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APC Payment Insider reports on the latest coding and policy changes affecting Medicare outpatient billing under ambulatory payment classifications (APCs). This monthly newsletter offers proven strategies to succeed under CMS's outpatient prospective payment system (OPPS), plus ways to enhance chargemaster maintenance, recruit and retain qualified coders, speed billing turnaround, improve documentation habits, and use modifiers properly.

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APC Payment Insider

Issue 12, December 1, 2010 - VIEW THE FULL ISSUE

• RAC audits are not just an inpatient issue

  Although a lot of attention is being given to the RACs’ focus on DRG validation and other...

• This month's coding Q&A

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

Issue 11, November 1, 2010 - VIEW THE FULL ISSUE

• Learn potential outpatient implications of the three-day payment rule

  Think the three-day payment rule affects only inpatient coders?  Think again. Changes that...

• Look for medical necessity, signs and symptoms, time units

  For more than a decade, the U.S. Department of Health and Human Services has celebrated National...

• This month's coding Q&A

  Q. My practice is spine specialty, and in many situations, NCCI edits apply. If modifier -59 is...

Issue 10, October 1, 2010 - VIEW THE FULL ISSUE

• Fewer new ICD-9-CM  codes for 2011

  Coders will have fewer new ICD-9-CM codes to deal with in 2011, but they should still be aware of...

• Right modifier, wrong modifier? How can you tell?

  Determining proper modifier use can be a challenge for even the most experienced coder. If you...

• This month's coding Q&A

  Q. I understand HCPCS Level II has added some new HIV screening codes. Can you elaborate?

Issue 9, September 1, 2010 - VIEW THE FULL ISSUE

• CMS proposes additional changes to physician  supervision for 2011

  CMS continues to refine its physician supervision requirements by proposing a new category of...

• CMS proposes few non-supervision changes for 2011 OPPS

  HIM professionals hoping that CMS would create national E/M guidelines in the 2011 OPPS proposed...

• This Month?s Coding Q&A

  Q. Please explain how to report this scenario: magnesium sulfate 1 gram and calcium gluconate 10 ml...

Issue 8, August 1, 2010 - VIEW THE FULL ISSUE

• Effectively and accurately report trauma activation with critical care in the ED

  When a patient arrives at a facility after suffering a traumatic injury, his or her survival often...

• Get to the heart of percutaneous coronary procedures

  Approximately 81.1 million Americans have at least one form of cardiovascular disease and 17.6...

• This month's coding Q&A

  Q. Please explain the criteria necessary for condition code 44.

Issue 7, July 1, 2010 - VIEW THE FULL ISSUE

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

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

• Cure what ails your pain management coding

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

• This month's coding Q&A

  Q. Will Medicare will pay separately for an ED encounter if the patient is admitted to the hospital...

Issue 6, June 1, 2010 - VIEW THE FULL ISSUE

• Check off requirements for hyperbaric oxygen therapy before treatment

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

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

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

• This month's coding Q&A

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

Issue 5, May 1, 2010 - VIEW THE FULL ISSUE

• On the to-track list:  MUE denials and appeals

  Add one more thing to your list of items to track: medically unlikely edit (MUE) denials and...

• Check the total time to report correct units of therapy

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

• This months coding Q&A

  Abandoned newborn’s condition, needed  services determine codes Q. A newborn with the...

Issue 4, April 1, 2010 - VIEW THE FULL ISSUE

• Distinguish between ABNs for covered, noncovered Medicare services

  When a patient receives an ABN, coders and billers need to determine whether it’s because...

• Correctly code for new cardiac, pulmonary rehab benefits

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

• This month’s coding Q&A

  Q. A patient receives an L3 and L4 transforaminal epidural steroid bilaterally under fluoroscopic...

Issue 3, March 1, 2010 - VIEW THE FULL ISSUE

• 2010 CPT: Tumor excisions, facet joint injections among most  significant changes

  Coders will find more than 450 changes in the 2010 CPT Manual, with the most significant...

• Comply with CMS guidelines for cardiac, pulmonary rehab

  Cardiac and pulmonary rehabilitation program coordinators face plenty of challenges as they...

• This month's coding Q&A

  Guidelines help solve dilemma caused by  conflicting data from physician, radiologist Q...

Issue 2, February 1, 2010 - VIEW THE FULL ISSUE

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

  CMS revised requirements for physician supervision and finalized a variety of drug reimbursement...

• CMS finalizes changes to physician supervision requirements

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

• This month's coding Q&A

  Don’t charge for free samples   Q. We are unsure how to report/charge for free samples...

Issue 1, January 1, 2010 - VIEW THE FULL ISSUE

• Master modifiers to ensure accurate reimbursement

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

• This month’s coding Q&A

  Q. A patient presents to the ED and is triaged. A nurse takes the patient’s vital signs...

• APC Payment Insider 2009 index

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