Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, and Karla VonEschen, MS, CPC, CPMA, CCDS-O, take a look back at the progression of diagnosis and mortality coding before looking ahead to ICD-11 and how coding departments can prepare for it.
Heart failure affects more than 6 million adults in the U.S. and costs the nation more than $30 billion. Review ICD-10-CM guidance and documentation details required for accurately reporting the condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Artificial intelligence (AI) has burst on the scene with numerous clinical and coding applications for providers. This article looks at how the technology can be used and where human oversight is still required.
The behavioral health coverage that CMS calls among the most important in Medicare history were finalized and expanded in the 2024 Medicare Physician Fee Schedule final rule.
Most fracture cases originate in the ED, so orthopedic coders must understand the various scenarios that may arise based on the patient’s condition and the intent of the performing clinician. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Kyles, CPC , reviews the 2024 First Quarter National Correct Coding Initiative (NCCI) code update, which included 929 new procedure-to-procedure edit pairs.
Michael Malohifo’ou, RN, MBA, PhD , explains how excessive use of emergency departments can result in unfavorable outcomes . He also assesses the complicated relationships between EDs, social determinants of health ICD-10-CM coding, and mental and behavioral health CPT services.
The 2024 OPPS final rule details changes to price transparency compliance, reimbursement changes and, updates to numerous other hospital programs. Additionally, CMS is moving forward with its proposals to address unlawful payment reductions to 340B drug reimbursement.
Part B providers will have to prepare for a net 3.4% payment decrease across services in 2024, according to the 2024 Medicare Physician Fee Schedule final rule. The rule covers numerous operational areas for medical groups, including new coverage opportunities and billing revisions to coding and compliance updates.
The decision for an emergency clinician to report fracture or dislocation care CPT codes with an E/M code can have significant reimbursement ramifications. Hamilton Lempert, MD, FACEP, CEDC, explains the complexities of reporting this care and covers details coders should watch out for in documentation.
Coding staff and treating providers can increase E/M code reporting accuracy to ensure their claims hit the mark by reviewing these six Q&As. The material, created by Julia Kyles, CPC , covers medical decision making and time-based coding.
The 2024 Medicare Physician Fee Schedule proposed rule received more than 17,000 stakeholder comments. Julie Kyles, CPC , highlights some of the major concerns that commenters expressed, such as requests for more telehealth policy flexibility and community health integration services.
CMS recently proposed to pay for certain currently bundled caregiver training service CPT codes and three new CPT codes that, if finalized, will be established January 1. Review the criteria of defining a caregiver and which caregiver training services apply.
In this article, the author takes a closer look at CMS’ 2024 Medicare Physician Fee Schedule (MPFS) proposed rule—specifically a proposal to allow new providers to perform and bill behavioral health codes, offer providers new service categories, and give a code-valuation adjustment.
CMS published the 2024 Medicare Physician Fee Schedule (MPFS) proposed rule on July 13 with new potential policies and codes affecting physician reporting, including new HCPCS codes for E/M services and behavioral health.
Julie Kyles, CPC, explains that CMS issued a modest set of hospital and practitioner procedure-to-procedure and medically unlikely edits in the latest quarterly update to the National Correct Coding Initiative (NCCI) edits, effective July 1
Julia Kyles, CPC, offers insights into the risk category of the medical decision-making (MDM) table with three scenarios presented by Peter Hollmann, MD, and Barbara Levy, MD, co-chairs of the CPT/RUC Workgroup on E/M.
Pain treatment procedures for trigger point injections have a history of high denial rates. Julia Kyles, CPC , offers insight on what coders and physicians can do to improve reporting of these procedures.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , discusses how the 2023 ICD-10-CM guidelines update the instructions for reporting intraoperative care complications.
The January 2023 update to the CPT manual had almost every chapter undergoing some form of change. In this article, Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, delves into some of the major changes to E/M coding and considerations for documentation integrity.
E/M coding guidelines for emergency department services (CPT codes 99281-99285) were recently updated for the first time in decades. Hamilton Lempert, MD, FACEP, CEDC, reviews these changes, along with coding requirements for many other E/M services.
Kathleen M. Romero, MSN, RN, EBP-C , Cynthia Beal, MBA-HCM, BSN, RN, and Renee Pate, MSOL, MSN Ed., RN, CCDS, explain how they implemented a CDI program in their facility’s emergency department and the how establishing this program improved coding accuracy and increased reimbursement.
Pam Warren-Brooks, MHA, COC, CPC, explains different types of psychiatric healthcare providers, outpatient facilities, and best practices for reporting psychiatric services using CPT codes.
