Health Information Management Articles by Topic: CPT Coding
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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...
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Briefings on APCs, Issue 3, March 1, 2014
Although the AMA changed hundreds of codes in the 2014 CPT® Manual, most of the changes...
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Briefings on APCs, Issue 3, March 1, 2014
When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and...
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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...
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Briefings on APCs, Issue 3, March 1, 2014
How does CPT® define “final examination” for code 99238 (hospital discharge day...
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Briefings on APCs, Issue 3, March 1, 2014
In this month's issue, we review latest 2014 CPT® Manual changes, examine how MUEs are...
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APCs Insider, Issue 4, January 24, 2014
Q: Did CMS make any changes to the inpatient-only list for 2014?
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APCs Insider, Issue 4, January 24, 2014
The Hierarchical Condition Category (HCC)model used for Medicare Advantage (MA) patients...
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APCs Insider, Issue 3, January 17, 2014
CMS recently released MLN Matters® article 8572, covering the numerous January updates to the...
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APCs Insider, Issue 3, January 17, 2014
Q: Did CMS discontinue the device-to-procedure and radiopharmaceutical-to-nuclear medicine...
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APCs Insider, Issue 52, December 20, 2013
Q: Are there any changes for skin substitute application reporting for 2014? We are hearing rumors...
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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...
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APCs Insider, Issue 51, December 13, 2013
CMS recently announced a pair of CPT® code changes, including the replacement of a Category III...
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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...
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APCs Insider, Issue 50, December 6, 2013
CMS may not have finalized all of its sweeping proposals in the 2014 OPPS Final Rule released...
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APCs Insider, Issue 50, December 6, 2013
Accurate time documentation is critical for drug administration coding because it can sometimes...
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APCs Insider, Issue 49, November 22, 2013
For many, this is the time of year when the latest updated rules, regulations, and payment rates...
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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...
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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...
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APCs Insider, Issue 45, October 25, 2013
Q: Some of our patients have multiple biopsies or aspirations during a procedure. The physician...
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APCs Insider, Issue 39, September 13, 2013
Q: We have started administering the flu vaccine using Fluzone, but the CPT® code has a...
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APCs Insider, Issue 36, August 23, 2013
Receiving a billing rejection can be frustrating, especially when you’re confident the...
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APCs Insider, Issue 34, August 9, 2013
Q: We perform a mammogram after a breast procedure, like placement of a needle localization wire or...
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APCs Insider, Issue 33, August 2, 2013
At first glance, CMS’ proposal to eliminate the device-to-procedure and procedure-to-device...
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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...
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APCs Insider, Issue 30, July 26, 2013
Q: Our physicians order a chest x-ray (CPT ® code 71010) after placing an endotracheal (ET...
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APCs Insider, Issue 29, July 19, 2013
Q: Our radiologists order a glucometer reading for every patient who undergoes a PET...
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HIM-HIPAA Insider, Issue 26, July 15, 2013
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X-NONE...
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APCs Insider, Issue 28, July 12, 2013
The first step to providing radiation oncology services is the initial patient exam. Coders should...
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APCs Insider, Issue 26, June 28, 2013
Q: Can we use the same functional G codes for all therapies?
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APCs Insider, Issue 21, May 24, 2013
Q: We are hitting an edit for claims containing the codes for placement of implantable...
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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...
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APCs Insider, Issue 20, May 17, 2013
The AMA revamped coding for molecular pathology beginning in 2012 and continuing in the 2013...
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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...
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APCs Insider, Issue 20, May 17, 2013
Why do some molecular pathology codes clearly list variants as examples, not an exclusive list...
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APCs Insider, Issue 19, May 10, 2013
The term "interactive complexity" means that the provision of psychiatric services has...
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APCs Insider, Issue 18, May 3, 2013
Q: We are receiving errors on our scrubber software that we haven’t seen...
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APCs Insider, Issue 16, April 19, 2013
One potential source of confusion for coding molecular pathology services involves the...
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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?
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APCs Insider, Issue 14, April 5, 2013
Hospitals reimbursement is declining all the time for a variety of reasons. Facilities may not be...
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APCs Insider, Issue 14, April 5, 2013
Q: Did CMS add any new drugs with pass through status in the April OPPS update?
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APCs Insider, Issue 14, April 5, 2013
The AMA included or revised the parenthetical notes following a number of CPT® codes for image...
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HIM-HIPAA Insider, Issue 11, April 1, 2013
In a new transmittal, CMS has unveiled updated national coverage determination (NCD) edits that...
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HIM-HIPAA Insider, Issue 11, April 1, 2013
Coders are preparing for big changes on October 1, 2014, with ICD-10-PCS implementation rolling...
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APCs Insider, Issue 13, March 29, 2013
Q: We heard that CMS will reduce payment for CPT® code 77371 (radiation treatment delivery...
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APCs Insider, Issue 13, March 29, 2013
CMS added two new modifiers to the anatomical modifiers that may be used under appropriate clinical...
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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...
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APCs Insider, Issue 12, March 22, 2013
Q: Has CMS established any new procedure codes for the April OPPS update?
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APCs Insider, Issue 12, March 22, 2013
CMS added two codes to the list of primary procedures reportable with add-on code 33225 (insertion...
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APCs Insider, Issue 11, March 15, 2013
Coders can follow a simple path to choose the correct code for a non-vascular interventional...
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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...
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APCs Insider, Issue 10, March 8, 2013
Q: Our physicians perform diagnostic interventional procedures in the head and neck, represented in...
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APCs Insider, Issue 9, March 1, 2013
HIM managers and coders know that accurate wound care coding starts long before the record hits to...
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APCs Insider, Issue 9, March 1, 2013
Q: Our physicians use fluoroscopy for many procedures and we have always reported the...
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APCs Insider, Issue 9, March 1, 2013
Codes for reporting the insertion of a ventricular assist device (VAD) are not new. However, the...
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APCs Insider, Issue 8, February 22, 2013
The AMA added two new CPT® codes for influenza vaccinations for 2013.
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APCs Insider, Issue 7, February 15, 2013
Q: We’ve just completed our yearly audit and the ED portion was pretty good. We did...
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APCs Insider, Issue 7, February 15, 2013
When specific communication factors are present that complicate the delivery of a psychiatric...
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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...
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APCs Insider, Issue 6, February 8, 2013
New CPT® codes are now available to report the provision of a transcatheter aortic...
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APCs Insider, Issue 5, February 1, 2013
During Wednesday's audio conference, Injections and Infusions: Review of Drug Administration...
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APCs Insider, Issue 5, February 1, 2013
New CPT codes are now available to report the provision of a transcatheter aortic valve...
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APCs Insider, Issue 4, January 25, 2013
Over the past two years the AMA has made significant additions to the molecular pathology CPT...
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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...
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APCs Insider, Issue 3, January 18, 2013
Q: Why would a hospital bother to bill the transitional care management (TCM) codes for the visit...
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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...
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APCs Insider, Issue 52, December 28, 2012
Q: When the AMA created all the new codes for the combination procedures, such as stent placement...
