CMS generally took the path of least resistance and cushioned the ongoing impact of the COVID-19 pandemic in the fiscal year (FY) 2022 IPPS final rule. Effective October 1, the final rule covers payment rate updates, new technology add-on payments, and changes to MS-DRG rate setting and groupings.
Several CPT modifiers have similar definitions, which can make distinguishing between them challenging. Review guidance for the appropriate application of modifier -51 versus -59 and discontinued service modifiers -52, -53, -73, and -74. 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 diagnostic services performed during the second and third trimesters, and provides an overview of an obstetric (OB) hospitalist's role in caring for high-risk maternity patients.
John Peter Smith Hospital in Tarrant County, Texas, has agreed to pay $3.3 million to settle allegations that it was in violation of the False Claims Act by upcoding certain claims.
Q: The 2022 ICD-10-CM code set includes a new code, U09.9 (post-COVID-19 condition, unspecified), for post-COVID-19 conditions. When would it be appropriate to report this code? A: The fiscal year...
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , writes about endocrine anatomy and physiology as well as ICD-10-CM/CPT coding for thyroid, parathyroid, adrenal, and pineal irregularities.
Q: We have a patient admitted for heart failure who is also being treated for latent autoimmune diabetes of adulthood (LADA). What is LADA and how would it be reported in ICD-10-CM?
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, writes that CDI professionals and inpatient coders need to pay attention to the definitions and clinical indicators of acute kidney injury (AKI) to ensure proper ICD-10-CM reporting and reimbursement.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, reviews how critical thinking is important within the CDI and coding realm in order to enhance review accuracy and query rates and to help loosen reliance on technological tools such as encoders.
CMS recently released the fiscal year (FY) 2022 IPPS final rule, which repealed the MS-DRG relative weight methodology finalized in the FY 2021 IPPS final rule.
Through examples given within the wound care setting, Bobbie Starkey, RHIT, CCS-P , shows the importance of documentation and ICD-10-CM reporting to support hierarchical condition category (HCC) capture within the inpatient coding sphere. 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 Medicare Physician Fee Schedule proposed rule, which introduces new guidelines for reporting split/shared visit services. Julia Kyles, CPC , analyzes how the changes would impact physician practices.
CMS overpaid physicians an estimated $1.7 million for transitional care management (TCM) services over a two-year period, according to a recent Office of Inspector General (OIG) report. Overpayments were due to CPT coding and billing errors.
Q: A 32-year-old female presents for a planned vaginal delivery of twins. Twin A is delivered vaginally but due to complications, the second-born is delivered via a caesarean section (C-section). How would these obstetric services be reported in CPT?
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for ancillary services provided by obstetric providers including targeted ultrasound services and maternal serum tests used to screen for fetal abnormalities.
Outpatient coding for injections and infusions can be challenging given the foundational definitions and complex rules that drive reporting of these services. This article breaks down the facility drug administration hierarchy and CPT coding for therapeutic infusions, injections, and hydration. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Outpatient coding for injections and infusions can be challenging given the foundational definitions and complex rules that drive reporting of these services. This article breaks down the facility drug administration hierarchy and CPT coding for therapeutic infusions, injections, and hydration.
Review proposed updates to the CPT set for 2022, including new codes for chronic care management, laser interstitial thermal therapy, spinal anesthesia, and more.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
CMS recently released the fiscal year (FY) 2022 IPPS final rule which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.
Medicare overcompensated providers for complex and noncomplex chronic care management (CCM) services billed over a two-year period, according to a recent OIG report. These overpayments occurred because CMS did not have claim edits in place to prevent billing of overlapping care management services.
CPT coding for vaginal and cesarean deliveries and postpartum care requires strong attention to detail. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down stages of delivery and CPT coding guidance for childbirth.
Review proposed updates to the CPT set for 2022, including new codes for chronic care management, laser interstitial thermal therapy, spinal anesthesia, and more. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Earlier this year, the Office of Inspector General (OIG) added a new OIG Work Plan item for reporting E/M services with minor surgical procedures. Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO , reviews appropriate use of modifier -25 for separately identifiable E/M services.
The Office of Inspector General (OIG) recently released its fiscal year (FY) 2020 Healthcare Fraud and Abuse Control Program report. During FY 2020, the federal government won or negotiated more than $1.8 billion in healthcare fraud judgments and settlements, according to the report.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM/PCS reporting for the cardiac system is complex and requires frequent review in order to report the most accurate codes. In this article, Nehring covers ICD-10-CM/PCS coding and clinical indicators for cardiogenic shock, intra-aortic balloon pumps, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Judith L. Kares, JD, details pertinant changes found in the fiscal year (FY) 2022 IPPS final rule, including payment rate updates and the repeal of the MS-DRG relative weight (RW) methodology.
Dawn Valdez, RN, LNC, CDIP, CCDS, says that the clinical indicators used to validate sepsis can also have other possible etiologies that could be equally responsible for the clinical indicators that are present—these are known as competing diagnoses.
Q: We recently had a patient admitted with severe acute meningitis causing respiratory decompensation. A diagnostic lumbar puncture and mechanical ventilation were both performed during the inpatient stay. Which of these two procedures would be the principal procedure?
The American Medical Association (AMA) recently announced that it updated the CPT code set to include new codes for third doses of the Moderna and Pfizer/BioNTech COVID-19 vaccines.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
Read up on ICD-10-CM code updates for fiscal year 2022, including new codes for post-COVID-19 symptoms, social determinants of health, and poisonings by cannabis and synthetic cannabinoids.
Hospital coders often review charts for patients with diarrhea, ulcerative colitis, and other colorectal problems. Review ICD-10-CM coding for common conditions of the large intestine and CPT coding for proctosigmoidoscopies, sigmoidoscopies, and colonoscopies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Howard Rodenberg, MD, MPH, CCDS, and Lynn Shay, CPHQ , say that making sense of varying COVID-19 case-mix index metrics is an important endeavor that will sometimes require a bit of DIY. In this article, they explain how they were able to unscramble their departments’ COVID-19 case-mix index data.
In this article, Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, reviews Coding Clinic , Second Quarter 2021, advice for reporting encephalopathy, a laparoscopic salpingo-oophorectomy, and more.
CMS released the fiscal year (FY) 2022 IPPS final rule on Monday, August 2, which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes that inpatient coding for pacemaker Insertions can be confusing to both novice and experienced coders. Because of this, it’s important for all inpatient coders to regularly review ICD-10-PCS reporting for these procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2022 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant policy updates affecting physician coding and billing. Review proposals to decrease to the Medicare conversion factor, revise guidelines for critical care services, and loosen telehealth coverage requirements.
Cardiovascular conditions affect the structure and function of the heart and are a leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. This article details ICD-10-CM coding for common heart conditions and CPT coding for cardiac catheterization procedures.
Read up on ICD-10-CM code updates for fiscal year 2022, including new codes for post-COVID-19 symptoms, social determinants of health, and poisonings by cannabis and synthetic cannabinoids.
