Medical Coding Updates
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.
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 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.”
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).
The Refresh With YES: CPT Spinal Fusion Procedures webinar consists of 12-18-minute modules that examine Spinal Fusion procedures and topics.
On March 11, the World Health Organization (WHO) issued a declaration of the COVID-19 as a global pandemic. Two days later, the AMA announced the development of a specific code for laboratory testing for the coronavirus, code 87635 (AMA, 2020). The Centers for Medicare and Medicaid Services (CMS) released two new HCPCS codes for coronavirus testing for Medicare claims. The reporting for COVID-19 testing is dependent on the payer, either an HCPCS or CPT code should be used; there should not be more than one COVID-19 testing code on a given claim.
The Refresh With YES: ICD-10-CM Respiratory Diagnoses webinar consists of 15-21 modules that examine Respiratory diagnoses, such as COPD, Respiratory Failure, Pneumonia, Asthma, and E-Cigarettes and Vaping.
ICD-10-CM code U07.1 COVID-19 will be in effect as of April 1 in the US, which was pushed up from the normal effective date of October 1 for new codes. The reasoning for this unprecedented change is for the urgent need of immediate data collection. CMS has released a new update on 3/23/2020: “The ICD-10 MCE Version 37.1 R1 uses edits for the ICD-10 codes reported to validate correct coding on claims for discharges on or after April 1, 2020″ (2020). The ICD-10 MS-DRG Grouper software package to accommodate this new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.
Medical coding is the process of assigning numeric or alphanumeric codes to the diseases, injuries, treatments, and procedures that healthcare providers perform to record each encounter accurately and correctly bill the patient.
Preparations are underway for the incoming financial, organizational, and human burden that will be thrust upon hospitals and medical facilities across the nation due to the spread of the Novel Coronavirus and its corresponding disease (COVID-19).