The best time to determine code edits is when the account is coded, meaning coding professionals play a key role in establishing overarching principles and best practices for edit management.
Compliance is more than just abiding by coding guidelines and payer policy. Coding professionals must become familiar with ethical standards and federal regulations to avoid facing denials or federal penalties. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our vascular physician prescribes exercise to some of his patients who have peripheral artery disease and wants to provide the exercise program in the office because he wants to have these patients monitored closely for their response. Is there a way to get reimbursed for this?
The October 2017 OPPS quarterly update introduced 12 new proprietary laboratory analysis CPT codes as well as a new modifier for a biosimilar biological product.
The 2018 update to the ICD-10-CM code set introduced a number of new gynecological codes, and Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about the significance and distinguishing details of the new codes.
As part of the October 2017 OPPS update, CMS will revise its policy on upper eyelid blepharoplasty and blepharoptosis repairs to allow physicians to receive payment for medically necessary blepharoptosis repairs when performed with cosmetic blepharoplasty.
The rise of clinical documentation improvement programs was a game changer for inpatient documentation. Now, the Quality Payment Program and similar systems are creating an opportunity for CDI to expand into the outpatient arena.
Atrial fibrillation is the most common type of heart arrhythmia in the U.S. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, writes about common symptoms and treatments as well as proper ICD-10-CM coding for the condition.
Changes to the ICD-10-CM guidelines go into effect October 1, and coders will need to master knowledge of alterations to the general coding guidelines as well as new additions to guidelines on reporting diabetes, substance abuse, and myocardial infarctions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Can you explain where in the clinical documentation it would be acceptable to report from for hierarchical condition category purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?
The 2018 updates to the CPT Manual released in early September feature a total of 314 code changes. New codes for E/M visits, genetic testing services, and endovascular repairs of aortic aneurysms are among the 172 additions.
With weeks remaining before the 2018 ICD-10-CM codes are implemented, it is important to review new codes—including myocardial infarction and ophthalmology codes--as well as changes to the coding guidelines and documentation requirements. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one Medicare administrative contractor tightened up physician supervision requirements.
Outpatient coding’s impact on reimbursement is evolving as healthcare continues its march toward value-based care. Kim Miller, CPC, CHC , and Kerri Wing, RN, MS , detail how coders play a central role in this shift.
Q: What are some times when it might be acceptable for a provider to copy and paste medical information into an electronic health record and when is it absolutely not acceptable?
One of the most controversial changes to the 2017 ICD-10-CM guidelines was the contradictory guidance for the term “with,” and that issue is addressed in the 2018 version of the guidelines.
The urinary system might not be one of the body systems people are most eager to discuss, but learning the anatomy of the urinary system is key in coding certain procedures, especially in the surgical and interventional radiology specialties. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The 2018 OPPS proposed rule is one of the shortest—and latest—in recent memory, being released July 13 at only 663 pages, but it contains major proposed policy changes for the 340B drug discount program, incorporates new modifiers, and expands packaging to drug administration for the first time.
The words “endometriosis” and “endometrioma” look similar, but as Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes, these conditions vary greatly in terms of physiology and coding.
In the outpatient world, physicians are accustomed to seeing services as the key to reimbursement, but diagnoses and outcomes will increasingly factor into reimbursement as healthcare shifts toward value-based care. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What are the applicable modifiers that can be used when a test fails for medical necessity or if an Advance Beneficiary Notice (ABN) has been signed?
The 2018 OPPS proposed rule included potential changes to certain radiology modifiers used by CMS to identify services for data collection as well as reimbursement.
James S. Kennedy, MD, CCS, CDIP , discusses the new ICD-10-CM codes for FY 2018 and describes some of the changes that could be made to documentation and billing habits for these conditions.
Coding and billing for the transgender patient can be difficult even when society in general has become more aware of people who are transgender. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, covers some of the challenges coders may face when filing claims for transgender patients.
With the increased focus on clinical documentation improvement in the outpatient arena, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, shares her tips for proving medical necessity on claims.
The 2018 OPPS and Medicare Physician Fee Schedule proposed rules usually make their debuts around the Fourth of July, but despite a later release this year, there were plenty of fireworks within each rule that should generate provider feedback during the comment periods.
