Review proposed updates to the CPT set for 2022, including new codes for chronic care management, laser interstitial thermal therapy, spinal anesthesia, and more. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CPT coding for vaginal and cesarean deliveries and postpartum care requires strong attention to detail. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down stages of delivery and CPT coding guidance for childbirth.
Earlier this year, the Office of Inspector General (OIG) added a new OIG Work Plan item for reporting E/M services with minor surgical procedures. Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO , reviews appropriate use of modifier -25 for separately identifiable E/M services.
Medicare overcompensated providers for complex and noncomplex chronic care management (CCM) services billed over a two-year period, according to a recent OIG report. These overpayments occurred because CMS did not have claim edits in place to prevent billing of overlapping care management services.
Read up on ICD-10-CM code updates for fiscal year 2022, including new codes for post-COVID-19 symptoms, social determinants of health, and poisonings by cannabis and synthetic cannabinoids.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include new codes for third doses of the Moderna and Pfizer/BioNTech COVID-19 vaccines.
To select the most specific CPT codes for prenatal care, physician coders must have a solid understanding of complex guidelines for reporting pregnancy-related office visits. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks services included in the global obstetric package and CPT coding for routine prenatal care.
Hospital coders often review charts for patients with diarrhea, ulcerative colitis, and other colorectal problems. Review ICD-10-CM coding for common conditions of the large intestine and CPT coding for proctosigmoidoscopies, sigmoidoscopies, and colonoscopies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Debbie Jones, CPC, CCA , breaks down CPT coding for extracorporeal shock wave lithotripsy (ESWL)—a non-surgical treatment used to destroy kidney stones.
Cardiovascular conditions affect the structure and function of the heart and are a leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. This article details ICD-10-CM coding for common heart conditions and CPT coding for cardiac catheterization procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2022 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant policy updates affecting physician coding and billing. Review proposals to decrease to the Medicare conversion factor, revise guidelines for critical care services, and loosen telehealth coverage requirements.
Hip and knee replacements are two of the most commonly performed elective surgeries, according to the American Academy of Orthopedic Surgeons. Review major joint anatomy and CPT coding for hip and knee revisions and replacements. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pacemakers are small devices implanted in the chest to help regulate inconsistent heart rates. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down documentation and CPT coding for pacemaker insertions, repairs, and relocations.
While technological solutions and electronic health records have made leaps and bounds over the past years in the inpatient setting, there still seems to be much lacking on the outpatient side. Learn how to leverage existing technology to track Hierarchical Condition Category capture and other coding metrics.
Staten Island University Hospital overcharged Medicare an estimated $11.8 million for inpatient and outpatient services billed over a two-year period, according to a recent Office of Inspector General (OIG) report.
CPT coding for psychotherapy and psychiatric diagnostic evaluations can be challenging, especially when these services are provided with office visits. Shelley C. Safian, PhD, RHIA, CCS-P , breaks down documentation and CPT coding for visit services provided with psychiatric care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medicare waivers and flexibilities allow providers to deliver care via telecommunication technology during the COVID-19 public health emergency (PHE). Judith Kares, JD , reviews CPT coding for e-visits, virtual communication services, and telephone E/M services.
CMS withdrew the split/shared and critical care sections of the Medicare Claims Processing Manual and announced its intent to update coverage policies for these services. Prepare for changes to come by reviewing documentation, CPT coding, and billing guidance for split/shared and critical care services.
University of Michigan Health System overcharged Medicare an estimated $12.5k for polysomnography services submitted over a two-year period, according to a recent Office of Inspector General (OIG) report. Overpayments were due to insufficient documentation and CPT coding errors.
CPT codes 63685 and 63688 for spinal neurostimulator procedures have been removed from the list of services that would require Medicare prior authorization when performed in a hospital outpatient department, CMS announced on May 13.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CICA, CAC, CACO , describes upcoming changes to CMS’ prior authorization program, including expansion of the program to include two additional outpatient services, effective July 1.
