Some providers are billing only add-on codes without their respective primary codes, resulting in overpayments, according to CMS. Add-on codes billed without their primary codes are considered an overpayment, with one exception.
Coding may not be brain surgery, but understanding brain anatomy can greatly help coders when reporting head injuries or disorders. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews some major components of brain anatomy and the impact of ICD-10-CM on coding for some common diagnoses.
Q: A patient comes into the ED with chest pain. An EKG (CPT® code 93005) is performed. The patient goes directly to the catheterization lab for catheterization (code 93454). Is a modifier appropriate for the EKG?
Modifiers are sometimes essential to ensure proper payment, but choosing the correct one can be tricky. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS; Katherine Abel, CPC, CPMA, CEMC, CPC-I; and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, discusssome confusing modifiers and how to use them accurately.
When it comes to ICD-10-CM/PCS, coders may be the hardest and most directly hit employees. Laura A. Shaffer, PhD, and Monica Lenahan, CCS, explain how hospitals may be lagging behind in terms of actually managing the change for these individuals.
After a cerebrovascular accident (CVA, also known as stroke), a patient may suffer additional health problems, lasting after the event has passed. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, compares coding for these lasting effects, known as sequela, in ICD-9-CM and ICD-10-CM.
Q: We have a patient with documented age-related osteoporosis. She bent over to pick up a newspaper from a table and fractured a vertebrae. Should we code the fracture as pathologic or traumatic?
CMS’ Pat Brooks, RHIA, senior technical advisor, Hospital and Ambulatory Policy Group, and AHIMA’s Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, reviewed basic ICD-10 information during a CMS National Provider Call August 22.
Q: The patient comes in for a cardioversion, but the international normalized ratio results were unsatisfactory. The physicians canceled the cardioversion. Would modifier -73 (discontinued outpatient/hospital ambulatory surgery center procedure prior to the administration of anesthesia) be appropriate?
One of the bigger challenges with the birth of the new ICD-10-CM coding system is the assignment of the letter O as the leading indicator for OB/GYN codes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS AHIMA-accredited trainer, delivers a comparative look at coding for OB/GYN coding in ICD-9-CM and ICD-10-CM.
Evaluation and management (E/M) coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G codes. Dave Fee, MBA, Peggy S. Blue, MPH, CCS-P, CPC, Jugna Shah, MPH, Kimberly Anderwood Hoy, JD, CPC, Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Valerie A. Rinkle discuss the possible impact if CMS finalizes its proposal.
Medical necessity establishes the foundation for evaluation and management (E/M) code selection and supports the need to services provided to the patient. Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-approved ICD-10-CM/PCS trainer, explain how to define, determine, and defend medical necessity for E/M codes.
CMS added three new HCPCS C codes and one G code to the integrated outpatient code editor (I/OCE) as part of the October quarterly update. The new codes are effective October 1.
CMS has been gathering information about the use of observation services and short inpatient hospital stays because hospitals have been placing patients in observation for longer periods of time. CMS recently finalized a change that will substantially affect how hospitals bill for observation stays, long outpatient stays, and short inpatient stays.
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable), but instituted a six-month trial period. That grace period ended July 1. Denise Williams, RN, CPC-H, Dave Fee, MBA, and Debbie Mackaman, RHIA, CHCO, explain how to report these G codes and their related functional modifiers.
Medical necessity is as simple as it sounds and it isn’t important just for inpatients. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the importance of establishing medical necessity for outpatient services.
Q: A clinician goes to a patient's home and does not perform an evaluation and management, but performs a catheter replacement. How should we code this encounter?
The AMA significantly changed how coders report cervicocerebral imaging in 2013. Andrea Clark, RHIA, CCS, CPC-H, and David Zielske, MD, CIRCC, CPC?H, CCC, CCS, RCC, discuss the changes and provide tips for coding these services.
Coding debridement of ulcers requires that coders know the type, location, and depth of the ulcer and the treatment provided. Gloria Miller, CPC, and Robert S. Gold, MD, review the clinical and coding aspects of ulcer debridement.
The U.S Centers for Disease Control and Prevention recently posted the updated ICD-10-CM guidelines . Narrative changes in the guidelines appear in bold text and content that moved within the guidelines is underscored.
Coders append modifiers to claims every day, but use some modifiers less frequently than others. Lori- Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, discusses the proper use of two less common modifiers, modifiers -62 and -66.
CMS’ July update to the Integrated Outpatient Code Editor features new codes, new APCs, and a new modifier. Dave Fee, MBA, explains the most noteworthy changes for this quarter.
Coders who want to get a head start on coding in ICD-10-CM can now download the 2014 ICD-10-CM codes from the Centers for Disease Control and Prevention (CDC) and CMS websites. The updated coding guidelines for ICD-10-CM are not available yet.
ICD-10-CM coding for diabetes mellitus will look very different from the ICD-9-CM coding . Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-Approved ICD-10-CM/PCS Trainer, explains what coders need to know to code diabetes in ICD-10-CM.
The upcoming transition to ICD-10 is a great opportunity to build relationships with physicians. Kathy DeVault, RHIA, CCS, CCS-P, Mark N. Dominesey, MBA, RN, CCDS, CDIP, HIT Pro-CP, and Ann Barta, MSA, RHIA, reveal how coders and clinicians can educate each other to make the ICD-10 transition smoother.
Ancillary department staff may think they don’t need ICD-10 training, but they’re wrong. Lori Purcell, RHIA, CCS, and Kathy DeVault, RHIA, CCS, CCS-P, offer tips for preparing ancillary department staff for ICD-10-CM.
