Revenue cycle leaders reported denials management as their most time-consuming revenue cycle task, followed by prior authorizations, according to a new survey by AKASA.
Physicians have found ways to treat many congenital defects in utero, enabling the neonate to be born without defects. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, details ICD-10-CM coding for common birth defects, and ICD-10-PCS and HCPCS Level II coding for their treatment.
Key performance indicators are used by organizations to monitor the progress of CDI initiatives. Waldo Herrera, MD, MBA, MSc, FACP, SFHM, CHCQM-PHYADV , describes performance metrics that professionals at his facility use to track revenue cycle performance and opportunities for improvement.
Spinal fusions can effectively eliminate pain and restore stability to the spine. Learn how to apply ICD-10-PCS codes and guidelines for spinal fusions and related procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -25 is used to report a significant, separately identifiable E/M service by the same physician. Courtney Crozier, MA, RHIA, CCS, CDIP , reviews the American Medical Association’s guidance on correct reporting of modifier -25, and outlines when and how to report it.
Laura Evans, CPC , takes a deep dive into four CPT Category III codes that were released in the 2023 CPT Manual . Those codes are used to report cutting-edge regenerative musculoskeletal procedures, the use of animal implants, and facet joint replacements.
Q: A patient with a history of prostatic hypertrophy and dysuria receives a laparoscopic prostatectomy conducted with robotic assistance. Which CPT code would be used to report this?
This article reviews the most common types of external diagnostic cardiology tests, examines relevant CPT coding guidelines, and offers reporting advice from an expert. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS published its first quarter 2023 HCPCS Application Summaries and Coding Recommendations April 27, which summarizes the final decisions on HCPCS Level II code assignments. CMS created 58 new HCPCS codes, deleted seven codes, and revised one code. Most changes will be implemented July 1.
Q: A patient with fatty liver disease undergoes ultrasound cavitation. What diagnoses are treated using ultrasound cavitation and how is the procedure reported in ICD-10-PCS?
The gap between clinical reality and coding terminology can be addressed by empowering coders to use clinical judgment. Merle Zuel, RN, CCDS , discusses when it is appropriate for coders to interpret provider documentation and use their clinical judgment to code it in a certain way.
What may be considered a simple task, such as confirming present on admission status, can be complicated by discrepancies between coding and quality reporting criteria. Kate Siemens, RN, CMSRN, CCDS , outlines the ways in which coding and quality metrics do not align.
Pneumonia is the eighth-leading cause of death in the U.S. This article outlines signs and symptoms of respiratory infection, pneumonia etiologies, and ICD-10-CM coding for complex pneumonia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published its evaluation of New Technology Add-on Payment (NTAP) applications and proposed revisions to NTAP eligibility criteria in its fiscal year (FY) 2024 IPPS proposed rule.
Shockwave intravascular lithotripsy treats areas of severely calcified coronary arteries. Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, explains the procedure and how to report it in HCPCS with coding examples.
Q: Which CPT code would be reported for an emergency department (ED) visit for an asthma patient experiencing exacerbated symptoms and released with a prescription for treatment?
CMS released the fiscal year (FY) 2024 IPPS proposed rule on April 10. The document contains proposals for 395 new, 12 revised, and 25 invalidated ICD-10-CM codes.
Atrial fibrillation is the most common type of cardiac rhythm disorder in the U.S. This article defines the condition, reviews relevant ICD-10-CM coding guidelines, and provides documentation and reporting guidance from experts. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pain treatment procedures for trigger point injections have a history of high denial rates. Julia Kyles, CPC , offers insight on what coders and physicians can do to improve reporting of these procedures.
Kerri Swart, RN, CCRN, CCDS, writes about how a previously 100%on-site CDI program shifted to remote work and maintained productivity and education standards.
Spinal fusions can effectively eliminate pain and restore stability to the spine. Learn how to apply ICD-10-PCS codes and guidelines for spinal fusions and related procedures.
Coding audits are often a source of irritation in small and large practices alike. This article covers common misconceptions about the auditing process and offers tips from experts on how to correct them.
