Hospital Outpatient Articles

Below is a complete listing of all Hospital Outpatient articles that have appeared in JustCoding News.

  • CMS changes Medically Unlikely Edits

    April 2, 2013

    CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them from line-item edits to date-of-service edits, effective April 1. Jugna Shah, MPH, Kathy Dorale, RHIA, CCS, CCS-P, John Settlemyer, MBA/MHA, and Valerie Rinkle, MPA, explain how the change could affect coding and reimbursement.

  • Q&A: ICD-9 codes for lumbrosacral radiology

    April 2, 2013

    Q: We received an outpatient radiology report (exam performed 7/11/12) where the radiologist states:

    COMPARISON: MAY 23, 2012
    FINDINGS: There is posterior spinal fusion L-3-L-5 with solid posterolateral bridging bone graft. Pedicle screws and rods are stable in position. There are bilateral laminectomy defects at L3-L-4. The vertebral body and disc space heights are preserved. The spinal alignment is maintained without evidence of spondylolisthesis. No acute fracture is identified. No lytic or blastic lesions are seen. The sacroiliac joints are unremarkable.
    IMPRESSION: Stable postsurgical changes with solid posterolateral fusion graft.

    Would you use the following ICD-9 codes: V67.09, 724.4. or 724.4, V45.4? Our coders disagree.

  • Scrutinize documentation for clues to code breast biopsies

    April 2, 2013

    Breast biopsies should be easy to code because coders have so few codes to assign, but it is one area where documentation is lacking. Stacie L. Buck, RHIA, CCS-P, RCC, CIC, reveals what key elements coders should look for in a breast biopsy note.

  • Use case studies to determine ED E/M level

    April 2, 2013

    With no national guidelines in place for facilities to use to determine evaluation and management (E/M) level, coders must apply their facility’s guidelines when coding an outpatient visit. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, and Joanne M. Becker, RHIT, CCS, CCS-P, CPC, CPC-I, use three ED case studies to highlight potential pitfalls for ED E/M leveling.

  • Healthcare News: CMS revises device/procedure edits

    April 2, 2013

    CMS added numerous device/procedure edits as part of the April update to the Integrated Outpatient Code Editor. To avoid triggering the edits, coders must report particular procedure codes and device codes together on the claim form.

  • Avoid common pitfalls with E/M levels and EMRs

    March 19, 2013

    Evaluation and management (E/M) coding is incredibly subjective. Two coders can look at the same documentation and choose two different E/M levels and both will be able to justify their choice. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer , Lori Owens, RHIT, CCS, and Deborah Robb, BSHA, CPC, discuss how electronic medical records can complicate E/M coding even more.

  • Healthcare News: CMS issues proposed changes to Part B inpatient billing in hospitals

    March 19, 2013

    On March 13, CMS issued a notice of ruling that establishes a policy that revises the current policy on Part B billing following the denial of a Part A inpatient hospital claim that a Medicare review contractor deemed to be not reasonable or necessary. The revisions are intended as an interim measure until CMS can finalize an official policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council decisions going forward.

  • Differentiate between physician and facility billing

    March 19, 2013

    In the coding world, it’s a never-ending clash that can cause compliance concerns—facility vs. professional. Kimberly Anderwood Hoy, JD, CPC, and Peggy Blue, MPH, CPC, CCS-P, explain how coders in each setting use different codes for the exact same services based on the payment systems, the rules, and how each setting applies those rules.

  • CMS adds significant number of new codes to I/OCE

    March 19, 2013

    CMS added 410 new codes and seven new therapy and patient condition modifiers to the Integrated Outpatient Code Editor (I/OCE) as part of the January 2013 update. Dave Fee, MBA, highlights the key changes to the I/OCE.

  • Q&A: Charging for hydration

    March 19, 2013

    Q: A patient received Toradol 30 mg IV and Zofran 4 mg IV at 14:38. He also had normal saline wide open with documented start of 14:30 and stop of 15:40.

    Is the hydration chargeable as 96361 (intravenous infusion, hydration; each additional hour) even though the initial service is not 90 minutes?
    Is the hydration a concurrent service?