Coding updates

icd 10 codes for spinal fusion

The Challenging ICD 10 PCS Codes for Spinal Fusion Procedures Explained

By YES HIM Consulting / July 9, 2020 /

The Refresh With YES: PCS Spinal Fusion Procedures Learning Path shows learners how to correctly document the ICD 10 codes for spinal fusion procedures divided into 20-23-minute modules. The courses within this learning path review one of the most challenging ICD-10-PCS coding topics of spinal fusion, including cervical and lumbar fusion ICD 10. Official coding guidelines, case examples, and Coding Clinic topics related to spinal fusion procedures will be reviewed.

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learning styles

Personalized Medical Coding Education Tailored to Coders’ Learning Styles

By YES HIM Consulting / July 7, 2020 /

YES HIM Consulting designs learning paths and coding tracks for busy professionals who need to take courses on their own time. Our catalog offers customizable formats to fit physicians’, coders’, and auditors’ schedules and learning styles – including on-site, online, and hybrid or blended models. Ongoing coding education is one of the ways to keep your team and organization compliant. Click here to review the other benefits of keeping your team up-to-date with coding and guideline changes with customizable coding education formats.

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telehealth resource center

Telehealth Resource Center for Revised PHE Coding & Billing Policies Due to COVID-19

By YES HIM Consulting / June 30, 2020 /

The Center for Medicare & Medicaid Services (CMS) expanded the payment guidelines for professional telehealth services provided to Medicare beneficiaries during the Public Health Emergency (PHE) declared for COVID-19 (CMS, 2020). The temporary protocol expansion was deemed necessary to aid healthcare reimbursement, and will be active only during the PHE. To keep coders and auditors up-to-date on the expanded services and reimbursement guidelines, YES HIM Consulting has gathered all the latest updates to form a telehealth resource center.

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hcc education

Webinar Recap for HCCs background and a deeper dive into M.E.A.T. Criteria

By YES HIM Consulting / June 30, 2020 /

In conjunction with TruCode’s Educational Series of free webinars, YES President and CEO, Karen Youmans hosted a webinar focused on HCC education and coding, and the application of the M.E.A.T. Criteria. The webinar, which was held twice due to popular demand, was attended by over 3,000 HIM professionals. If you missed the opportunity to attend either session, you can download the presentation slides here. We will recap the main points made during the webinar, and provide additional resources to help you and your organization become HCC experts.

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antigen testing

COVID-19 Antigen Testing Code 87426 Available for Immediate Use from AMA

By Teri Jorwic / June 29, 2020 /

The American Medical Association (AMA) has released a new code for antigen testing of patients suspected to have been infected with COVID-19 (AMA, 2020). The CPT code for antigen testing was approved at a special meeting of the CPT Editorial Panel and released with a June 25, 2020, effective date. The special meeting and action by AMA was designed to react rapidly to the urgent need for the code. AMA President Susan R. Bailey M.D. commented, “Moving quickly during this crisis to meet the medical coding needs of the health care industry has enhanced the reporting of innovative tools now available to advance medicine’s overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs” (AMA, 2020).

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fee for service

Updates for Medicare Fee For Service (FFS): CMS MLN Matters Special Edition Article

By YES HIM Consulting / June 23, 2020 /

The Centers for Medicare & Medicaid Services (CMS) has updated Special Edition (SE) MLN Matters® article SE20011 Medicare Fee for Service response to address the changes made for the issuance of additional guidelines and waivers regarding the 2019 Novel Coronavirus, COVID-19 (CMS, 2020). This MLN Matters® Special Edition Article is for providers and suppliers who bill Medicare Fee For-Service (FFS). This includes blanket waivers for providers and suppliers, a CMS telehealth video regarding coverage of services, guidance on Beneficiary Notice Delivery, and expansion of Ambulance origins and destination modifiers.

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professional fee coding

Eliminate These Professional Fee Coding Risks to Save Your Bottom Line

By Vanessa Youmans / June 16, 2020 /

Many facilities, when completing a merger or acquisition, bring together professional fee coding and facility coding departments in order to increase productivity and claims reimbursement, but that’s easier said than done. These healthcare facilities must first consider if they have the knowledge base to accurately document and code professional fee services. The risks of inaccurate professional fee coding could be detrimental to your organization’s revenue and overall success.

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hcc risk adjustment

Everything You Need to Know About the HCC Risk Adjustment Models

By Karen Youmans / June 15, 2020 /

There are two different models for Hierarchical Condition Category (HCC) risk adjustments. The U.S. Department of Health and Human Services (HHS) oversees the HHS-HCC model, which covers commercial payers of all ages and determines risk payments for the current year. The Centers for Medicare and Medicaid Services (CMS) uses the CMS-HCC model for the Medicare Advantage program and those who qualify for Medicare or patients 65 and older, calculating risk payments for the next year. Both HCC models use a risk adjustment factor (RAF) score to calculate expected future health costs for each patient.

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hcc coding

Implement These Best Practices to Improve HCC Coding

By Mari Cely / June 12, 2020 /

Every healthcare organization that has Medicare patients who receive coverage and benefits through the Medicare Advantage program uses HCC coding. CMS established the HCC coding risk-adjustment model in 2004 to better predict healthcare costs for every patient and increase the accuracy in risk adjustment data for reimbursement claims (AAFP, 2020). But, what is HCC coding? Hierarchical condition category (HCC) coding utilizes the ICD-10 code set to identify risks for each patient and assign risk values, or RAF scores, in value-based care models. If your coding team needs HCC coding help, here are 4 HCC coding best practices you can implement right now to see a positive impact immediately.

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telehealth policies

Review the Temporary Physician-Based Telehealth Policies & Regulatory Revisions for COVID-19

By YES HIM Consulting / June 10, 2020 /

Due to the ongoing PHE regarding the 2019 Novel Coronavirus (COVID-19) outbreak, CMS has issued an interim final rule (IFC) to provide guidance on the updated telehealth policies and other services (CMS, 2020). The current PHE has relaxed many supervision requirements, allowing for supervision to be provided through audio/video telecommunications. Telehealth policies and procedures have been expanded further, and now include E/M services for emergency department visits, critical care services, nursing facilities, End State Renal Disease (ESRD) services, psychological/neuropsychological testing, and radiation treatment management (CMS, 2020).

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