Health Information Management

Health Information Management Articles by Topic: CPT Coding

Q&A: Acute or chronic cor pulmonale

  • CDI Strategies, Issue 19, September 11, 2014

    Q: We’re having a lot of discussions with physicians right now and need to get some clarity...

Parenthetical note changes dominate 2014 CPT updates

  • Briefings on APCs, Issue 3, March 1, 2014

      Although the AMA changed hundreds of codes in the 2014 CPT® Manual, most of the changes...

Understanding the value of MUEs

  • Briefings on APCs, Issue 3, March 1, 2014

      When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and...

Packaging labs under 2014 OPPS

  • Briefings on APCs, Issue 3, March 1, 2014

      CMS has been making it clear over the years that packaging would become a larger and larger...

This month’s coding Q&A

  • Briefings on APCs, Issue 3, March 1, 2014

    How does CPT® define “final examination” for code 99238 (hospital discharge day...

Briefings on APCs - March 2014 issue

  • Briefings on APCs, Issue 3, March 1, 2014

    In this month's issue, we review latest 2014 CPT® Manual changes, examine how MUEs are...

Q&A: Did CMS change the inpatient-only list?

  • APCs Insider, Issue 4, January 24, 2014

    Q: Did CMS make any changes to the inpatient-only list for 2014?

Tip: Understanding HCCs

  • APCs Insider, Issue 4, January 24, 2014

    The Hierarchical Condition Category (HCC)model used for Medicare Advantage (MA) patients...

January OPPS update notes changes for 2014

  • APCs Insider, Issue 3, January 17, 2014

    CMS recently released MLN Matters® article 8572, covering the numerous January updates to the...

Q&A: Which edits did CMS discontinue for 2014?

  • APCs Insider, Issue 3, January 17, 2014

    Q: Did CMS discontinue the device-to-procedure and radiopharmaceutical-to-nuclear medicine...

Q&A: Are there changes for skin substitute reporting in 2014?

  • APCs Insider, Issue 52, December 20, 2013

    Q: Are there any changes for skin substitute application reporting for 2014? We are hearing rumors...

Tip: Using modifier -59 with an EKG

  • APCs Insider, Issue 52, December 20, 2013

    A patient comes into the ED with chest pain. An EKG (CPT® code 93005) is performed. The patient...

CMS announces changes to two CPT codes

  • APCs Insider, Issue 51, December 13, 2013

    CMS recently announced a pair of CPT® code changes, including the replacement of a Category III...

Q&A: Can we still report a modifier for device credits?

  • APCs Insider, Issue 51, December 13, 2013

    Q: Will we need to continue appending the modifier when we receive credit for a device from the...

OPPS final rule serves as sign of things to come

  • APCs Insider, Issue 50, December 6, 2013

    CMS may not have finalized all of its sweeping proposals in the 2014 OPPS Final Rule released...

Tip: Time documentation crucial for drug administration

  • APCs Insider, Issue 50, December 6, 2013

    Accurate time documentation is critical for drug administration coding because it can sometimes...

OPPS delay means no holiday for outpatient facilities

  • APCs Insider, Issue 49, November 22, 2013

    For many, this is the time of year when the latest updated rules, regulations, and payment rates...

Q&A: Coding drug administration for observation patients

  • APCs Insider, Issue 49, November 22, 2013

    Q: An observation patient received an IV push on the first day (9/28) and an infusion the...

CMS releases latest round of CLIA updates

  • APCs Insider, Issue 47, November 8, 2013

    CMS has released its update of the latest tests approved by the FDA as waived tests under the...

Q&A: How do we resolve edits for needle placements?

  • APCs Insider, Issue 45, October 25, 2013

    Q: Some of our patients have multiple biopsies or aspirations during a procedure. The physician...

Q&A: Should we wait to bill flu vaccine?

  • APCs Insider, Issue 39, September 13, 2013

    Q: We have started administering the flu vaccine using Fluzone, but the CPT® code has a...

Rejected debridement claims should be resubmitted

  • APCs Insider, Issue 36, August 23, 2013

    Receiving a billing rejection can be frustrating, especially when you’re confident the...

Q/A: Should we report a mammogram?

  • APCs Insider, Issue 34, August 9, 2013

    Q: We perform a mammogram after a breast procedure, like placement of a needle localization wire or...

Device/procedure edits may disappear

  • APCs Insider, Issue 33, August 2, 2013

    At first glance, CMS’ proposal to eliminate the device-to-procedure and procedure-to-device...

Q/A: Can we report a chest x-ray done before ET tube placement?

  • APCs Insider, Issue 33, August 2, 2013

    Q: Last week, you said that a modifier should not be used when a chest x-ray is done to check...

Q/A: Can we report a chest x-ray for ET tube placement in ED?

  • APCs Insider, Issue 30, July 26, 2013

    Q: Our physicians order a chest x-ray (CPT ® code 71010) after placing an endotracheal (ET...

Q/A: Is a glucose reading before a PET scan considered routine?

  • APCs Insider, Issue 29, July 19, 2013

    Q: Our radiologists order a glucometer reading for every patient who undergoes a PET...

CMS releases 2014 OPPS Proposed Rule

  • HIM-HIPAA Insider, Issue 26, July 15, 2013

    Normal 0 false false false EN-US X-NONE X-NONE...

Tip: Correctly report initial patient exam for radiation oncology

  • APCs Insider, Issue 28, July 12, 2013

    The first step to providing radiation oncology services is the initial patient exam. Coders should...

Q/A: Can we use the same functional G codes for all therapies?

  • APCs Insider, Issue 26, June 28, 2013

    Q: Can we use the same functional G codes for all therapies? Normal 0...

Q/A: Should we use modifier -Q0 to override edits for ICDs?

  • APCs Insider, Issue 21, May 24, 2013

    Q: We are hitting an edit for claims containing the codes for placement of implantable...

Tip: Review codes that are now packaged

  • APCs Insider, Issue 21, May 24, 2013

    As part of the April update to the I/OCE, CMS changed the status of the following codes from E (not...

CMS looking for comments on molecular pathology payments

  • APCs Insider, Issue 20, May 17, 2013

    The AMA revamped coding for molecular pathology beginning in 2012 and continuing in the 2013...

Q/A: How should we report irradiated blood products?

  • APCs Insider, Issue 20, May 17, 2013

    Q: We have patients who have received a lot of blood and now the orders are for irradiated...

Tip: Keep an eye on evolving molecular pathology codes

  • APCs Insider, Issue 20, May 17, 2013

    Why do some molecular pathology codes clearly list variants as examples, not an exclusive list...

Tip: Review guidelines for add-on code for interactive complexity for psychotherapy

  • APCs Insider, Issue 19, May 10, 2013

    The term "interactive complexity" means that the provision of psychiatric services has...

Q/A: Why are we hitting an edit for flushing a line?

  • APCs Insider, Issue 18, May 3, 2013

    Q: We are receiving errors on our scrubber software that we haven’t seen...

Tip: Differentiate between abbreviations for molecular pathology coding

  • APCs Insider, Issue 16, April 19, 2013

    One potential source of confusion for coding molecular pathology services involves the...

Q/A: Did CMS add any codes to the conditionally bilateral list?

  • APCs Insider, Issue 15, April 12, 2013

    Q: Did CMS add any codes to the conditionally bilateral list as part of the April OPPS update?

CMS reduces payment for single session cobalt-60 based stereotactic radiosurgery

  • APCs Insider, Issue 14, April 5, 2013

    Hospitals reimbursement is declining all the time for a variety of reasons. Facilities may not be...

Q/A: Did CMS add any new drugs with pass through status in the April OPPS update?

  • APCs Insider, Issue 14, April 5, 2013

    Q:  Did CMS add any new drugs with pass through status in the April OPPS update?

Tip: Review CPT notes for imaging guidance

  • APCs Insider, Issue 14, April 5, 2013

    The AMA included or revised the parenthetical notes following a number of CPT® codes for image...

CMS releases second ICD-10 NCD transmittal

  • HIM-HIPAA Insider, Issue 11, April 1, 2013

    In a new transmittal, CMS has unveiled updated national coverage determination (NCD) edits that...

ICD-10 tip: ICD-10-PCS root operation change will do you good

  • HIM-HIPAA Insider, Issue 11, April 1, 2013

    Coders are preparing for big changes on October 1, 2014, with ICD-10-PCS implementation rolling...

Q/A: Is CMS reducing payment for CPT code 77371?

  • APCs Insider, Issue 13, March 29, 2013

    Q: We heard that CMS will reduce payment for CPT® code 77371 (radiation treatment delivery...

Tip: Keep track of new modifiers

  • APCs Insider, Issue 13, March 29, 2013

    CMS added two new modifiers to the anatomical modifiers that may be used under appropriate clinical...

Mapping or crosswalking?

  • APCs Insider, Issue 12, March 22, 2013

    Crosswalks are quite in vogue as we prepare for the October 1, 2014 implementation of ICD-10. But...

Q/A: Has CMS established any new procedure codes for the April OPPS update?

  • APCs Insider, Issue 12, March 22, 2013

    Q: Has CMS established any new procedure codes for the April OPPS update?

Tip: Keep up with base codes for add-on code 33225

  • APCs Insider, Issue 12, March 22, 2013

    CMS added two codes to the list of primary procedures reportable with add-on code 33225 (insertion...

Tip: Check off elements needed for non-vascular interventional radiology code selection

  • APCs Insider, Issue 11, March 15, 2013

    Coders can follow a simple path to choose the correct code for a non-vascular interventional...

IV pushes that last more than 15 minutes

  • APCs Insider, Issue 10, March 8, 2013

    A push is a push is a push. If I’ve heard Jugna Shah, MPH, say that once in relation...

Q&A: What modifier do we use for bilateral diagnostic interventional procedures?

  • APCs Insider, Issue 10, March 8, 2013

    Q: Our physicians perform diagnostic interventional procedures in the head and neck, represented in...

Ensure your wound care coding is compliant

  • APCs Insider, Issue 9, March 1, 2013

    HIM managers and coders know that accurate wound care coding starts long before the record hits to...

Q&A: How should we code fluoroscopy for outpatient procedures?

  • APCs Insider, Issue 9, March 1, 2013

    Q:  Our physicians use fluoroscopy for many procedures and we have always reported the...

Tip: Note new codes for ventricular assist devices

  • APCs Insider, Issue 9, March 1, 2013

    Codes for reporting the insertion of a ventricular assist device (VAD) are not new. However, the...

Tip: Check out the new flu codes

  • APCs Insider, Issue 8, February 22, 2013

    The AMA added two new CPT® codes for influenza vaccinations for 2013.

Q/A: Can we report cardioversion performed during an ED code?

  • APCs Insider, Issue 7, February 15, 2013

    Q: We’ve just completed our yearly audit and the ED portion was pretty good.  We did...

Tip: Follow guidelines for reporting Interactive complexity

  • APCs Insider, Issue 7, February 15, 2013

    When specific communication factors are present that complicate the delivery of a psychiatric...

Q&A: Why are multiple port film line items denied?

  • APCs Insider, Issue 6, February 8, 2013

    Q: We received a line item denial for our port films. The documentation in the record supported the...

Tip: Note new base codes for aortic valve replacement

  • APCs Insider, Issue 6, February 8, 2013

    New CPT® codes are now available to report the ­provision of a ­transcatheter aortic...

Capturing start and stop times for infusions

  • APCs Insider, Issue 5, February 1, 2013

    During Wednesday's audio conference, Injections and Infusions: Review of Drug Administration...

Tip: Note new base codes for aortic valve replacement

  • APCs Insider, Issue 5, February 1, 2013

    New CPT codes are now available to report the ­provision of a ­transcatheter aortic valve...

Tip: Note molecular pathology changes in MPFS

  • APCs Insider, Issue 4, January 25, 2013

    Over the past two years the AMA has made significant additions to the molecular pathology CPT...

Make sure you review AMA's CPT errata

  • APCs Insider, Issue 3, January 18, 2013

    It turns out that the AMA can’t actually predict the future. On January 9, the AMA sent out a...

Q&A: Reporting transitional care management codes

  • APCs Insider, Issue 3, January 18, 2013

    Q: Why would a hospital bother to bill the transitional care management (TCM) codes for the visit...

