Hospital outpatient

This resource reviews common anatomy and physiology terminology that coders might encounter when reporting hip traumatic injuries in ICD-10-CM. It has been excerpted from HCPro’s 2024 Orthopedic Coding & Documentation Trainer: A Comprehensive Guide to Orthopedic Coding for Physician Practices.

This expanded Q&A from Hamilton Lempert, MD, FACEP, CEDC, provides an in-depth examination of the types of organ system failure that constitute critical care CPT services with examples from his own experience as an emergency physician.

This reference chart details bundling rules for reporting bone allograft CPT codes, according to AMA guidelines. This reference chart is an excerpt from 2024 Orthopedic Coding & Documentation Trainer: A Comprehensive Guide to Orthopedic Coding for Physician Practices.

This expanded Q&A from Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, an independent medical coding education consultant, clarifies CPT reporting of removal and replacement of spacers in hip and knee arthroplasty procedures. It was excerpted from the HCPro webinar, “Answering Top Questions in Orthopedic CPT Coding.” 

This expanded Q&A covers CPT documentation requirements for hypothenar fat pad creation. Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, an independent medical coding education consultant, answered this question.

Medicare covers two caregiver training services that are similar enough to cause confusion, claims errors and denials.

For example, behavior management training (96202-96203) and the separate training that shows caregivers how to assist patients who have functional deficits (97550-97552) both include time-based code pairs.

Use this Antibiotic Efficacy Table to aid in identification of antibiotics by brand name and their effectiveness against gram-negative and gram-positive bacteria. 

Reporting discussion of management or test interpretation

Count discussions that meet the E/M definition. A “discussion of management or test interpretation” can earn a moderate or high score under the data review element of an E/M office visit. But before you give the billing practitioner credit for a discussion, make sure the documentation shows that it met the definition of a discussion.

Use the illustrated guide on discussions to train staff.

Coders should make sure their physicians and qualified healthcare professionals (QHP) are ready for the crucial role in reporting HCPCS Level II code G0136 (administration of a standardized, evidence-based social determinants of health [SDOH] risk assessment tool, 5-15 minutes, not more often than every 6 months).
While practices can perform a SDOH assessment for all of its patients, members of the medical team will take the lead in identifying patients who meet Medicare’s requirements for the billable service.
Share the following illustration with providers to help them negotiate Medicare’s rules. This tool was originally published on Part B News.

Coders had to review and update their training materials for split/shared visits for physician reporting when CMS completely revamped the rules in 2022. It wouldn’t hurt to do so again with this tool to make sure they match the CMS rules and CPT manual guidelines that went into effect January 1, 2024.