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APCs Insider

This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations. Topics include the outpatient code editor (OCE), complex coding issues, beneficiary co-payment discounting, and cross-department APCs tracking.

2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2001

Issue 47, December 18, 2015

Outpatient coding, billing errors continue to lead to majority of automated denials
Outpatient coding and billing errors lead to more than half of all automated denials by Recovery...
Q&A: Prepare for requirements when reporting biosimilars
Q: Last week, you said there is a code for reporting the biosimilar for filgrastim. How is CMS...
Tip: Check claims submitted during the ICD-10 transition
Providers should also make sure claims submitted over the ICD-10 transition date of October 1 are...
Trivia
Which U.S. president attempted to ban Christmas trees at the White House in a bid to encourage...

Issue 46, December 11, 2015

CMS gives providers a chance to comment on 2-midnight rule payment methodology
Small tweaks to the 2-midnight rule in the 2016 OPPS final rule should help providers, but a...
Q&A: Which code do I use to report a biosimilar of filgrastim?
Q: Our doctors have started prescribing a form of filgrastim that the pharmacy tells me is called a...
Tip: Determine whether an urgent care center needs to report modifier -PO
Hospital-owned urgent care centers are subject to modifier -PO (services, procedures and/or...
Pay-per-view: NCCI logic could lead to no payment for claims including comprehensive APCs
Providers need to be careful when reporting multiple services with status indicator J1 on the same...
Trivia
Who was once given a key to the city of Detroit?

Issue 45, December 4, 2015

CMS adds 10 new comprehensive APCs for 2016
CMS did not change the logic for comprehensive APCs (C-APC) or complexity adjustments in the 2016...
Q&A: How will CMS handle device edits related to procedures in 2016?
Q: Is CMS going to resurrect the device-to-procedure and procedure-to-device edits for 2016? They...
Tip: CMS issues revision of October I/OCE update
CMS issued a revision of the October 2015 I/OCE update that included changes for HCPCS code Q5101...
Pay-per-view: Making sense of modifier -PO
Provider-based clinics and departments are increasingly common, but the rules for provider-based...
Trivia
Which property on the Monopoly board is misspelled?

Issue 44, November 20, 2015

Are you ready for modifier -CT in 2016?
As providers work to implement policies and regulations introduced by CMS in the 2016 OPPS final...
Q&A: Requirements for reporting value code FD
Q: Are we still required to report value code FD (credit received from the manufacturer for a...
Tip: Leveraging technology to manage ICD-10 implementation
Technology can play a key role in reducing the administrative burden of sending queries to...
Pay-per-view: Predicting ICD-10 losses and tracking key performance indicators
After several delays, ICD-10 implementation is finally here. The healthcare industry has spent...
Trivia
Which of the following was invented for Ronald Reagan on the occasion of his 1981 presidential...

Issue 43, November 13, 2015

Provision in 2016 OPPS final rule on 2-midnight rule is positive for providers
Most policies in the OPPS final rule are not effective until the following January, but providers...
Q&A: CMS makes annual updates for items with pass-through status
Q: Is CMS adding any items with pass-through status for 2016? We are starting to look at...
Tip: Minimize ICD-10-CM denials by focusing on key performance indicators
To help minimize the impact ICD-10-CM can have on key performance indicators, start by ensuring you...
Pay-per-view: Providers need more time to analyze CMS’ proposed bundled payment model
Providers know the drill for addressing and operationalizing CMS' annual IPPS and OPPS updates...
Trivia
The first official copper penny authorized by the U.S. Confederation Congress included what phrase...

Issue 42, November 6, 2015

Providers dodge a bullet as CMS limits data collection modifier in 2016 OPPS final rule
The 2016 OPPS final rule certainly has some provisions that providers won’t be happy about...
Q&A: Receive payment for low-dose CT lung cancer screening
Q: We have been providing lung cancer screening using a low-dose computed tomography (LDCT) scan...
Tip: Analyze CMS' proposed bundled payment model
The idea behind CMS’ Comprehensive Care for Joint Replacement model is that payments for hip...
Pay-per-view: Beware of the limitations of GEMs
After years of delays, industry and legislative pushback, and millions spent on technology upgrades...
Trivia
Before the advent of mechanical clocks in the Late Middle Ages, the most sophisticated clocks...

