other information remains the same.
HCPro’s 2019 coding productivity survey showed that coding productivity held steady for 2019, but facilities continue to struggle with miscommunications between coding and CDI staff and unanswered physician queries.
The American Medical Association introduced new CPT codes for long-term electroencephalogram (EEG) monitoring sessions that went into effect on January 1. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how to accurately apply these codes based on details in provider documentation.
Q: A physician performed a pleural catheter flush using saline with manual clearance of clots under ultrasound guidance. Should we bill an E/M code for an outpatient office visit or report this using other CPT codes?
The American Medical Association (AMA) recently published a checklist to help physician practices transition to the new E/M coding and documentation guidelines slated to take effect January 1, 2021.
The flu vaccine is changed each year based on the virus types that the Centers for Disease Control and Prevention estimates will be the most prevalent. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews CPT and ICD-10-CM coding for this year’s flu vaccine and its administration.
Modifier -25 can cause frustration as it is not recognized by many payers, including Medicaid. When applying this modifier, coders must consider CPT reporting rules and adhere to potentially restrictive billing rules followed by payers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2020 edition of the National Correct Coding Initiative (NCCI) Policy Manual features new guidance and clinical examples to help coders appropriately apply the -X{EPSU} modifiers debuted by CMS several years ago.
A new ICD-10-CM code for reporting vaping-related disorders will become effective April 1, 2020, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics announced on December 9.
Although the dollar figures aren’t big, the Office of Inspector General’s (OIG) report on faulty chronic care management (CCM) billing should be concerning for physician practices billing these codes.
James S. Kennedy, MD, CCS, CDIP, CCDS , reviews updated policies in the 2020 Medicare Physician Fee Schedule final rule that will affect ICD-10-CM risk-adjustment reporting and documentation for facilities.
The American Medical Association released its annual update to the CPT code set in September, introducing several new codes for cardiovascular and digestive procedures. Review the new 2020 CPT codes for preperitoneal pelvic packing, hemorrhoidectomy procedures, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In the 2020 Medicare Physician Fee Schedule final rule, CMS proposes to adopt four new time-based HCPCS codes to be used in place of existing CPT codes for complex and non-complex chronic care management (CCM) services.
JustCoding’s sister publication, HIM Briefings, conducted a benchmarking survey to shed light on edit and denial management processes across the industry. Review findings from the survey to see how your organization compares to those across the industry.
Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , writes about new E/M codes, effective January 1, for patient-initiated services administered by a physician or other qualified healthcare provider.
Because the cardiovascular system circulates oxygen and nutrients to all body parts, procedures of the cardiovascular system can be complex and challenging to accurately report. This article reviews CPT guidelines for reporting ECMO procedures and endovascular interventions in the lower extremities. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CPT reporting for surgical heart procedures requires an in-depth understanding of cardiovascular anatomy and terminology. This article reviews CPT reporting for procedures involving cardiac pacemakers and implantable cardioverter-defibrillators based on key details in provider documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In the 2020 Medicare Physician Fee Schedule final rule, CMS increased the performance threshold for Merit-based Incentive Payment System (MIPS) eligible providers and finalized its proposal to implement the MIPS Value Pathways (MVP) framework in calendar year 2021.
Q: A patient presents for routine obstetrical (OB) care following a vaginal delivery. During the visit, the provider performs a postpartum depression screening. Should the depression screening be charged separately from the global OB visit service?
Review finalized changes to relative value units for office visits, new HCPCS codes for chronic care management and opioid treatment services, and future updates to the E/M reporting guidelines.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews the appropriate application of 14 new HCPCS codes that will allow opioid treatment programs to report medication-assisted treatments beginning January 1, 2020.