Q/A: Addendum B as the basis for coverage

  • APCs Insider, Issue 1, January 4, 2013

    Q: In the 2013 OPPS Addendum B, when we look up a specific CPT® code, it shows status indicator...

Q&A: Reporting stent placement with other procedures

  • APCs Insider, Issue 52, December 28, 2012

    Q: When the AMA created all the new codes for the combination procedures, such as stent placement...

Q&A: Bypassing NCCI edits

  • APCs Insider, Issue 51, December 21, 2012

    Q:  We are applying modifiers to line items on claims to bypass the National Correct Coding...

Tip: Know when to bill post-operative observation separately

  • APCs Insider, Issue 50, December 14, 2012

    Coding for observation services can be confusing and complicated. The following case study explains...

Q&A: Appending modifier -59 for critical care

  • APCs Insider, Issue 50, December 14, 2012

    Q: We have been reporting services, such as chest x-rays and pulse oximetry, on critical care...

Q/A: Difference between bilateral coding and payment

  • APCs Insider, Issue 48, December 7, 2012

    Q: Our physicians perform a bronchoscopy and scope both lungs. Lungs are bilateral...

Q/A: Codes removed from inpatient-only list

  • APCs Insider, Issue 46, November 30, 2012

    Q: Did CMS remove any CPT® codes from the inpatient-only list as part of the 2013 OPPS...

Tip: Review claims with critical care

  • APCs Insider, Issue 45, November 16, 2012

    Each facility should review its current reporting practices for critical care (CPT 99291) and the...

Q/A: Reporting L code and CPT code for splinting

  • APCs Insider, Issue 42, October 26, 2012

    Q:  After a recent audit, an auditor provided us with provided education on the splinting...

Q&A: Should cystic fibrosis always be first-listed diagnosis

  • CDI Strategies, Issue 22, October 25, 2012

    Q: I have heard that there is an AHA Coding Clinic for ICD-9-CM, which states that the exacerbation...

Tip: White Paper available on principal diagnosis selection

  • CDI Strategies, Issue 22, October 25, 2012

    A clear understanding of the definition of principal diagnosis and the factors that play into...

Q/A: Coding for wound care with no-cost skin substitute

  • APCs Insider, Issue 41, October 19, 2012

    Q: Our wound care department receives skin substitutes, such as Apligraf, from our vendor free of...

Use case studies to explore observation services

  • JustCoding News: Outpatient, Issue 42, October 17, 2012

    Accurate reporting of observation services depends on a lot of factors. Deborah K. Hale, CCS, CCDS...

Avoid common hospitalist documentation errors

  • JustCoding News: Outpatient, Issue 42, October 17, 2012

    Hospital medicine is a specialty that provides inpatient services for patients admitted to the...

Q/A: Billing CT and CTA

  • APCs Insider, Issue 39, October 5, 2012

    Q: Our ED physicians order both computed tomography (CT) and CT angiography (CTA) exams to insure...

Q/A: Laparascopic bariatric surgery removed from inpatient-only

  • APCs Insider, Issue 37, September 21, 2012

    Q:  In the October OPPS update transmittal, they note that laparascopic bariatric surgery is...

Tip: Use CMS guidelines when creating E/M level

  • APCs Insider, Issue 36, September 14, 2012

    CMS has not created national guidelines for determining an E/M service visit level, instead...

Note similarities and differences between HCPCS, CPT® codes

  • JustCoding News: Outpatient, Issue 36, September 5, 2012

    As a medical coder, you are sometimes presented with code sets that embody similar codes. Such is...

Q&A: Charging for drug administration during urgent care visit

  • JustCoding News: Outpatient, Issue 36, September 5, 2012

    QUESTION: I work in an urgent care setting and need to know if we can bill an administration code...

Q/A: Billing for fluoroscopy

  • APCs Insider, Issue 34, August 31, 2012

    Q: We continually get requests from our billing office to change the fluoroscopy charges on our...

Tip: Be prepared for medically unlikely edits

  • APCs Insider, Issue 33, August 24, 2012

    Medically unlikely edits (MUEs) represent the maximum number of units of a given service that a...

Coding essentials for HBO therapy

  • JustCoding News: Outpatient, Issue 34, August 22, 2012

    Some wounds and conditions don’t respond to conventional therapies and treatment modalities...

Simplify the decision to use modifier -59

  • JustCoding News: Outpatient, Issue 34, August 22, 2012

    When is in appropriate to use modifier -59 to override coding edits? When is another modifier more...

Differentiating between modifiers -52, -73, -74

  • JustCoding News: Outpatient, Issue 34, August 22, 2012

    Q. When is it appropriate to append modifier -74 (procedures discontinued after anesthesia...

Q/A: Reporting limits for doses of Provenge

  • APCs Insider, Issue 32, August 17, 2012

    Q: We received a denial on a claim for Provenge® administration saying that the frequency had...

Tip: Correctly code SI joint injections

  • APCs Insider, Issue 32, August 17, 2012

    Historically, outpatient hospitals reported therapeutic sacroiliac joint (SI) joint injections...

Q/A: Charging for venipunctures

  • APCs Insider, Issue 31, August 10, 2012

    Q: I am relatively new to auditing and when I look at my facilities claims I see the venipuncture...

Q/A: Payment for critical care and separately reported services

  • APCs Insider, Issue 30, August 3, 2012

    Q: Since the AMA changed the instructions regarding hospital reporting of critical care services...

Q/A: Proposed changes to the inpatient-only list

  • APCs Insider, Issue 29, July 27, 2012

    Q: Did CMS propose any changes to the inpatient-only list of procedures as part of the 2013 OPPS...

Tip: Look for appropriate documentation for selective wound debridement

  • APCs Insider, Issue 29, July 27, 2012

    The removal of devitalized tissue is called selective debridement or active wound management...

Q/A: New HCPCS codes

  • APCs Insider, Issue 28, July 20, 2012

    Q:  CMS consistently replaces established HCPCS codes for drugs with new ones.  Did CMS...

Tip: Correctly report concurrent infusions

  • APCs Insider, Issue 28, July 20, 2012

    Unlike subsequent infusions that run after an initial infusion, concurrent infusions run at the...

CMS proposes two significant changes for OPPS in 2013

  • HIM-HIPAA Insider, Issue 2, July 16, 2012

    CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS...

Q/A: Changes in supervision levels for outpatient therapeutic services

  • APCs Insider, Issue 27, July 13, 2012

    Q:  In the calendar year (CY) 2012 final OPPS rule, CMS noted that the APC Panel would be...

Tip: Know when to separately report adhesion removal

  • APCs Insider, Issue 27, July 13, 2012

    Removal or release of simple adhesions is included in the general surgical package. If the...

Challenges facing anesthesia coders

  • JustCoding News: Outpatient, Issue 28, July 11, 2012

    An anesthesia provider faces plenty of challenges: cancelled anesthesia, failed medical direction...

Differentiate between types of coding edits to determine appropriate modifier use

  • JustCoding News: Outpatient, Issue 28, July 11, 2012

    Coders can run into two types of edits that may require them to append modifier -59 (distinct...

Simplify diagnostic, procedural pain management coding

  • JustCoding News: Outpatient, Issue 28, July 11, 2012

    Pain is an expected component of injuries, illnesses, and surgical procedures. In some instances...

Q&A: Coding for CBC with and without differential

  • JustCoding News: Outpatient, Issue 28, July 11, 2012

    QUESTION: Our laboratory medical director sent out a notification to our medical staff, patient...

Tip: Correctly select initial infusion service

  • APCs Insider, Issue 26, July 6, 2012

    Typically, coders will only report one initial service per visit, unless the patient has more than...

Unravel complications of outpatient coding for chronic kidney disease

  • JustCoding News: Outpatient, Issue 26, June 27, 2012

    Chronic kidney disease (CKD) is the permanent alteration in the kidney’s ability to perform...

Learn documentation requirement for critical care coding in the ED

  • JustCoding News: Outpatient, Issue 26, June 27, 2012

    Emergency Departments (EDs) see a wide range of illnesses and injuries, from minor to major, which...

Q&A: Coding for cochlear implants

  • JustCoding News: Outpatient, Issue 26, June 27, 2012

    QUESTION: The vendor for our cochlear implants has stated it’s standard to provide our...

Q/A: Device edits with CPT® code 33249

  • APCs Insider, Issue 23, June 15, 2012

    Q: We continue to have problems with our claims hanging up in the edits when we report CPT®...

Anatomy and approach lead to correct brain surgery coding

  • JustCoding News: Outpatient, Issue 24, June 13, 2012

    In coding, sometimes it really is brain surgery and coders need a strong understanding of the...

Injections and infusions continue to confuse coders

  • JustCoding News: Outpatient, Issue 24, June 13, 2012

    An absence of start and stop times is one of the more frequent challenges that coders face when...

Consider two options for coding Rho(D) immune globulin given in pregnancy

  • JustCoding News: Outpatient, Issue 24, June 13, 2012

    The Rh factor of positive and negative can lead to problems between a mother and the developing...

Get to the heart of cardiac catheterization coding

  • JustCoding News: Outpatient, Issue 22, May 30, 2012

    Cardiac catheterization is a common procedure performed to study cardiac function and anatomy and...

Note changes for skin substitutes, mental health codes

  • JustCoding News: Outpatient, Issue 22, May 30, 2012

    Facilities can't bill for skin substitutes unless they also bill for a skin substitute application...

Q/A: Volume requirement for reporting hydration services

  • APCs Insider, Issue 21, May 25, 2012

    Normal 0 false false false EN-US X-NONE X-NONE...

Q/A: Coding infusions to correct low potassium levels

  • APCs Insider, Issue 20, May 18, 2012

    Q. Can you help resolve an ongoing debate in our department?   Patients come to our ED and...

Q/A: Bilateral code changes

  • APCs Insider, Issue 18, May 4, 2012

    Q: Did CMS revise the list of bilateral codes in the OPPS April update?

Catch up on what's new with injections and infusions

  • JustCoding News: Outpatient, Issue 18, May 2, 2012

    CMS did not discuss drug administration services in the 2012 OPPS final rule, but the AMA did make...

Learn about the Bishop's Score and its relationship to labor and delivery

  • JustCoding News: Outpatient, Issue 18, May 2, 2012

    The Bishop’s Score is primarily a scoring system to assess the viability and/or success of an...

Healthcare News: CMS instructs FIs/MACs to hold certain claims for missing device edit

  • JustCoding News: Outpatient, Issue 18, May 2, 2012

    CMS instructed fiscal intermediaries (FI) and Medicare Administrative Contractors (MAC) to hold...

Q/A: Appropriate reporting of IVP followed by infusion of the same drug

  • APCs Insider, Issue 17, April 27, 2012

    Q: We give a loading dose of a drug via IV push before we start an infusion. May we report this...

Learn how to read an OP report

  • JustCoding News: Outpatient, Issue 16, April 18, 2012

    To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report...

Correctly bill ancillary bedside procedures in addition to the room rate

  • JustCoding News: Outpatient, Issue 16, April 18, 2012

    As charges become more specific to provide additional concrete and transparent cost data, providers...

Code freeze to extend through ICD-10 implementation

  • HIM-HIPAA Insider, Issue 16, April 17, 2012

    After HHS proposed a year-long delay of ICD-10-CM/PCS, questions emerged regarding the current...

Q/A: Payment for skin substitutes

  • APCs Insider, Issue 15, April 13, 2012

    Q: We do not always receive payment for skin substitutes that we report. They appear in Addendum...

Despite gains, coders dissatisfied with compensation given increased responsibilities

  • JustCoding News: Inpatient, Issue 15, April 11, 2012

    During the last year, the buzz from the health information management (HIM) and coding community...

Q&A: Deducting push time from infusions

  • HIM-HIPAA Insider, Issue 15, April 10, 2012

    Q. If a nurse administers an IV push without a stop time at the same time hydration is running...

Tip: Note codes that require two devices to bypass edit

  • APCs Insider, Issue 13, March 30, 2012

    Codes 0238T (transluminal peripheral atherectomy, including radiological supervision and...

Q/A: Provenge® payment problems persist

  • APCs Insider, Issue 12, March 23, 2012

    Q: We continue to receive no payment for administering the drug Provenge®, CMS had said that...

Q/A: Assigning modifier -52 for cancelled procedures

  • APCs Insider, Issue 11, March 16, 2012

    Q: Our radiology department has begun billing for cancelled diagnostic procedures. For example, a...