Issue 41, October 30, 2015

CMS releases promising update on early ICD-10 claims data
CMS issued its first update this week on how ICD-10 implementation has impacted the industry and...
Q&A: Billing injections and infusions in the ED prior to surgery
Q: I have a question about billing infusion/injections in the ED prior to a decision for surgery...
Tip: Determine how to report cause of injury codes in ICD-10-CM
When a body part meets with an external object and the result is an injury, you must explain what...
Pay-per-view: Review ICD-10-CM coding for common cardiac conditions
Heart disease is the most common cause of death for both men and women in the U.S., according to...
Trivia
The first woman to be appointed to the U.S. Cabinet served under which president?

Issue 40, October 23, 2015

Congressional concern may not matter for OPPS negative payment adjustment
Members of Congress have thrown their support behind providers in an effort to get CMS to...
Q&A: We?re getting denials for correct vaccine administration claims
Q: We are receiving denials for pneumococcal and influenza vaccine administrations due to an...
Tip: Review critical care criteria for the ED
Angina occurs when the heart doesn't get enough blood due to narrow or blocked coronary arteries...
Pay-per-view: E/M reporting remains a challenge in the ED
Because CMS has not created any national ED E/M guidelines, providers must create their own...
Trivia
In 1901, Connecticut became the first state to institute what car-related law?

Issue 39, October 16, 2015

ICD-10 transition appears to be going smoothly for most providers
It’s been more than two weeks since ICD-10 became the official code set and the sky...
Q&A: What are the risks associated with providers only initializing orders?
Q: We are having a difficult time getting our practitioners to sign their orders. We have a hybrid...
Tip: Review critical care criteria for the ED
Coders may report critical care provided in the ED. Critical care is defined as the direct delivery...
Tip: Review critical care criteria for the ED
Coders may report critical care provided in the ED. Critical care is defined as the direct delivery...
Pay-per-view: Reporting ICD-10-CM external causes is no joke
When a patient suffers a traumatic injury or poisoning, we need to report how he or she became...
Pay-per-view: Reporting ICD-10-CM external causes is no joke
When a patient suffers a traumatic injury or poisoning, we need to report how he or she became...
Trivia
Which of the following is illegal in North Carolina?
The week in Medicare updates
Normal 0 false false false EN-US X-NONE X-NONE...
Upcoming CMS events
http://www.medicarecompliancewatch.com/network-events/cms-events

Issue 38, October 9, 2015

Public comments highlight provider concerns with CMS' 2016 OPPS proposals
Despite dealing with the final touches for ICD-10 implementation, providers submitted more...
Q&A: Does CMS' ICD-10 guidance apply to medical necessity?
Q: CMS released guidance this summer about not auditing or counting errors for the specificity of...
Tip: How to report activity codes in ICD-10-CM
Code category Y93 in ICD-10-CM provides coders with many activities to identify what exactly the...
Pay-per-view: Prepare for ICD-10-CM implementation by reviewing common cardiac conditions
Heart disease is the most common cause of death for both men and women in the U.S., according to...
Trivia
Which day of the week are workers most productive, according to numerous surveys of human resource...
The week in Medicare updates
The week in Medicare updates

Issue 37, October 2, 2015

Providers concerned about reporting unspecified ICD-10 codes and seventh characters
ICD-10 is finally here. After several delays, both by CMS and Congress, and continued pressure by...
Q&A: Rejections for compounded drug combinations
Q: We have been receiving rejections on claims including a line item for a compounded drug. We...
Tip: Reporting heart failure in ICD-10-CM
Codes for heart failure are located in ICD-10-CM category I50. Coders should note the list of...
Pay-per-view: E/M reporting remains a challenge in the ED
Because CMS has not created any national ED E/M guidelines, providers must create their own...
Trivia
What did the U.S. Supreme Court declare unconstitutional in 1895?
This week in Medicare updates
This week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 36, September 25, 2015

Court gives providers a chance to comment on 2-midnight rule payment reduction
CMS proposed relatively small tweaks to its controversial 2-midnight rule in the 2016 OPPS...
Q&A: How do we report antibiotic injections during cataract surgery?
Q: Our ophthalmologists have begun using injections of antibiotics during cataract surgery rather...
Tip: CMS proposes new C-APCs for 2016
CMS proposes adding new comprehensive APCs (C-APC) in 2016, but did not change the logic or...
Pay-per-view: CMS proposes to expand ancillary services packaging policies
CMS proposes to continue expanding its policies for packaging ancillary services one year after...
Trivia
Which of the following mammals does not have sweat glands?

