Hamilton Lempert, MD, FACEP, CEDC, reviews the basics of critical care services in CPT and addresses common reporting questions, such as services that pass midnight, continuous care, and which clinical tasks count toward critical care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Nancy Reading, RN, CPC, CPC-P , explains how understanding liver disease and its many complications is key to supporting higher-specificity ICD-10-CM coding and reimbursement.
Penny Jefferson, MSN, RN, CCDS, CCDS-O, CCS, CDIP, CRC, CHDA, CRCR, CPHQ , and Mercedes K. C. Dullum, MD, FACS, FACC , describe the advantages of creating CDI programs in outpatient settings and how they can decrease gaps in patient care and improve financial management.
The Food and Drug Administration’s (FDA) emergency use authorization for Pemgarda, a pre-exposure COVID-19 prophylaxis, has led to the release of HCPCS Level II codes for the drug and its administration.
CMS published a summary of its first quarter 2024 HCPCS Level II code update application decisions. There were 48 additions, two code definition revisions, and seven discontinuations.
Q: How would a coder report the scenario of an unmedicated diabetic patient with diabetic renal nephrosis and out-of-control blood sugar during an encounter?
Julia Kyles, CPC , examines the factors of medical necessity required to decrease chance of denials for preoperative E/M visits, including who performs the visit, associated risks, and the patient’s health.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , explains how to report neonatal respiratory failure, including meconium aspiration, failure to thrive, and associated symptoms in ICD-10-CM.
Lynn Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC , covers FAQs she has received, specifically about CPT reporting for arthrodesis, acromioplasty, arthroplasty, arthroscopy, and spinal decompression procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Tonya Chandler, RHIT , brings light to the declining mental health in youth, clarifies possible contributing factors, and explains how to report mental and behavioral conditions in ICD-10-CM with several case scenarios.
Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC , answers frequent questions she receives from providers pertaining to physician coding for CPT orthopedic services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS proposed hundreds of ICD-10-CM code changes in the 2025 IPPS proposed rule, published April 10, including 252 new codes, 13 revised codes, 36 invalidated codes.
Ronald Hirsch, MD, FACP, CHCQM, CHRI , and Valerie A. Rinkle, MPA, CHRI , explore common causes of denial, including prior authorization, missing documentation, medical necessity, and EHR formatting.
CMS published its HCPCS Quarterly Update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations, and definition revisions. The changes became effective April 1.
The lack of interaction with remote work has a variety of impacts. Managers must develop strategies for remote onboarding and training, find different ways to measure productivity, and keep employees engaged.
Orthopedists perform injections and aspirations to address a range of ailments, but reporting injections can be difficult. This article reviews proper CPT coding for sacroiliac joint injections and joint arthrocentesis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Physician coders should watch out for recently implemented edits to codes that debuted January 1 in the quarterly updates to the NCCI files. The latest updates introduce 2,171 new PTP edits and 164 new MUEs.
The Journal of the American Medical Association (JAMA) published a study in March found that “foot and ankle care was associated with an 11% lower likelihood of death…and a 9% lower likelihood of major amputation (above or below knee).”
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , analyzes the challenges that both inpatient and outpatient CDI specialists encounter and offers advice to lessen provider opposition to participating in outpatient CDI.
Shelley C. Safian, PhD, RHIA, CCS-P , and Mary A. Johnson, MBA-HM-HI, CPC , review the purpose of modifiers and analyze their integral part in reporting encounters, receiving reimbursement, and promoting continuity of care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Katie Patterson, CPC , summarizes the Medicare Quality Payment Program, provider qualifications, clinician participation, and how they work to achieve the program’s main objectives.
C. diff results from a disruption of the normal bacterial flora of the colon. Recognize the diagnostic criteria, treatment, and ICD-10-CM coding tips for reporting this disorder. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Kyles, CPC , summarizes the advice CMS provided during a January event about reporting HCPCS add-on code G2211 for increased complexity with E/M codes.
CMS retroactively added two new CPT codes for respiratory syncytial virus (RSV) vaccine administration. The codes affect services rendered on or after October 6, 2023.
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.
Q: How should we report services with modifier -50 (bilateral procedure) for physician claims when a private payer’s instructions contradict our Medicare administrative contractor (MAC)?
A JAMA study published in January found that patients with the highest risk for severe COVID-19 infection received outpatient therapy less often than those with the least risk.
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.
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.
Teresa Seville, RHIT, CCS , explains that a thorough review of code updates must include analysis of the addenda, including index, tabular notes, guidelines, and committee meeting highlights.
CMS published a summary of its fourth quarter 2023 HCPCS Level II code update application decisions, including 36 additions, four revisions, and 18 deletions.
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.
For accurate CPT and ICD-10-CM coding of fractures, coders will need to identify many pieces of information, including location and type. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Diane Pittman, CPC, CPMA, CRC, CCD-O, and April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O , explain how reporting ICD-10-CM social determinants of health, their context, and coder feedback can influence natural language understanding.
This Q&A with Nancy Enos, FACMPE, CPC-I, CPMA, CEMC , covers independent historians, independent interpretations, discussion with external physicians, risk, and billing for separate E/M visits. 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.
CMS posted its 2024 Therapy Code List and Dispositions on December 28. This list indicates whether therapy services, as distinguished by HCPCS Level II and CPT codes, are recognized under CMS as “sometimes therapy” or “always therapy.”
Q: What terms need to be included in physician documentation to code in ICD-10-CM whether the patient’s migraine is chronic, intractable, or with status migrainosus?