Telemedicine Guidelines & COVID-19: Coding in Response to the 1135 Waiver Authority

telemedicine guidelines

Due to the stay-at-home orders put in effect by state governors and the highly contagious COVID-19 virus, CMS has expanded coverage for its Medicare recipients through the use of telemedicine (CMS, 2020). According to CMS, “The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus” (2020).

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CMS Increases List of Payable Medicare Telemedicine Services


Adapting to the influx of telehealth services in response to the COVID-19 outbreak, CMS has adjusted the “List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth” in order to provide as much support and care as possible (2020). In addition, CMS issued updated criteria for risk adjustment of Medicare telemedicine services, as well as guidelines on how to bill for telemedicine.

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Brush Up on the Latest Hot Topics for ICD-10-PCS & Gain 2 CEUs

ICD-10-PCS Hot Topics

The ICD-10-PCS Hot Topics Updated webinar reviews and clarifies some of the most challenging ICD-10-PCS procedure codes and ICD-10-PCS coding issues divided into 10-20-minute modules, including Aneurysms Background and Cerebral Aneurysms, Aortic Aneurysms, Control, Overview and Coding Applications for Vascular Access Devices, and Background and Coding Applications for Tunneled and Totally Implantable VADs. This learning path provides 2 CEU certificates after attaining a passing grade (2 AAPC CEUs and towards 2 AHIMA CEUs).

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CMS Clarifies Risk Adjustment Criteria for Coding Telehealth Services

Coding Telehealth

CMS clarified on April 10, 2020, that the submission of ICD-10-CM diagnoses codes for Risk Adjustment are permitted from coding telehealth services as long as it meets the set criteria (i.e. inpatient, outpatient, or professional service and from a face-to-face encounter) (CMS, 2020). CMS is stating that telehealth services can meet the face-to-face requirement “when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication” (2020). From a medical coding and billing standpoint, the change in the telehealth services criteria for risk adjustment is causing updates to how these services are billed.

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AMA Releases Two New CPT Codes for COVID-19 Antibody Detection

COVID-19 Antibody

Perhaps the most important upcoming development in the fight against COVID-19 is detecting antibodies to the infection, and new tests for this purpose are being developed. As these are new tests, existing codes do not reflect these antibody studies. To assist, the CPT Editorial Board has fast-tracked the approval of two new CPT codes for the COVID-19 antibody blood testing (AMA, 2020). The new codes were published April 10, 2020, and are effective immediately. Use of the codes will allow for tracking and reporting of antibody tests specifically for COVID-19.

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The Importance of Specificity in Documentation and Coding HCCs

HCC specificity

As a follow-up to our previous articles on the subject of Risk Adjustment and HCCs, we now review some scenarios of HCC chronic conditions and the importance of specificity in documentation and coding. Accurate and complete documentation of chronic condition diagnoses by clinicians is an essential component of the risk adjustment and the HCC process. It is also imperative that the documentation of a disease/condition be as specific as possible. Specificity can make a difference in the patient’s treatment plans, as well as accurate code assignments, which then leads to appropriate HCC assignment and payment.

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Coding Audits: How Identifying Issues Sooner Rather than Later Saves Money for the Hospital/Facility

hospital coding audits

The establishment of a coding compliance program remains a significant effort by the Office of the Inspector General (OIG) in its attempt to engage the healthcare community in combating fraud and abuse. The OIG developed a Compliance Resource Portal with materials and guidelines for healthcare professionals. A fundamental element to an effective compliance program is conducting internal monitoring and auditing. Coding audits have the added value of ensuring you are running an efficient and profitable, not to mention minimized liability, operation. Earlier detection of any potential coding issues will pay off financially and will reduce risks for additional external audits.

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Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition Process of a Large Physician Group

facility acquisition process

Healthcare facilities and independent practices face unique challenges when merging or being acquired. As an HIM and Coding consulting company, YES has encountered several opportunities to implement auditing, coding, and education improvement plans in similar scenarios. This case study provides a thorough analysis on the unique challenges a medical facility faces when merging with independent practices, as well as solutions for a successful facility acquisition process. Challenges impact overall medical coding quality, turnover rate, productivity and the bottom line. The analysis covers the solutions implemented, and an overview of the impact these presented to a facility, practiced over a 33-month period.

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Tech Innovations for the Healthcare Sector: How to Bridge the Gap with Coding

tech innovations

In the year 2020, there are not many industries left that haven’t been modernized and streamlined by innovative technology. The healthcare sector itself has seen numerous improvements in recent years, including cutting-edge treatments, less invasive procedures, digital health records, mobile healthcare apps, and more (Medium/Healthcare in America, 2018). Most of these technologies alone have improved the level of care, efficiency, disease control, and access to better treatments (UIC, 2020). How medical coding adapts to new healthcare technology will have a great impact on preventive and corrective healthcare (Healthcare Business & Technology, 2020).

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