Medical Coding Updates
There are two different Hierarchical Condition Category (HCC) models used to calculate risk adjustments: the CMS-HCC model and the HHS-HCC model. Does your facility know how and when to use them? Our detailed HCC risk adjustment infographic explains the differences and usages for each HCC model.
In anticipation of the release of COVID-19 vaccines, the AMA has released CPT codes for each of the two COVID-19 vaccines together with administration codes for first and second doses (AMA, 2020). AMA President Susan R. Bailey, M.D., remarked, “An effective national immunization program is key to bringing the coronavirus pandemic to an end. Correlating each coronavirus vaccine with its own unique CPT code provides analytical advantages to help track, allocate and optimize resources as an immunization program ramps up in the United States” (AMA, 2020). The AMA worked closely with the Centers for Disease Control and Prevention to develop the codes.
COVID-19 vaccines that have been approved by the FDA will be covered by Medicare and most private insurers once they are available, according to CMS (2020). An IFC was released to establish that any COVID-19 vaccine that receives FDA authorization via an EUA or licensed under a Biologics License Application (BLA) will be covered at no cost to beneficiaries.
CMS has added 11 new services to the Medicare telehealth services list. These new services focus on specific neurostimulator analysis and programming, and cardiac and pulmonary rehabilitation (CMS, 2020). There have been over 135 services added to the list of payable Medicare telehealth services since CMS started expanding Medicare coverage, including ED visits and inpatient encounters. Review our Telehealth Resource Center for the full list of revised coding and billing guidelines for COVID-19. If your facility is struggling with deciphering the revised telehealth guidelines, contact YES HIM Consulting for coding support from our HIM-credentialed experts.
Outsourcing no longer means time-zone hopping overseas to find reliable, skilled, and affordable medical coding and auditing companies dedicated to achieving high coding productivity and quality standards. It is increasingly common for healthcare organizations to outsource coding overflow and quarterly audits by sourcing talent from a U.S.-based company. YES HIM Consulting is proud to be a premier coding, auditing, and education preferred partner to large-scale healthcare systems, individual hospitals, physician groups, and more around the U.S.
In continuing response to the COVID-19 pandemic, AMA has released two new CPT codes that allow for nucleic acid infectious agent detection for Coronavirus, influenza types A and B, and respiratory syncytial virus (RSV) via a single test (AMA, 2020). Do you want to learn the ICD-10-CM coding guidelines for COVID-19 code U07.1? Sign up for our Respiratory Diagnoses Hot Topics Webinar and find out how to code Coronavirus infections, symptoms, screening, and patient encounters. The webinar on hot coding topics provides an overview of the Official Coding Guidelines for COVID-19. See more here.
The impact of COVID-19 has been felt everywhere, including the release of the IPPS Final Rule. Generally released in late July or early August, the 2021 Final Rule was released on September 2 and published in the Federal Register on September 18, 2020 (CMS, 2020). The effective date, October 1, 2020, stays the same, offering an especially short turnaround time for analyzing and implementing the provisions of the rule.
CMS has released Part 1 of the 2022 Medicare Advantage Advance Notice, which reviews the updates to the Part C CMS-HCC risk adjustment model and the application of encounter data (CMS, 2020). Changes to the CMS Advance Notice are scheduled to be finalized by April 5, 2021. HCC coding and risk adjustments are one of YES HIM Consulting’s many specialties. The Risk Adjustments & HCC Basics learning path from YES HIM Education provides an overview of the HHS and CMS risk adjustment models, documentation, coding practices, and much more.
The Refresh With YES: CPT Eye Procedures Learning Path provides learners with highlights of eye surgery CPT codes, such as cataract extraction, retinal repair, vitrectomy, and Mohs surgery, divided into 14-29-minute webinars. This learning path goes in-depth on the anatomy of the eye and adnexa. Learners will also review CPT Guidelines, CPT Assistant instructions, and real-world coding scenarios for eye procedures.
The AMA CPT Editorial Panel has expedited the publication of two new CPT codes to document the latest in COVD-19 testing and medical services (AMA, 2020). These new Category I codes for COVID-19 supplies, services, and tests are available for review on the AMA’s Public Health Resource Center (AMA, 2020).