hcc coding

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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PCI CPT codes

The Refresh With YES: CPT PCI Procedures Webinar provides an overview of the CPT codes for Percutaneous Coronary Intervention (PCI) procedures divided into 14-19-minute modules. During this four-part series on PCI CPT codes, learners will receive information on various PCI procedures, including a review of the heart’s anatomy and pathophysiology of conditions that may necessitate a PCI procedure. The coding guidelines and codes for PCI are thoroughly examined, and case examples of PCI are presented. The modules offered within this course include: Anatomy and Disease Process Review, CPT Guidelines and Coding (Parts 1 and 2), and Review of Case Studies.

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inpatient coding

Healthcare organizations, including coders, often struggle with a true return on investment when aiming to cross-train from outpatient to inpatient coding. There are several key differences between inpatient and outpatient coding. Inpatient coding documents a patient’s diagnosis and treatment during hospitalization, while outpatient coding generates a detailed report for diagnoses treated in one visit. Coding for inpatient vs. outpatient also requires different code sets and payment systems.

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telemedicine reimbursement guidelines

CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020). According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).

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history of covid-19

COVID-19, or “Coronavirus Disease 2019,” is an infectious respiratory disease caused by the newly discovered Coronavirus, SARS-CoV-2, that ranges from mild to no symptoms, to severe symptoms and death (CDC, 2020). As of April 30, there are 3,222,107 confirmed COVID-19 cases worldwide, with 228,757 deaths and 992,592 recoveries (Johns Hopkins Coronavirus Resource Center, 2020). Coronaviruses consist of a large family of viruses that commonly occur in humans and different species of animals, such as bats, cattle, cats, and more (CDC, 2020). Animal coronaviruses may infect and spread among humans in rare occurrences, such as the outbreak of SARS-CoV-2 in Wuhan, Hubei Province, China (CDC, 2020).

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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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Telemedicine

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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Telehealth and Covid-19

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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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 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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