Drug administration services are one of the most commonly coded and billed services, but that does not mean providers always include complete documentation. Review what physicians and nurses should be including in order to report the most accurate codes.
Chronic care management codes were adopted by CMS in 2015, but relatively few providers use them. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about the criteria needed to code and bill these services, as well as how coders can work with providers to ensure documentation supports the codes.
CMS made no changes for quality measures related to 2019 payment determinations that require reporting next year in the 2017 OPPS final rule. However, for payment determinations in 2020 and subsequent years, CMS is finalizing proposals on seven quality measures.
The 2017 OPPS final rule brings the end of modifier –L1 for separately reportable laboratory tests, along with changes to CMS’ packaging logic. Jugna Shah, MPH, and Valerie A. Rinkle, MPA, review how these changes will impact providers.
The complex anatomy of the arm, wrist, and hand can make coding for procedures on them challenging. Review the bones of the arm and common codes used to report fractures and dislocations.
Q: We are a critical access hospital and don’t get paid under the OPPS. We get reimbursed based on our cost of procedures, tests and services. Is modifier –JW (drug amount discarded/not administered to any patient) applicable to us beginning in January?
With the grace period from CMS for reporting unspecified ICD-10-CM codes over, Erica E. Remer, MD, FACEP, CCDS, writes about diagnoses to target for improvement.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, writes about methods coders can use to improve the quality and detail of physician documentation to ensure important information is captured.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, continues her look at 2017 diagnosis code changes for genitourinary conditions by focusing tips for reporting urinary and male genitourinary diagnoses.
CMS released the 2017 OPPS final rule November 1, implementing site-neutral payment policies required by Section 603 of the Bipartisan Budget Act, adding new comprehensive APCs, and refining several packaging policies.
Providers need to make sure that electronic order templates include all the necessary information to bill correctly and avoid issues during audits. Valerie A. Rinkle, MPA, writes about what must be contained in the order and ICD-10-specific updates providers should consider.
Providers frequently need to treat fractures in the ED, so coders need to be aware of the types of fractures and how to report them using CPT codes. Review types of fractures, treatment, and coding tips for reporting fractures in the ED.
E/M reporting remains challenging for coders and an area of scrutiny for auditors. These challenges can be amplified in the ED, but coders can reduce confusion by reviewing rules for reporting critical care and other components.
Facilities may not yet be using clinical documentation improvement staff to review outpatient records, but the increasing number of value-based payment models and Medicare Advantage patients could make the practice worthwhile, according to Angela Carmichael, MBA, RHIA, CDIP, CCS, CCS-P, CRC, and Lena Lizberg, BSN.
Q. Since ICD-10-CM code O24.415 (gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs) has been added for 2017, do we need to add which specific drug is being used by the patient when reporting the code?
The new ICD-10-CM codes activated October 1 affect nearly every section of the manual. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about codes that impact genitourinary and gynecological diagnoses with tips for reporting them accurately.
CMS released the final rule implementing provisions of the Medicare Access and CHIP Reauthorization Act of 2015 on October 14, giving providers a timeline and outline of the quality programs and payment models that will replace the Sustainable Growth Rate and other programs.
The 2017 OPPS final rule is scheduled to be released in just a few weeks. Jugna Shah, MPH, writes about what facilities should be preparing for in case some of CMS’ proposals related to off-campus, provider-based departments, packaging, and device-intensive procedures are finalized.
Human papillomavirus is the most common sexually transmitted infection in the U.S. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, reviews how to report vaccinations for the virus and how coverage policies by differ by carrier. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
Q: We are struggling with how to report the functional status codes that are required when a physical therapist provides therapy services post-operatively. We have a process for doing that for our “regular” therapy patients, but are struggling with how to implement this for the outpatient surgeries.
More than half of the members of Congress have written to CMS to consider changes to its proposals for implementation of Section 603 of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments.
Wound care procedures can be uniquely complicated due to the range of severity in injuries and potential need to incorporate measurements for multiple wounds. Review these coding tips and anatomical details for reporting wound care procedures.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, continues her review of the updated 2017 ICD-10-CM guidelines by explaining how changes to sections for laterality and non-provider documentation will impact coders and physicians. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, delves into chapter-specific guidance included in the updated 2017 ICD-10-CM guidelines, including changes for diabetes, hypertension, pressure ulcers, and more.