Q&A: Documentation for hydration

  • HIM-HIPAA Insider, Issue 11, March 13, 2012

    QUESTION: We have a question in regards to hydration that we are trying to figure out. Does the...

Q/A: Reporting vaccine administration codes

  • APCs Insider, Issue 10, March 9, 2012

    Q: We have been reporting the CPT® code for vaccine administration (90471) when administering...

Tip: Differentiate integral, non-integral self-administered drugs

  • APCs Insider, Issue 10, March 9, 2012

    In 2002, CMS provided specific guidelines for understanding which self-administered drugs are...

The nose knows the importance of correct otolaryngology coding

  • JustCoding News: Outpatient, Issue 10, March 7, 2012

    Otolaryngology coding covers a wide range of procedures and four parts of the respiratory...

CMS adds new modifier -PD, two edits, and additional APCs

  • JustCoding News: Outpatient, Issue 10, March 7, 2012

    The January update to the Integrated Outpatient Code editor generally includes a large number of...

Healthcare News: Medicare adds screening services to covered list

  • JustCoding News: Outpatient, Issue 14, March 7, 2012

    CMS continues to add more screening services to the list of covered preventative services. The...

Q&A: Reporting incidental durotomy

  • JustCoding News: Outpatient, Issue 10, March 7, 2012

    QUESTION: If a physician performs a durotomy during an anterior cervical fusion, should we report...

Q/A: Drug administration services that cross midnight

  • APCs Insider, Issue 8, March 2, 2012

    Q: The AMA issued new CPT® drug administration services guidelines for reporting an initial...

Tip: Note new guidelines for molecular pathology codes

  • APCs Insider, Issue 8, March 2, 2012

    Molecular pathology procedures are laboratory procedures that analyze nucleic acid to detect...

Outpatient CDI efforts offer documentation opportunities

  • JustCoding News: Outpatient, Issue 8, February 22, 2012

    Payers are now looking to ensure that physician and facility billing match, which could mean new...

Get the facts on coding for non-biodegradeable drug delivery implants

  • JustCoding News: Outpatient, Issue 8, February 22, 2012

    Drug delivery implants are designed to provide active pharmaceuticals to a targeted area in into...

Defining 'integral' for self-administered drugs is challenging

  • JustCoding News: Outpatient, Issue 8, February 22, 2012

    In many instances, payers may consider a drug to be self-administered in some circumstances but not...

Q&A: Documentation for hydration

  • JustCoding News: Outpatient, Issue 8, February 22, 2012

    QUESTION: We have a question in regards to hydration that we are trying to figure out. Does the...

Q/A: New composites for 2012

  • APCs Insider, Issue 7, February 17, 2012

    Q. What new composites, if any, did CMS create for 2012?

Tip: Note integumentary system code changes

  • APCs Insider, Issue 7, February 17, 2012

    The integumentary system subsection of the 2012 CPT® Manual includes nine new codes, 26 deleted...

Note major updates to pathology and laboratory section

  • JustCoding News: Outpatient, Issue 6, February 8, 2012

    Coders can find the largest number of new codes in the pathology and laboratory section of the 2012...

Healthcare News: CMS adds new modifier -PD

  • JustCoding News: Outpatient, Issue 6, February 8, 2012

    CMS added modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly...

Q&A: Facility codes for peritoneal dialysis

  • JustCoding News: Outpatient, Issue 6, February 8, 2012

    QUESTION: We are a nondialysis facility, so when a patient is in observation for some other reason...

Q/A: Reporting negative pressure therapy

  • APCs Insider, Issue 4, January 27, 2012

     Q: The new guidelines for the integumentary system section state that CPT® codes...

Tip: Set rates that reflect intent of new codes

  • APCs Insider, Issue 4, January 27, 2012

    CMS expects hospital charges to reflect the relative resources that are required to provide a...

Take the fear out of ICD-10-CM fracture coding

  • JustCoding News: Outpatient, Issue 4, January 25, 2012

    Coders will need more information to correctly assign fracture codes in ICD-10-CM, but don’t...

Q/A: Reporting molecular pathology codes

  • APCs Insider, Issue 3, January 20, 2012

    Q: Addendum B of the APC updates for 2012 lists the new molecular pathology codes as status...

Tip: Corrrectly code image-guided lumbar decompression

  • APCs Insider, Issue 3, January 20, 2012

    Percutaneous image-guided, minimally invasive lumbar decompression witha specially designed toolkit...

Q/A: Correct use of modifier -FB and -FC

  • APCs Insider, Issue 2, January 13, 2012

    Q: Our billing office is concerned about reports that the OIG is auditing for appropriate use of...

Tip: Take note of inpatient-only list revisions

  • APCs Insider, Issue 2, January 13, 2012

    CMS removed 10 codes from the inpatient-only list as part of the 2012 OPPS Final Rule. For CY 2012...

CPT code changes spread throughout surgery sections

  • JustCoding News: Outpatient, Issue 2, January 11, 2012

    The AMA added a total of 60 new codes throughout the surgery section of the 2012 CPT® Manual...

Fetal non-stress tests represent important part of maternal and fetal health

  • JustCoding News: Outpatient, Issue 2, January 11, 2012

    The ultimate goal of fetal surveillance is to prevent fetal death. Part of this process is a fetal...

CMS finalizes numerous provider-friendly OPPS changes for CY 2012

  • JustCoding News: Outpatient, Issue 2, January 11, 2012

    CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy...

Q&A: Typical time for CPT initial observation codes

  • JustCoding News: Outpatient, Issue 2, January 11, 2012

    QUESTION: The 2012 CPT® Manual includes the typical time physicians spend at the bedside and on...

Tip: Know when limits on liability apply

  • APCs Insider, Issue 51, December 23, 2011

    A facility must provide patients an ABN when limits on liability (LOL) apply. LOL specifically...

Tip: Consider the benefits of inter-departmental coding conferences with ICD-10 on the horizon

  • CDI Strategies, Issue 27, December 22, 2011

    Most of the cases that HIM professionals code are straightforward; some are more difficult, and a...

Q/A: Billing chest x-ray and venipuncture separately from critical care

  • APCs Insider, Issue 50, December 16, 2011

    Q: Our MAC audited some of our critical care accounts and denied charges for chest x-ray and...

Review guideline changes as well as CPT code updates

  • JustCoding News: Outpatient, Issue 50, December 14, 2011

    Coders know to go through CPT® code changes each year, but they shouldn’t overlook the...

Get the facts on emergency department FAST exams

  • JustCoding News: Outpatient, Issue 50, December 14, 2011

    Emergency and trauma medicine is ever-changing, as illustrated in the development of the focused...

Report condition code 51 for nondiagnostic services unrelated to inpatient stay

  • JustCoding News: Outpatient, Issue 50, December 14, 2011

    If a facility provides nondiagnostic outpatient services that are unrelated to an inpatient...

Q&A: Reporting discontinued radiology procedures

  • APCs Insider, Issue 49, December 9, 2011

    Q: Our radiologist attempted to perform a barium enema with air contrast. However, the radiologist...

Tip: Use OIG?s strategy for tracking device credits

  • APCs Insider, Issue 49, December 9, 2011

    Special billing rules apply when facilities receive devices for free or at a reduced cost. The OIG...

Q/A: Appropriate reporting of CPT code 95810

  • APCs Insider, Issue 48, December 2, 2011

    Q: Our hospital performs a lot of sleep testing, especially CPT® code 95810 (Polysomnography...

Tip: Evaluate CAC and software expenses

  • CDI Strategies, Issue 25, December 1, 2011

    Invest in computer-assisted coding (CAC) now because of its potential positive impact on...

2012 CPT code changes for ASCs: Shoulder and knee scopes and pain management

  • JustCoding News: Outpatient, Issue 48, November 30, 2011

    Providers at ambulatory surgery centers (ASC) often perform shoulder and knee arthroscopic...

CMS adds new radiopharmaceutical, modifier

  • JustCoding News: Outpatient, Issue 48, November 30, 2011

    CMS reclassified HCPCS code C9406 as a radiopharmaceutical and added modifier -92 to the list of...

Healthcare News: CMS adds modifier -PD for clinics

  • JustCoding News: Outpatient, Issue 48, November 30, 2011

    Coders in a physician practice that is wholly owned or operated by a hospital must append new...

Q&A: Limited open reduction without internal fixation

  • JustCoding News: Outpatient, Issue 48, November 30, 2011

    QUESTION: In the past, we reported CPT® code 25620 for open reduction of distal radius and ulna...

Q/A: Publication date for NCCI guideline updates

  • APCs Insider, Issue 47, November 18, 2011

    Q: I have been searching for the National Correct Coding Initiative (NCCI) guidelines update. I...

Tip: Ensure accurate billing of no-cost devices

  • APCs Insider, Issue 47, November 18, 2011

    When a replacement device is provided at no cost, coders or another hospital staff member must...

Q/A: Reporting hydration with phlebotomy

  • APCs Insider, Issue 46, November 11, 2011

    Q: We provide IV fluids to our patients who undergo therapeutic phlebotomy procedures to replace...

Tip: Differentiate between packaged, bundled services

  • APCs Insider, Issue 46, November 11, 2011

    Packaging is different from bundling—bundling is a coding concept, whereas packaging is a...

Q/A: May we create a protocol for complete pulmonary function test?

  • APCs Insider, Issue 44, October 28, 2011

    Q: Some physicians send patients to our hospital outpatient department with an order for...

Evaluate CAC and software expenses

  • HIM-HIPAA Insider, Issue 43, October 25, 2011

    Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM (Northern California Revenue...

Q/A: Reporting allografts with 153xx code series

  • APCs Insider, Issue 43, October 21, 2011

    Q: Physicians at our facility use allografts (e.g., GRAFTJACKET™) in surgical procedures such...

Q/A: Payment when reporting CPT code 97602

  • APCs Insider, Issue 42, October 14, 2011

    Q: Members of our hospital outpatient wound care department recently listened to our FI/MAC’s...

Q/A: Reporting irradiation of blood products

  • APCs Insider, Issue 39, September 23, 2011

    Q: How should we report the irradiation of blood products? We have been reporting the P code for...

Q/A: Understand requirements for separately reporting CBC with manual differential

  • APCs Insider, Issue 38, September 16, 2011

    Q: Our MAC recently conducted a focused review based on CERT results concerning complete blood...

Q/A: Understand proper use of modifier-58

  • APCs Insider, Issue 37, September 9, 2011

    Q: A patient underwent an excision of large infected mass in our hospital outpatient surgery...

Remote coding: The good, the bad, and the productivity

  • HIM-HIPAA Insider, Issue 36, September 6, 2011

    According to a survey on coder productivity published in the May edition of MRB, 83% of those with...

Q/A: Know important dates for outpatient updates

  • APCs Insider, Issue 35, August 26, 2011

    Q: Fall is sneaking up on us as we near the end of summer. What are most the important tasks that...

Tip: Create useful, meaningful audit report package

  • APCs Insider, Issue 35, August 26, 2011

    Upon completion of an audit, package it in a manner that provides meaningful, easy-to-follow...

Q/A: Billing for Provenge

  • APCs Insider, Issue 33, August 19, 2011

    Q: Our facility’s billing office tells us that our FI/MAC is not reimbursing us for drug...

Tip: Use caution with E/M templates, checklists

  • APCs Insider, Issue 33, August 19, 2011

    When used appropriately, templates are good tools for any practice. Templates help promote the...

Special report: APC Panel debates requiring HCPCS drug codes for packaged services

  • APCs Insider, Issue 33, August 19, 2011

    Should CMS require hospitals to report HCPCS codes for packaged services? This topic generated...

Q/A: New code for image-guided minimally invasive lumbar decompression

  • APCs Insider, Issue 32, August 12, 2011

    Q: Has CMS provided any updates regarding image-guided minimally invasive lumbar decompression...

Special report: News from the Advisory Panel on Ambulatory Payment Classification Groups Meeting

  • APCs Insider, Issue 32, August 12, 2011

    Editor’s note: Kimberly Anderwood Hoy, JD, CPC, Director of Medicare and compliance at HCPro...

Q/A: Note new HCPCS codes for outpatient procedures

  • APCs Insider, Issue 31, August 5, 2011

    Q: Did CMS add any new HCPCS codes for hospital outpatient procedures effective July 1?

