With CMS’ release of its proposed 2025 Medicare physician fee schedule, the agency proposed many policy changes and revisions. Explore several of them and other announcements made by CMS.
Stand-alone and integrated physician practices have unique challenges and requirements regarding revenue cycle management. Discover how revenue integrity programs in professional fee settings are designed and function.
Gain unique and fresh insights from clinical documentation integrity professionals in unique settings to help you strengthen your organization’s denials management efforts.
CMS’ proposed rule to revise the Medicare hospital Outpatient Prospective Payment System for calendar year 2025 has been released. Review some of the proposals that could directly impact your organization.
Q: Is it appropriate to code metabolic encephalopathy related to alcohol withdrawal or alcohol withdrawal delirium? And if so, how do you successfully defend against denials?
It can be especially challenging to thoroughly document rendered services in the emergency department due to the unique needs of the setting. Hamilton Lempert, MD, CEDC, reviews several areas of critical care coding that may trip up clinicians and coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The concept of expanding clinical documentation integrity (CDI) programs into the outpatient setting is not new but the COVID-19 pandemic threw a wrench into a lot of organizations’ expansion plans. Now it might be time for organizations to revisit the idea. Review the steps to expand into outpatient CDI.
CMS finalized many behavioral health requirements related to social determinants of health risk assessments, care management services, and more with the 2024 Medicare Physician Fee Schedule final rule. With all these changes where do providers start?
Medical decision-making (MDM) documentation has gained increased importance in recent years to justify a visit’s medical necessity. Review CMS’ MDM table and guidelines to take the guesswork out of your coding.
Q: A specialty society's fact sheet offers guidance for determining E/M level when an ICD-10-CM social determinant of health code affected the diagnosis or treatment. What is Medicare's policy on this?
It is important for both coders and providers to understand that they can report critical care along with other services such as ED E/M and CPR. Hamilton Lempert, MD, FACEP, CEDC, answers questions about the proper ways to do so, as well as the importance of doing so. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently finalized a multitude of new price transparency requirements in the 2024 Outpatient Prospective Payment System (OPPS) final rule. These requirements have staggered enforcement deadlines, which means that revenue integrity professionals have their work cut out for them in the coming year to ensure their organization is in compliance.
CMS recently released an updated MLN fact sheet reminding providers about documentation requirements for requests from its Comprehensive Error Rate Testing (CERT) program.
A few years ago, providers started using new guidelines for their office/outpatient services that based the level of service on medical decision-making (MDM) or time on the date of the face-to-face encounter. This article focuses on office/other outpatient coding basic guidelines that apply to all level-based E/M codes. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , delves into ICD-10-CM and CPT coding for urogynecology, a subspeciality that provides necessary crossover care for female patients. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Should signs, symptoms, or unspecified ICD-10-CM codes (e.g. M54.50 [low back pain, unspecified]) be reported when the condition (e.g. M51.36 [other intervertebral disc degeneration, lumbar region]) is also reported on the same outpatient encounter?
CMS recently released a revision to its benefit policy manual to stress that codes and modifier combinations should be reported when social determinants of health risk assessments and Medicare annual wellness visits are conducted together.
CMS updated its July 2024 HCPCS Quarterly update file in May with a total of 70 new HCPCS codes, 11 discontinued codes, and 32 revised codes. All code changes will be implemented July 1.
Nancy Reading, RN, CPC, CPC-P , explains how understanding liver disease and its many complications is key to supporting higher-specificity ICD-10-CM coding and reimbursement.
Penny Jefferson, MSN, RN, CCDS, CCDS-O, CCS, CDIP, CRC, CHDA, CRCR, CPHQ , and Mercedes K. C. Dullum, MD, FACS, FACC , describe the advantages of creating CDI programs in outpatient settings and how they can decrease gaps in patient care and improve financial management.
The Food and Drug Administration’s (FDA) emergency use authorization for Pemgarda, a pre-exposure COVID-19 prophylaxis, has led to the release of HCPCS Level II codes for the drug and its administration.
Hamilton Lempert, MD, FACEP, CEDC, reviews the basics of critical care services in CPT and addresses common reporting questions, such as services that pass midnight, continuous care, and which clinical tasks count toward critical care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Kyles, CPC , examines the factors of medical necessity required to decrease chance of denials for preoperative E/M visits, including who performs the visit, associated risks, and the patient’s health.
CMS published a summary of its first quarter 2024 HCPCS Level II code update application decisions. There were 48 additions, two code definition revisions, and seven discontinuations.
Q: How would a coder report the scenario of an unmedicated diabetic patient with diabetic renal nephrosis and out-of-control blood sugar during an encounter?
Lynn Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC , covers FAQs she has received, specifically about CPT reporting for arthrodesis, acromioplasty, arthroplasty, arthroscopy, and spinal decompression procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , explains how to report neonatal respiratory failure, including meconium aspiration, failure to thrive, and associated symptoms in ICD-10-CM.
Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC , answers frequent questions she receives from providers pertaining to physician coding for CPT orthopedic services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Ronald Hirsch, MD, FACP, CHCQM, CHRI , and Valerie A. Rinkle, MPA, CHRI , explore common causes of denial, including prior authorization, missing documentation, medical necessity, and EHR formatting.
CMS proposed hundreds of ICD-10-CM code changes in the 2025 IPPS proposed rule, published April 10, including 252 new codes, 13 revised codes, 36 invalidated codes.
Tonya Chandler, RHIT , brings light to the declining mental health in youth, clarifies possible contributing factors, and explains how to report mental and behavioral conditions in ICD-10-CM with several case scenarios.
CMS published its HCPCS Quarterly Update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations, and definition revisions. The changes became effective April 1.
Physician coders should watch out for recently implemented edits to codes that debuted January 1 in the quarterly updates to the NCCI files. The latest updates introduce 2,171 new PTP edits and 164 new MUEs.
Orthopedists perform injections and aspirations to address a range of ailments, but reporting injections can be difficult. This article reviews proper CPT coding for sacroiliac joint injections and joint arthrocentesis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The lack of interaction with remote work has a variety of impacts. Managers must develop strategies for remote onboarding and training, find different ways to measure productivity, and keep employees engaged.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , analyzes the challenges that both inpatient and outpatient CDI specialists encounter and offers advice to lessen provider opposition to participating in outpatient CDI.
The Journal of the American Medical Association (JAMA) published a study in March found that “foot and ankle care was associated with an 11% lower likelihood of death…and a 9% lower likelihood of major amputation (above or below knee).”
Shelley C. Safian, PhD, RHIA, CCS-P , and Mary A. Johnson, MBA-HM-HI, CPC , review the purpose of modifiers and analyze their integral part in reporting encounters, receiving reimbursement, and promoting continuity of care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Katie Patterson, CPC , summarizes the Medicare Quality Payment Program, provider qualifications, clinician participation, and how they work to achieve the program’s main objectives.
