Coding for Coronavirus Outbreak: Interim Guidance from the CDC

CDC Coronavirus coding guidelines

The World Health Organization (WHO) declared the 2019 Novel Coronavirus (COVID-19) disease outbreak a public health emergency of international concern on January 30, 2020 (CDC, 2020). As a result of the public health emergency, the document, “Announcement New ICD-10-CM Code 2019 Novel Coronavirus (COVID-19),” was released to provide guidance on coding this virus.

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Increase Revenue & Lower Compliance Risk With These 6 E/M Tips

E/M

Selecting the right E/M code can be tricky – and sometimes, costly – business. On the one hand, the coder does not want to choose a diagnosis that’s too high, which could potentially incur audits or claims denials. But, if the coder selects a code that’s too low, there’s a chance of losing revenue for his or her organization. According to Medical Economics, “payers and auditors use a quantitative scoring process that requires specific elements (i.e., history, exam, and medical decision-making [MDM] – or time spent counseling and coordinating care) for each E/M level” (2020).

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Top 8 Changes Medicare Payment Systems Will See In 2020

Medicare Payment Systems

The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019).

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Changes to Appropriate Use Criteria for Advanced Diagnostic Imaging

Appropriate Use Criteria

Starting January 1, CMS began testing the condition for Appropriate Use Criteria (AUC) requiring a qualified Clinical Decision Support Mechanism (CDSM) consultation by a qualified provider for payment on Advanced Diagnostic Imaging for Medicare beneficiaries. Claims must include the ordering professional’s NPI, which CDSM tool was utilized for the consultation, and “whether the service ordered would or would not adhere to consulted AUC or whether consulted AUC was not applicable to the service ordered” (Medicine Learning Network, 2018). The program will be fully implemented by January 1, 2021.

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