Tip: Count observation hours correctly

  • APCs Insider, Issue 31, August 5, 2011

    Report observation services with HCPCS code G0378 (observation services, per hour) under revenue...

Tip: Don't bill these bundled procedures with hysteroscopic procedures

  • APCs Insider, Issue 30, July 29, 2011

    When using a hysteroscope, physicians inflate the uterus with gas or fluid to obtain a better view...

Q/A: Charging for PICC line insertion radiologic guidance

  • APCs Insider, Issue 28, July 15, 2011

    Q: We have been told that we may not charge for radiology chest one view or two views (CPT®...

CMS releases 2012 OPPS proposed rule

  • HIM-HIPAA Insider, Issue 28, July 12, 2011

    CMS released the 2012 outpatient prospective payment system (OPPS) proposed rule July 1. The...

Tip: Ask these questions before appending modifier -59

  • APCs Insider, Issue 27, July 8, 2011

    Coders can use a decision tree to ensure they append modifier -59 (distinct procedural service...

Q&A: Determine documentation difference between skin graft and debridement

  • CDI Strategies, Issue 14, July 7, 2011

    Q:  I have been trying to determine whether a skin graft includes debridement. Based on what I...

Q/A: Reporting multiple outpatient visits that occur the same day

  • APCs Insider, Issue 24, June 17, 2011

    Q: Some of our outpatient claims contain multiple charges reported with revenue code 0761...

Tip: Stay up-to-date with conditionally bilateral code changes

  • APCs Insider, Issue 22, May 27, 2011

    Each quarter, CMS releases updates to the Integrated Outpatient Code Editor (I/OCE), with revisions...

Inpatient-only procedures: Ensure compliance, avoid RAC recoupments

  • HIM-HIPAA Insider, Issue 19, May 10, 2011

    Inpatient coders may lack familiarity with the ¬inpatient-only procedure list because CMS...

Q/A: Using modifier -59 with EKGs and cardiac catheterization

  • APCs Insider, Issue 17, April 29, 2011

    Q. We have an ongoing debate about modifier -59 (distinct procedural service). Some physicians...

Tip: Assign modifiers correctly for multiple E/M visits with procedures

  • APCs Insider, Issue 17, April 29, 2011

    In some cases, you may need to append more than one modifier to explain what happened with a...

Q/A: Reimbursement for composite CPT codes

  • APCs Insider, Issue 15, April 15, 2011

    Q: We’ve been reporting the new combination CPT® code for a CT of the abdomen and pelvis...

Q/A: Reimbursement for composite CPT codes

  • APCs Insider, Issue 15, April 15, 2011

    Q: We’ve been reporting the new combination CPT® code for a CT of the abdomen and pelvis...

Tip: Ensure record supports use of modifier -25

  • APCs Insider, Issue 15, April 15, 2011

    As part of the standard of care, a physician or nurse will record a patient's vital signs and...

This Month's Coding Q&A

  • Briefings on APCs, Issue 4, April 1, 2011

    In this month's coding Q&A, our experts answer questions about modifier -33, -PT, and -25; when...

Increased coding compliance, improved productivity: The benefits of computer-assisted coding

  • HIM-HIPAA Insider, Issue 12, March 22, 2011

    If you haven't already considered adopting computer-assisted coding (CAC) software, there's no time...

Q/A: Wound care and NCCI edits

  • APCs Insider, Issue 10, March 11, 2011

    Q: We are almost to the second quarter of 2011. Medicare often updates the Integrated Outpatient...

Q/A: NCCI edits and wound care management

  • APCs Insider, Issue 9, March 4, 2011

    Q: We have been coding active wound care management based on the new 2011 narrative updates and...

Tip: Keep up with pain management code changes

  • APCs Insider, Issue 9, March 4, 2011

    The AMA continues to revise codes for the extracranial nerves, peripheral nerves, and autonomic...

Q/A: Critical care and NCCI edits

  • APCs Insider, Issue 8, February 25, 2011

    Q: A note in the 2011 CPT® update states that facilities may now bill separately for services...

Tip: Count time correctly under new CPT guidelines

  • APCs Insider, Issue 8, February 25, 2011

    The AMA included a new subhead (Time) and guidelines for reporting time in the 2011 CPT®...

Q/A: Automatic denials with modifier -GZ

  • APCs Insider, Issue 7, February 18, 2011

    Q: Our MAC denied line items with modifier -GZ (Item or service expected to be denied as not...

Contractors to deny claim line items with -GZ modifier

  • HIM-HIPAA Insider, Issue 7, February 15, 2011

    In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs...

Coder productivity survey prize winners announced

  • HIM-HIPAA Insider, Issue 7, February 15, 2011

    MRB recently conducted its 2010 coder productivity benchmarking report. (Stay tuned for the...

Q/A: Reporting drug administration services that cross days

  • APCs Insider, Issue 6, February 11, 2011

    Q: We noticed that the 2011 CPT® Manual under the main section Introduction includes a...

An ounce of prevention: Keep HIM and coding running smoothly during EHR go-live

  • HIM-HIPAA Insider, Issue 5, February 1, 2011

    The last thing you need is more to do, but when it comes to preparing your HIM department for EHR...

Q/A: Reporting platelet rich plasma injection on Medicare claims

  • APCs Insider, Issue 4, January 28, 2011

    Q: The 2011 CPT® Manual includes code 0232T for injection(s), platelet rich plasma, any tissue...

Tip: Report drug administration codes properly

  • APCs Insider, Issue 4, January 28, 2011

    Medicare recognizes the 2011 CPT® Manual’s drug administration codes, and hospitals...

Last chance! Take the 2010 Coder productivity survey, win a prize!

  • HIM-HIPAA Insider, Issue 4, January 25, 2011

    HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...

2010 Coder productivity survey

  • HIM-HIPAA Insider, Issue 3, January 18, 2011

    HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...

Q/A: Additional OPPS changes for 2011

  • APCs Insider, Issue 2, January 14, 2011

    Q: We have read the final OPPS 2011 rules. However, between publication of the rule and the...

Q/A: Changes to HBO therapy billing

  • APCs Insider, Issue 1, January 7, 2011

    Q: Did CMS provide any new updates for hyperbaric oxygen (HBO) therapy services for 2011?

2010 Coder productivity survey

  • HIM-HIPAA Insider, Issue 1, January 4, 2011

    HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...

APC Answer Letter, January 2011

  • APC Answer Letter, Issue 1, January 1, 2011

    Learn about reporting condition code 44, ED services, modifier -JW, modifier -58, modifier -78...

Q/A: Setting up chargemaster for new codes

  • APCs Insider, Issue 51, December 31, 2010

    Q: I’ve been working through the new 2011 CPT® codes. I’m finding that not every...

Tip: Get your documentation 'RAC ready'

  • APCs Insider, Issue 51, December 31, 2010

    If you aren’t preparing for the RACs now, you should be. Although much attention is being...

2010 Coder productivity survey

  • HIM-HIPAA Insider, Issue 51, December 28, 2010

    HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...

Tip: Consider IT obstacles to ICD-10-CM implementation

  • APCs Insider, Issue 50, December 17, 2010

    Facilities need to start planning for IT obstacles that may arise during the transition from...

Q/A: 2011 Critical care coding changes

  • APCs Insider, Issue 48, December 3, 2010

    Q: Did CMS make any more changes to critical care coding for 2011?

APC Answer Letter, December 2010

  • APC Answer Letter, Issue 12, December 1, 2010

    Learn about reporting ED services, injections and infusions, medication therapy, observation...

Q&A: Coding removal of a Bartholin's gland cyst catheter in the ED

  • HIM-HIPAA Insider, Issue 47, November 30, 2010

    Q: What code should I report for a patient who presents to the ED for removal of a...

Tip: Additional documentation needed for Glasgow coma scale in ICD-10

  • APCs Insider, Issue 47, November 19, 2010

    In ICD-10-CM, clinicians may use the Glasgow coma scale codes that follow in conjunction with...

CMS announces physician supervision changes as part of 2011 OPPS final rule

  • HIM-HIPAA Insider, Issue 44, November 9, 2010

    CMS finalized four changes to its physician supervision requirements as part of the 2011 OPPS final...

Q/A: Inpatient-only procedures

  • APCs Insider, Issue 45, November 5, 2010

    Q: Did CMS remove any more procedures from the inpatient-only list for 2011?

Tip: Know which type of ED your facility operates

  • APCs Insider, Issue 45, November 5, 2010

    Which type of ED your facility operates will determine which codes you assign. EDs are classified...

APC Answer Letter, November 2010

  • APC Answer Letter, Issue 11, November 1, 2010

    Learn about reporting condition code 44, E/M services, visit levels, injections and infusions...

Q/A: Packaged vs. bundled services

  • APCs Insider, Issue 44, October 29, 2010

    Q: People in our hospital use the terms “bundling” and “packaging&rdquo...

Tip: Differentiate between modifiers -58 and -78

  • APCs Insider, Issue 44, October 29, 2010

    Coders may struggle to determine when to use modifier -58 (staged or related procedure or service...

Q/A: Modifier -GA and automatic denials

  • APCs Insider, Issue 43, October 22, 2010

    Q: Is CMS still denying all line items with modifier -GA?

Tip: Know when to properly append modifier -52

  • APCs Insider, Issue 43, October 22, 2010

    Modifier -52 (reduced services) indicates that a service was partially reduced or eliminated at a...

Q/A: Billing observation and condition code 44

  • APCs Insider, Issue 42, October 15, 2010

    Q: An inpatient is converted to outpatient status using condition code 44. Assuming the patient...

Tip: Know payer policies for modifier use

  • APCs Insider, Issue 42, October 15, 2010

    Knowing when to append a modifier can challenge even the most experienced coder. Coders need to...

Q/A: Charging for drug administration in ED by nurse

  • APCs Insider, Issue 41, October 8, 2010

    Q: A patient comes into the ED and the nurse administers drugs as an injection or IV. Do we charge...

APC Answer Letter, October 2010

  • APC Answer Letter, Issue 10, October 1, 2010

    Learn about reporting ED services, injections and infusions, lumbar procedures, modifier -25...

Q/A: OPPS and CPT updates

  • APCs Insider, Issue 40, October 1, 2010

    Q: When will the final OPPS rules for 2011 and the 2011 CPT codes be released, and when do they...

Revenue Cycle Institute offers free white papers

  • HIM-HIPAA Insider, Issue 38, September 28, 2010

    Did you know that HCPro Revenue Cycle Institute offers free white papers on a variety of coding and...

Q/A: Adding hydration times

  • APCs Insider, Issue 39, September 24, 2010

    Q: A patient in the ED receives 20 minutes of hydration, and one hour later receives another 20...

Tip: Append modifier to correct code

  • APCs Insider, Issue 39, September 24, 2010

    Each National Correct Coding Edits table contains edits, which are pairs of codes that, in general...

Q/A: Correct use of modifier -JW

  • APCs Insider, Issue 37, September 10, 2010

    Q: We’ve been hearing about CPT modifier -JW (drug amount discarded/not administered to any...

Tip: Differentiate between new, established patients when selecting E/M level

  • APCs Insider, Issue 37, September 10, 2010

    Designating a patient as new or established depends on whether the patient has been registered as...

Tip: Append modifier -59 to correct code

  • APCs Insider, Issue 36, September 3, 2010

    One myth around usage of modifier -59 is that you can append it to either code and it will override...

News: Review coding, documentation guidelines for latest RAC target-neoplasms

  • CDI Strategies, Issue 18, September 2, 2010

    Confusing coding guidelines and insufficient documentation have made neoplasms a target area as...

APC Answer Letter, September 2010

  • APC Answer Letter, Issue 9, September 1, 2010

    Inside: Learn about reporting ESRD, HBO therapy, HIV, injections and infusions, modifier -25...

Tip: Correctly code percutaneous transluminal coronary angioplasty

  • APCs Insider, Issue 35, August 27, 2010

    Percutaneous transluminal coronary angioplasty is a nonsurgical procedure that involves inserting a...

Q&A: Observation after surgery

  • APCs Insider, Issue 34, August 20, 2010

    Q. A Medicare patient is admitted for same-day surgery. After surgery, the physician orders...

Tip: Coding drug-eluting stents for coronary interventions

  • APCs Insider, Issue 34, August 20, 2010

    Stents used for percutaneous coronary interventions can be either bare-metal or drug-eluting...