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APCs Insider, Issue 51, December 21, 2012
Q: We are applying modifiers to line items on claims to bypass the National Correct Coding...
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APCs Insider, Issue 50, December 14, 2012
Coding for observation services can be confusing and complicated. The following case study explains...
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APCs Insider, Issue 50, December 14, 2012
Q: We have been reporting services, such as chest x-rays and pulse oximetry, on critical care...
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APCs Insider, Issue 48, December 7, 2012
Q: Our physicians perform a bronchoscopy and scope both lungs. Lungs are bilateral...
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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...
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APCs Insider, Issue 45, November 16, 2012
Each facility should review its current reporting practices for critical care (CPT 99291) and the...
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APCs Insider, Issue 42, October 26, 2012
Q: After a recent audit, an auditor provided us with provided education on the splinting...
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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...
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CDI Strategies, Issue 22, October 25, 2012
A clear understanding of the definition of principal diagnosis and the factors that play into...
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APCs Insider, Issue 41, October 19, 2012
Q: Our wound care department receives skin substitutes, such as Apligraf, from our vendor free of...
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JustCoding News: Outpatient, Issue 42, October 17, 2012
Accurate reporting of observation services depends on a lot of factors. Deborah K. Hale, CCS, CCDS...
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JustCoding News: Outpatient, Issue 42, October 17, 2012
Hospital medicine is a specialty that provides inpatient services for patients admitted to the...
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APCs Insider, Issue 39, October 5, 2012
Q: Our ED physicians order both computed tomography (CT) and CT angiography (CTA) exams to insure...
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APCs Insider, Issue 37, September 21, 2012
Q: In the October OPPS update transmittal, they note that laparascopic bariatric surgery is...
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APCs Insider, Issue 36, September 14, 2012
CMS has not created national guidelines for determining an E/M service visit level, instead...
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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...
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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...
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APCs Insider, Issue 34, August 31, 2012
Q: We continually get requests from our billing office to change the fluoroscopy charges on our...
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APCs Insider, Issue 33, August 24, 2012
Medically unlikely edits (MUEs) represent the maximum number of units of a given service that a...
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JustCoding News: Outpatient, Issue 34, August 22, 2012
Some wounds and conditions don’t respond to conventional therapies and treatment modalities...
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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...
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JustCoding News: Outpatient, Issue 34, August 22, 2012
Q. When is it appropriate to append modifier -74 (procedures discontinued after anesthesia...
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APCs Insider, Issue 32, August 17, 2012
Q: We received a denial on a claim for Provenge® administration saying that the frequency had...
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APCs Insider, Issue 32, August 17, 2012
Historically, outpatient hospitals reported therapeutic sacroiliac joint (SI) joint injections...
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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...
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APCs Insider, Issue 30, August 3, 2012
Q: Since the AMA changed the instructions regarding hospital reporting of critical care services...
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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...
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APCs Insider, Issue 29, July 27, 2012
The removal of devitalized tissue is called selective debridement or active wound management...
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APCs Insider, Issue 28, July 20, 2012
Q: CMS consistently replaces established HCPCS codes for drugs with new ones. Did CMS...
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APCs Insider, Issue 28, July 20, 2012
Unlike subsequent infusions that run after an initial infusion, concurrent infusions run at the...
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HIM-HIPAA Insider, Issue 2, July 16, 2012
CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS...
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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...
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APCs Insider, Issue 27, July 13, 2012
Removal or release of simple adhesions is included in the general surgical package. If the...
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JustCoding News: Outpatient, Issue 28, July 11, 2012
An anesthesia provider faces plenty of challenges: cancelled anesthesia, failed medical direction...
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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...
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JustCoding News: Outpatient, Issue 28, July 11, 2012
Pain is an expected component of injuries, illnesses, and surgical procedures. In some instances...
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JustCoding News: Outpatient, Issue 28, July 11, 2012
QUESTION: Our laboratory medical director sent out a notification to our medical staff, patient...
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APCs Insider, Issue 26, July 6, 2012
Typically, coders will only report one initial service per visit, unless the patient has more than...
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JustCoding News: Outpatient, Issue 26, June 27, 2012
Chronic kidney disease (CKD) is the permanent alteration in the kidney’s ability to perform...
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JustCoding News: Outpatient, Issue 26, June 27, 2012
Emergency Departments (EDs) see a wide range of illnesses and injuries, from minor to major, which...
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JustCoding News: Outpatient, Issue 26, June 27, 2012
QUESTION: The vendor for our cochlear implants has stated it’s standard to provide our...
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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®...
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JustCoding News: Outpatient, Issue 24, June 13, 2012
In coding, sometimes it really is brain surgery and coders need a strong understanding of the...
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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...
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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...
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JustCoding News: Outpatient, Issue 22, May 30, 2012
Cardiac catheterization is a common procedure performed to study cardiac function and anatomy and...
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JustCoding News: Outpatient, Issue 22, May 30, 2012
Facilities can't bill for skin substitutes unless they also bill for a skin substitute application...
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APCs Insider, Issue 21, May 25, 2012
Normal
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APCs Insider, Issue 20, May 18, 2012
Q. Can you help resolve an ongoing debate in our department?
Patients come to our ED and...
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APCs Insider, Issue 18, May 4, 2012
Q: Did CMS revise the list of bilateral codes in the OPPS April update?
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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...
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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...
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JustCoding News: Outpatient, Issue 18, May 2, 2012
CMS instructed fiscal intermediaries (FI) and Medicare Administrative Contractors (MAC) to hold...
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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...
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JustCoding News: Outpatient, Issue 16, April 18, 2012
To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report...
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JustCoding News: Outpatient, Issue 16, April 18, 2012
As charges become more specific to provide additional concrete and transparent cost data, providers...
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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...
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APCs Insider, Issue 15, April 13, 2012
Q: We do not always receive payment for skin substitutes that we report. They appear in Addendum...
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JustCoding News: Inpatient, Issue 15, April 11, 2012
During the last year, the buzz from the health information management (HIM) and coding community...
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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...
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APCs Insider, Issue 13, March 30, 2012
Codes 0238T (transluminal peripheral atherectomy, including radiological supervision and...
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APCs Insider, Issue 12, March 23, 2012
Q: We continue to receive no payment for administering the drug Provenge®, CMS had said that...
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APCs Insider, Issue 11, March 16, 2012
Q: Our radiology department has begun billing for cancelled diagnostic procedures. For example, a...
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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...
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APCs Insider, Issue 10, March 9, 2012
Q: We have been reporting the CPT® code for vaccine administration (90471) when administering...
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APCs Insider, Issue 10, March 9, 2012
In 2002, CMS provided specific guidelines for understanding which self-administered drugs are...
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JustCoding News: Outpatient, Issue 10, March 7, 2012
Otolaryngology coding covers a wide range of procedures and four parts of the respiratory...
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JustCoding News: Outpatient, Issue 10, March 7, 2012
The January update to the Integrated Outpatient Code editor generally includes a large number of...
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JustCoding News: Outpatient, Issue 14, March 7, 2012
CMS continues to add more screening services to the list of covered preventative services. The...
