Healthcare News
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).
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.
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.
Healthcare facilities and independent practices face unique challenges when merging or being acquired. 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.
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.
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.
Coding Audits: How Identifying Issues Sooner Rather than Later Saves Money for the Hospital/Facility
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.
In the 2020 Medicare Physician Fee Schedule Final Rule released by the Centers for Medicare and Medicaid Services late last year, several changes were made to the value-based Quality Payment Program (QPP) to simplify the rules for providers. These updates will “impact more than 1 million clinicians eligible for one or both of the QPP’s two performance tracks, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). CMS estimates that 880,000 clinicians will be MIPS-eligible in 2020, and between 210,000 and 270,000 clinicians will achieve Qualifying APM Participant (QP) status in 2020.”
YES HIM Consulting provides most up-to-date content with a practical approach compliant with latest HIM & coding guidelines. The ICD-10-PCS Refresh With YES webinar series provides refresher courses for coders and auditors. These courses offer a practical review to complex ICD-10-PCS topics, provided by our nationally recognized educators and our YES HIM Executive team. The Refresh With YES: PCS Gastrointestinal Procedures webinar consists of 14-19-minute modules that examine Gastrointestinal procedures, such as Lysis of Adhesions, GI Anatomy and Guidelines, Bowel Procedures, and Gastric Procedures.
Previously the CDC/NCHS provided the ICD-10-CM Official Coding Guideline Supplement for 2019 Novel Coronavirus (COVID-19) coding, effective February 20, 2020. With the confirmation that the U07.1 code is implemented April 1, 2020, additions to the Official Coding and Reporting Guidelines were released to accompany the new code. These Guidelines appear in the Chapter 1 guidelines for Infectious Disease, and Chapter 15 for Pregnancy, Childbirth and the Puerperium, and are included in this article. The Official Coding and Reporting Guidelines are effective April 1, 2020, through September 30, 2020 (CDC/NCHS, 2020).