Q/A: Length of recovery time

  • APCs Insider, Issue 33, August 13, 2010

    Q: Compliance staff at the central billing office of our OPPS hospital have indicated a potential...

Take note of signature requirements to ensure compliance when coding for labs and diagnostic testing

  • JustCoding News: Outpatient, Issue 12, August 11, 2010

    Providers must understand the signature guidelines outlined in MedLearn Matters article 6698 and...

Q/A: Correct coding for unilateral venous Doppler on upper and lower extremity

  • APCs Insider, Issue 32, August 6, 2010

    Q: We performed a unilateral venous Doppler on a patient in our imaging center for the right upper...

APC Answer Letter, August 2010

  • APC Answer Letter, Issue 8, August 1, 2010

    Learn about coding ED visits, injections and infusions, packaged drugs, radiology services, and...

Q/A: Extended recovery time

  • APCs Insider, Issue 31, July 30, 2010

    Q: For extended recovery time, the patient stayed longer than 10 hours after surgery. Should we add...

Tip: Create consistent E/M guidelines

  • APCs Insider, Issue 31, July 30, 2010

    CMS has not yet implemented national E/M guidelines for hospitals. However, it requires that every...

Q/A: Billing for six-hour chemotherapy infusion

  • APCs Insider, Issue 30, July 23, 2010

    Q: How should we bill a patient for a six-hour chemotherapy infusion? The patient occupies an...

Tip: Use correct modifiers for pain management codes

  • APCs Insider, Issue 30, July 23, 2010

    Although -RT and -LT are the most common modifiers used for pain management, coders may need to...

Q/A: Counting observation hours with condition code 44

  • APCs Insider, Issue 29, July 16, 2010

    Q: A patient is admitted as an inpatient, but the utilization review committee determines that the...

Tip: Correctly code bilateral pain management procedures

  • APCs Insider, Issue 29, July 16, 2010

    Bilateral procedures can be a challenge to coders, especially when modifiers accompany procedure...

CMS releases 2011 OPPS proposed rule

  • HIM-HIPAA Insider, Issue 27, July 13, 2010

    CMS continues to refine the physician supervision requirements for diagnostic and therapeutic...

Q/A: Injections in the recovery room

  • APCs Insider, Issue 28, July 9, 2010

    Q: A GE Lab hospital has its own separately identifiable recovery room setting. Is it appropriate...

Tip: Take these actions to ensure correct use of modifier -25

  • APCs Insider, Issue 28, July 9, 2010

    Modifier -25 indicates a “significant, separately identifiable E/M service by the same...

Tip: Correctly code multiple turbinate removal

  • APCs Insider, Issue 27, July 2, 2010

    The AMA’s CPT Assistant advises in its December 2004 issue not to report code 30930 (fracture...

Q&A: Resolve confusion around injection, infusion coding

  • Briefings on APCs, Issue 7, July 1, 2010

    Many HIM professionals, coders, and billers continue to struggle with correct coding for injections...

Build a base for comprehensive review of procedure data

  • Briefings on APCs, Issue 7, July 1, 2010

    The technical nature of the CPT coding system can be very challenging for coding specialists, and...

Cure what ails your pain management coding

  • Briefings on APCs, Issue 7, July 1, 2010

    As reimbursement for complex pain management continues to decrease, your coding must drive accurate...

Modifier -25: Is that E/M service really above and beyond the norm?

  • Briefings on APCs, Issue 7, July 1, 2010

    A patient comes into your outpatient facility for a minor surgical procedure and the physician...

Briefings on APCs, July 2010

  • Briefings on APCs, Issue 7, July 1, 2010

    Inside: Is that E/M service really above and beyond the norm?  Cure what ails your pain...

APC Answer Letter, July 2010

  • APC Answer Letter, Issue 7, July 1, 2010

    Learn about NCCI and coding scenarios involving condition code 44, the ED, injections and...

Q/A: Correctly report port flush

  • APCs Insider, Issue 26, June 25, 2010

    Q: How can a hospital report a PICC line flush and dressing change when no infusion service is...

Tip: Beware of hard-coding modifiers in the chargemaster

  • APCs Insider, Issue 26, June 25, 2010

    Determine which modifiers, if any, you have hard-coded into your chargemaster. In some situations...

Q/A: Infusions in an interosseous line

  • APCs Insider, Issue 25, June 18, 2010

    Q: When the nurses access an interosseous line to infuse medication, is there an infusion code we...

Tip: Learn your contractor?s rules for hyperbaric oxygen therapy

  • APCs Insider, Issue 25, June 18, 2010

    Hyperbaric oxygen (HBO) therapy is a relatively new service, so the various MACs and FIs interpret...

Q/A: Therapeutic drugs running in multiple lines with multiple sites

  • APCs Insider, Issue 24, June 11, 2010

    Q: How should we report the administration of therapeutic drugs in two separate lines connected to...

Tip: Know appropriate codes for use with modifier -25

  • APCs Insider, Issue 24, June 11, 2010

    According to CMS, you may append modifier -25 only to E/M service codes within the following ranges.

Master HCPCS level II and anatomical modifiers

  • HIM-HIPAA Insider, Issue 22, June 8, 2010

    Certain modifiers are well-known as being difficult for coders. (Modifier -59, anyone?) Others...

Q/A: Level 5 ED visit or critical care?

  • APCs Insider, Issue 23, June 4, 2010

    Q: When does a level 5 ED visit become a critical care visit? Many providers have asked me this...

Tip: Know who assigns modifiers

  • APCs Insider, Issue 23, June 4, 2010

    Staff members in numerous areas of a facility may be appending modifiers. Consider establishing a...

This month's coding Q&A

  • APC Payment Insider, Issue 6, June 1, 2010

    In this month's coding Q&A, our experts answer questions about how to report Unna boot...

Reduce coding and billing errors by always knowing who is appending modifiers, always reviewing documentation

  • APC Payment Insider, Issue 6, June 1, 2010

    The sheer number of modifiers can cause plenty of confusion for HIM staff. The rules about which...

Check off requirements for hyperbaric oxygen therapy before treatment

  • APC Payment Insider, Issue 6, June 1, 2010

    Hyperbaric oxygen (HBO) therapy is a relatively new service, meaning different MACs and FIs...

APC Answer Letter, June 2010

  • APC Answer Letter, Issue 6, June 1, 2010

    Learn about coding scenarios involving the ED, injections and infusions, observation, orthopedics...

CMS makes few changes to I/OCE edits for April

  • Briefings on APCs, Issue 6, June 1, 2010

    CMS added 10 new HCPCS codes and six new APCs to the I/OCE as part of Transmittal R1927CP’s...

Reduce coding and billing errors by knowing who appends modifiers, always reviewing documentation

  • Briefings on APCs, Issue 6, June 1, 2010

    The sheer number of modifiers can cause plenty of confusion for HIM staff. The rules about which...

CAHs get a break on physician supervision rules for 2010

  • Briefings on APCs, Issue 6, June 1, 2010

    When CMS released its physician supervision requirements as part of the 2010 OPPS final rule...

Check off requirements for hyperbaric oxygen therapy before treatment

  • Briefings on APCs, Issue 6, June 1, 2010

    Hyperbaric oxygen (HBO) therapy is a relatively new service, meaning different MACs and FIs...

Briefings on APCs, June 2010

  • Briefings on APCs, Issue 6, June 1, 2010

    In this month's issue, we detail the importance of prequalifying patients for hyperbaric oxygen...

Understand individual needs to effectively motivate your team

  • HIM-HIPAA Insider, Issue 21, June 1, 2010

    Motivation HIM department staff members is important because it affects performance. It is the...

Establish a robust coding auditing program

  • HIM-HIPAA Insider, Issue 21, June 1, 2010

    Many reasons justify establishing an internal auditing program. An organization may have a...

Understand the difference between modifiers -73 and -74

  • HIM-HIPAA Insider, Issue 20, May 25, 2010

    Coders should use modifiers -73 and -74 to report discontinued outpatient procedures. Modifier -73...

Coming soon in Medical Records Briefing

  • HIM-HIPAA Insider, Issue 20, May 25, 2010

    In the June issue of MRB, you’ll find the following articles.Click here for more information...

Tip: Responding to MUE denials

  • APCs Insider, Issue 21, May 21, 2010

    In one-time notification R617OTN, CMS notes that organizations can report reasonable and necessary...

Q/A: Appending modifier -GZ

  • APCs Insider, Issue 20, May 14, 2010

    Q: Is reporting modifier –GZ (item or service expected to be denied as not reasonable and...

Use PEPPER to improve coding compliance

  • HIM-HIPAA Insider, Issue 18, May 11, 2010

    Aside from being a catchy acronym, PEPPER (Program for Evaluating Payment Patterns Electronic...

CMS discusses the three-day rule, pulmonary rehab

  • Briefings on APCs, Issue 5, May 1, 2010

    CMS representatives discussed the three-day rule and pulmonary rehab supervision during a Hospital...

Check the total time to report correct units of therapy

  • Briefings on APCs, Issue 5, May 1, 2010

    A therapist spends five minutes performing an ultrasound and performs 20 minutes of therapeutic...

Briefings on APCs, May 2010

  • Briefings on APCs, Issue 5, May 1, 2010

    Inside: Complex compendia rules complicate reimbursement Now on the to-track list: Medically...

Check the total time to report correct units of therapy

  • APC Payment Insider, Issue 5, May 1, 2010

    A therapist spends five minutes performing an ultrasound and performs 20 minutes of therapeutic...

APC Payment Insider, May 2010

  • APC Payment Insider, Issue 5, May 1, 2010

    In this issue, we explain how CMS’ decision to denial units in excess of medically unlikely...

Coming soon in Medical Records Briefing

  • HIM-HIPAA Insider, Issue 15, April 20, 2010

    In the May issue of MRB, you’ll find the following articles, and more!

Tip: Correctly assign modifier -59 to override NCCI edits

  • APCs Insider, Issue 16, April 16, 2010

    Some therapies are considered edited pairs and are not billable on the same date of service unless...

Q/A: Report CPT code for procedure, bill supply charge for adhesive

  • APCs Insider, Issue 16, April 16, 2010

    Q: How should we report DERMABOND® wound repair? Does this differ depending on whether the...

News: CMS to count more codes on UB forms

  • CDI Strategies, Issue 8, April 15, 2010

    Effective January 1, 2011, CMS is expanding the number of ICD-9 diagnosis and procedure codes...

Consider internal auditing options

  • HIM-HIPAA Insider, Issue 13, April 6, 2010

    Coding managers often conduct internal audits, but other alternatives exist. Some organizations...

Q/A: Appropriate reporting of modifier -59 with EKGs

  • APCs Insider, Issue 13, April 2, 2010

    Q: I have a question pertaining to APCs Weekly Monitor’s advice published March 12...

Correctly code for new cardiac, pulmonary rehab benefits

  • APC Payment Insider, Issue 4, April 1, 2010

    To take advantage of the new Medicare benefits for cardiac and pulmonary rehab services, coders...

APC Payment Insider, April 2010

  • APC Payment Insider, Issue 4, April 1, 2010

    In this issue, we explain the necessity of differentiating between mandatory and voluntary ABNs and...

Audit injections and infusions to ensure correct coding

  • Briefings on APCs, Issue 4, April 1, 2010

    In an environment of increasing audits, hospitals must monitor and resolve drug administration...

Should you override that outpatient therapy NCCI edit?

  • Briefings on APCs, Issue 4, April 1, 2010

    When an outpatient physical therapist provides exercise using land- and water-based therapy to the...

Briefings on APCs, April 2010

  • Briefings on APCs, Issue 4, April 1, 2010

    In this issue, we explain the basics of condition code 44 and explore the challenges presented by...

Q/A: No MUE limits published for 96372

  • APCs Insider, Issue 12, March 26, 2010

    Q: A physician orders one dose of a medication to be administered intramuscularly (IM) or...

Tip: Understand NCCI edits

  • APCs Insider, Issue 12, March 26, 2010

      CMS introduced NCCI edits for outpatient therapy in 1996 to prevent improper payment when...

