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.
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.
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.
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.
Q: Can modifier -59 (distinct procedural service) be used to bypass the NCCI edit that bundles CPT codes 11055 for lesion removal and 11721 for nail debridement?
In July, the Office of Inspector General (OIG) released a report regarding the incorrect assignment of ICD-10-CM codes for severe malnutrition on inpatient hospital claims. In this article, Yvette M. DeVay, MHA, CPC, CPMA, CIC , reviews these findings and explains how to better document and report malnutrition.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that attention must be paid to coding conventions and general coding guidelines when reviewing the ICD-10-CM manual for correct code assignment for diseases of the skin and subcutaneous tissue. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We have an elderly patient admitted in our hospital who is also presenting with glaucoma. Since we don’t report glaucoma on a regular basis, can you explain any background, guidelines, or tips for reporting glaucoma in ICD-10-CM?
Sharme Brodie, RN, CCDS, CCDS-O , writes that the cost of new technologies can lead to an overwhelming financial burden to hospitals and patients, which is why accurate reporting of ICD-10-PCS codes in the new technology section of the ICD-10-PCS manual is more important than ever.
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.
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.
Q: Would it be appropriate to use family psychotherapy CPT codes 90846-90849 to report therapy for the benefit of one person that involves input from family members?
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.
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.
Heart disease is a broad category, but for this article Julian Everett, RN, BSN, CDIP , takes a look at ICD-10-CM reporting for myocardial infarctions (MI). It is essential to understand what defines an MI, current quality initiatives for MIs, and documentation and coding requirements for this diagnosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This article details CDI quality review processes from various hospitals, some of which zero in on patient safety indicator and mortality cases to improve their facility’s severity of illness and rate of mortality scores.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, writes that it’s important for inpatient coders to acquaint themselves with any underlying conditions related to novel coronavirus (COVID-19) in order to ensure accurate reporting, reimbursement, and data gathering.
On July 30 CMS announced the addition of 12 new ICD-10-PCS codes to describe the Introduction or Transfusion of therapeutics for treating patients with COVID-19. These new codes became effective August 1.
Q: We have patients being admitted for COVID-19 and most of them have a laundry list of various manifestations and complications. Do all manifestations and complications need to be reported in ICD-10-CM?
Coronaviruses are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). The SARS-CoV-2 coronavirus, which had not previously been identified in humans, is the strain that was discovered in 2019. It causes novel coronavirus disease (COVID-19) and is responsible for the current global pandemic.
EHRs have fundamentally changed the healthcare industry. The wealth of data they’ve generated has been a boon to research and population health—and has also helped payers use sophisticated data analytics to drive denials.
Physicians can be a bit prickly at times. While this statement intentionally downplays the behavior of (hopefully) only a few doctors, I believe that most physicians are amenable to CDI concepts. While attempting to effect change in physician documentation patterns, I’ve learned many lessons from my medical staff and from other creative CDI colleagues.
As the U.S. slowly tries to recover from the novel coronavirus (COVID-19) pandemic, the country might not ever be the same. States have been trying to reopen to regain their local economy, but in April, the U.S. unemployment rate was at the highest it’s ever been since the Great Depression.
In response to the novel coronavirus (COVID-19) public health emergency, CMS has expanded patient access to telehealth services, allowing beneficiaries to receive a wide range of services without having to visit a healthcare facility.
HIM directors’ and managers’ salaries have largely held steady, but the economic impact of the COVID-19 pandemic is making itself felt. Learn how your salary compares to your peers’ and what you can do to improve your earning power in the future.
Judith L. Kares, JD, writes about the unique coverage, billing, and payment rules that apply to these blood products and related services under Part B.
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 .
Valerie Rinkle, MPA, CHRI , breaks down updated CMS guidance for reporting virtual clinic visits and other telehealth services rendered at on- and excepted off-campus provider-based departments.
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.
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.
Sarah Nehring, CCS, CCDS , says to ensure ICD-10-PCS coding accuracy and appropriate MS-DRG assignment, inpatient coders must understand the device being inserted and how to apply the coding conventions and guidelines for pacemaker-related procedure coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To deal with the rising rate of infection and increased hospital admissions for extraordinarily sick patients due to the novel coronavirus (COVID-19), CDI teams have had to act quickly by adapting to remote work, modifying CDI practices, and more.
Joel Moorhead, MD, PhD, CPC , writes that certain clinical indicators provide strong support for a diagnosis of acute-on-chronic congestive heart failure (CHF) in adults. Because of this, it’s important for inpatient coders to familiarize themselves with baselines and clinical indicators in order to ensure accurate reporting.
Q: We have a patient who gave birth while admitted for novel coronavirus (COVID-19). How should this be reported and sequenced in ICD-10-CM and which MS-DRG would this be assigned to?
According to a recent audit by the Department of Health and Human Services’ Office of Inspector General (OIG), Ohio State University Hospital received millions in overpayments during an audit period due to errors in coding, MS-DRG assignment, and billing.
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.
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.
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?
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.
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.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, reviews Chapter 11 of the ICD-10-CM manual, Diseases of the Digestive System, as attention must be paid to the coding conventions and general coding guidelines when reviewing the manual for correct code assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Dawn Valdez RN, LNC, CCDS, reviews MS-DRG and code assignment for COVID-19-related pediatric multi-system inflammatory syndrome (PIMS), as well as common findings and treatments for the condition.
Q: We have a patient that was admitted with sepsis due to COVID-19 who also has human immunodeficiency virus (HIV). How should we report this in ICD-10-CM, and which MS-DRG would this be assigned to?
Cheryl Manchenton, RN, BSN, CCDS, CPHM, writes that when it comes it reporting novel coronavirus (COVID-19), our understanding of it and its sequelae/manifestations is continually evolving. There is one “manifestation” of COVID-19 that is of interest for experimental treatment: cytokines.
