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.
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?
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.
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.
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.
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?
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 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.
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.
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.
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.
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.
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.
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?
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.