Provider Round Table seeking new members

  • APCs Insider, Issue 12, March 26, 2010

    In 2003 HCPro, Inc., Nimitt Consulting, Inc., and 3M Health Information Systems joined forces to...

Consider centralizing your HIM department: Unexpected benefits may await you

  • HIM-HIPAA Insider, Issue 11, March 23, 2010

    Memorial Hermann Healthcare System (MHHS) in Houston includes nine acute care hospitals, one...

Tips to keep your coding compliance program fresh

  • HIM-HIPAA Insider, Issue 10, March 16, 2010

    Just because your coding compliance program is in place doesn’t mean it’s doing its job...

Heal the divide between HIM and CDI

  • HIM-HIPAA Insider, Issue 10, March 16, 2010

    Divisions between HIM and clinical documentation improvement (CDI) staff members are common. But in...

Q/A: Using modifier -59 for EKGs

  • APCs Insider, Issue 10, March 12, 2010

    Q: Should we use CPT modifier -59 (distinct procedural service) for a preoperative EKG performed on...

Tip: Consider whether to provide voluntary ABN

  • APCs Insider, Issue 10, March 12, 2010

    CMS’ decision allowing facilities to voluntarily provide patients with an ABN for statutorily...

Tip: Report correct units for drugs

  • APCs Insider, Issue 9, March 5, 2010

    One challenge for coding drugs is ensuring that you code them according to their descriptions...

Q&A: Avoid coding confusion for TPA

  • CDI Strategies, Issue 5, March 4, 2010

    Q: Do you code the procedure for tissue plasminogen activator (tPA) administration when it is done...

Tips to help providers meet new IRF documentation and coverage requirements

  • HIM-HIPAA Insider, Issue 8, March 2, 2010

    CMS is taking a closer look at admissions to inpatient rehabilitation facilities (IRF) thanks to...

Consider implementing a productivity incentive plan for coders and transcriptionists

  • HIM Briefings, Issue 3, March 1, 2010

    Sarah Bush Lincoln Health Center in Mattoon, IL developed a productivity incentive plan for their...

Medical Records Briefing, March 2010

  • HIM Briefings, Issue 3, March 1, 2010

    This month's issue includes an article on EHR meaningful use standards and what hospitals should do...

APC Payment Insider, March 2010

  • APC Payment Insider, Issue 3, March 1, 2010

     In this issue, we examine some of the major CPT code changes for 2010 and review the coding...

Briefings on Coding Compliance Strategies, March 2010

  • Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010

    In this issue, we detail how to ensure compliance and date accuracy by auditing...

Q/A: Unbundling therapy services

  • APCs Insider, Issue 8, February 26, 2010

    Q: If a physical performance test is conducted (97750, physical performance test or measurement...

Q/A: Correct revenue code for wound care depends on provider, location

  • APCs Insider, Issue 7, February 19, 2010

    Q: Which revenue code should we use to report wound care if an occupational therapist or physical...

Tip: Meet CMS' new pulmonary rehabilitation guidelines

  • APCs Insider, Issue 7, February 19, 2010

    All Medicare patients with moderate, severe, or very severe classifications of chronic obstructive...

Article of the month: Avoid sequencing oversights

  • CDI Strategies, Issue 4, February 18, 2010

    by Robert S. Gold, MD   Every so often, I come across some coding issues that recall other...

Q/A: Don't report 94002 in ED

  • APCs Insider, Issue 6, February 12, 2010

    Q: May we report CPT code 94002 for a patient started on a ventilator in the ED? Must the patient...

Use PEPPER reports to stay on top of common coding errors

  • HIM-HIPAA Insider, Issue 5, February 9, 2010

    HIM directors can evaluate their hospital’s potential risk for overcoding and unnecessary...

Coming soon in Medical Records Briefing

  • HIM-HIPAA Insider, Issue 5, February 9, 2010

    In the March issue of MRB, you’ll find the following articles, and more! EHR beat...

Tip: Create a chart to aid hemorrhoid coding

  • APCs Insider, Issue 4, February 5, 2010

    The revised CPT codes for hemorrhoids may be problematic for coders. Avoid confusion by developing...

CMS finalizes changes to physician supervision requirements

  • APC Payment Insider, Issue 2, February 1, 2010

    CMS adopted a new standard for supervision of therapeutic services provided in a hospital or...

APC Payment Insider, February 2010

  • APC Payment Insider, Issue 2, February 1, 2010

    In this issue examine how to properly assign modifiers. This issue also contains our index of 2009...

CMS clarifies physician signatures needed on all lab orders

  • Briefings on APCs, Issue 2, February 1, 2010

    If your healthcare organization doesn’t require a physician signature on all orders for...

Prevent and react to outpatient never events

  • Briefings on APCs, Issue 2, February 1, 2010

    In October 2009, an orthopedic surgeon at Rhode Island Hospital operated on the wrong finger of a...

2010 CPT changes: Rethink revamped radiology codes

  • Briefings on APCs, Issue 2, February 1, 2010

    Three changes in diagnostic and interventional radiology will require coders to rethink how they...

Briefings on APCs, February 2010

  • Briefings on APCs, Issue 2, February 1, 2010

    In this issue, we examine specific CPT code changes for 2010. We also explain the new cardiac and...

Tip: Know what documentation is necessary to code tumor excisions

  • APCs Insider, Issue 4, January 29, 2010

    The AMA made a significant number of changes to soft tissue and bone tumor excision codes for 2010...

Q/A: Billing for H1N1 flu vaccine administration

  • APCs Insider, Issue 2, January 15, 2010

    Q: We submitted claims to Medicare for the H1N1 flu vaccine using CPT code 90470 (H1N1 immunization...

Tip: Train employees to avoid 'never events'

  • APCs Insider, Issue 2, January 15, 2010

    Training employees is the important thing employers can do to prevent “never events.”

Q/A: Correct orders for lab services

  • APCs Insider, Issue 1, January 8, 2010

    Q: All of a sudden we are receiving recoupments for some lab work we performed. The information...

Briefings on APCs 2009 index

  • Briefings on APCs, Issue 1, January 1, 2010

    Track down that hard-to-find Briefings on APCs article. Use our index to find articles we published...

Understand challenges, opportunities with PET coverage

  • Briefings on APCs, Issue 1, January 1, 2010

    CMS’ recent national coverage determination (NCD) is fairly straightforward, spelling out...

CMS finalizes changes to physician supervision requirements

  • Briefings on APCs, Issue 1, January 1, 2010

    CMS adopted a new standard for supervision of therapeutic services provided in a hospital or...

Briefings on APCs, January 2010

  • Briefings on APCs, Issue 1, January 1, 2010

    In this issue, we examine the 2010 OPPS final rule, including the changes to drug reimbursement and...

APC Payment Insider 2009 index

  • APC Payment Insider, Issue 1, January 1, 2010

    Track down that hard-to-find APC Payment Insider article. Use our index to find articles we...

Master modifiers to ensure accurate reimbursement

  • APC Payment Insider, Issue 1, January 1, 2010

    Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...

APC Payment Insider, January 2010

  • APC Payment Insider, Issue 1, January 1, 2010

    In this issue examine how to properly assign modifiers. This issue also contains our index of 2009...

Editor's note: Correction

  • HIM-HIPAA Insider, Issue 52, December 29, 2009

    Editor’s note: We regret the error in last week’s Q&A on coding anemia due to...

Q/A: Coding for Dermabond® wound repair

  • APCs Insider, Issue 49, December 18, 2009

    Q: We have a question about Dermabond wound repair. Should we code and charge only HCPCS code G0168...

Q/A: Coding 'in and out' bladder catherizations

  • APCs Insider, Issue 48, December 11, 2009

    Q: Can we code bladder catheterizations when a urine specimen is obtained for an analysis and the...

Tip: Use modifier -58 for planned return to the OR

  • APCs Insider, Issue 48, December 11, 2009

    Physicians sometimes decide to perform surgery in stages. These situations involve a planned return...

RAC begins complex DRG validation audits: Medical record documentation requests imminent

  • HIM-HIPAA Insider, Issue 49, December 8, 2009

    Connolly Healthcare has announced the first issues approved for complex RAC review, so providers in...

Tip: Use procedural modifiers to further describe services

  • APCs Insider, Issue 47, December 4, 2009

    Procedural modifiers can provide a wealth of information to further describe services provided...

APC Payment Insider, December 2009

  • APC Payment Insider, Issue 12, December 1, 2009

    In this issue examine how to properly bill for supplies to eliminate lost revenue. Inside...

‘Clarification’ muddies the waters on lab order signatures

  • Briefings on APCs, Issue 12, December 1, 2009

    If you thought you understood CMS’ policy when it comes to physician orders for clinical...

Master modifiers to ensure accurate reimbursement

  • Briefings on APCs, Issue 12, December 1, 2009

    Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...

Examine codes for complex OB/GYN procedures

  • Briefings on APCs, Issue 12, December 1, 2009

    Understand how to sift through detailed OB/GYN operative notes to ensure accurate code assignment.

Briefings on APCs, December 2009

  • Briefings on APCs, Issue 12, December 1, 2009

    In this issue, we examine outpatient coding challenges that facilities are still facing. We unravel...

Tip: Use 3rd Quarter Coding Clinic to help resolve surgery complication questions

  • CDI Strategies, Issue 24, November 26, 2009

    The American Hospital Association’s Coding Clinic for ICD-9-CM contains official advice from...

Coding from nurses' notes

  • HIM-HIPAA Insider, Issue 47, November 24, 2009

    Q. We have been told that coders are not allowed to code from nurses’ notes. Can anyone tell...

Tip: CPT Chapter 11 codes take precedence in OB/GYN cases

  • APCs Insider, Issue 46, November 20, 2009

    When coding OB/GYN procedures, remember that ICD-9 codes 630–679 in Chapter 11 (Complications...

Q/A: Billing telemetry daily monitoring

  • APCs Insider, Issue 46, November 20, 2009

    Q: Can our hospital code and bill telemetry daily monitoring in conjunction with a chest pain...

Refresh your knowledge of core concepts for coding accuracy

  • HIM-HIPAA Insider, Issue 46, November 17, 2009

    Clinical knowledge is an essential element for capturing severity and MS-DRG assignment, according...

Q/A: Documenting lesion size

  • APCs Insider, Issue 45, November 13, 2009

    Q: A surgeon excises a lesion on a patient’s back, but fails to document its size or the...

Tip: Don't overlook small-dollar savings

  • APCs Insider, Issue 45, November 13, 2009

    When considering ways to reduce revenue loss at your facility, don’t look just for big-dollar...

OPPS final rule: CMS finalizes changes for drug payment formula, physician supervision

  • HIM-HIPAA Insider, Issue 45, November 10, 2009

    The 2010 OPPS final rule released on October 30 contains few surprises, but does finalize two...

Q/A: May we bill an E/M code for a wound care first visit

  • APCs Insider, Issue 44, November 6, 2009

    Q.  Several of our facilities that include hospital-based outpatient wound care clinics have...

Tip: Determine the number of specimens to code surgical pathology correctly

  • APCs Insider, Issue 44, November 6, 2009

    If you perform a level IV surgical pathology (88305) on more than one specimen from the same...

Modifier -59: Reduce risk, receive correct reimbursement

  • APC Payment Insider, Issue 11, November 1, 2009

    Learn how to correctly use modifier -59 and when to avoid it.

Two years later, medically unlike edits still a puzzle

  • APC Payment Insider, Issue 11, November 1, 2009

    Given the continuing confusion, what can facilities do to handle MUEs?

APC Payment Insider, November 2009

  • APC Payment Insider, Issue 11, November 1, 2009

    In this issue we unravel the mysteries surrounding medically unlikely edits. Inside: &bull...

Q&A: Determining the proper use of modifier -59

  • Briefings on APCs, Issue 11, November 1, 2009

    Our experts answer questions about the appropriate use of modifier -59.

I/OCE quarterly update: CMS addresses condition code 44, billing for radiopharmaceuticals and nuclear medicine

  • Briefings on APCs, Issue 11, November 1, 2009

    Condition code 44, billing for radiopharmaceuticals highlight I/OCE changes

Briefings on APCs, November 2009

  • Briefings on APCs, Issue 11, November 1, 2009

    This issue features the second part of our series on physician supervision requirements for...

Q/A: Calcium gluconate administration: Infusion or hydration?

