CMS has posted a summary report from the discussion of procedure codes at the ICD-9-CM Coordination and Maintenance Committee meeting held March 5. The agenda addressed only a small number of code requests due to the implementation of the partial code freeze.
CMS released in February a fact sheet, “Global Surgery,” which contains information regarding the components of a global surgery package, including guidance about billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.
Special Edition MLN Matters article #SE1210 , “Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders,” outlines recovery auditor findings upon completion of medical necessity reviews. In the article, which addresses documentation and billing for inpatients, recovery auditors concluded that providers had been admitting patients even for clinical situations for which outpatient observation services would have been appropriate.
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
Cross-training coders has definitive short-term advantages, such as enhancing staff coverage during holidays and vacations and increasing the department's ability to handle periods of fluctuation in certain bill types, but these aren't the only benefits.
Trailblazer Health Enterprises, LLC, the Medicare administrative contractor (MAC) for Jurisdiction 4 (i.e., Colorado, New Mexico, Oklahoma, and Texas) stated in a February 21 notice that about 68% of reviewed claims billed with MS-DRG 470 (joint replacement or reattachment of lower extremity without MCC) resulted in denials. The MAC cited missing or insufficient documentation as the reason for 96% of these denials.
