Posts Tagged ‘medical billing’
PCI CPT Codes Online Course Covers PCI Procedures
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.
Read MoreCOVID-19 Explained: Screening for Suspected COVID-19 Infection
This article offers guidelines on how to code screening tests for suspected COVID-19 infection. There are two different kinds of tests for COVID-19: a viral test to detect a current Coronavirus infection, and an antibody test to confirm is the patient previously had COVID-19 (CDC, 2020). The CDC has issued guidance on conducting screening tests for COVID-19 and other recommendations for viral testing (2022).
Read MoreReview the ICD-10-CM Codes for Complications & Drug Diagnoses in 1-Hour Webinar
The Refresh With YES: Complications & Drug Diagnoses Webinar examines the ICD-10-CM guidelines and applicable Coding Clinic discussions with practical coding examples regarding Complications and Drug diagnoses divided into 15-18 minute modules. Learners will find out how to select the right ICD-10-CM codes for Complications & Drug Diagnoses topics, such as poisoning, adverse effects and underdosing of drugs. The four modules offered within this course include: Complications, Adverse Effects of Drugs, Poisoning, and Underdosing.
Read MoreCMS Guidelines for Telehealth Coding & Billing During PHE
The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).
Read MoreReview the 2021 IPPS Proposed Rule’s MS-DRG & Other ICD-10 Coding Updates
The 2021 Proposed Rule for Inpatient Prospective Payment System (IPPS) was released on May 11, and will be published in the May 29, 2020, Federal Register (2020). Provisions in the rule increase the Medicare IPPS rate for hospitals that report quality data and are meaningful users of EHRs by approximately 3.1%, resulting in an increase of $2.07 billion in spending. With other adjustments, the overall payment increase for inpatient hospitals will be around 1.6%. The Proposed Rule adjusts the payment rates, MS-DRG codes, and other provisions, including new ICD-10-CM and ICD-10-PCS codes.
Read MoreCOVID-19 Explained: Coding COVID-19 Possible Infection & Symptoms
This article offers guidelines on Coding COVID-19 suspected Infection & Symptoms. Symptoms of the Coronavirus, according to the CDC, include cough, shortness of breath, fever, chills, muscle pain, headache, sore throat, and loss of taste and smell (2020). The reporting guidelines dictate: In patients with acute bronchitis that has been caused by COVID-19, use codes U07.1 and J20.8. For lower respiratory infection due to COVID-19, assign codes U07.1 and J22.
Read MoreCross-Training Coders to Become Inpatient Coding Experts: Live Sessions are the Key to Success
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.
Read MoreCMS Clarifies Risk Adjustment Criteria for Coding Telehealth Services
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.
Read MoreAMA Releases Two New CPT Codes for COVID-19 Antibody Detection
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.
Read MoreCoding 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.
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