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.
Prader-Willi syndrome (PWS) is a rare genetic disorder that causes significant physical and intellectual abnormalities. Debbie Jones, CPC, CCA , writes about signs and symptoms of PWS and diagnostic and CPT coding for the disorder.
Advances in technology have made it easier for providers to administer remote physiologic monitoring services. However, because these services are relatively new, they remain underutilized and Part B providers have questions on how to accurately report and bill for them.
Q: Does a psychiatrist need to document a physical examination and a review of prescriptions in order to support the reporting of CPT code 90792 (psychiatric diagnostic evaluation with medical services)?
CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule and OPPS final rules approving changes to E/M documentation guidelines, introducing new HCPCS codes, and continuing its potentially unlawful payment policy for drugs purchased through the 340B drug discount program.
CPT coding for behavioral health can be challenging given the multitude of factors that influence code selection. Review procedural coding for psychiatric diagnostic assessments, psychotherapy, and other mental health services commonly performed in the office setting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If a patient comes in twice a day over the course of a week to receive an IV infusion of Vancomycin and the same line is used daily, would the coder report one initial infusion CPT code per day?
The Centers for Disease Control and Prevention (CDC) recently released documentation guidance for providers who evaluate patients with symptoms of e-cigarette- or vaping-associated lung injury, as well as official ICD-10-CM coding guidance for reporting these encounters.
Many physician practices are now performing chronic care management (CCM) services yet providers continue to encounter significant barriers in completely connecting eligible patients to such care. Read about these regulatory challenges and how CCM providers should report their services using CPT codes.
Every day, more than 130 people in the U.S. die after overdosing on opioids, according to the National Institute on Drug Abuse. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about accurate documentation and ICD-10-CM coding for opioid use, abuse, and dependence.
By selecting the most specific codes for cancer diagnoses, coders can help epidemiologists track disease trends and measure the efficacy of drug therapies and radiation oncology treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
One thousand eighty cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S. as of October 1, according to the Centers for Disease Control and Prevention. Review provider documentation and ICD-10-CM reporting for vaping-induced illnesses. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Hospital Association, Community Oncology Alliance, and other hospital organizations expressed concerns regarding CMS’ proposed mandatory payment model for radiation oncology (RO), which if finalized, would go into effect January 1.
Perhaps the most momentous Quality Payment Program (QPP) news in the 2020 Medicare Physician Fee Schedule proposed rule is the Pathways version of the Merit-based Incentive Payment System (MIPS)—but that’s not happening until 2021.
A wide range of diagnostic tests may be used by hospital providers to examine respiratory functioning. In this article, Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, CPC-I , interprets CPT guidance for reporting pulmonary functioning tests used to diagnose patients with asthma and chronic obstructive pulmonary disease.
Q: The 2020 ICD-10-CM update added several new codes for legal interventions. What are these codes, and can they be assigned based on nonphysician documentation?
U.S. District Judge Rosemary M. Collyer recently ruled that CMS exceeded its authority when it expanded a site-neutral payment policy that cut reimbursement for certain E/M services provided in previously excepted off-campus hospital clinics.
Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC , reviews 2021 proposals to E/M codes for office visits and other outpatient services and draft guidelines for the implementation of these changes.
The fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about significant guideline updates that will impact facilities starting October 1.
Internal audits can reveal inconsistencies in provider documentation and coding, reporting errors, and fraudulent billing practices. Review internal auditing basics and advice from regulatory experts on how to effectively educate providers on audit findings. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association released the 2020 CPT code set on August 26, introducing 248 new codes including many for drug implants, dry needling, and cardiac drainage procedures.
The 2020 CPT update added new codes for the preparation and insertion of drug delivery devices, dry needling, and anesthetic nerve injection administration. Familiarize yourself with these and other updates before they go into effect January 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Gastrointestinal cancer is the fourth most common cancer in the U.S., according to the National Cancer Institute. Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, COC , writes about ICD-10-CM coding for colon cancer screening and CPT coding for diagnostic colonoscopies.
Q: Would it be appropriate to query the provider for clarification if documentation for an orbital fracture doesn’t specify the location of the fracture and whether it is open or closed?
