The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic. Julia Kyles, CPC, explains the significance of using the OIG’s data brief and offers tips to adhere to compliance guidelines.
The American Medical Association (AMA) released the calendar year 2023 CPT code set on September 9. Learn about new codes pertaining to virtual reality technology, cognitive behavioral therapy, and abdominal hernia procedures.
Q: For colonoscopies, is it appropriate in CPT coding to report the excision of several lesions in the same portion of colon separately if they are removed by the same technique?
The 2023 ICD-10-CM update, which took effect on October 1, includes almost 1,500 code changes. This article focuses on new codes in Chapter 9, Diseases of the Circulatory System. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The ICD-10-CM Official Guidelines for Coding and Reporting provide a roadmap for accurate diagnosis coding. Kimberly Lee, M.Ed., RHIA, CCS-P, unpacks fundamental ICD-10-CM coding concepts.
Shelley Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how, beginning in 2023, medical decision-making (MDM) will be used to determine E/M leveling for additional visit services, following similar changes for outpatient visits implemented in 2022.
Q: How do CPT codes 28295 (correction, hallux valgus, with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method) and 28298 (…; with proximal phalanx osteotomy, any method) differ?
Many healthcare systems are looking at how to expand their CDI program to include outpatient and ambulatory settings. Jennifer Boles, BS, COC, CRC, CCDS-O, explores her ambulatory CDI program’s success and offers advice for those looking to expand.
On August 31, the American Medical Association (AMA) announced eight new CPT codes for bivalent COVID-19 vaccine booster doses. The vaccine boosters are designed to combat both the original COVID-19 strain and omicron subvariants BA.4 and BA.5. Of the eight new CPT codes, four are to be used for Moderna booster vaccines and four are to be used for Pfizer-BioNTech boosters.
The 2023 ICD-10-CM update features many new, revised, and deleted codes. This article focuses on code changes pertaining to blood/blood-forming organs including new codes for von Willebrand disease, heparin-induced thrombocytopenia, and platelet-activating anti-PF4 disorders.
Streamlined coding and shorter time requirements for prolonged services are on the horizon for physicians and qualified healthcare professionals. The pending update to the E/M chapter of the CPT Manual , effective January 1, 2023, will replace four prolonged services with two 15-minute codes.
A recent Medicare Provider Compliance Newsletter highlights accurate documentation and CPT coding for total hip arthroplasty (THA) surgery. This newsletter explains relevant codes and reminders when reporting these procedures.
Q: New ICD-10-CM codes for unspecified vascular dementia with behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety take effect October 1. Do these new codes require linkage and specific documentation by the provider that the conditions are related?
Erectile dysfunction, sometimes called impotence, is a common male disorder. Debbie Jones, CPC, CCA covers physiology, symptoms, and treatment for erectile dysfunction, as well as associated ICD-10-CM and CPT codes.
Effective October 1, the ICD-10-CM code set will be updated to include over 1,100 new codes before counting code revisions and deletions. This article covers new codes for musculoskeletal and genitourinary conditions including muscle wasting, rib and sternal fractures, drug-induced neuropathy, and endometriosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Arthroscopic procedures have been the topic of controversy and confusion in the coding community. This article covers relevant anatomy, common shoulder arthroscopy and arthroplasty procedures, and National Correct Coding Initiative edits to keep in mind. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Revenue erosion and denials are often easily prevented, but simple errors may evade traditional, reactive denials management processes. Coders are encouraged to shift focus to take a proactive approach that targets common errors in claim submission and charge capture and eliminates resource-intensive rework.
Each year, coders must review updates to the ICD-10-CM code set including new, revised, and deleted codes and reporting guidelines. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, explains that for 2023, coders will find several new codes in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.
CMS published a notice in the Federal Register on August 9 stating that it will be suspending prior authorization requirements for specific durable medical equipment, prosthetics/orthotics, and supply (DMEPOS) codes under certain circumstances, beginning January 1, 2023. All claims submitted before that date will require prior authorization documentation.
Interventional radiology describes a set of procedures that involve the insertion of medical devices and instruments to diagnose or treat disorders of blood vessels. This article covers common revascularization procedures, CPT codes associated with each vascular territory, and potential coding errors. 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) released the Category I vaccine product codes for monkeypox tests and vaccines. The organization made them effective immediately upon their approval by the CPT Editorial Panel on July 26. The new codes are scheduled to appear in the in the 2024 CPT Manual.
