CMS made incorrect payments to hospitals for established patient clinic visits estimated at approximately $4.6 million in 2012, according to a recent Office of Inspector General (OIG) audit.
After years of consideration, CMS introduced extensive changes for modifier -59 (distinct procedural service) for 2015. Jugna Shah, MPH , explains these changes and when to use the new modifiers instead of modifier -59.
The nervous system consists of the brain, spinal cord, sensory organs, and other specialized cells throughout the body, and is involved in nearly every bodily function. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the anatomy of the nervous system and some guidelines changes for it in ICD-10-CM.
CMS expanded packaging and finalized Comprehensive APCs in the 2015 OPPS final rule. Jugna Shah, MPH, and Valerie Rinkle, MPA, analyze the changes and the potential impact on providers.
CMS accepted 76% of all national ICD-10 test claims submitted during its November 2014 ICD-10 acknowledgement testing week. More than 500 providers, suppliers, billing companies, and clearinghouses participated in the tests, which identified no issues with Medicare's system.
In part two of a series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews ICD-10-CM Z codes, explaining how and when to use them and how they differ from ICD-9-CM V codes.
With the ICD-10 implementation date set for October 1, 2015, CMS has continued its efforts to provide education and information to help organizations prepare for the change. Recently, CMS published a recording of its Transitioning to ICD-10 Provider Call and a new Coding for ICD-10-CM video to YouTube.
Q: If the physician does not perform a formal myelography and just administers an injection before the patient goes straight for computed tomography (CT), which CPT ® code would we report in 2015? The 2015 combination codes are for use when the same radiologist or physician who performs the injection reads his or her own study.
We've compiled the numbers from the latest JustCoding Salary Survey and now you can see how you compare to the average coder in terms of salary, experience, and other factors. Monica Lenahan, CCS, and Susan E. Garrison, CHCA, CHCAS, CHC, CCS-P, CPC, CPC-H , analyze the results and discuss the future of coder salary and responsibilities.
The added detail found in ICD-10-CM may require coders to brush up on their anatomy and physiology training to select the most appropriate codes. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews the anatomy of the male reproductive system and how coding for it will change in ICD-10-CM.
Q: I have a question regarding CPT ® code 99184 (initiation of selective head or total body hypothermia in critically ill neonate, includes appropriate patient selection by review of clinical, imaging, and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling) in the 2015 CPT Manual . What if the neonate is in the hospital for several weeks? The total body hypothermia is performed, the baby improves, but remains in the hospital and then needs the procedure performed a second time. Can we report it a second time if several weeks have elapsed?
Recovery Auditors have identified improper payments for claims involving end-stage renal disease (ESRD) services when more than one monthly service was billed per month and per-day codes exceeded the limit, according to the latest Medicare Quarterly Provider Compliance Newsletter .
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about how to reduce queries by highlighting the information providers need to document for the most common OB ultrasound procedures.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the endocrine system and how to code for conditions affecting it.
Q: We have a patient diagnosed with neuropathy due to poorly controlled insulin-dependent Type 1 diabetes mellitus. What should we report in ICD-10-CM?
AHIMA is calling for coders, billers, and providers to contact Congress to ask for no additional delays to ICD-10 after physician groups have recently started to advocate for members to petition Congress to introduce a new, two-year implementation delay to push the compliance date to October 1, 2017.
The majority of providers either stopped or slowed their ICD-10 preparations as a result of the latest implementation delay, but now providers have less than a year to become ready. CMS' Denesecia Green and Stacey Shagena offer advice on how providers can create an action plan to be ready by October 1, 2015—even if they haven't started yet.
Nearly 30% of Medicare patients are enrolled in Medicare Advantage (MA) programs, which come with specific coding and documentation challenges. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, and Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, highlight key requirements for reporting diagnoses that map to Hierarchical Condition Category codes, the basis of MA plans.
CMS finalized a new data collection requirement for services performed in off-campus, provider-based clinics in the 2015 OPPS final rule , which was released October 31.
Q: I work in a large, provider-based orthopedic clinic with a rheumatology department that has many patients who are very ill with several comorbid conditions. Does the physician need to document every comorbid condition that impacts his or her medical decision making for each encounter? Do we need to code every comorbidity each time in order to meet hierarchical condition category (HCC) requirements?
The House of Representatives recently passed a bill that would impact supervision levels for certain outpatient services. Debbie Mackaman, RHIA, CPCO , reviews the impact of the legislation and which provider types and services it would affect.
When is a mammogram a screening procedure and when does it qualify as a diagnostic test? Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, outlines the differences between the two and what to look for in the documentation.
Q: Do any general guidelines exist for queries on outpatient services? We are beginning the process of developing such a query system for our hospital outpatient services and clinical documentation team.
Coders aren’t the only ones who run into problems due to a lack of complete physician documentation. Lack of sufficient documentation also causes problems for audit review of submitted claims, which in turn leads to delays in payment, according to the October 2014 Medicare Quarterly Provider Compliance Newsletter .
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the thoracic cage and coding concepts in ICD-10-CM related to coding diagnoses of this region.
Steven Espinosa , CCS , AHIMA-approved ICD-10-CM/PCS trainer, and Denise Williams, RN, CPC-H, outline the anatomy of the upper gastrointestinal system and how anatomical details, along with the provider's approach and intent, help determine the proper procedure code.