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JustCoding News: Outpatient, Issue 10, March 7, 2012
QUESTION: If a physician performs a durotomy during an anterior cervical fusion, should we report...
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APCs Insider, Issue 8, March 2, 2012
Q: The AMA issued new CPT® drug administration services guidelines for reporting an initial...
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APCs Insider, Issue 8, March 2, 2012
Molecular pathology procedures are laboratory procedures that analyze nucleic acid to detect...
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JustCoding News: Outpatient, Issue 8, February 22, 2012
Payers are now looking to ensure that physician and facility billing match, which could mean new...
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JustCoding News: Outpatient, Issue 8, February 22, 2012
Drug delivery implants are designed to provide active pharmaceuticals to a targeted area in into...
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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...
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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...
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APCs Insider, Issue 7, February 17, 2012
Q. What new composites, if any, did CMS create for 2012?
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APCs Insider, Issue 7, February 17, 2012
The integumentary system subsection of the 2012 CPT® Manual includes nine new codes, 26 deleted...
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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...
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JustCoding News: Outpatient, Issue 6, February 8, 2012
CMS added modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly...
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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...
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APCs Insider, Issue 4, January 27, 2012
Q: The new guidelines for the integumentary system section state that CPT® codes...
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APCs Insider, Issue 4, January 27, 2012
CMS expects hospital charges to reflect the relative resources that are required to provide a...
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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...
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APCs Insider, Issue 3, January 20, 2012
Q: Addendum B of the APC updates for 2012 lists the new molecular pathology codes as status...
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APCs Insider, Issue 3, January 20, 2012
Percutaneous image-guided, minimally invasive lumbar decompression witha specially designed toolkit...
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APCs Insider, Issue 2, January 13, 2012
Q: Our billing office is concerned about reports that the OIG is auditing for appropriate use of...
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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...
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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...
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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...
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JustCoding News: Outpatient, Issue 2, January 11, 2012
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy...
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JustCoding News: Outpatient, Issue 2, January 11, 2012
QUESTION: The 2012 CPT® Manual includes the typical time physicians spend at the bedside and on...
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APCs Insider, Issue 51, December 23, 2011
A facility must provide patients an ABN when limits on liability (LOL) apply. LOL specifically...
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CDI Strategies, Issue 27, December 22, 2011
Most of the cases that HIM professionals code are straightforward; some are more difficult, and a...
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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...
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JustCoding News: Outpatient, Issue 50, December 14, 2011
Coders know to go through CPT® code changes each year, but they shouldn’t overlook the...
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JustCoding News: Outpatient, Issue 50, December 14, 2011
Emergency and trauma medicine is ever-changing, as illustrated in the development of the focused...
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JustCoding News: Outpatient, Issue 50, December 14, 2011
If a facility provides nondiagnostic outpatient services that are unrelated to an inpatient...
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APCs Insider, Issue 49, December 9, 2011
Q: Our radiologist attempted to perform a barium enema with air contrast. However, the radiologist...
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APCs Insider, Issue 49, December 9, 2011
Special billing rules apply when facilities receive devices for free or at a reduced cost. The OIG...
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APCs Insider, Issue 48, December 2, 2011
Q: Our hospital performs a lot of sleep testing, especially CPT® code 95810 (Polysomnography...
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CDI Strategies, Issue 25, December 1, 2011
Invest in computer-assisted coding (CAC) now because of its potential positive impact on...
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JustCoding News: Outpatient, Issue 48, November 30, 2011
Providers at ambulatory surgery centers (ASC) often perform shoulder and knee arthroscopic...
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JustCoding News: Outpatient, Issue 48, November 30, 2011
CMS reclassified HCPCS code C9406 as a radiopharmaceutical and added modifier -92 to the list of...
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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...
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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...
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APCs Insider, Issue 47, November 18, 2011
Q: I have been searching for the National Correct Coding Initiative (NCCI) guidelines update. I...
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APCs Insider, Issue 47, November 18, 2011
When a replacement device is provided at no cost, coders or another hospital staff member must...
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APCs Insider, Issue 46, November 11, 2011
Q: We provide IV fluids to our patients who undergo therapeutic phlebotomy procedures to replace...
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APCs Insider, Issue 46, November 11, 2011
Packaging is different from bundling—bundling is a coding concept, whereas packaging is a...
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APCs Insider, Issue 44, October 28, 2011
Q: Some physicians send patients to our hospital outpatient department with an order for...
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HIM-HIPAA Insider, Issue 43, October 25, 2011
Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM (Northern California Revenue...
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APCs Insider, Issue 43, October 21, 2011
Q: Physicians at our facility use allografts (e.g., GRAFTJACKET™) in surgical procedures such...
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APCs Insider, Issue 42, October 14, 2011
Q: Members of our hospital outpatient wound care department recently listened to our FI/MAC’s...
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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...
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APCs Insider, Issue 38, September 16, 2011
Q: Our MAC recently conducted a focused review based on CERT results concerning complete blood...
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APCs Insider, Issue 37, September 9, 2011
Q: A patient underwent an excision of large infected mass in our hospital outpatient surgery...
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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...
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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...
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APCs Insider, Issue 35, August 26, 2011
Upon completion of an audit, package it in a manner that provides meaningful, easy-to-follow...
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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...
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APCs Insider, Issue 33, August 19, 2011
When used appropriately, templates are good tools for any practice. Templates help promote the...
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APCs Insider, Issue 33, August 19, 2011
Should CMS require hospitals to report HCPCS codes for packaged services? This topic generated...
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APCs Insider, Issue 32, August 12, 2011
Q: Has CMS provided any updates regarding image-guided minimally invasive lumbar decompression...
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APCs Insider, Issue 32, August 12, 2011
Editor’s note: Kimberly Anderwood Hoy, JD, CPC, Director of Medicare and compliance at HCPro...
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APCs Insider, Issue 31, August 5, 2011
Q: Did CMS add any new HCPCS codes for hospital outpatient procedures effective July 1?
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APCs Insider, Issue 31, August 5, 2011
Report observation services with HCPCS code G0378 (observation services, per hour) under revenue...
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APCs Insider, Issue 30, July 29, 2011
When using a hysteroscope, physicians inflate the uterus with gas or fluid to obtain a better view...
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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®...
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HIM-HIPAA Insider, Issue 28, July 12, 2011
CMS released the 2012 outpatient prospective payment system (OPPS) proposed rule July 1. The...
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APCs Insider, Issue 27, July 8, 2011
Coders can use a decision tree to ensure they append modifier -59 (distinct procedural service...
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CDI Strategies, Issue 14, July 7, 2011
Q: I have been trying to determine whether a skin graft includes debridement. Based on what I...
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APCs Insider, Issue 24, June 17, 2011
Q: Some of our outpatient claims contain multiple charges reported with revenue code 0761...
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APCs Insider, Issue 22, May 27, 2011
Each quarter, CMS releases updates to the Integrated Outpatient Code Editor (I/OCE), with revisions...
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HIM-HIPAA Insider, Issue 19, May 10, 2011
Inpatient coders may lack familiarity with the ¬inpatient-only procedure list because CMS...