As providers prepare for the thousands of new codes and updated guidelines to be implemented October 1, the ICD-10 Coordination and Maintenance Committee recently met to discuss the next batch of updates to be implemented October 1, 2017.
Q: We have a new pharmacy director and he wants to monitor all separately payable drugs to ensure that we receive appropriate reimbursement. We’re trying to figure out how to do this because the payment is subject to change each quarter. Do you have any suggestions?
Billing correctly for observation hours is a challenge for many organizations. Getting it right requires knowing how to calculate observation hours for each patient, which is far from straightforward. Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW, writes about how to properly calculate hours and report observation services properly.
Q: Is it true that if the patient has hypertension and heart disease such as coronary artery disease that the coder may code the hypertension from the I11 (hypertensive heart disease) series of codes?
Updated ICD-10-CM guidelines, effective October 1, could cause confusion for some coders. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, looks at how changes to reporting linking conditions measure up to previous guidance.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, reviews additional changes to the ICD-10-CM guidelines for 2017, including coding and clinical criteria, new guidelines for Excludes1 notes, and updates for reporting pressure ulcers.
Coders may not be aware of the impact place of service codes can have on coding and billing. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about how the codes are used and what coders should know about their application.
CMS recently released a fact sheet regarding the coding and billing of advance care planning services, following the release of a frequently asked questions document in July on the topic.
Q: Our surgeons perform a lot of blepharoptosis repairs. Because each patient is different, different amounts of eyelid tissue has to be removed. One of our surgeons wants to set a maximum amount that is included in the procedure and then charge a blepharoplasty to cover anything over and above this maximum. We are trying to figure out how to even start to operationalize this. It seems to us that this is just a “patient differential” in the surgery like you have in any other surgery. Is there any guidance or standard for this?
Jugna Shah, MPH, and Valerie Rinkle, MPA, recap CMS’ proposed changes to packaging logic in the 2017 OPPS proposed rule, as well as plans for new and deleted modifiers.
While coders can choose among many CPT codes, provider documentation may sometimes not differentiate between similar options. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about some tricky procedures to distinguish and how coders can ensure they’re reporting which procedures providers actually performed. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
CMS is proposing to replace status indicator E (services not paid, non-allowed item or service) with two more specific status indicators in the 2017 OPPS proposed rule. The agency proposes status indicator E1 for items and services not covered by Medicare and E2 for items and services for which pricing information or claims data are not available.
Debbie Mackaman, RHIA, CPCO, CCDS, reviews how CMS determines inpatient-only procedures and what changes the agency is considering in the 2017 OPPS proposed rule.
Deciphering documentation is frequently the most difficult aspect of coding. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about what documented information coders can use to assign codes—and what to do when that information is lacking.
Modifier -58 describes a staged or related procedure or service by the same provider during the postoperative period. For outpatient hospitals, the postoperative period is defined as the same service date.
CMS recently released a short guide aimed at teaching healthcare professionals how to use the Medicare National Correct Coding Initiative tools and the differences between types of edits.
Q: When our pharmacy mixes medications for infusion, they sometimes have to waste a part of the vial that was opened. They log this in the pharmacy log, which they keep in the department. We have been billing the full amount of the drug that was in the vial and have had no issues with getting paid. Our pharmacist came from a regional meeting and told us that this is going to change.
Jugna Shah, MPH, and Valerie Rinkle, MPA, review changes in the 2017 OPPS proposed rule for providers to comment on, including site-neutral payments and comprehensive APC updates.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about the types of treatment for infertility for both men and women, highlighting the associated diagnosis and procedure codes used to report them.
Providers must link the medical necessity of the treatment they give to the documented diagnoses or they may not get paid. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, looks at how to ensure medical necessity is proven for fertility services.
Q: Can a hospital that is not a critical access hospital (CAH) bill professional charges on UB-04 claims, Type of Bill (TOB) 013X? I have not read anywhere that hospitals cannot bill this way, but usually when discussing revenue 96X and other professional revenue codes there is mention of CAHs only.
CMS’ 2017 OPPS and Medicare Physician Fee Schedule (MPFS) proposed rules, released July 6 and 7, respectively, introduce policies that focus on improving payment accuracy across sites and for professionals in primary care, care management, and patient-centered services.