Outpatient providers are beginning to see more and more medical necessity audits, especially in the ED and for evaluation and management (E/M) levels. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer, and Joanne M. Becker, RHIT, CCS, CCSP, CPC, CPC-I, AHIMA approved ICD-10-CM/PCS trainer, review the guidelines for ED E/M services and highlight common audit risk areas.
Q: My question pertains to CPT® vasectomy code 55250. This code includes "unilateral or bilateral (separate procedure) including postoperative semen examination(s).” The CPT manual states that a reference laboratory that performs the semen analysis may bill separately for this service. May we bill CPT code 89321 ( semen analysis; sperm presence and motility of sperm, if performed .) in addition to 55250 when the laboratory performs the semen analysis and the surgeon only performs the vasectomy?
Even experienced coders struggle to determine when to append modifiers -58, -78 and -79 because they are very similar in definition, but very different in scope and usage. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reveals the nuances coders must understand to correctly use these modifiers.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. James S. Kennedy, MD, CCS, CDIP, and Kimberly Anderwood Hoy, JD, CPC, discuss CMS’ proposed changes and how they could affect outpatient observation services.
ICD-10 implementation is less than 16 months away, but a recent survey by TrustHCS and AHIMA reveals that 25% of responding healthcare organizations have not yet established an ICD-10 steering committee.
Coders use the same CPT ® codes to report outpatient services whether they are coding physician or facility services. Jaci Johnson, CPC,CPC-H,CPMA,CEMC,CPC- I, and Judy Wilson, CPC, CPC-H, CPCO, CPC-P, CPPM, CPCI, CANPC, CMRS, examine the similarities and differences between coding in the two settings.
Clinical documentation improvement (CDI) initiatives often focus on inpatient documentation to ensure that documentation accurately reflects patient severity. Laura Legg, RHIT, CCS, explains how CDI efforts can also benefit outpatient coding.
Q: We get an NCCI edit when billing an intramuscular/subcutaneous injection (CPT® code 96372) during the same encounter as billing an injection, infusion, or hydration. Should we append modifier -59 (distinct procedural service)? Does it matter if an IV line is already in place before intramuscular/subcutaneous administration?
CMS released Special Edition MLN Matters ® Article SE1325 to clarify split billing for certain institutional encounters that span the ICD-10 implementation date of October 1, 2014.
To correctly code for radiation oncology services, coders need to understand the various elements of the treatment. Rebecca Vandiver, CPC, CPC-I, and Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, analyze these complex services from a coding perspective.
Everyone in healthcare—providers and payers alike—faces the same problems when preparing for ICD-10 implementation . Stephen Spain, MD, CPC, Michael Miscoe, Esq., CPC, CPCO, CASCC, CCPC, CUC, and Annie Boynton, BS, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, offer the physician, compliance, and payer perspectives on the ICD-10 transition.
CMS is translating only 27% of its current National Coverage Determinations (NCD) from ICD-9-CM to ICD-10-CM, according to Janet Anderson Brock, CMS’ director of the Division of Operations and Information Management, Coverage and Analysis Group Center for Clinical Standards and Quality.
General equivalence mapping (GEM) is a good tool to use to convert ICD-9-CM codes to ICD-10-CM, but the maps are only a tool. Lori Andersen, MS, and Patrick Romano, MD, MPH, explain to use GEMs as part of your ICD-10 coding transition.
Coder productivity is expected to decline by as much as 50% immediately after the transition to ICD-10. Many organizations are looking to computer-assisted coding (CAC) to help offset those productivity declines. Lisa Knowles-Ward, RHIT, CCS , and Susan White, PhD, CHDA, discuss the results of the Cleveland Clinic’s study of coding accuracy and productivity with CAC.
Q: A patient suffered a nontraumatic intracerebral hemorrhage six months ago and is now being seen for long-standing aphasia as a result of the stroke. How would we code this in ICD-10-CM?
Q: If a patient has a spinal deformity on L5-S1 and we use the appropriate codes from 2280X and then the physician performs an arthrodesis/fusion on the same level, can we bill the appropriate fusion codes (225XX-226XX) as well? My impression is no, but I would love to get some insight into this question.
According to the Centers for Disease Control and Prevention, 31% of all American adults have high blood pressure, so odds are coders see the condition documented often. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-Approved ICD-10-CM/PCS Trainer , compares coding for hypertension in ICD-9-CM and ICD-10-CM.
Gloria Miller, CPC, vice president of reimbursement services for Comprehensive Healthcare Solutions, Inc., located in Tacoma, Wash, created this quick reference for HCPCS Level 1 modifiers commonly used in wound care coding.
Anesthesia coding in some ways is similar to evaluation and management coding—only easier. Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, explained the 10 steps to coding anesthesia during the AAPC National Conference in Orlando, Fla., April 14-17.
The April 2013 issue of CMS’ Medicare Quarterly Provider Compliance Newsletter highlights two Comprehensive Error Rate Testing (CERT) issues that affect outpatient providers.
CMS corrected edit 84, added five APCs, deleted two APCs, and changed the description of another as part of the April updates to the I/OCE. Dave Fee, MBA, reviews the most significant changes CMS implemented
At first glance, the new CPT ® codes for reporting molecular pathology services might seem simple. They certainly look easier than the old stacking codes that focused on methodology and processes, resulting in multiple codes and quantities being used to report a single test. Jugna Shah, MPH, and Michelle L. Ruben, detail some of the nuances of correct code assignment for molecular pathology tests.