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APCs Insider, Issue 17, April 29, 2011
Q. We have an ongoing debate about modifier -59 (distinct procedural service). Some physicians...
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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...
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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...
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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...
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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...
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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...
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HIM-HIPAA Insider, Issue 12, March 22, 2011
If you haven't already considered adopting computer-assisted coding (CAC) software, there's no time...
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APCs Insider, Issue 10, March 11, 2011
Q: We are almost to the second quarter of 2011. Medicare often updates the Integrated Outpatient...
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APCs Insider, Issue 9, March 4, 2011
Q: We have been coding active wound care management based on the new 2011 narrative updates and...
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APCs Insider, Issue 9, March 4, 2011
The AMA continues to revise codes for the extracranial nerves, peripheral nerves, and autonomic...
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APCs Insider, Issue 8, February 25, 2011
Q: A note in the 2011 CPT® update states that facilities may now bill separately for services...
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APCs Insider, Issue 8, February 25, 2011
The AMA included a new subhead (Time) and guidelines for reporting time in the 2011 CPT®...
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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...
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HIM-HIPAA Insider, Issue 7, February 15, 2011
In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs...
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HIM-HIPAA Insider, Issue 7, February 15, 2011
MRB recently conducted its 2010 coder productivity benchmarking report. (Stay tuned for the...
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APCs Insider, Issue 6, February 11, 2011
Q: We noticed that the 2011 CPT® Manual under the main section Introduction includes a...
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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...
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APCs Insider, Issue 4, January 28, 2011
Q: The 2011 CPT® Manual includes code 0232T for injection(s), platelet rich plasma, any tissue...
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APCs Insider, Issue 4, January 28, 2011
Medicare recognizes the 2011 CPT® Manual’s drug administration codes, and hospitals...
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HIM-HIPAA Insider, Issue 4, January 25, 2011
HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...
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HIM-HIPAA Insider, Issue 3, January 18, 2011
HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...
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APCs Insider, Issue 2, January 14, 2011
Q: We have read the final OPPS 2011 rules. However, between publication of the rule and the...
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APCs Insider, Issue 1, January 7, 2011
Q: Did CMS provide any new updates for hyperbaric oxygen (HBO) therapy services for 2011?
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HIM-HIPAA Insider, Issue 1, January 4, 2011
HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...
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APC Answer Letter, Issue 1, January 1, 2011
Learn about reporting condition code 44, ED services, modifier -JW, modifier -58, modifier -78...
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APCs Insider, Issue 51, December 31, 2010
Q: I’ve been working through the new 2011 CPT® codes. I’m finding that not every...
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APCs Insider, Issue 51, December 31, 2010
If you aren’t preparing for the RACs now, you should be. Although much attention is being...
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HIM-HIPAA Insider, Issue 51, December 28, 2010
HCPro is conducting in-depth research into coder productivity, and we value your input. The survey...
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APCs Insider, Issue 50, December 17, 2010
Facilities need to start planning for IT obstacles that may arise during the transition from...
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APCs Insider, Issue 48, December 3, 2010
Q: Did CMS make any more changes to critical care coding for 2011?
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APC Answer Letter, Issue 12, December 1, 2010
Learn about reporting ED services, injections and infusions, medication therapy, observation...
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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...
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APCs Insider, Issue 47, November 19, 2010
In ICD-10-CM, clinicians may use the Glasgow coma scale codes that follow in conjunction with...
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HIM-HIPAA Insider, Issue 44, November 9, 2010
CMS finalized four changes to its physician supervision requirements as part of the 2011 OPPS final...
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APCs Insider, Issue 45, November 5, 2010
Q: Did CMS remove any more procedures from the inpatient-only list for 2011?
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APCs Insider, Issue 45, November 5, 2010
Which type of ED your facility operates will determine which codes you assign. EDs are classified...
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APC Answer Letter, Issue 11, November 1, 2010
Learn about reporting condition code 44, E/M services, visit levels, injections and infusions...
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APCs Insider, Issue 44, October 29, 2010
Q: People in our hospital use the terms “bundling” and “packaging&rdquo...
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APCs Insider, Issue 44, October 29, 2010
Coders may struggle to determine when to use modifier -58 (staged or related procedure or service...
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APCs Insider, Issue 43, October 22, 2010
Q: Is CMS still denying all line items with modifier -GA?
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APCs Insider, Issue 43, October 22, 2010
Modifier -52 (reduced services) indicates that a service was partially reduced or eliminated at a...
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APCs Insider, Issue 42, October 15, 2010
Q: An inpatient is converted to outpatient status using condition code 44. Assuming the patient...
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APCs Insider, Issue 42, October 15, 2010
Knowing when to append a modifier can challenge even the most experienced coder. Coders need to...
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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...
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APC Answer Letter, Issue 10, October 1, 2010
Learn about reporting ED services, injections and infusions, lumbar procedures, modifier -25...
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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...
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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...
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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...
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APCs Insider, Issue 39, September 24, 2010
Each National Correct Coding Edits table contains edits, which are pairs of codes that, in general...
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APCs Insider, Issue 37, September 10, 2010
Q: We’ve been hearing about CPT modifier -JW (drug amount discarded/not administered to any...
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APCs Insider, Issue 37, September 10, 2010
Designating a patient as new or established depends on whether the patient has been registered as...
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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...
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CDI Strategies, Issue 18, September 2, 2010
Confusing coding guidelines and insufficient documentation have made neoplasms a target area as...
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APC Answer Letter, Issue 9, September 1, 2010
Inside:
Learn about reporting ESRD, HBO therapy, HIV, injections and infusions, modifier -25...
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APCs Insider, Issue 35, August 27, 2010
Percutaneous transluminal coronary angioplasty is a nonsurgical procedure that involves inserting a...
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APCs Insider, Issue 34, August 20, 2010
Q. A Medicare patient is admitted for same-day surgery. After surgery, the physician orders...
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APCs Insider, Issue 34, August 20, 2010
Stents used for percutaneous coronary interventions can be either bare-metal or drug-eluting...
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APCs Insider, Issue 33, August 13, 2010
Q: Compliance staff at the central billing office of our OPPS hospital have indicated a potential...
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JustCoding News: Outpatient, Issue 12, August 11, 2010
Providers must understand the signature guidelines outlined in MedLearn Matters article 6698 and...
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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...
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APC Answer Letter, Issue 8, August 1, 2010
Learn about coding ED visits, injections and infusions, packaged drugs, radiology services, and...
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APCs Insider, Issue 31, July 30, 2010
Q: For extended recovery time, the patient stayed longer than 10 hours after surgery. Should we add...
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APCs Insider, Issue 31, July 30, 2010
CMS has not yet implemented national E/M guidelines for hospitals. However, it requires that every...
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APCs Insider, Issue 30, July 23, 2010
Q: How should we bill a patient for a six-hour chemotherapy infusion? The patient occupies an...
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APCs Insider, Issue 30, July 23, 2010
Although -RT and -LT are the most common modifiers used for pain management, coders may need to...