Healthcare providers know that denials are not a matter of if, but when. One way to prevent and manage denials is by looking for opportunities to involve other departments.
Our experts answer questions about reporting E/M codes for ED patients with chronic illnesses and choosing the right CPT code for a laparoscopic prostatectomy.
What may be considered a simple task, such as confirming present on admission status, can be complicated by discrepancies between coding and quality reporting criteria. Kate Siemens, RN, CMSRN, CCDS , outlines the ways in which coding and quality metrics do not align.
The 2023 update to the CPT manual had almost every chapter undergoing some form of change. In this article, Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, delves into some of the major changes to E/M coding and considerations for documentation integrity.
CMS proposes 395 new, 12 revised, and 25 invalidated codes for implementation in October, according to the 2024 IPPS proposed rule. Read up on the changes which, if finalized, will have an impact on reimbursement and documentation.
Congestive heart failure (CHF) is used ubiquitously in medical records. Nancy Reading, RN, CPC , breaks down CHF types and pathophysiology, and discusses ICD-10-CM coding for the condition.
Approximately 1.7 million adults in America develop sepsis each year, according to the Centers for Disease Control and Prevention. Review documentation requirements and ICD-10-CM coding for severe sepsis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Patients with Alzheimer’s disease and related dementias have higher readmission rates than the general geriatric population, according to a retrospective cohort study published in JAMA Network Open .
Receiving payments for rendered physician services relies on clean claim submission with accurate CPT codes. This article reviews common CPT coding and billing errors, their causes, and strategies for preventing them.
The American Medical Association’s (AMA) CPT Editorial Panel recently approved a new vaccine administration code for COVID-19. It also released a summary of panel actions, which includes accepted and deleted code and guideline revisions for July 2023, January 2024, and January 2025.
Coding audits are often a source of irritation in small and large practices alike. This article covers common misconceptions about the auditing process and offers tips from experts on how to correct them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , discusses how the 2023 ICD-10-CM guidelines update the instructions for reporting intraoperative care complications.
CMS released the fiscal year (FY) 2024 IPPS proposed rule on April 10, with proposals for the annual ICD-10-CM/PCS code update and increases to hospital payment rates. The rule also introduces new quality measures aimed at reducing health equity gaps.
When reporting ICD-10-CM codes for encephalopathy with comorbidities, coders must carefully review documentation to determine which conditions are separately reportable. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , breaks down ICD-10-CM reporting guidance for complex cases of encephalopathy.
CMS’ quality measures rank hospital mortality data as better than, no different than, or worse than the national mortality rate. JoAnne Mullins, DNP, MSN, RN, CCDS , describes how to perform quality reviews targeting missed coding opportunities and other factors that influence mortality data.
Functional and structural disorders, infections, and irritations of the large intestine can cause debilitating digestive complications that require surgical intervention. Review ICD-10-PCS coding for colectomy and ostomy procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The January 2023 update to the CPT manual had almost every chapter undergoing some form of change. In this article, Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, delves into some of the major changes to E/M coding and considerations for documentation integrity.
Hypothyroidism is a common chronic disorder that involves the underproduction of the thyroxine hormone. This article defines hypothyroidism, reviews relevant ICD-10-CM codes, and provides insight from experts. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS has published CPT and HCPCS Level II updates that take effect in April. Review highlights of the code and modifier changes in the April 2023 HCPCS Level II and OPPS updates.
The beginning of March brought the release of the first quarter 2023 Coding Clinic . Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, summarizes key information provided in this publication, including analysis of ICD-10-CM guidelines , code changes, and coding Q&As.
Though outpatient settings have in some form been reviewed by CDI specialists practically since CDI itself started, this progress remains slow and steady for a reason.
E/M coding guidelines for emergency department services (CPT codes 99281-99285) were recently updated for the first time in decades. Hamilton Lempert, MD, FACEP, CEDC, reviews these changes, along with coding requirements for many other E/M services.