If payment updates in the 2020 Medicare Physician Fee Schedule proposed rule are finalized, they will significantly impact physician reimbursement for x-ray and E/M CPT codes, among others. Review payment proposals and the specialties that would see the greatest impact.
Evolving diagnostic terminology and a general lack of awareness surrounding gender fluidity can cause confusion for healthcare providers and coders. Review key considerations for the ICD-10-CM reporting of biological sex, gender identity, and other gender-related diagnoses. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In response to a formal request for information from industry stakeholders, CMS received 567 comments on ways to improve its Patients Over Paperwork Initiative, including many requests from hospital groups to simplify billing and prior approval requirements.
CMS proposed a new framework for the Merit-based Incentive Payment System (MIPS) intended to make the transition to value-based care easier for physicians. Read up on the proposed framework, MIPS Value Pathways (MVP), and its potential impact on patients and providers beginning in 2021.
When applying CPT modifiers -80, -81, and -82, physician coders must carefully consider details in the operative note. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about the correct application of modifiers used to identify services performed by surgical assistants.
Drug administration is one of the most commonly performed procedures in outpatient departments; however, this topic continues to generate confusion for coders and providers alike. Brush up on CPT coding rules for intravenous (IV) injections, infusions, and hydration services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The four organizations that make up the Cooperating Parties for ICD-10 recently approved the 2020 ICD-10-CM guidelines, which include updated guidance for reporting pressure-induced deep tissue damage, multiple drugs or medicinal substances, injuries and complications.
Q: A patient presents to a wound care clinic for assessment of a 15 sq. cm open wound. A nurse evaluates the wound and performs selective debridement. Would it be appropriate to bill an E/M code and if so, should we report modifier -25?
The 2020 Medicare Physician Fee Schedule proposed rule includes significant documentation and payment changes for outpatient office visits reporting using E/M codes 99202-99215. Beginning in 2021, these proposed updates could add billions of dollars to the national E/M revenue stream.
Atrial fibrillation (AF) is the most common type of heart arrhythmia, according to the Centers for Disease Control and Prevention. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , reviews outpatient coding for AF and surgical techniques used to treat the condition on a case-by-case basis.
Q: Suppose a patient comes in for psychological testing evaluation. The provider interprets the test results and patient data, prepares a report, and begins treatment planning. If the interactive feedback session is held several days later, how would this be reported using CPT codes?
CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) and OPPS proposed rules on July 29, introducing new CPT codes and extensive changes to documentation requirements for E/M office visits, and seeking commentary on how to overhaul MIPS and potentially undo its payment policy for drugs purchased through the 340B discount program.
Before starting an ambulatory or outpatient clinical documentation improvement (CDI) program, those tasked with the project must first create some universal definitions, so everyone is on the same page and speaking the same language.
Several surgical techniques can be used to excise or slow the growth of a paratubal cyst. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the etiology of paratubal cysts and CPT coding for their treatment.
Physician coders need to know when it’s appropriate it apply modifier -25 for significant, separately identifiable E/M service. Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC , reviews the correct application of this frequently misused modifier. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The ICD-10-CM Manual lists hundreds of code options for mental disorders with unique characters to specify symptoms and complications. This article breaks down outpatient coding for commonly reported mental health conditions, psychiatric assessments, and psychotherapy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A Medicare billing study recently published in The Journal of Hand Surgery found that provider reimbursement for magnetic resonance imaging (MRI) and computed tomography (CT) scans of the upper extremities significantly decreased over the last decade.
Medicare appropriate use criteria (AUC) requirements, currently in a voluntary testing period, will become mandatory starting January 1, 2020. Denise Williams, COC, CHRI , shares insight and analysis on AUC reporting requirements to help facilities prepare for what’s to come.
CMS released the 2020 ICD-10-CM code set in May, adding 273 new codes effective for reporting beginning October 1. Shelley C. Safian, PhD, RHIA, CCS-P, COC , reviews new ICD-10-CM Z codes for factors influencing health status and Y codes for legal interventions.