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APCs Insider, Issue 29, July 16, 2010
Q: A patient is admitted as an inpatient, but the utilization review committee determines that the...
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APCs Insider, Issue 29, July 16, 2010
Bilateral procedures can be a challenge to coders, especially when modifiers accompany procedure...
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HIM-HIPAA Insider, Issue 27, July 13, 2010
CMS continues to refine the physician supervision requirements for diagnostic and therapeutic...
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APCs Insider, Issue 28, July 9, 2010
Q: A GE Lab hospital has its own separately identifiable recovery room setting. Is it appropriate...
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APCs Insider, Issue 28, July 9, 2010
Modifier -25 indicates a “significant, separately identifiable E/M service by the same...
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APCs Insider, Issue 27, July 2, 2010
The AMA’s CPT Assistant advises in its December 2004 issue not to report code 30930 (fracture...
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Briefings on APCs, Issue 7, July 1, 2010
Many HIM professionals, coders, and billers continue to struggle with correct coding for injections...
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Briefings on APCs, Issue 7, July 1, 2010
The technical nature of the CPT coding system can be very challenging for coding specialists, and...
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Briefings on APCs, Issue 7, July 1, 2010
As reimbursement for complex pain management continues to decrease, your coding must drive accurate...
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Briefings on APCs, Issue 7, July 1, 2010
A patient comes into your outpatient facility for a minor surgical procedure and the physician...
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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...
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APC Answer Letter, Issue 7, July 1, 2010
Learn about NCCI and coding scenarios involving condition code 44, the ED, injections and...
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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...
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APCs Insider, Issue 26, June 25, 2010
Determine which modifiers, if any, you have hard-coded into your chargemaster. In some situations...
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APCs Insider, Issue 25, June 18, 2010
Q: When the nurses access an interosseous line to infuse medication, is there an infusion code we...
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APCs Insider, Issue 25, June 18, 2010
Hyperbaric oxygen (HBO) therapy is a relatively new service, so the various MACs and FIs interpret...
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APCs Insider, Issue 24, June 11, 2010
Q: How should we report the administration of therapeutic drugs in two separate lines connected to...
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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.
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HIM-HIPAA Insider, Issue 22, June 8, 2010
Certain modifiers are well-known as being difficult for coders. (Modifier -59, anyone?) Others...
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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...
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APCs Insider, Issue 23, June 4, 2010
Staff members in numerous areas of a facility may be appending modifiers. Consider establishing a...
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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...
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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...
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APC Payment Insider, Issue 6, June 1, 2010
Hyperbaric oxygen (HBO) therapy is a relatively new service, meaning different MACs and FIs...
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APC Answer Letter, Issue 6, June 1, 2010
Learn about coding scenarios involving the ED, injections and infusions, observation, orthopedics...
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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...
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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...
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Briefings on APCs, Issue 6, June 1, 2010
When CMS released its physician supervision requirements as part of the 2010 OPPS final rule...
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Briefings on APCs, Issue 6, June 1, 2010
Hyperbaric oxygen (HBO) therapy is a relatively new service, meaning different MACs and FIs...
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Briefings on APCs, Issue 6, June 1, 2010
In this month's issue, we detail the importance of prequalifying patients for hyperbaric oxygen...
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HIM-HIPAA Insider, Issue 21, June 1, 2010
Motivation HIM department staff members is important because it affects performance. It is the...
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HIM-HIPAA Insider, Issue 21, June 1, 2010
Many reasons justify establishing an internal auditing program. An organization may have a...
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HIM-HIPAA Insider, Issue 20, May 25, 2010
Coders should use modifiers -73 and -74 to report discontinued outpatient procedures. Modifier -73...
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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...
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APCs Insider, Issue 21, May 21, 2010
In one-time notification R617OTN, CMS notes that organizations can report reasonable and necessary...
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APCs Insider, Issue 20, May 14, 2010
Q: Is reporting modifier –GZ (item or service expected to be denied as not reasonable and...
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HIM-HIPAA Insider, Issue 18, May 11, 2010
Aside from being a catchy acronym, PEPPER (Program for Evaluating Payment Patterns Electronic...
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Briefings on APCs, Issue 5, May 1, 2010
CMS representatives discussed the three-day rule and pulmonary rehab supervision during a Hospital...
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Briefings on APCs, Issue 5, May 1, 2010
A therapist spends five minutes performing an ultrasound and performs 20 minutes of therapeutic...
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Briefings on APCs, Issue 5, May 1, 2010
Inside: Complex compendia rules complicate reimbursement Now on the to-track list: Medically...
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APC Payment Insider, Issue 5, May 1, 2010
A therapist spends five minutes performing an ultrasound and performs 20 minutes of therapeutic...
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APC Payment Insider, Issue 5, May 1, 2010
In this issue, we explain how CMS’ decision to denial units in excess of medically unlikely...
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HIM-HIPAA Insider, Issue 15, April 20, 2010
In the May issue of MRB, you’ll find the following articles, and more!
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APCs Insider, Issue 16, April 16, 2010
Some therapies are considered edited pairs and are not billable on the same date of service unless...
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APCs Insider, Issue 16, April 16, 2010
Q: How should we report DERMABOND® wound repair? Does this differ depending on whether the...
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CDI Strategies, Issue 8, April 15, 2010
Effective January 1, 2011, CMS is expanding the number of ICD-9 diagnosis and procedure codes...
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HIM-HIPAA Insider, Issue 13, April 6, 2010
Coding managers often conduct internal audits, but other alternatives exist. Some organizations...
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APCs Insider, Issue 13, April 2, 2010
Q: I have a question pertaining to APCs Weekly Monitor’s advice published March 12...
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APC Payment Insider, Issue 4, April 1, 2010
To take advantage of the new Medicare benefits for cardiac and pulmonary rehab services, coders...
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APC Payment Insider, Issue 4, April 1, 2010
In this issue, we explain the necessity of differentiating between mandatory and voluntary ABNs and...
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Briefings on APCs, Issue 4, April 1, 2010
In an environment of increasing audits, hospitals must monitor and resolve drug administration...
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Briefings on APCs, Issue 4, April 1, 2010
When an outpatient physical therapist provides exercise using land- and water-based therapy to the...
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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...
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APCs Insider, Issue 12, March 26, 2010
Q: A physician orders one dose of a medication to be administered intramuscularly (IM) or...
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APCs Insider, Issue 12, March 26, 2010
CMS introduced NCCI edits for outpatient therapy in 1996 to prevent improper payment when...
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APCs Insider, Issue 12, March 26, 2010
In 2003 HCPro, Inc., Nimitt Consulting, Inc., and 3M Health Information Systems joined forces to...
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HIM-HIPAA Insider, Issue 11, March 23, 2010
Memorial Hermann Healthcare System (MHHS) in Houston includes nine acute care hospitals, one...
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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...
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HIM-HIPAA Insider, Issue 10, March 16, 2010
Divisions between HIM and clinical documentation improvement (CDI) staff members are common. But in...
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APCs Insider, Issue 10, March 12, 2010
Q: Should we use CPT modifier -59 (distinct procedural service) for a preoperative EKG performed on...