  • APCs Insider, Issue 43, October 30, 2009

    Q. A patient who has undergone a kidney transplant and has plasmapheresis intravenously receives IV...

Q/A: Proper coding for multiple wounds at different sites

  • APCs Insider, Issue 42, October 23, 2009

    Q: A patient with multiple wounds at different sites receives active wound management at one wound...

Tip: Distinguish between therapeutic and diagnostic tests

  • APCs Insider, Issue 42, October 23, 2009

    Facilities need to have a clear understanding of when a procedure is diagnostic and when it is...

Q/A: Does physician documentation in written reports constitute an official order?

  • APCs Insider, Issue 41, October 16, 2009

    Q: We don’t have the usual written orders for several tests. However, physicians dictate or...

Tip: Appropriately report units in excess of MUE

  • APCs Insider, Issue 41, October 16, 2009

    In FAQ 8736, CMS instructs hospitals how to report units in excess of the medically unlikely edits...

Tip: Determine whether a colonoscopy is really a screening procedure

  • APCs Insider, Issue 40, October 9, 2009

    Coding a screening colonoscopy should be relatively straightforward. However, the interpretation of...

Q/A: Infusions in multilumen catheters

  • APCs Insider, Issue 39, October 2, 2009

    Q: How should we assign CPT codes for an infusion of desferal at the same time as blood products...

Tip: Meet physician supervision requirements for diagnostic services

  • APCs Insider, Issue 39, October 2, 2009

    How can your facility ensure compliance with the physician supervision requirements for diagnostic...

Coding Q&A

  • APC Payment Insider, Issue 10, October 1, 2009

    Does CPT 36592 pertain to a pre-existing catheter (such as a PICC line) that is available for use...

Separately payable drugs: New calculation method proposed for 2010 doesn’t equal increased payment

  • APC Payment Insider, Issue 10, October 1, 2009

    CMS proposes new methodology to calculate drug APC payment rates.

CMS proposes more changes to physician supervision requirements

  • APC Payment Insider, Issue 10, October 1, 2009

    Proposed changes to outpatient supervision could be a huge boon.

Coders beware?Is that screening colonoscopy really a screening?

  • Briefings on APCs, Issue 10, October 1, 2009

    Coders must understand what constitutes a ‘screening’ colonoscopy.

Two years later, MUEs are still a puzzle

  • Briefings on APCs, Issue 10, October 1, 2009

    Given the continuing confusion, what can facilities do to handle MUEs?

Briefings on APCs, October 2009

  • Briefings on APCs, Issue 10, October 1, 2009

    This issue features the first part of our series on physician supervision requirements for...

Tip: Understand medically unlikely edits

  • APCs Insider, Issue 38, September 25, 2009

    CMS created medically unlikely edits (MUEs) to ensure that providers don’t report excessive...

Q/A: Billing code 92960 in the ED

  • APCs Insider, Issue 38, September 25, 2009

    Q: Is elective cardioversion code 92960 billable in the ED? For example, a patient presents in the...

Q/A: Billing for items used with DME

  • APCs Insider, Issue 37, September 18, 2009

    Q: We understand that we cannot charge for the use of equipment, but can we charge for the soft...

Tip: Understand Q status indicators

  • APCs Insider, Issue 37, September 18, 2009

    Under the 2009 OPPS final rule, bundling is now subdivided into status indicators Q1, Q2, and Q3.

Q/A: Billing for open but unused supplies

  • APCs Insider, Issue 36, September 11, 2009

    Q: Can we bill for supplies or implants that we opened but did not use? If so, how do we report...

Tip: Differentiate between packaged and bundled services

  • APCs Insider, Issue 36, September 11, 2009

    To distinguish between bundled and packaged services, remember that bundling applies to coding and...

Q/A: Reporting code 96372 for one dose administered via two injections

  • APCs Insider, Issue 35, September 5, 2009

    Q. A physician orders one dose of a medication to be administered intramuscularly (IM) or...

Tip: Know the general definiation of 'immediately available' for physician supervision

  • APCs Insider, Issue 35, September 4, 2009

    In its 2010 OPPS proposed rule, CMS acknowledges never having specifically defined...

News: Trailblazer outlines inpatient vs. observation status documentation pitfalls

  • CDI Strategies, Issue 18, September 3, 2009

    Following a targeted review of 250 claims with DRG 247, TrailBlazer, the Medicare Administrative...

TIP: Couch your query when clarifying unstable angina

  • CDI Strategies, Issue 18, September 3, 2009

    Editor’s Note: The following tip was excerpted from the article “Tips for problematic...

Clarification: Anemia documentation and coding presents communication hazards

  • CDI Strategies, Issue 18, September 3, 2009

    Editor’s note: The following Q&A first appeared in the August 20, 2009, edition of CDI...

Briefings on APCs, September 2009

  • Briefings on APCs, Issue 9, September 1, 2009

    In this issue, you will find an overview of the 2010 OPPS proposed rule, plus articles expanding on...

OPPS 2010 proposed rule: Earliest release brings fewer substantial policy changes

  • Briefings on APCs, Issue 9, September 1, 2009

    The text portion of the 2010 OPPS proposed rule is shorter than previous years’ rules, and...

2010 OPPS proposed rule: CMS proposes more changes to physician supervision requirements

  • Briefings on APCs, Issue 9, September 1, 2009

    Proposed changes to outpatient supervision could be a huge boon.

Separately payable drugs: New calculation method proposed for 2010 doesn’t equal increased payment

  • Briefings on APCs, Issue 9, September 1, 2009

    CMS proposes new methodology to calculate drug APC payment rates.

CMS discusses Section 1011 updates, OPPS proposed rule during HODF

  • Briefings on APCs, Issue 9, September 1, 2009

    Several items of interest to OPPS hospitals from Open Door Forum call.

Concepts review: Sort out packaged versus bundled services

  • Briefings on APCs, Issue 9, September 1, 2009

    Q status indicators add to packaged vs. bundled confusion.

Decode the language of physicians

  • Briefings on Coding Compliance Strategies, Issue 9, September 1, 2009

    Robert S. Gold, M.D., helps coders decipher physician language in order to code hypertension and...

APC Payment Insider September 2009

  • APC Payment Insider, Issue 9, September 1, 2009

    In this issue we look at how the new ICD-9-CM codes increase specificity. Inside: CMS...

CMS clarifies outpatient ?observation services?

  • APC Payment Insider, Issue 9, September 1, 2009

    CMS revised language to clarify outpatient observation services.

Don?t code stent if lesion not crossed

  • APC Payment Insider, Issue 9, September 1, 2009

    Physician can’t cross lesion to place noncoronary stent

Code intended procedure when not completed

  • APC Payment Insider, Issue 9, September 1, 2009

    What should you do if a physician can’t complete the procedure?

Lack of start, stop times affects code selection

  • APC Payment Insider, Issue 9, September 1, 2009

    What should you do if a physician can’t complete the procedure?

Setting, insurer dictate payment policy

  • APC Payment Insider, Issue 9, September 1, 2009

    Is charging a patient for a low level facility visit appropriate?

Report drug and administration codes

  • APC Payment Insider, Issue 9, September 1, 2009

    Make sure you include CPT and HCPCS codes for drugs

Report in facility setting only

  • APC Payment Insider, Issue 9, September 1, 2009

    Know when to report an IV push of the same substance in ER

Q/A: Coding for incomplete stent placement

  • APCs Insider, Issue 32, August 21, 2009

    Q: How should we code the following scenario: A patient arrives at the catheterization laboratory...

Q/A: Limits on PET scans

  • APCs Insider, Issue 31, August 13, 2009

    Q: Is there a limit on how frequently patients may receive PET scans, such as 78815 (Tumor...

Tip: Use these principles to develop E/M coding guidelines

  • APCs Insider, Issue 31, August 13, 2009

    No national guidelines for E/M leveling exist, so facilities must develop their own.

Q/A: Report modifier -59 for EKGs performed before or after cardiac catheterization

  • APCs Insider, Issue 30, August 7, 2009

    Q. An APC edit states that 93005 (electrocardiogram, routine EKG with at least 12 leads; tracing...

Tip: Look for injuries sustained during military service

  • APCs Insider, Issue 30, August 7, 2009

    Coders need to be aware of a new set of E codes that detail injuries sustained by military...

CMS updates revenue code description

  • HIM-HIPAA Insider, Issue 31, August 4, 2009

    On July 10, CMS issued Transmittal 1767 to change the description for revenue code 076X. The...

Proposed OPPS changes may bring greater flexibility for physician supervision

  • HIM-HIPAA Insider, Issue 31, August 4, 2009

    Despite several industry groups’ efforts to advocate for a moratorium on physician...

Ensure medical necessity to curb outpatient revenue loss

  • Briefings on APCs, Issue 8, August 1, 2009

    Facilities are failing to meet medical necessity requirements

Briefings on APCs, August 2009

  • Briefings on APCs, Issue 8, August 1, 2009

    In this issue, you will find information about the new updates to the ICD-9 codes and look at how...

APC Payment Insider, August 2009

  • APC Payment Insider, Issue 8, August 1, 2009

    In this issue we look at six questions you should ask when you evaluate coder productivity...

Q/A: Physical and occupational therapy in the outpatient department

  • APCs Insider, Issue 29, July 31, 2009

    Q: What are the guidelines for physician supervision for physical therapy/occupational therapy and...

Q/A: Facility guidelines for E/M levels

  • APCs Insider, Issue 28, July 24, 2009

    Q: I work in a hospital outpatient clinic setting. Has CMS issued a deadline for developing...

Tip: Ensure medical necessity to curb outpatient revenue loss

  • APCs Insider, Issue 28, July 24, 2009

    Providers must ensure the medical necessity of procedures they perform. To reduce revenue loss...

Q/A: Use of modifier -25

  • APCs Insider, Issue 28, July 17, 2009

    Q: We know we should append CPT modifier –25 to the visit level when one of our EDs or...

Tip: Consider non-coding tasks when setting coder productivity goals

  • APCs Insider, Issue 28, July 17, 2009

    When setting productivity goals, don’t forget to include non-coding responsibilities when...

CMS releases 2010 OPPS proposed rule

  • HIM-HIPAA Insider, Issue 28, July 14, 2009

    Outpatient facilities and pharmacies hoping to see an increase in reimbursement for separately...

Q/A: Coding for blood glucose checks

  • APCs Insider, Issue 27, July 10, 2009

    Q: Which CPT code is appropriate for blood glucose monitoring with a device such as...

Q/A: Appropriate use of code 96376

  • APCs Insider, Issue 26, July 3, 2009

    Q: My question pertains to CPT code 96376 (therapeutic, prophylactic, or diagnostic injection...

APC Payment Insider, July 2009

  • APC Payment Insider, Issue 7, July 1, 2009

    In this issue we look at CMS’ recent decision to expand coverage of testing for obstructive...

Carefully review CMS’ national coverage analysis on PET scans

  • Briefings on APCs, Issue 7, July 1, 2009

    For years, it has been a challenge for healthcare facilities to determine whether Medicare will...

Inpatient ancillary services: Are your costs covered?

  • Briefings on APCs, Issue 7, July 1, 2009

    As the current economic climate continues to constrict cash flow for consumers and payers alike...

Briefings on APCs, July 2009

  • Briefings on APCs, Issue 7, July 1, 2009

    In this issue, you will find information about how your facility can increase its revenue by...

Q/A: Hydration services continuing past midnight

  • APCs Insider, Issue 25, June 26, 2009

    Q: How should we report hydration services that run past midnight into the next calendar day along...

Tip: Don't forget to monitor coding productivity standards

  • APCs Insider, Issue 25, June 26, 2009

    Establishing coding productivity standards is a necessary and challenging aspect of managing an...

Q/A: Critical care coding

  • APCs Insider, Issue 24, June 19, 2009

    Q: My question pertains to critical care provided in an ER at a Level 1 Trauma Center. If a patient...

Q/A: CPT code 97760 and L-codes

  • APCs Insider, Issue 23, June 12, 2009

    Q:  Please clarify the overlap between CPT code 97760 and the L-code. Precisely, when and...

CMS releases April I/OCE update

  • Briefings on APCs, Issue 6, June 1, 2009

    CMS released its April 2009 quarterly update to the integrated outpatient code editor on March 13.