In part two of this series, expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, addresses the “nuts and bolts” of ICD-10-CM coding for anesthesia services, including how and when to append modifiers.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the proposed 2023 Medicare Physician Fee Schedule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
CMS proposes to adapt the 2023 AMA CPT guideline changes to the nursing facility (NF) codes into its Medicare policy structure next year, according to the 2023 Medicare Physician Fee Schedule proposed rule.
Because of the prevalence of eating disorders, coders should become familiar with their types, symptoms, codes, and relevant guidelines. They appear in ICD-10-CM under category F50 (eating disorders), but codes for individual symptoms appear throughout the manual. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The current year (CY) 2023 OPPS proposed rule, released July 15, details hospital payment updates, remote behavioral services, and enrollment requirements for rural emergency hospitals, among other proposals.
Most coders never have the opportunity to code for anesthesia. Expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains that ICD-10-CM coding for anesthesia services is interesting and straightforward, but can be confusing if an individual is unfamiliar with coding guidelines and terminology for anesthesia administration.
This article analyzes ICD-10-CM codes for diseases that can manifest from prolonged hypertension. These codes appear throughout the ICD-10-CM manual, but most are found in Chapter 9 (Diseases of the circulatory system). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-19-related billing flexibilities, and value-based care, according to the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule released July 7.
Q: We are getting some National Correct Coding Initiative (NCCI) edits for repeat laboratory services. What modifier do we use if a component of a panel test is repeated later?
A broken nose is a break in the bone or cartilage over the bridge of the nose or over the septum—the structure that separates the nostrils. Debbie Jones, CPC, CCA , explains how to select the most specific CPT codes for nasal fracture and dislocation treatments.
The American Medical Association’s (AMA) CPT Editorial Panel recently published changes to its E/M Services Guidelines. The update includes code revisions, additions, and deletions, which are scheduled to take effect January 1, 2023.
The 3-day payment rule is known to coders by various names such as the 72-hour rule, the 3-day payment window, or MS-DRG window policy. Kimberly Lee M.Ed., RHIA, CCS-P , describes how to navigate the rule’s nuances for billing purposes.
CMS recently published its first quarter HCPCS Application Summaries and Coding Recommendations, which, included 22 requests to establish new HCPCS Level II codes for drugs and biologicals and CMS' final HCPCS coding decisions.
Q: Based on National Correct Coding Initiative Manual guidelines, CMS allows facilities to bill 1 unit of CPT code 94640 per episode of care regardless of the number of treatments provided. Should you bill 1 unit of CPT code 94640 even if the service was performed three times?
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting. Review key ICD-10-CM updates including new codes for dementia, head injuries, and long-term drug therapy.
Hypertension, also known as high blood pressure, is a condition in which the force of blood exerted against the artery walls is higher than normal for a prolonged period. This article explains hypertension pathophysiology and ICD-10-CM coding for the condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently announced that it released a new HCPCS Level II code for AstraZeneca's EVUSHELD COVID-19 antibody treatment, effective for dates of service on or after February 24. The initial dose authorized for use during the public health emergency has been changed to 600 mg for pre-exposure prevention of COVID-19.
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services is used to control improper coding leading to inappropriate payment for Part B services. This article provides an in-depth overview of 2022 updates to the NCCI Manual including new and revised reporting guidance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
Many factors influence the identification of a primary diagnosis, including varying provider documentation styles and health record nuances. Holly Cassano CPC, CRC, navigates challenges that come with selecting an appropriate primary diagnosis code.
Although many provisions of the 2022 OPPS final rule are a light lift for hospitals, several have far-reaching implications. Apply these expert tips to ensure you're up to speed and aware of compliance pitfalls.
The American Medical Association (AMA) recently announced an editorial update to the CPT code set for COVID-19 vaccines that includes new codes for Pfizer-BioNTech’s booster vaccine and Sanofi-GlaxoSmithKline’s (Sanofi-GSK) vaccine candidate.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What is the best way to determine if an E/M service is above and beyond the physician work normally associated with a procedure to justify the use of modifier -25?
Medication Therapy Management (MTM) is a group of services provided by pharmacists that involve active management of drug therapy. Review CPT coding, the role of pharmacists, and documentation tips associated with MTM.