Issue 35, September 18, 2015

CMS offers alternatives for providers having difficulty submitting ICD-10 claims
Despite years of lead time and numerous delays, it’s almost certain that some providers...
Q&A: October updates for skin substitutes
Q: Did CMS make any changes to skin substitutes for October?
Tip: CMS looks to add new modifier to identify services performed prior to C-APCs
Providers anticipated an update to the 2-midnight rule in the 2016 IPPS final rule released April...
Pay-per-view: Industry stakeholders respond to physician concerns with ICD-10 implementation
A few days after Briefings on APCs conducted the interview that appeared in last...
Trivia
It’s well-known that Coca-Cola’s original recipe included cocaine, but what...
The week in Medicare updates
The week in Medicare updates

Issue 34, September 11, 2015

CMS grants extension to state Medicaid programs unprepared for ICD-10
By now, providers are no doubt familiar with the group of entities required to switch to...
Q&A: Reporting injections of bulking substances
Q: Our physicians are injecting a lot of bulking substances, such as those for strengthening the...
Tip: CMS looks to add new modifier to identify services performed prior to C-APCs
CMS notes that as comprehensive APC (C-APC) policies expand, the agency needs a way to identify...
Pay-per-view: CMS proposes massive APC reconfiguration, updates 2-midnight rule
The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is...
Trivia
Francis Scott Key was inspired to write “The Star-Spangled Banner” after seeing the...
The week in Medicare updates
The week in Medicare updates

Issue 33, September 4, 2015

Providers appear ready for ICD-10 according to latest end-to-end testing results
With less than one month until implementation, CMS says it’s ready for ICD-10, and so are...
Q&A: Did CMS add any pass-through drugs for October?
Q: Will CMS be adding any new drugs or biologicals to its pass-through list in its next OPPS...
Tip: CMS proposes extensive APC reconfiguration in 2016 OPPS proposed
For 2015, CMS finalized changes to reconfigure and consolidate ophthalmology and gynecology APCs...
Pay-per-view: CMS proposes 2% reduction in 2016 conversion factor due to laboratory overestimation
OPPS costs rose approximately $1 billion more than expected in 2014 due to a CMS overestimation...
Trivia
The tuxedo got its name from which of the following?
The week in Medicare updates
The week in Medicare updates

Issue 32, August 28, 2015

Panel recommends hospital payment for advance care planning at summer meeting
Many healthcare industry stakeholders, including providers, technology vendors, and payers, are...
Q&A: Authentication is key to establishing medical necessity
Q: We received a denial for services based on medical necessity. A Comprehensive Error Rate...
Tip: CMS reverses decision on device offset
Providers may want to review claims containing HCPCS code C2623 (catheter, transluminal...
Pay-per-view: Coding Clinic defines ICD-10-CM seventh character
Coders and clinical documentation improvement specialists need a clear understanding of how...
Trivia
Johnny Cash once suffered severe injuries due to which of the following?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 31, August 21, 2015

WEDI survey shows hospitals nearly ready for ICD-10
Despite implementation efforts taking place in fits and starts for years, hospitals are largely...
Q&A: Can we still use modifier -JF?
Q: What happened to modifier –JF (compounded drug)? CMS added it in April, but...
Tip: CMS adds new CPT codes in July quarterly I/OCE update
CMS implemented two new CPT® Category III codes originally introduced by the AMA in...
Pay-per-view: A physician offers his perspective on ICD-10 implementation
Physician groups have led much of the resistance against ICD-10 implementation. At its June...
Trivia
Castoreum is a substance used in perfumes and food additives extracted from the castor sacs of...
The week in Medicare updates
The week in Medicare updates

Issue 30, August 14, 2015

CMS extends 2-midnight rule enforcement delay, proposes 2016 changes
CMS announced this week an expected extension of the enforcement delay for Recovery Auditor reviews...
Q&A: How do we report alemtuzumab?
Q: Our physicians want to administer a drug that’s new to us called alemtuzumab, with the...
Tip: Reporting aftercare codes in ICD-10-CM
Aftercare, or Z codes, should not be used for conditions found in Chapter 19 of the ICD-10-CM...
Pay-per-view: CMS adds code pairs for complexity adjustment in July quarterly I/OCE update
CMS continues to update payment logic for comprehensive APCs (C-APC) with additional changes in...
Trivia
In North America, two short soundings of a train whistle indicates what?
The week in Medicare updates
The week in Medicare updates