Kathleen M. Romero, MSN, RN, EBP-C, Cynthia Beal, MBA-HCM, BSN, RN, and Renee Pate, MSOL, MSN Ed., RN, CCDS, explain how they implemented a CDI program in their facility’s emergency department and the how establishing this program improved coding accuracy and increased reimbursement.
Approximately 1.7 million adults in America develop sepsis each year, according to the Centers for Disease Control and Prevention. Review documentation requirements and ICD-10-CM coding for severe sepsis.
Expanding into psychiatric units or facilities is a step that CDI programs may take because of their current patient population, a newly acquired center, or just another chance to improve their risk adjustment factor (RAF) score.
Our experts answer questions about ICD-10-PCS coding for pacemaker implants, how and when to report transcranial magnetic stimulation, and querying pathology results.
Functional and structural disorders, infections, and irritations of the large intestine can cause debilitating digestive complications that require surgical intervention. Review ICD-10-PCS coding for colectomy and ostomy procedures.
Cerebrovascular accidents (CVA) are the fifth-leading cause of death and a leading cause of disability in the U.S., according to the Centers for Disease Control and Prevention. Review ICD-10-CM coding for CVA and ICD-10-PCS coding for surgical interventions used to open blocked arteries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Encephalopathy refers to any disease of the brain that alters its function or structure. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , breaks down documentation requirements and ICD-10-CM coding for toxic, acute, and chronic encephalopathy.
Clinical documentation and ICD-10-CM coding terminology for neonatal conditions do not always match. Review documentation requirements and ICD-10-CM coding guidelines for reporting common neonatal diagnoses, as well as advice for querying pediatric healthcare providers.
Nearly 80% of healthcare organizations are collecting data on social determinants of health (SDoH), or non-clinical factors that affect health, including family and home life, education, employment, and food insecurity, according to a new AHIMA survey.
CMS recently published its fourth quarter 2022 HCPCS Application Summaries and Coding Recommendations. The new codes will be used to report injections and skin substitutes and are scheduled to take effect April 1.
Limb girdle muscular dystrophy is a group of genetic disorders that cause myopathy of the proximal shoulder and hip girdle muscles. This article reviews the disease, 2023 ICD-10-CM code updates, and relevant coding guidance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
E/M coding guidelines for emergency department services (CPT codes 99281-99285) were recently updated for the first time in decades. Hamilton Lempert, MD, FACEP, CEDC, reviews these changes, along with coding requirements for many other E/M services.
The American Medical Association introduced E/M updates for 2023 and there are more E/M changes scheduled for 2024, according to the CPT Editorial Summary of Panel Actions. Julia Kyles, CPC, explains several 2023 and 2024 code revisions and additions that coders would benefit from making note of in their CPT manuals.
Kathleen M. Romero, MSN, RN, EBP-C , Cynthia Beal, MBA-HCM, BSN, RN, and Renee Pate, MSOL, MSN Ed., RN, CCDS, explain how they implemented a CDI program in their facility’s emergency department and the how establishing this program improved coding accuracy and increased reimbursement.
The HCPCS first quarter 2023 update, released in December, introduced several new codes and modifiers for medical products and procedural services. Most of the changes took effect January 1.
The CPT Editorial Panel made a handful of changes to codes for ocular and auditory system procedures as part of its 2023 update to the code set. This article reviews canaloplasty and auditory osseointegrated implant CPT code revisions and additions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Would a same date admission/discharge E/M code be used for a scenario in which a patient is admitted at 11 p.m. on a Monday, is seen by the provider at 4 a.m. on Tuesday, and discharged at 8 p.m. on Tuesday?
Pam Warren-Brooks, MHA, COC, CPC, explains different types of psychiatric healthcare providers, outpatient facilities, and best practices for reporting psychiatric services using CPT codes.
As healthcare systems look to replicate successful CDI programs outside of large complex community or academic health centers, there are unique considerations for rural settings.
Determine whether your facility needs to change E/M documentation habits and capture different details based on the revisions made by CMS to observation and inpatient reporting in the 2023 OPPS final rule.
