E/M services are some of the most frequently used CPT codes, and they are also some of the most frequent examples of incorrect coding. One of the problem areas in selecting the proper E/M code is distinguishing between new and established patients. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
July is National Juvenile Arthritis Awareness Month. Yvette DeVay, MHA, CPC, CIC, CPC-I, explains the differences between the many different types of juvenile arthritis in order to help coders report the disease correctly.
The Quality Payment Program proposed rule seems to bring relief to providers anticipating escalation of Medicare Access and CHIP Reauthorization Act (MACRA) requirements, but there are a plethora of reasons for coding professionals to start adapting their workflow for MACRA now. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
In ICD-10-CM, defining, diagnosing, and documenting the various forms of altered mental status and their underlying causes remains an ongoing challenge for physicians and their facilities, according to James S. Kennedy, MD, CCS, CDIP .
The American College of Obstetricians and Gynecologists is encouraging providers to decrease the number of cesarean section deliveries. According to Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, this means coders should brush up on their knowledge of how to code fetal intervention procedures for babies who are in a breech position.
Modifier assignment can be a confusing task, and that work is sometimes made more difficult by encountering a set of modifiers which apply to the same circumstance with only one differentiating factor. A review of some of these modifiers, including modifiers -PO, -PN, -73, and -74, can be essential for accurate claims submissions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CMS Special Edition article 1609 was released in April to clarify CMS’ policy on prolonged drug and biological infusions using an external pump. Valerie A. Rinkle, MPA , breaks down that article and discusses its billing and reimbursement implications in the first of this two-part series.
In the second part of a two-part series on SE1609, Valerie A. Rinkle, MPA , distinguishes between CPT code 96416 and HCPCS code G0498 for billing and reimbursement purposes while outlining how practices can achieve compliance with CMS’ current external pump policy.
May was a busy month for telehealth in the political world on both the federal and state levels. This action serves as a reminder that expanded access will mean an increase in telehealth coding, but navigating eligibility requirements and coding regulations can be a challenge. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
There is an extensive list of coverage requirements that must be met to furnish outpatient services to Medicare beneficiaries. Gina M. Reese, RN, JD, CPHRM , discusses some of the trickier issues that facilities will need to audit more carefully while monitoring for compliance in provider-based departments.
The Ochsner Health System in Louisiana revolutionized the way its clinical documentation excellence (CDE) team captures annual hierarchical condition categories for all patients across its vast system. Now, Ochsner can serve as a case study to educate others on how to create an outpatient focus on CDI in an increasingly risk-adjusted world.
There is an extensive list of coverage requirements that must be met to furnish outpatient services to Medicare beneficiaries. Hospitals may find that certain coverage requirements for therapeutic and diagnostic service are more difficult to meet than others, especially in off-campus provider-based departments.
CMS issued SE1609 to clarify long-standing policy concerning external infusion pumps. Apparently, both freestanding physician offices and outpatient hospital departments were treating external pumps as an item of durable medical equipment, even when the physician or hospital department set up the pump on the patient, supplied the drug, and programmed the infusion rate and dose into the pump.
Podiatry coding can become complicated quickly, as a number of procedures can be performed on the same site or region of the foot. This means codes could easily run into NCCI edits or denials. One way to ensure physicians are reimbursed properly for provided services is to review NCCI edits pertaining to podiatry.
Alcohol and Other Drug-Related Birth Defects Awareness Week began on Mother’s Day and aimed to raise awareness of the dangers of substance abuse during pregnancy. In honor of this awareness week, Yvette DeVay, MHA, CPC, CIC, CPC-I , discusses fetal alcohol syndrome disorders and ICD-10-CM coding for the condition.
Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But Jugna Shah, MPH , writes that, increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
As physicians and society debate the rising incidence and devastating effects of opioid dependency, neonatal abstinence syndrome, and the use and abuse of other mood-altering chemicals, James Kennedy, MD, CCS, CDIP , explains how providers must partner together to define, diagnose, document, and report drug-related events so that ICD-10-CM-dependent administrative data can accurately measure its epidemiology, responses to treatment, and consequences.
Coding plays a large role in claims and therefore is a key factor in reimbursement compliance. As such, coders have a responsibility to be as accurate and up-to-date on coding practices as possible. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , explores some of the organizations and regulatory bodies available to assist coders.