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APCs Insider, Issue 10, March 12, 2010
CMS’ decision allowing facilities to voluntarily provide patients with an ABN for statutorily...
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APCs Insider, Issue 9, March 5, 2010
One challenge for coding drugs is ensuring that you code them according to their descriptions...
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CDI Strategies, Issue 5, March 4, 2010
Q: Do you code the procedure for tissue plasminogen activator (tPA) administration when it is done...
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HIM-HIPAA Insider, Issue 8, March 2, 2010
CMS is taking a closer look at admissions to inpatient rehabilitation facilities (IRF) thanks to...
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HIM Briefings, Issue 3, March 1, 2010
Sarah Bush Lincoln Health Center in Mattoon, IL developed a productivity incentive plan for their...
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HIM Briefings, Issue 3, March 1, 2010
This month's issue includes an article on EHR meaningful use standards and what hospitals should do...
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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...
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Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010
In this issue, we detail how to ensure compliance and date accuracy by auditing...
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APCs Insider, Issue 8, February 26, 2010
Q: If a physical performance test is conducted (97750, physical performance test or measurement...
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APCs Insider, Issue 7, February 19, 2010
Q: Which revenue code should we use to report wound care if an occupational therapist or physical...
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APCs Insider, Issue 7, February 19, 2010
All Medicare patients with moderate, severe, or very severe classifications of chronic obstructive...
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CDI Strategies, Issue 4, February 18, 2010
by Robert S. Gold, MD
Every so often, I come across some coding issues that recall other...
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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...
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HIM-HIPAA Insider, Issue 5, February 9, 2010
HIM directors can evaluate their hospital’s potential risk for overcoding and unnecessary...
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HIM-HIPAA Insider, Issue 5, February 9, 2010
In the March issue of MRB, you’ll find the following articles, and more!
EHR beat...
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APCs Insider, Issue 4, February 5, 2010
The revised CPT codes for hemorrhoids may be problematic for coders. Avoid confusion by developing...
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APC Payment Insider, Issue 2, February 1, 2010
CMS adopted a new standard for supervision of therapeutic services provided in a hospital or...
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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...
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Briefings on APCs, Issue 2, February 1, 2010
If your healthcare organization doesn’t require a physician signature on all orders for...
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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...
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Briefings on APCs, Issue 2, February 1, 2010
Three changes in diagnostic and interventional radiology will require coders to rethink how they...
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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...
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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...
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APCs Insider, Issue 2, January 15, 2010
Q: We submitted claims to Medicare for the H1N1 flu vaccine using CPT code 90470 (H1N1 immunization...
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APCs Insider, Issue 2, January 15, 2010
Training employees is the important thing employers can do to prevent “never events.”
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APCs Insider, Issue 1, January 8, 2010
Q: All of a sudden we are receiving recoupments for some lab work we performed. The information...
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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...
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Briefings on APCs, Issue 1, January 1, 2010
CMS’ recent national coverage determination (NCD) is fairly straightforward, spelling out...
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Briefings on APCs, Issue 1, January 1, 2010
CMS adopted a new standard for supervision of therapeutic services provided in a hospital or...
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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...
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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...
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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, Issue 1, January 1, 2010
In this issue examine how to properly assign modifiers. This issue also contains our index of 2009...
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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...
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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...
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APCs Insider, Issue 48, December 11, 2009
Q: Can we code bladder catheterizations when a urine specimen is obtained for an analysis and the...
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APCs Insider, Issue 48, December 11, 2009
Physicians sometimes decide to perform surgery in stages. These situations involve a planned return...
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HIM-HIPAA Insider, Issue 49, December 8, 2009
Connolly Healthcare has announced the first issues approved for complex RAC review, so providers in...
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APCs Insider, Issue 47, December 4, 2009
Procedural modifiers can provide a wealth of information to further describe services provided...
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APC Payment Insider, Issue 12, December 1, 2009
In this issue examine how to properly bill for supplies to eliminate lost revenue.
Inside...
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Briefings on APCs, Issue 12, December 1, 2009
If you thought you understood CMS’ policy when it comes to physician orders for clinical...
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Briefings on APCs, Issue 12, December 1, 2009
Proper modifier use is a critical part of coding, billing, and reimbursement. Currently, coders can...
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Briefings on APCs, Issue 12, December 1, 2009
Understand how to sift through detailed OB/GYN operative notes to ensure accurate code assignment.
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Briefings on APCs, Issue 12, December 1, 2009
In this issue, we examine outpatient coding challenges that facilities are still facing. We unravel...
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CDI Strategies, Issue 24, November 26, 2009
The American Hospital Association’s Coding Clinic for ICD-9-CM contains official advice from...
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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...
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APCs Insider, Issue 46, November 20, 2009
When coding OB/GYN procedures, remember that ICD-9 codes 630–679 in Chapter 11 (Complications...
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APCs Insider, Issue 46, November 20, 2009
Q: Can our hospital code and bill telemetry daily monitoring in conjunction with a chest pain...
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HIM-HIPAA Insider, Issue 46, November 17, 2009
Clinical knowledge is an essential element for capturing severity and MS-DRG assignment, according...
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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...
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APCs Insider, Issue 45, November 13, 2009
When considering ways to reduce revenue loss at your facility, don’t look just for big-dollar...
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HIM-HIPAA Insider, Issue 45, November 10, 2009
The 2010 OPPS final rule released on October 30 contains few surprises, but does finalize two...
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APCs Insider, Issue 44, November 6, 2009
Q. Several of our facilities that include hospital-based outpatient wound care clinics have...
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APCs Insider, Issue 44, November 6, 2009
If you perform a level IV surgical pathology (88305) on more than one specimen from the same...
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APC Payment Insider, Issue 11, November 1, 2009
Learn how to correctly use modifier -59 and when to avoid it.
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APC Payment Insider, Issue 11, November 1, 2009
Given the continuing confusion, what can facilities do to handle MUEs?
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APC Payment Insider, Issue 11, November 1, 2009
In this issue we unravel the mysteries surrounding medically unlikely edits.
Inside:
&bull...
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Briefings on APCs, Issue 11, November 1, 2009
Our experts answer questions about the appropriate use of modifier -59.
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Briefings on APCs, Issue 11, November 1, 2009
Condition code 44, billing for radiopharmaceuticals highlight I/OCE changes
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Briefings on APCs, Issue 11, November 1, 2009
This issue features the second part of our series on physician supervision requirements for...
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APCs Insider, Issue 43, October 30, 2009
Q. A patient who has undergone a kidney transplant and has plasmapheresis intravenously receives IV...
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APCs Insider, Issue 42, October 23, 2009
Q: A patient with multiple wounds at different sites receives active wound management at one wound...
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APCs Insider, Issue 42, October 23, 2009
Facilities need to have a clear understanding of when a procedure is diagnostic and when it is...
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APCs Insider, Issue 41, October 16, 2009
Q: We don’t have the usual written orders for several tests. However, physicians dictate or...