The October update to the OPPS and Integrated Outpatient Code Editor (I/OCE) includes a payment correction, in addition to new HCPCS codes and other changes. Dave Fee, MBA, reviews CMS' changes and details the retroactive payment correction.
Q: A patient was in a hyperbaric oxygen chamber for eight minutes and the physician had to abort the treatment because the patient was feeling anxious. Which HCPCS/CPT ® code should the hospital bill: HCPCS code C1300 (hyperbaric oxygen under pressure, full body chamber, per 30 minute interval) or an E/M code? Which code should the supervising physician bill: CPT code 99183 (physician or other qualified healthcare professional attendance and supervision of hyperbaric oxygen therapy, per session) or an E/M code?
Evaluation and management services continue to be a major target for auditors. In the second part of a series, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about frequently targeted areas providers can review in order to protect against audits.
In its latest survey of the healthcare industry's ICD-10 readiness, the Workgroup for Electronic Data Interchange (WEDI) found that this year's delay negatively impacted provider progress, with two-thirds reporting slowing down or putting implementation initiatives on hold as a result.
Coding for endovascular revascularization requires following a unique hierarchy and specific guidelines. Caren J. Swartz, CPC-I, CPC-H, CPMA, CPB , and Denise Williams, RN, CPC-H , look at the anatomy of the lower body and the necessary documentation to report these services.
Most diabetes codes in ICD-10-CM include more details than ICD-9-CM codes, but coders also need to consider additional codes. Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, MHP , and Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, review key aspects for coding diabetes in ICD-10-CM.
CMS recently updated the Medicare Claims Processing Manual , with changes announced in Transmittal 3020 , to include ICD-10-specific language ahead of next year's implementation.
ICD-10 implementation will impact different specialties and hospital departments in distinct ways. Andrew D. Boyd, MD, and Neeta K. Venepalli, MD, MBA , recently conducted a pair of studies to determine the financial and informational impact of ICD-10 on a variety of specialties.
Q: What if the provider states that diabetes is due to the adverse effects of a drug, but doesn't tell us which drug? How do we report that in ICD-10-CM?
ICD-10-CM readiness goes beyond training coders on the new code set. Rhonda Buckholtz , Wendy Aiken, and Sid Hebert, look at the impact of implementation on physicians and payers, and how providers can ease the transition.
Evaluation and management (E/M) services are one of the top areas of review by federal auditors. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about common errors found in audits and how providers can take steps to correct them.
The ICD-10-CM delay has at least one silver lining: the ability to spend more time on coding and documentation requirements before implementation. Providers may want to also think about aligning their ICD-10-CM efforts with outpatient clinical documentation improvement (CDI) during this time. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, examines the benefits and challenges of outpatient CDI programs.
The 2015 OPPS proposed rule includes new Comprehensive APCs, increased packaging, and many other changes. Kimberly Anderwood Hoy Baker, JD, and Jugna Shah, MPH , review the proposed rule and policies that may be finalized by CMS.
CMS is introducing four new HCPCS modifiers to specifically define subsets of modifier -59 (distinct procedural service), the most frequently used modifier.
Q: We're not sure what to report in this situation: A patient comes to the ED and goes into respiratory failure. The respiratory therapist comes in to put patient on a vent in the ED, then the patient is transferred to another facility. We can’t report CPT ® code 94002 (ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) because it is for inpatient/observation, per the definition. We wondered about using 94660 (continuous positive airway pressure ventilation [CPAP], initiation and management) for the CPAP. The lay description seems to be basically the same as 94002, except for “applies to ventilation assistance using adjustments in volume and pressure on the initial day…" Would 94660 be appropriate?
Coding depends on clear and accurate documentation, especially with the added specificity available in ICD-10-CM. Andrea Clark-Rubinowitz, RHIA, CCS, CPCH , highlights tactics for improving provider documentationahead of implementation.
While coders have two options to report patella fractures in ICD-9-CM, they will find more than 400 options in ICD-10-CM. Review the anatomy of the lower leg and ankle, as well as ICD-10-CM coding concepts, to learn how to choose the most accurate ICD-10-CM code.
Coding for arthroplasty can be challenging due to the multiple types of procedures and lack of specific CPT ® codes for many of them. Ruby O'Brochta-Woodward, BSN, CPC, COSC, CSFAC, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, explain what to look for in documentation to report the correct codes.
Q: We're wondering about how to use CPT ® code 73225 (magnetic resonance angiography [MRA], upper extremity, with or without contrast material) in our hospital. When providing an MRA of an upper extremity with and without contrast material, should we bill this service twice (since CPT indicates with or without contrast material) or only once?
October 1, 2015, will be the new ICD-10 implementation date, according to the final rule, Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD–10–CM and ICD-10-PCS) Medical Data Code Set, published in the August 4 Federal Register .
The codes for reporting pelvic fractures in ICD-10-CM have expanded, due to added specificity and classification systems that may be new to coders. Review the anatomy of the pelvis to prepare for coding pelvic fractures in ICD-10-CM.
Hospitals will still use CPT ® codes to report procedures after ICD-10 is implemented, but some will also code with ICD-10-PCS. Andrea Clark, RHIA, CCS, CPC-H , reviews the advantages and challenges outpatient facilities may face when using ICD-10-PCS.
