Determination of what is medically necessary for any given diagnosis is set forth by the healthcare industry’s Standard of Care. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation .
Podiatry is the study, diagnosis, and treatment of disorders or deformities of the foot and ankle. Read up on foot and ankle anatomy and CPT coding for hallux valgus and rigidus corrections, cock-up fifth toe repairs, toe amputations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ recently released fiscal year (FY) 2023 IPPS proposed rule includes 1,179 proposed ICD-10-CM code additions, mainly affecting reporting for dementia, concussions, and injuries due to motor vehicle collisions. The code changes, if finalized, would take effect October 1, 2022.
Sometimes even the most seasoned revenue integrity professionals get stumped trying to navigate the maze of billing, charging, and coding rules that govern chargemaster structure. Review expert answers to perplexing chargemaster questions.
A New York City provider received an estimated $1.1 million in Medicare overpayments for behavioral health services that did not comply with billing requirements, according to a recent Office of Inspector General (OIG) report.
Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Although most organizations do a good job of tracking denials by reason, payer, and volume, they miss the mark when communicating information about appeals, according to the results of HIM Briefings’ 2022 Denials Management Survey.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the difference between an implant and a foreign body removal and outlines CPT coding for these procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Physician service modifier -FT for unrelated E/M visits provided on the same day has been a source of confusion for many coding and billing professionals. Review the latest coding and billing guidance for reporting this modifier.
CMS recently released an update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edit files, introducing more than 4,000 new CPT code pairs. The PTP edits took effect April 1 and primarily involve codes found in the pathology and laboratory section of the CPT Manual .
Bruxism, or excessive teeth grinding, is a common condition that is often brought on by stress and anxiety . Debbie Jones, CPC, CCA , describes the causes and symptoms of bruxism and ICD-10-CM coding for the condition.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Anxiety disorders are the most common mental illness in the U.S., according to the National Institute of Mental Health Statistics. Shelley Safian, PhD, RHIA, CCS-P, COC, CIC , breaks down ICD-10-CM coding for common types of anxiety disorders and psychotherapy treatments used to manage them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Arterial embolization is less invasive than open surgery and is often performed as an outpatient procedure in a hospital setting. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, evaluates medical necessity and CPT coding for uterine artery embolization.
Providers can now code for E/M visits based solely on medical decision-making. Julia Kyles, CPC , outlines how to use the first column of the medical decision-making chart in the CPT Manual to determine E/M level selection.
Following the release of the Medicare Payment Advisory Commission’s March report to Congress, the American Medical Association (AMA) urged Congress to revise the Medicare Physician Fee Schedule (MPFS) to include stable, annual payment updates that keep up with inflation and practice costs.
CMS recently released new HCPCS modifiers -FR, -FQ, -FS, and -FT for telehealth visits. Julia Kyles, CPC , breaks down reporting guidance for these new physician modifiers that took effect January 1.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
CMS recently announced a new HCPCS Level II code for COVID-19 convalescent plasma administered in the outpatient setting, effective for claims submitted on or after December 28, 2021.
To assign the most specific CPT codes for spinal procedures, coders need a solid understanding of spinal anatomy and surgical terminology. Review spinal anatomy and CPT coding for vertebral corpectomies, discectomies, laminectomies, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Chapter 19 of ICD-10-CM includes codes for various types of injuries, poisonings, and other consequences of external causes. Review integumentary anatomy and ICD-10-CM coding for burns and superficial injuries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
State and federal prosecutors continue to extract sizable settlements from practices that allegedly submitted fraudulent claims for one type of service—urine drug tests (UDT). In this article, Julia Kyles, CPC , breaks down fraudulent coding and billing patterns for UDT services.
Q: What is the difference between anterior and posterior approaches to spinal surgery, and when might a physician use a combined (anterior and posterior) approach?
The 2022 ICD-10-CM manual includes new codes for thrombotic microangiopathy (TMA)—a rare clinical syndrome defined by the presence of hemolytic anemia, organ dysfunction, and low platelets. Read up on TMA pathophysiology and diagnosis coding.
The American Medical Association (AMA) recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old.
Coding for spinal diagnoses requires careful attention to detail. Take time to review spinal anatomy and ICD-10-CM coding for common diseases of the spinal column and paravertebral tissues. 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 , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
Review new CPT codes 98975-98981 for the monitoring of non-physiologic patient data such as musculoskeletal system status, respiratory system status, and medication adherence.
CMS recently issued a new HCPCS code for the antiviral medication remdesivir when administered in the outpatient setting. The new code is a response to a statement from the National Institutes of Health regarding therapies for the COVID-19 omicron variant.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include a new code for a third dose of Pfizer’s COVID-19 vaccine in children 5 through 11 years old.
Selecting the most specific E/M code for a physician-patient encounter can be tricky. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down facility documentation and E/M coding for office visits and initial hospital care.
Coders continue to be in high demand, and given the importance of this function, evaluating coders’ performance is an essential task for revenue integrity. In this article, Lawrence A. Allen, MBA, CPC, CPMA, CEMA , makes the case for reevaluating coding performance.
Review documentation requirements and CPT coding for radiology services including computed tomography and x-ray scans, breast mammography, and bone length studies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released the 2022 National Correct Coding Initiative Policy Manual for Medicare Services . Julia Kyles, CPC , breaks down procedure-to-procedure and medically unlikely edits for a selection of new provider-based services.
Medical practices in the U.S. are expanding treatment options for major depressive disorder to include transcranial magnetic stimulation (TMS). Laurie Bouzarelos, MHA, CPC, reviews the basics of TMS, types of providers who can deliver TMS, and ICD-10-CM/CPT coding for TMS delivery and management.
The 2022 CPT code set includes 249 new codes that went into effect January 1. Review new CPT codes for spinal decompressions, cataract removals, auditory implantations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Between 2016 and 2019, Medicare payments to laboratories for genetic tests quadrupled from $351 million to $1.41 billion. This sharp increase in spending on genetic testing is likely linked to excessive and fraudulent billing, according to a recent Office of Inspector General (OIG) report.
Between January 2019 and August 2020, CMS overpaid physicians an estimated $9.5 million in unallowable Medicare payments associated with facet joint denervation procedures, according to a recent Office of Inspector General (OIG) report.
Q: Effective January 1, CPT codes 94625 and 94626 will replace HCPCS code G0424 for pulmonary rehabilitation. Will these new CPT codes have the same reporting requirements as G0424?
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT. 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 , breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
Tackling reporting errors early on is an essential component of denials management. Leyna Belcher, MSN, RN, CCDS, CCDS-O , describes strategies that coding and billing professionals can employ to reduce claim denials and increase the success rate of appeals.