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APCs Insider, Issue 41, October 16, 2009
In FAQ 8736, CMS instructs hospitals how to report units in excess of the medically unlikely edits...
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APCs Insider, Issue 40, October 9, 2009
Coding a screening colonoscopy should be relatively straightforward. However, the interpretation of...
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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...
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APCs Insider, Issue 39, October 2, 2009
How can your facility ensure compliance with the physician supervision requirements for diagnostic...
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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...
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APC Payment Insider, Issue 10, October 1, 2009
CMS proposes new methodology to calculate drug APC payment rates.
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APC Payment Insider, Issue 10, October 1, 2009
Proposed changes to outpatient supervision could be a huge boon.
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Briefings on APCs, Issue 10, October 1, 2009
Coders must understand what constitutes a ‘screening’ colonoscopy.
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Briefings on APCs, Issue 10, October 1, 2009
Given the continuing confusion, what can facilities do to handle MUEs?
-
Briefings on APCs, Issue 10, October 1, 2009
This issue features the first part of our series on physician supervision requirements for...
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APCs Insider, Issue 38, September 25, 2009
CMS created medically unlikely edits (MUEs) to ensure that providers don’t report excessive...
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APCs Insider, Issue 38, September 25, 2009
Q: Is elective cardioversion code 92960 billable in the ED? For example, a patient presents in the...
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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...
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APCs Insider, Issue 37, September 18, 2009
Under the 2009 OPPS final rule, bundling is now subdivided into status indicators Q1, Q2, and Q3.
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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...
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APCs Insider, Issue 36, September 11, 2009
To distinguish between bundled and packaged services, remember that bundling applies to coding and...
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APCs Insider, Issue 35, September 5, 2009
Q. A physician orders one dose of a medication to be administered intramuscularly (IM) or...
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APCs Insider, Issue 35, September 4, 2009
In its 2010 OPPS proposed rule, CMS acknowledges never having specifically defined...
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CDI Strategies, Issue 18, September 3, 2009
Following a targeted review of 250 claims with DRG 247, TrailBlazer, the Medicare Administrative...
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CDI Strategies, Issue 18, September 3, 2009
Editor’s Note: The following tip was excerpted from the article “Tips for problematic...
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CDI Strategies, Issue 18, September 3, 2009
Editor’s note: The following Q&A first appeared in the August 20, 2009, edition of CDI...
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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...
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Briefings on APCs, Issue 9, September 1, 2009
The text portion of the 2010 OPPS proposed rule is shorter than previous years’ rules, and...
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Briefings on APCs, Issue 9, September 1, 2009
Proposed changes to outpatient supervision could be a huge boon.
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Briefings on APCs, Issue 9, September 1, 2009
CMS proposes new methodology to calculate drug APC payment rates.
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Briefings on APCs, Issue 9, September 1, 2009
Several items of interest to OPPS hospitals from Open Door Forum call.
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Briefings on APCs, Issue 9, September 1, 2009
Q status indicators add to packaged vs. bundled confusion.
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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...
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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...
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APC Payment Insider, Issue 9, September 1, 2009
CMS revised language to clarify outpatient observation services.
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APC Payment Insider, Issue 9, September 1, 2009
Physician can’t cross lesion to place noncoronary stent
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APC Payment Insider, Issue 9, September 1, 2009
What should you do if a physician can’t complete the procedure?
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APC Payment Insider, Issue 9, September 1, 2009
What should you do if a physician can’t complete the procedure?
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APC Payment Insider, Issue 9, September 1, 2009
Is charging a patient for a low level facility visit appropriate?
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APC Payment Insider, Issue 9, September 1, 2009
Make sure you include CPT and HCPCS codes for drugs
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APC Payment Insider, Issue 9, September 1, 2009
Know when to report an IV push of the same substance in ER
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APCs Insider, Issue 32, August 21, 2009
Q: How should we code the following scenario: A patient arrives at the catheterization laboratory...
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APCs Insider, Issue 31, August 13, 2009
Q: Is there a limit on how frequently patients may receive PET scans, such as 78815 (Tumor...
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APCs Insider, Issue 31, August 13, 2009
No national guidelines for E/M leveling exist, so facilities must develop their own.
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APCs Insider, Issue 30, August 7, 2009
Q. An APC edit states that 93005 (electrocardiogram, routine EKG with at least 12 leads; tracing...
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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...
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HIM-HIPAA Insider, Issue 31, August 4, 2009
On July 10, CMS issued Transmittal 1767 to change the description for revenue code 076X. The...
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HIM-HIPAA Insider, Issue 31, August 4, 2009
Despite several industry groups’ efforts to advocate for a moratorium on physician...
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Briefings on APCs, Issue 8, August 1, 2009
Facilities are failing to meet medical necessity requirements
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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...
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APC Payment Insider, Issue 8, August 1, 2009
In this issue we look at six questions you should ask when you evaluate coder productivity...
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APCs Insider, Issue 29, July 31, 2009
Q: What are the guidelines for physician supervision for physical therapy/occupational therapy and...
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APCs Insider, Issue 28, July 24, 2009
Q: I work in a hospital outpatient clinic setting. Has CMS issued a deadline for developing...
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APCs Insider, Issue 28, July 24, 2009
Providers must ensure the medical necessity of procedures they perform. To reduce revenue loss...
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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...
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APCs Insider, Issue 28, July 17, 2009
When setting productivity goals, don’t forget to include non-coding responsibilities when...
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HIM-HIPAA Insider, Issue 28, July 14, 2009
Outpatient facilities and pharmacies hoping to see an increase in reimbursement for separately...
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APCs Insider, Issue 27, July 10, 2009
Q: Which CPT code is appropriate for blood glucose monitoring with a device such as...
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APCs Insider, Issue 26, July 3, 2009
Q: My question pertains to CPT code 96376 (therapeutic, prophylactic, or diagnostic injection...
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APC Payment Insider, Issue 7, July 1, 2009
In this issue we look at CMS’ recent decision to expand coverage of testing for obstructive...
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Briefings on APCs, Issue 7, July 1, 2009
For years, it has been a challenge for healthcare facilities to determine whether Medicare will...
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Briefings on APCs, Issue 7, July 1, 2009
As the current economic climate continues to constrict cash flow for consumers and payers alike...
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Briefings on APCs, Issue 7, July 1, 2009
In this issue, you will find information about how your facility can increase its revenue by...
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APCs Insider, Issue 25, June 26, 2009
Q: How should we report hydration services that run past midnight into the next calendar day along...
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APCs Insider, Issue 25, June 26, 2009
Establishing coding productivity standards is a necessary and challenging aspect of managing an...
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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...
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APCs Insider, Issue 23, June 12, 2009
Q: Please clarify the overlap between CPT code 97760 and the L-code. Precisely, when and...
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Briefings on APCs, Issue 6, June 1, 2009
CMS released its April 2009 quarterly update to the integrated outpatient code editor on March 13.
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Briefings on APCs, Issue 6, June 1, 2009
With increased ED volume and the demands of more complete documentation, now is the time to...
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Briefings on APCs, Issue 6, June 1, 2009
Inside:
Go electronic to improve compliant charge capture
Strong documentation puts OSA coverage...
