CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.
When CMS introduced the -X{EPSU} modifiers in August 2014 to be used in specific instances to replace modifier -59 (distinct procedural service), the agency encouraged "rapid migration" to the new modifiers.
The policies that CMS publishes each year in the OPPS proposed rule don't always come as a surprise. Sometimes, CMS will announce its future intent in a previous rule in order to notify providers about data it is looking at or requesting comments on.
CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.
This month’s issue features the second article in a series of PSI 90, PSI 15. In addition, we highlight similarities and differences in coding poisonings and adverse events in ICD-9-CM and ICD-10-CM. Sharme Brodie highlights some of the top questions about ICD-10 answered by Coding Clinic and Robert S. Gold, MD, reviews how to identify conflicting documentation.
PSI 15 measures the hospital's risk-adjusted rate of accidental punctures and lacerations. PSI 15 has the highest weight in the PSI 90 composite under both the Hospital-Acquired Condition Program and the Hospital Value Based Purchasing Program. Coders and CDI specialists can improve performance for PSI 15 by ensuring complete documentation and correct ICD-9-CM code assignment for PSI 15?pertinent inclusions, exclusions, and risk adjustment variables.
Our friends at the Association of Clinical Documentation Improvement Specialists hold their annual conference next month in San Antonio , Texas. And like everything in Texas, it’s going to be BIG ...
You learn something new every day. Today’s new fact: you can be a professional video game player. I’m not sure why that surprises me. After all, video games have come a long way from the Atari and...
Primary care providers see patients for a wide variety of conditions, meaning coders in those settings may have to learn many of the new concepts and terms in ICD-10-CM. Annie Boynton, BS, RHIT, CPCO, CCS, CPC, CCS-P, COC, CPC-P, CPC-I, and Rhonda Buckholtz, CPC, CPC-I, CPMA, CRC, CHPSE, CGSC, CENTC, COBGC, CPEDC, discuss three common conditions seen in these settings and what information coders will need to look for in documentation to code them in ICD-10-CM.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, reviewsCPT® coding for interrupted pregnancies, while also highlighting changes coders can expect for related diagnoses in ICD-10-CM.
Dave Fee, MBA, identifies updates to CMS' programming logic for comprehensive APCs and provides a step-by-step approach to determine whether a complexity adjustment will be applied.
Q: We are trying to verify whether we should bill for two units of the CPT® code when the provider performs a service with and without magnetic resonance angiography (MRA), such as an MRA of the abdomen, with or without contrast material (code 74185). The description of the MRA CPT codes say "with or without," not with and without for billing all non-Medicare payers. We realize for Medicare we are to use HCPCS codes C8900-C8902.
A Recovery Auditor automated review of claims for cardiovascular nuclear medicine procedures found potential incorrect billing due to lack of medical necessity, according to the latest Medicare Quarterly Compliance Newsletter.
You may recall that Steve’s super streak at the Vegas craps table ended with a torn right ulnar collateral ligament. On the recommendation of his primary care physician, Steve consulted an orthopedic...
You know us and the staff at the Acme ED, Fix ‘Em Up Clinic, and the Stitch ‘EM Up Hospital. Now, we want to get to know a little bit about you, our readers. Please complete this short survey to tell...
When providers use different definitions for the same disease, confusion and chaos result. Trey La Charité, MD , discusses how coding and clinical documentation improvement specialists can clear up the situation.