Chronic obstructive pulmonary disease (COPD) was the sixth-leading cause of death in the U.S. in 2020 with 152,657 deaths, according to the Centers for Disease Control and Prevention. Read up on ICD-10-CM coding for different types of COPD including emphysema and chronic bronchitis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Findings from a recent medical record review published by JAMA Network Open show that physical assaults are often miscoded as accidents. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for specific details about an injury or health event.
Tonya Moton, RHIA, CCS, defines social determinants of health coding, explains the challenges of reporting these factors, and outlines how coders and providers can work together to create a positive impact in at-risk communities.
Postoperative mortality rates among Medicare beneficiaries are associated the characteristics of patients’ neighborhoods and the hospitals where they received treatment, according to a study published in JAMA Network Open in January.
Encephalopathy refers to any disease of the brain that alters its function or structure. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , breaks down documentation requirements and ICD-10-CM coding for toxic, acute, and chronic encephalopathy.
Remote therapeutic monitoring is one of the latest services to enter the virtual landscape since the COVID-19 public health emergency began. Debbie Jones, CPC, CCA, defines the services and reviews CPT guidance for reporting them.
Q: A 4-year-old managing lissencephaly, hypotonia, and dysphagia with aspiration of secretions presents with fever and tachypnea. A chest x-ray shows right lower lobe infiltrates. Would it be appropriate to query the provider to confirm a diagnosis of pneumonia?
Chronic obstructive pulmonary disease (COPD) was the sixth-leading cause of death in the U.S. in 2020 with 152,657 deaths, according to the Centers for Disease Control and Prevention. Read up on ICD-10-CM coding for different types of COPD including emphysema and chronic bronchitis.
Jorde Spitler, RN, CDI manager at Dayton Children’s Hospital, describes key considerations for documentation review, querying, and ICD-10-CM coding in a pediatric acute care setting.
This article outlines kidney anatomy, explains percutaneous nephrolithotomy and pyelolithotomy procedures, highlights relevant CPT guidance, and includes insight from experts. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Tonya Moton, RHIA, CCS, defines social determinants of health coding, explains the challenges of reporting these factors, and outlines how coders and providers can work together to create a positive impact in at-risk communities.
The 2023 Medicare Physician Fee Schedule (MPFS) final rule finalized major documentation and coding changes. This article summarizes new guidance for reporting E/M and telehealth services and a significant cut to physician payments.
CMS recently published an FAQ document on the use of drug waste modifiers. The resource addresses how the modifiers affect Medicare policy, to which products they can be appended, billing concerns, and more.
Q: What are the differences between remote therapeutic monitoring and remote physiologic monitoring and what details should we look for in documentation to report these services with CPT codes?
Q: What ICD-10-PCS codes would be used to report Stage 1 of a metatarsal resection involving Excision of nonviable tissue for diagnostic purposes and partial detachment of the fifth metatarsal?
Robotic and computer-assisted surgical procedures are still considered new technology despite having been used in the U.S. for many years. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , unpacks ICD-10-PCS coding for surgeries performed using specialized software and robotic technology.
Adhere to ICD-10-PCS guidance for reporting multiple procedures and procedural components when coding for wound debridement and skin grafting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laura Roberts, BSN, RN, CCDS , describes how to perform internal reviews that target Patient Safety Indicators, hospital-acquired conditions, and other quality indicators.
Q: When is it permissible under Medicare to assign CPT add-on code 37186 for a secondary thrombectomy when an atherectomy is performed in the same vascular territory?
The CPT Editorial Panel released 20 new Category III CPT codes. These new codes, along with two revisions, are mainly for cardiovascular procedures and take effect July 1.
Remote therapeutic monitoring is one of the latest services to enter the virtual landscape since the COVID-19 public health emergency began. Debbie Jones, CPC, CCA, defines the services and reviews CPT guidance for reporting them.
This article outlines when and how to report new and revised 2023 CPT codes for arthroplasty and arthrodesis procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The end of the public health emergency (PHE) will bring the expiration of many Medicare waivers issued since 2020. Ronald Hirsch, MD, FACP, CHCQM, CHRI, explains how facilities can maintain their compliance in this new era.