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APC Payment Insider, Issue 6, June 1, 2009
CMS discussion of direct supervision requirements likely to spark more questions.
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APC Payment Insider, Issue 6, June 1, 2009
In this issue, we cover CMS’ updated clarifications regarding incident-to services and looks...
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APCs Insider, Issue 21, May 29, 2009
Q: The nurse practitioner (NP) and physician assistant (PA) staff the off-campus clinic with...
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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?
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APCs Insider, Issue 20, May 22, 2009
The 2009 OPPS final rule further divided the Q status indicator into three subcategories, with...
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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...
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Briefings on APCs, Issue 5, May 1, 2009
Q. Is it appropriate to assign an IV injection code when facility nursing documentation does not...
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Briefings on APCs, Issue 5, May 1, 2009
Hospitals looking for more discussion about CMS? recent clarification of the direct supervision...
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Briefings on APCs, Issue 5, May 1, 2009
In 2008, CMS greatly expanded the number of packaged items and services payable under the OPPS...
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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...
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Briefings on APCs, Issue 5, May 1, 2009
Inside:
Solve the twin problems of ED revenue loss and compliance risk
Overcome critical care...
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APC Answer Letter, Issue 5, May 1, 2009
Inside:
Blood procedures: Code correctly when the only service is specimen collection via...
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APC Payment Insider, Issue 5, May 1, 2009
Inside: Watch for changing physician supervision requirements: today’s oversight may be...
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APCs Insider, Issue 18, May 1, 2009
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false
false
false...
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APCs Insider, Issue 16, April 17, 2009
How you report what appear to be multiple initial scenarios depends on the documentation in the...
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APCs Insider, Issue 16, April 17, 2009
Everyone knows that an immense amount of teamwork is necessary for a CDI program to truly be...
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APCs Insider, Issue 16, April 17, 2009
Christina Benjamin, MA, RHIA, CCS, CCS-P, presents several compliance traps that coders should...
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APCs Insider, Issue 14, April 3, 2009
An increase in the Medicare payment for bilateral procedures with a status indicator of T slipped...
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APC Answer Letter, Issue 4, April 1, 2009
Inside:
Charging for multiple ventricular leads
Quick coding quiz
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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...
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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...
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Briefings on APCs, Issue 4, April 1, 2009
Five successive pieces of CMS guidance in the past year have altered the landscape. They are...
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APC Payment Insider, Issue 4, April 1, 2009
Inside: Control charge compression by knowing your costs, because consumer reaction may cost you...
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APC Payment Insider, Issue 4, April 1, 2009
Assuming you meet all other documentation and trauma status criteria, you may report the trauma...
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Briefings on APCs, Issue 4, April 1, 2009
Inside:
Watch for changing physician supervision requirements
Few changes to date in HCPCS...
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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...
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APCs Insider, Issue 11, March 13, 2009
The NCCI manual instructions state that:
Procedures routinely performed as part of a comprehensive...
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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...
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APC Answer Letter, Issue 3, March 1, 2009
Inside:
DME licenses
Giving supplies away? Here’s how to become a supplier
Nonchemotherapy...
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APC Payment Insider, Issue 3, March 1, 2009
Inside: CMS opens the door to outpatient HAC program CPT checkup: Review the major changes for...
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APC Payment Insider, Issue 3, March 1, 2009
At a December 18, 2008, listening session, CMS presenters discussed possibilities for extending the...
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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
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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...
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APCs Insider, Issue 6, February 6, 2009
New CMS guidance describes the processes for using unlisted CPT codes.
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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...
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APCs Insider, Issue 5, January 30, 2009
Q&A: Why drug administration CPT codes are not hitting CCI edits.
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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.
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HIM-HIPAA Insider, Issue 2, January 13, 2009
CMS revised its July 2008 RAC appeal update to include appeals statistics through August 31, 2008.
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APCs Insider, Issue 2, January 9, 2009
The AMA has updated its list of errata to the 2009 CPT Manual.
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APCs Insider, Issue 1, January 2, 2009
CPT coders face a lengthy list of changes for 2009. According to the American Academy of...
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APC Answer Letter, Issue 1, January 1, 2009
Inside:
Blood draw via hep lock
Cardiac catheterization: LIMA visualization
Fluoroscopy for...
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APCs Insider, Issue 52, December 26, 2008
How to submit facility critical care claims for 2009
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APCs Insider, Issue 50, December 12, 2008
For 2009, hospitals must continue to use their internally developed guidelines for ED and clinic...
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Coding Educator, Issue 12, December 1, 2008
December is national hand washing month. It does seem like there is a season for everything, but...
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APCs Insider, Issue 47, November 14, 2008
You may report EKGs performed before or after cardiac catheterization with modifier -59. You cannot...
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APCs Insider, Issue 46, November 7, 2008
Charge CPT procedure codes to inpatients under certain conditions
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Briefings on APCs, Issue 11, November 1, 2008
Differentiate transfers, flaps, and grafting procedures, and make use of new codes and any trick to...
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APCs Insider, Issue 45, October 31, 2008
Use revenue code plus CPT, without HCPCS, to bill albuterol or Duoneb via nebulizer
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APCs Insider, Issue 42, October 17, 2008
Dispel the assumption that an integumentary code is the only solution. Decipher complex repairs and...
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Briefings on APCs, Issue 10, October 1, 2008
On June 18, CMS issued MLN Matters article SE0821, a reminder that Medicare pays for diabetes...
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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...
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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...
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APCs Insider, Issue 39, September 26, 2008
Q&A: Follow the infusion hierarchy, not chronological order of administration, when reporting...
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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...
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APCs Insider, Issue 36, September 5, 2008
Q: Is it inappropriate to bill all self-administered drug (SAD) charges as integral to a procedure...
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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...
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APCs Insider, Issue 35, August 29, 2008
Report CPT code 45331 when a physician performs a sigmoidoscopy with biopsy. This code is...
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Coding Educator, Issue 8, August 1, 2008
Children do not come with instruction manuals, but there are many books available to help us along...
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APCs Insider, Issue 24, June 13, 2008
There are many legitimate uses for modifier -59. But, with drug administration, as with other types...
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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...
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APCs Insider, Issue 22, May 30, 2008
Report code 90772 (therapeutic, prophylactic or diagnostic injection; subcutaneous of...
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APCs Insider, Issue 21, May 23, 2008
Do CMS and the Office of Inspector General (OIG) consider the intentional unbundling of codes to be...
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APCs Insider, Issue 20, May 16, 2008
We are negotiating to provide pain stimulator services. We will report code 63650 for the trial and...
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APCs Insider, Issue 19, May 9, 2008
Lingering coding and billing difficulties, 2008 CPT/HCPCS changes, and OIG scrutiny promise to keep...
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APCs Insider, Issue 19, May 2, 2008
We have had claims rejected for nuclear medicine procedures when we report both a procedure and a...
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APCs Insider, Issue 18, May 2, 2008
It is not acceptable to make assumptions about duration of drug infusion therapy solely based on...