E/M services are some of the most frequently used CPT codes, and they are also some of the most frequent examples of incorrect coding. One of the problem areas in selecting the proper E/M code is distinguishing between new and established patients. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Is CPT code 96416 (chemotherapy administration requiring use of portable pump) the same as HCPCS code G0498 (initiation of infusion of chemotherapy in office using portable pump)? Our facility is trying to determine if it would be appropriate to set up G0498 as a Medicare override for 96416.
July is National Juvenile Arthritis Awareness Month. Yvette DeVay, MHA, CPC, CIC, CPC-I, explains the differences between the many different types of juvenile arthritis in order to help coders report the disease correctly.
In ICD-10-CM, defining, diagnosing, and documenting the various forms of altered mental status and their underlying causes remains an ongoing challenge for physicians and their facilities, according to James S. Kennedy, MD, CCS, CDIP .
Q: For a ureteroscopy intended as a procedure with a biopsy and double-J stent, if the procedure ends when only the scope was placed before a biopsy was taken, could you just code ureteroscopy instead of coding it with the biopsy and the modifier-74 (discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia)?
The Quality Payment Program proposed rule seems to bring relief to providers anticipating escalation of Medicare Access and CHIP Reauthorization Act (MACRA) requirements, but there are a plethora of reasons for coding professionals to start adapting their workflow for MACRA now. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The American College of Obstetricians and Gynecologists is encouraging providers to decrease the number of cesarean section deliveries. According to Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, this means coders should brush up on their knowledge of how to code fetal intervention procedures for babies who are in a breech position.
CMS Special Edition article 1609 was released in April to clarify CMS’ policy on prolonged drug and biological infusions using an external pump. Valerie A. Rinkle, MPA , breaks down that article and discusses its billing and reimbursement implications in the first of this two-part series.
CMS released the final 2018 ICD-10-CM codes on its website on June 13, and the release contained more code changes than expected following a preview of the new code set in April’s 2018 IPPS proposed rule.
In the second part of a two-part series on SE1609, Valerie A. Rinkle, MPA , distinguishes between CPT code 96416 and HCPCS code G0498 for billing and reimbursement purposes while outlining how practices can achieve compliance with CMS’ current external pump policy.
Modifier assignment can be a confusing task, and that work is sometimes made more difficult by encountering a set of modifiers which apply to the same circumstance with only one differentiating factor. A review of some of these modifiers, including modifiers -PO, -PN, -73, and -74, can be essential for accurate claims submissions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released a change request May 30 describing modifications which will be implemented in the July 2017 quarterly update to the OPPS. These changes include new ophthalmologic and maternal care codes as well as a handful of new drug codes.
The Ochsner Health System in Louisiana revolutionized the way its clinical documentation excellence (CDE) team captures annual hierarchical condition categories for all patients across its vast system. Now, Ochsner can serve as a case study to educate others on how to create an outpatient focus on CDI in an increasingly risk-adjusted world.
May was a busy month for telehealth in the political world on both the federal and state levels. This action serves as a reminder that expanded access will mean an increase in telehealth coding, but navigating eligibility requirements and coding regulations can be a challenge. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
There is an extensive list of coverage requirements that must be met to furnish outpatient services to Medicare beneficiaries. Gina M. Reese, RN, JD, CPHRM , discusses some of the trickier issues that facilities will need to audit more carefully while monitoring for compliance in provider-based departments.
Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But Jugna Shah, MPH , writes that, increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
Podiatry coding can become complicated quickly, as a number of procedures can be performed on the same site or region of the foot. This means codes could easily run into NCCI edits or denials. One way to ensure physicians are reimbursed properly for provided services is to review NCCI edits pertaining to podiatry.
Alcohol and Other Drug-Related Birth Defects Awareness Week began on Mother’s Day and aimed to raise awareness of the dangers of substance abuse during pregnancy. In honor of this awareness week, Yvette DeVay, MHA, CPC, CIC, CPC-I , discusses fetal alcohol syndrome disorders and ICD-10-CM coding for the condition.
Q: What is the best way to document time spent by physicians performing procedures? The CPT® codes state a vague time amount but the doctors struggle with this.
CMS issued a change request to provide guidance to Medicare Administrative Contractors on the use of a new modifier to append to claims for dialysis treatments for end-stage renal disease exceeding the 13 or 14 monthly allowable treatments.
