In a recent National Correct Coding Initiative (NCCI) update, CMS rolled back many of the procedural edits that it temporarily extended in light of the novel coronavirus public health emergency. Read up on the changes, including 291,274 procedure-to-procedure edits, which took effect October 1.
Outpatient coding for behavioral health services can be tricky given number of conditions that influence mental wellbeing. Review potentially confusing CPT coding guidelines for psychiatric evaluations, E/M visit services, and 2021 updates to ICD-10-CM codes for behavioral health. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
On January 1, new patient office visit code 99201 will be deleted from the CPT code set and coders will find revised descriptors for E/M codes 99202-99205 and 99211-99215. Read about how these changes will impact E/M leveling, medical decision-making (MDM), and code selection for outpatient visits.
Baylor Scott & White-College Station didn't properly bill Medicare for supplemental outlier payments, according to a September Office of Inspector General (OIG) report. Reviewed claims contained errors due to overcharging and inaccurate coding, resulting in $189,276 in overpayments, said the report.
Review significant updates to the musculoskeletal chapter of the ICD-10-CM manual including 57 new codes and updated guidelines for reporting arthritis, temporomandibular joint disorders, osteoporosis, and osteochondrosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A patient with a history of hypertension sees a cardiologist for chest discomfort during exercise. The cardiologist completes an office visit and performs a cardiac stress test the same day. Would it be appropriate to report the visit using an E/M code with modifier -25?
Between 50-80% of pregnant women complain of back pain, according to the American College of Obstetricians and Gynecologists. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about ICD-10-CM documentation and coding for back pain during pregnancy.
CMS continues to focus on site-neutral payment policies and keeping payments down for 340B-acquired drugs in the 2021 OPPS proposed rule, released in early August. Read about these proposals which if finalized, will impact hospital billing and payment starting January 1.
The fiscal year (FY) 2021 update to the ICD-10-CM code set includes 26 new codes for nervous system conditions such as cerebellar ataxia and Dravet syndrome. Review these new codes and associated updates to the ICD-10-CM guidelines set to go into effect October 1. 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) on September 8 published two new CPT codes for novel coronavirus (COVID-19)-related services, including one that accounts for additional supplies and clinical staff time used to mitigate the spread of the virus.
Strabismus is one of the most common eye problems in children, according to Stanford Children’s Health. In this article, Debbie Jones, CPC, CCA , details ICD-10-CM coding for strabismus and CPT coding for surgical treatments used to correct eye misalignment.
Q: During an outpatient visit, a nurse reviews the patient’s medical history and a physician performs an examination in the presence of the nurse. If you adhere to the 2021 E/M guidelines and use time as the controlling factor for code selection, can you report one E/M code for these shared services?
Q: When would it be appropriate to report modifier -58 (staged or related procedure or service by the same physician during the postoperative period) for a procedure performed during the postoperative period?
Outpatient coders should be familiar with CPT reporting for knee surgeries based on information in the operative note. This article reviews the anatomy of the knee joint and CPT coding for arthroscopic and reconstructive procedures used to visualize and treat common knee conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The final 2021 CPT, ICD-10-CM, and ICD-10-PCS code sets were released last week, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes. Read up on the changes, which will impact payment for hospital services in 2021.
Medicare’s rules for reporting blood products and applying the Part B blood deductible can be confusing. Judith L. Kares, JD , writes about unique HCPCS reporting and billing rules for blood products and related services reimbursed under the OPPS.
Review ICD-10-CM codes for age-related macular degeneration and glaucoma and the 2021 updates to Chapter 7 of the ICD-10-CM manual, “Diseases of the Eye and Adnexa.” Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Familiarize yourself with notable code updates in the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule, including new E/M reporting guidelines and CPT® codes for lung biopsies, auditory testing, and chronic care management.
The 2021 MPFS proposed rule, released August 3, introduces new policies under the Quality Payment Program (QPP) including plans to delay implementation of the Merit-based Incentive Payment System Value Payment (MVP) model and introduce 108 new quality measures.