Go electronic to improve compliant charge capture

  • Briefings on APCs, Issue 6, June 1, 2009

    With increased ED volume and the demands of more complete documentation, now is the time to...

Briefings on APCs, June 2009

  • Briefings on APCs, Issue 6, June 1, 2009

    Inside: Go electronic to improve compliant charge capture Strong documentation puts OSA coverage...

Conform to the new CMS physician supervision requirements

  • APC Payment Insider, Issue 6, June 1, 2009

    CMS discussion of direct supervision requirements likely to spark more questions.

APC Payment Insider, June 2009

  • APC Payment Insider, Issue 6, June 1, 2009

    In this issue, we cover CMS’ updated clarifications regarding incident-to services and looks...

Q/A: Physician supervision requirements for outpatient facility

  • APCs Insider, Issue 21, May 29, 2009

    Q: The nurse practitioner (NP) and physician assistant (PA) staff the off-campus clinic with...

Q/A: Billing for DME

  • APCs Insider, Issue 20, May 22, 2009

    Q: What if your hospital doesn’t have a DME license? Do you still use only the L codes?

Tip: Understand Q status indicator subcategories

  • APCs Insider, Issue 20, May 22, 2009

    The 2009 OPPS final rule further divided the Q status indicator into three subcategories, with...

Q/A: Global payment structure and scheduled ED visits

  • APCs Insider, Issue 19, May 15, 2009

    Q: A patient is seen in the ED for laceration repair and then returns for suture or staple removal...

Q&A: Assigning IV injection codes without stop times

  • Briefings on APCs, Issue 5, May 1, 2009

    Q. Is it appropriate to assign an IV injection code when facility nursing documentation does not...

Conform to the new CMS physician supervision requirements

  • Briefings on APCs, Issue 5, May 1, 2009

    Hospitals looking for more discussion about CMS? recent clarification of the direct supervision...

Review these important CY 2009 OPPS status indicator changes

  • Briefings on APCs, Issue 5, May 1, 2009

    In 2008, CMS greatly expanded the number of packaged items and services payable under the OPPS...

Solve the twin problems of ED revenue loss and compliance risk

  • Briefings on APCs, Issue 5, May 1, 2009

    As always, E/M levels must reflect resources consumed, and you still must have written policies and...

Briefings on APCs, May 2009

  • Briefings on APCs, Issue 5, May 1, 2009

    Inside: Solve the twin problems of ED revenue loss and compliance risk Overcome critical care...

APC Answer Letter May 2009

  • APC Answer Letter, Issue 5, May 1, 2009

    Inside: Blood procedures: Code correctly when the only service is specimen collection via...

APC Payment Insider May 2009

  • APC Payment Insider, Issue 5, May 1, 2009

    Inside: Watch for changing physician supervision requirements: today’s oversight may be...

Q/A: Billing for CPT Code 86022

  • APCs Insider, Issue 18, May 1, 2009

    Normal 0 false false false...

QA:Coding multiple initial infusions

  • APCs Insider, Issue 16, April 17, 2009

    How you report what appear to be multiple initial scenarios depends on the documentation in the...

Tip of the week

  • APCs Insider, Issue 16, April 17, 2009

    Everyone knows that an immense amount of teamwork is necessary for a CDI program to truly be...

Championing the compliance cause

  • APCs Insider, Issue 16, April 17, 2009

    Christina Benjamin, MA, RHIA, CCS, CCS-P, presents several compliance traps that coders should...

CMS has reformulated payments for some bilateral procedures

  • APCs Insider, Issue 14, April 3, 2009

    An increase in the Medicare payment for bilateral procedures with a status indicator of T slipped...

APC Answer Letter, April 2009

  • APC Answer Letter, Issue 4, April 1, 2009

    Inside: Charging for multiple ventricular leads Quick coding quiz

Understand when to append modifier -58

  • Briefings on APCs, Issue 4, April 1, 2009

    It's often difficult for coders and providers to determine when it's appropriate to append modifier...

Coders may not miss modifier -21

  • Briefings on APCs, Issue 4, April 1, 2009

    The departure of modifier -21 (prolonged E/M services), effective with the 2009 CPT Manual, isn't...

Watch for changing physician supervision requirements

  • Briefings on APCs, Issue 4, April 1, 2009

    Five successive pieces of CMS guidance in the past year have altered the landscape. They are...

APC Payment Insider April 2009

  • APC Payment Insider, Issue 4, April 1, 2009

    Inside: Control charge compression by knowing your costs, because consumer reaction may cost you...

Trauma activation code

  • APC Payment Insider, Issue 4, April 1, 2009

    Assuming you meet all other documentation and trauma status criteria, you may report the trauma...

Briefings on APCs, April 2009

  • Briefings on APCs, Issue 4, April 1, 2009

    Inside: Watch for changing physician supervision requirements Few changes to date in HCPCS...

CPT checkup: Review the major changes for 2009

  • APC Payment Insider, Issue 3, March 27, 2009

    This is the second of two articles on this year?s CPT changes, effective January 1. Part two covers...

Q&A. Separate reporting of infusions before and after CPR

  • APCs Insider, Issue 11, March 13, 2009

    The NCCI manual instructions state that: Procedures routinely performed as part of a comprehensive...

While patient education alone isn't an E/M service, the technical component can be

  • APCs Insider, Issue 10, March 6, 2009

    Education alone is not a separate E/M service. However, it is customary to establish facility E/M...

APC Answer Letter, March 2009

  • APC Answer Letter, Issue 3, March 1, 2009

    Inside: DME licenses Giving supplies away? Here’s how to become a supplier Nonchemotherapy...

APC Payment Insider, March 2009

  • APC Payment Insider, Issue 3, March 1, 2009

    Inside: CMS opens the door to outpatient HAC program CPT checkup: Review the major changes for...

CMS opens the door to outpatient HAC program

  • APC Payment Insider, Issue 3, March 1, 2009

    At a December 18, 2008, listening session, CMS presenters discussed possibilities for extending the...

Avoid modifier -58 in the ED

  • APCs Insider, Issue 9, February 27, 2009

    It’s hard to think of a situation in which you would use modifier -58 in the ED

Low Vision Awareness Month

  • Coding Educator, Issue 2, February 9, 2009

    February is Low Vision Awareness Month, so I would like to take the opportunity to share a bit...

Unlisted CPT codes

  • APCs Insider, Issue 6, February 6, 2009

    New CMS guidance describes the processes for using unlisted CPT codes.

CPT: The back of the book and beyond

  • Briefings on APCs, Issue 2, February 1, 2009

    Pay attention to new details in all three categories of CPT codes For many coders, the Category II...

CPT codes change in CCI edits April 1

  • APCs Insider, Issue 5, January 30, 2009

    Q&A: Why drug administration CPT codes are not hitting CCI edits.

CPT: The back of the book

  • APCs Insider, Issue 5, January 30, 2009

    The Category II and Category III sections of the 2009 CPT Manual have seen many changes for 2009.

RAC appeals on the rise according to new CMS statistics

  • HIM-HIPAA Insider, Issue 2, January 13, 2009

    CMS revised its July 2008 RAC appeal update to include appeals statistics through August 31, 2008.

The CPT errata list

  • APCs Insider, Issue 2, January 9, 2009

    The AMA has updated its list of errata to the 2009 CPT Manual.

500-plus CPT changes in 2009

  • APCs Insider, Issue 1, January 2, 2009

    CPT coders face a lengthy list of changes for 2009. According to the American Academy of...

APC Answer Letter, January 2009

  • APC Answer Letter, Issue 1, January 1, 2009

    Inside: Blood draw via hep lock Cardiac catheterization: LIMA visualization Fluoroscopy for...

Facility critical care claims

  • APCs Insider, Issue 52, December 26, 2008

     How to submit facility critical care claims for 2009

Facility E/M Levels, 2009 OPPS

  • APCs Insider, Issue 50, December 12, 2008

    For 2009, hospitals must continue to use their internally developed guidelines for ED and clinic...

'Tis the season to wash your hands

  • Coding Educator, Issue 12, December 1, 2008

    December is national hand washing month. It does seem like there is a season for everything, but...

Modifier -59 for certain EKGs

  • APCs Insider, Issue 47, November 14, 2008

    You may report EKGs performed before or after cardiac catheterization with modifier -59. You cannot...

Charge CPT procedure codes to inpatients under certain conditions

  • APCs Insider, Issue 46, November 7, 2008

    Charge CPT procedure codes to inpatients under certain conditions  

Decipher integumentary codes for correct coding

  • Briefings on APCs, Issue 11, November 1, 2008

    Differentiate transfers, flaps, and grafting procedures, and make use of new codes and any trick to...

Use revenue code plus CPT, without HCPCS, to bill albuterol or Duoneb via nebulizer

  • APCs Insider, Issue 45, October 31, 2008

    Use revenue code plus CPT, without HCPCS, to bill albuterol or Duoneb via nebulizer

Decipher integumentary codes

  • APCs Insider, Issue 42, October 17, 2008

    Dispel the assumption that an integumentary code is the only solution. Decipher complex repairs and...

Reminder: Medicare covers diabetes screening

  • Briefings on APCs, Issue 10, October 1, 2008

    On June 18, CMS issued MLN Matters article SE0821, a reminder that Medicare pays for diabetes...

Decipher integumentary codes for correct coding

  • Briefings on APCs, Issue 10, October 1, 2008

    Be aware of all your options when coding integumentary procedures so that you arrive at the most...

Questions on E/M for hospital-based outpatient clinics

  • Briefings on APCs, Issue 10, October 1, 2008

    Editor’s note: Susan Garrison, CHCA, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, executive vice...

Q&A: Follow the infusion hierarchy when reporting drug administration

  • APCs Insider, Issue 39, September 26, 2008

    Q&A: Follow the infusion hierarchy, not chronological order of administration, when reporting...

Q&A: Don't use modifier -53 for hospital OPPS claims

  • APCs Insider, Issue 38, September 19, 2008

    Why we shouldn’t append modifier -53 to the procedure if the patient is in the room, we...

Distinguish between revenue codes 637, 250 for SADs

  • APCs Insider, Issue 36, September 5, 2008

    Q: Is it inappropriate to bill all self-administered drug (SAD) charges as integral to a procedure...

Avoid encoder traps

  • Briefings on APCs, Issue 9, September 1, 2008

    Encoders are among the most valuable coding resources on the market, but software is just one tool...

Tip of the week: Report CPT code 45331 for sigmoidoscopy with biopsy

  • APCs Insider, Issue 35, August 29, 2008

    Report CPT code 45331 when a physician performs a sigmoidoscopy with biopsy. This code is...

Coding for vaccinations during National Immunization Awareness Month

  • Coding Educator, Issue 8, August 1, 2008

    Children do not come with instruction manuals, but there are many books available to help us along...

Tip of the week: Append modifier -59 correctly

  • APCs Insider, Issue 24, June 13, 2008

    There are many legitimate uses for modifier -59. But, with drug administration, as with other types...

Q&A: OIG considers "unbundling" fraudulent

  • APCs Insider, Issue 22, May 30, 2008

    Part 2 of a 2-part series. See the May 23, 2008 APCs Weekly Monitor for the CMS stance on...

Tip: Ensure accurate coding of injections

  • APCs Insider, Issue 22, May 30, 2008

    Report code 90772 (therapeutic, prophylactic or diagnostic injection; subcutaneous of...

Q&A: CMS considers "unbundling" fraudulent

  • APCs Insider, Issue 21, May 23, 2008

    Do CMS and the Office of Inspector General (OIG) consider the intentional unbundling of codes to be...

Q&A: Report appropriate device codes for device-dependent procedures

  • APCs Insider, Issue 20, May 16, 2008

    We are negotiating to provide pain stimulator services. We will report code 63650 for the trial and...

Wound care coding and billing

  • APCs Insider, Issue 19, May 9, 2008

    Lingering coding and billing difficulties, 2008 CPT/HCPCS changes, and OIG scrutiny promise to keep...

Q&A: Rebill rejected claims containing HCPCS code A4641

  • APCs Insider, Issue 19, May 2, 2008

    We have had claims rejected for nuclear medicine procedures when we report both a procedure and a...

Tip of the week: Don't make assumptions about duration for drug infusion therapy

  • APCs Insider, Issue 18, May 2, 2008

    It is not acceptable to make assumptions about duration of drug infusion therapy solely based on...