In the U.S., tympanostomy tube insertion is the most common ambulatory surgery performed on children under 15, according to StatPearls. Debbie Jones, CPC, CCA , reviews common types of ear infections and CPT coding for myringotomies with tympanostomy tube insertion. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A relatively small 2022 ICD-10-CM update will contain 14 codes of interest to pain management practices if the proposed changes go into effect October 1. Julia Kyles, CPC , unpacks proposed updates to ICD-10-CM codes for painful chronic conditions.
Q: When might it be appropriate to report CPT codes for multiday electroencephalograms (EEG)? In addition, should these codes be billed on the day of initiating or ending the EEG study?
The Centers for Disease Control and Prevention reports that approximately 15 million people in the U.S. report experiencing acute joint pain due to arthritis. Shelley C. Safian, Ph.D., RHIA, CCS-P, reviews ICD-10-CM and CPT coding for lower extremity arthritis and procedures used to treat it.
The American Medical Association (AMA) recently updated the CPT code set to include immunization and administration codes for a COVID-19 vaccine under development by Novavax Inc.
The perinatal period begins before birth and ends 28 days after delivery. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down ICD-10-CM coding for fetal and newborn conditions originating in the perinatal period. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The monetary value of outpatient clinical documentation integrity (CDI) programs is increasing dramatically year after year. Read about steps your facility can take to create and maintain a successful outpatient CDI program.
Q: A patient receives Apligraf® (44 sq. cm) after subcutaneous wound debridement. Ten sq. cm is applied to a diabetic foot ulcer on the patient’s left heel and 20 sq. cm to an ulcer on the patient’s right ankle. What CPT codes would the facility use to report these services?
Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how facilities can create internal guidelines and point systems for determining E/M level section. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ recently released fiscal year (FY) 2022 IPPS proposed rule includes 153 proposed ICD-10-CM code additions, mainly affecting reporting for immune effector cell-associated neurotoxicity syndrome, gastric intestinal metaplasia, and poisonings by cannabis and synthetic cannabinoids.
Laura Evans, CPC , and Julia Kyles, CPC , break down potentially confusing updates to the 2021 E/M guidelines, including new definitions for technical terms and revised guidance for reporting diagnostic laboratory testing with interpretation.
Q: A patient is diagnosed with Type 2 diabetes mellitus and arteriosclerotic peripheral artery disease (PAD). Can we report ICD-10-CM code E11.51 with a code from subcategory I70.2- to describe affected vessels?
Viral hemorrhagic fevers (VHF) are infectious diseases that pose a great public health risk due to their epidemic potential. Debbie Jones, CPC, CCA , breaks down ICD-10-CM coding for four VHFs: Crimean-Congo hemorrhagic fever, Ebola virus disease, Lassa fever, and Marburg virus disease. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Essential newborn care includes services provided at the time of birth and over the first hours of life. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about E/M coding for these routine obstetric services.
CMS recently added 24 audiology and speech-language pathology services to its list of telehealth services covered under Medicare during the COVID-19 public health emergency (PHE). These services include speech, hearing, and swallowing assessments, and cognitive interventions.
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
Approximately 34.2 million Americans, or 10.5% of the U.S. population, were diagnosed with diabetes in 2018, according to the Centers for Disease Control and Prevention. Review signs and symptoms of diabetes mellitus types 1 and 2 and ICD-10-CM coding for these conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2x4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)?
Medicare auditors have identified failure to document time as a key flaw in claims for advance care planning (ACP), and the Office of Inspector General plans to conduct an audit of these services. Read up on documentation requirements and CPT coding for ACP to prevent claim denials.
Physician and non-physician practitioners may benefit from reviewing documentation requirements and HCPCS Level II codes for knee orthoses, according to a recent Medicare Quarterly Compliance Newsletter .
Corneal dystrophies are a group of genetic, often progressive, eye disorders that alter functioning of the cornea. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for corneal dystrophies and CPT coding for procedures used to treat them.