CMS released the calendar year (CY) 2021 MPFS and OPPS proposed rules on August 3, introducing new CPT codes, reducing the PFS conversion factor by nearly 11%, and seeking commentary on how to gradually eliminate the inpatient only list.
Review digestive anatomy and ICD-10-CM coding for common diseases of the digestive tract including diverticulitis, cholecystitis, and abdominal adhesions. Also look at new codes to be added to Chapter 11: Disease of the Digestive System of the ICD-10-CM manual on October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Familiarize yourself with proposed updates to the Medicare Physician Fee Schedule (MPFS), including plans to significantly revise the E/M coding guidelines and extend telehealth flexibilities beyond the COVID-19 public health emergency.
Bill Wagner, CHPS, CPCO , unpacks findings from a survey conducted by KIWI-TEK, a medical coding company in Indianapolis, that asked 157 coders how the novel coronavirus (COVID-19) pandemic has impacted their finances, workflow, and career prospects.
CPT® coding for respiratory procedures can be challenging, given the structural complexity of the upper and lower respiratory tracts. Refresh your knowledge of respiratory anatomy and CPT reporting of angiographies, laryngoscopies, and endotracheal intubations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS , describes simple actions you can take to show appreciation for providers and make education unobtrusive during the novel coronavirus (COVID-19) public health emergency.
Medicare Recovery Audit Contractors (RAC) reported that several outpatient claims did not meet medical necessity requirements for hyperbaric oxygen (HBO) therapy for diabetic wounds of the lower extremities, according to the July 2020 Medicare Quarterly Provider Compliance Newsletter .
The American Medical Association (AMA) recently announced a new CPT® code for reporting antigen testing performed on patients suspected of being infected with the novel coronavirus (COVID-19). The new code is intended to improve reporting of antigen tests using an immunofluorescent or immunochromatographic technique for detection of COVID-19.
Coders must apply modifiers to CPT codes for select services rendered during the novel coronavirus (COVID-19) public health emergency to ensure that providers are paid in full for documented work. This article details reporting of telehealth modifiers -95, -G0, and -GQ, and emergency modifiers -CR and -CS. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A child presents to the ED with a closed fracture of his left hand. The physician performs a two-view hand x-ray that shows a small fracture. The physician reduces the fracture and performs a one-view x-ray to ensure alignment. Which CPT® codes and modifiers would be used to report the physician’s services?
Coding managers: Take steps to effectively prepare staff for the transition to the new E/M guidelines, scheduled to take effect January 1. Review advice from coding experts on updating patient forms, medical record software, and rethinking your workflow to prepare staff for the changes to come.
Recently published CMS guidance clarifies billing requirements for services rendered via telecommunications technology during the public health emergency. Valerie Rinkle, MPA, CHRI , breaks down the updated guidance as it applies to outpatient services provided at alternative care sites such as patient homes.
CMS on April 30 released an interim final rule with regulatory relief for hospital outpatient departments. In this article, Kimberly A. Hoy, JD, CPC , reviews Medicare provisions that allow outpatient departments to bill services at alternate locations during the novel coronavirus (COVID-19) public health emergency.
Outpatient coders must be able to assign E/M codes for the providers’ work and resources utilized by the facility during emergency visits. This article takes a close look at facility E/M coding and payment for visit services rendered in Type A and Type B emergency departments (ED). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Changes to office E/M guidelines, effective January 1, 2021, will give providers the option to code based on the total time they spend on a patient’s care per date of service. Prepare for these changes by reviewing rules for time-based E/M documentation and code selection.
CMS recently published details on prior authorization requirements, established by the 2020 OPPS final rule, for select hospital outpatient department (HOPD) services, scheduled to go into effect July 1.
Physician practices have started reopening to patients but are not expecting a return to normal anytime soon. They continue to struggle with staffing shortages and lost revenue due to COVID-19 restrictions.