Tonya Moton, RHIA, CCS, defines social determinants of health coding, explains the challenges of reporting these factors, and outlines how coders and providers can work together to create a positive impact in at-risk communities.
The end of the public health emergency (PHE) will bring the expiration of many Medicare waivers issued since 2020. Ronald Hirsch, MD, FACP, CHCQM, CHRI, explains how facilities can maintain their compliance in this new era.
The new batch of diagnosis codes and revised guidelines for social determinants of health (SDOH) that will go into effect April 1 highlight the importance policymakers place on collecting this data. Julia Kyles, CPC, provides tips for capturing the SDOH using these new codes.
Coders can reinforce their understanding of the 2023 CPT E/M medical decision-making (MDM) requirements with tips from Peter Hollman, MD , who oversaw the changes.
Peter Hollman, MD , breaks down 2023 CPT guidance in a new section of the manual for initial and subsequent E/M services, which will impact reporting of hospital inpatient and observation care services beginning January 1.
Medicare finalized a care management service for chronic pain management (CPM). Effective January 1, CPM services can be reported by a wide range of providers, including primary care practitioners.
The Office of Inspector General (OIG) recently released a report investigating instances of incorrect co-surgery and assistant-at-surgery modifier usage, which found that 69 of 100 sampled procedural services did not meet federal requirements.
CMS confirmed in the 2023 Medicare Physician Fee Schedule final rule that it will adopt the framework of the revised AMA E/M guidelines, including payment based on medical decision-making (MDM) or time, effective January 1, 2023. Laura Evans, CPC, explains how the agency will diverge from the AMA on some points, however.
Coding and billing professionals must ensure that medical record information is accurate, up to date, and compliant. In this article, Holly Cassano, CPC, CRC , defines late entries, corrections, and addendums, and explains the proper methods used to alter health records while maintaining Medicare compliance.
A coder’s practice should check its telehealth claims against the information in the recent Office of Inspector General data brief on telehealth services, healthcare attorneys advise. Julia Kyles, CPC, reviews the September 2 report, which contains findings and program integrity measures for telehealth services.
The Office of Inspector General (OIG) recently released a data brief on billing risks associated with Medicare telehealth services during first year of the COVID-19 pandemic. Julia Kyles, CPC, explains the significance of using the OIG’s data brief and offers tips to adhere to compliance guidelines.
In part two of this series, expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, addresses the “nuts and bolts” of ICD-10-CM coding for anesthesia services, including how and when to append modifiers.
Most coders never have the opportunity to code for anesthesia. Expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains that ICD-10-CM coding for anesthesia services is interesting and straightforward, but can be confusing if an individual is unfamiliar with coding guidelines and terminology for anesthesia administration.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting. Review key ICD-10-CM updates including new codes for dementia, head injuries, and long-term drug therapy.
Medication Therapy Management (MTM) is a group of services provided by pharmacists that involve active management of drug therapy. Review CPT coding, the role of pharmacists, and documentation tips associated with MTM.
Physician service modifier -FT for unrelated E/M visits provided on the same day has been a source of confusion for many coding and billing professionals. Review the latest coding and billing guidance for reporting this modifier.
CMS recently released new HCPCS modifiers -FR, -FQ, -FS, and -FT for telehealth visits. Julia Kyles, CPC , breaks down reporting guidance for these new physician modifiers that took effect January 1.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
Review new CPT codes 98975-98981 for the monitoring of non-physiologic patient data such as musculoskeletal system status, respiratory system status, and medication adherence.
CMS recently released the 2022 National Correct Coding Initiative Policy Manual for Medicare Services . Julia Kyles, CPC , breaks down procedure-to-procedure and medically unlikely edits for a selection of new provider-based services.
Medical practices in the U.S. are expanding treatment options for major depressive disorder to include transcranial magnetic stimulation (TMS). Laurie Bouzarelos, MHA, CPC, reviews the basics of TMS, types of providers who can deliver TMS, and ICD-10-CM/CPT coding for TMS delivery and management.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Four new CPT codes for principal care management services take effect January 1, 2022. Review documentation requirements and billing edits that will affect reporting of these new codes.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CACO, CAC, reviews findings from a recent Office of Inspector General audit of claims for neurostimulator implantation surgeries and their implications for coders.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Kimberly A. Hoy, JD, CPC , summarizes proposed changes to physician coding and billing for therapy assistant services in the 2022 Medicare Physician Fee Schedule proposed rule.