Issue 29, August 7, 2015

CMS' billion dollar projection error will cost hospitals in 2016
Anyone who has looked at an OPPS proposed or final rule is aware the rules contain a...
Q&A: Should we hard code modifier -PO?
Q: Our business office wants us to start using modifier -PO (services, procedures, and/or...
Tip: Calculating time for hyperbaric oxygen treatment
CMS deleted HCPCS code C1300 (hyperbaric oxygen [HBO] under pressure, full body chamber, per 30...
Pay-per-view: Coding Clinic defines ICD-10-CM seventh character
We're less than two months away from the implementation of ICD-10-CM/PCS, and the AHA Coding...
Trivia
Which symbol was at one point considered part of the English alphabet?
The week in Medicare updates
The week in Medicare updates

Issue 28, July 31, 2015

Take the time to comment on 2016 OPPS proposed rule
If healthcare workers lack one thing right now, it’s probably free time. Dealing with...
Q&A: Which revenue code is used for IV fluid given in ED?
Q: If IV fluid such as sodium chloride is given in the ED, should the revenue code be 250...
Tip: Steps to account for appropriate modifier -25 usage
Providers should look at their existing procedure charges and make sure they have built some...
Pay-per-view: Use caution when applying modifier -59 for drug administration services
With drug administration services, providers likely find themselves prompted to use modifier -59...
Trivia
Which of the following is not the nickname of a player enshrined in the National Baseball Hall of...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 27, July 24, 2015

CMS proposes C-APC for observation services in 2016
CMS did not propose making any radical changes to comprehensive APCs (C-APC) methodology, such as...
Q&A: Reporting modifiers with infusions in the ED
Q: I have been told by our billers that infusion codes reported in the ED along with an E/M...
Tip: Using modifier -59 to bypass drug administration edits
Use modifier -59 (distinct procedural service) only when appropriate to bypass medically unlikely...
Pay-per-view: Overhauled 2015 CPT drug test codes bring changes for coders and providers
In an effort to accommodate the latest advances in technology and make the code set easier to...
Trivia
Although both states are considering legislation to change the laws, New Jersey and which other...
The week in Medicare updates
The week in Medicare updates

Issue 26, July 17, 2015

What does AMA and CMS ICD-10 agreement mean for hospitals?
Providers got an unexpected surprise following the Fourth of July holiday when CMS and the American...
Q&A: Reporting magnetic band implantations to treat GERD
Q: Our physicians want to start implanting a magnetic band around the distal esophagus to treat...
Tip: Pay attention to CMS rules for reporting drug testing codes
In addition to extensive drug testing code changes in the CPT® Manual, facility reporting for...
Pay-per-view: Use caution when applying modifier -59 for drug administration services
Most coding professionals have heard modifier -59 (distinct procedural service) referred to as a...
Trivia
A British historian researching his country’s history found that of approximately 200...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 25, July 10, 2015

2016 OPPS proposed rule: CMS looks to extensively reconfigure and consolidate APCs
CMS appeared to give providers a break with this year’s OPPS proposed rule, released July...
Q&A: New codes receive pass-through status
Q: Did CMS add any new codes for drugs that have pass-through status this month?
Tip: Reporting definitive drugs tests in 2015
Coders will find 59 new codes in the 2015 CPT® Manual for reporting definitive drug tests...
Pay-per-view: Providers continue to grapple with reporting modifier -25
Lately I've received a lot of questions from hospitals about how to determine when and if it's...
Trivia
Scooby Doo was originally named Too Much, but a vocal improvisation in a 1967 song by this singer...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 24, June 26, 2015

AMA clarifies its intent with ICD-10 grace period
The bill from Congress calling for a two-year grace period during which providers are not...
Q&A: Claims for hyperbaric oxygen therapy rejected
Q: We have been receiving rejections of our claims with HCPCS code C1300 (hyperbaric oxygen under...
Tip: CMS added two new modifiers effective April 1
As part of the April quarterly OPPS update, CMS added two new modifiers valid April 1...
Pay-per-view: Refresh your knowledge of taxonomy codes
Taxonomy codes play a very important role in medical billing and credentialing for...
Trivia
What is the most expensive spice in the world?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 23, June 19, 2015

MedPAC report could serve as preview of OPPS proposed rule
CMS deferred making any updates to the 2-midnight rule in its 2016 IPPS proposed rule, but the...
Q&A: Did CMS update pass-through devices in July’s quarterly update?
Q: Are there any new pass-through devices or changes for July under the OPPS?
Tip: Departments need to work together for successful ICD-10 implementation
One of the largest challenges with ICD-10 may be overcoming the perception that transitioning is...
Pay-per-view: Recent rules and regulations should reduce provider ICD-10 uncertainty
Providers have been plagued by uncertainty regarding ICD-10, with multiple delays pushing out...
Trivia
What was President Harry S. Truman's middle name?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 22, June 12, 2015

Congress foregoes all logic with latest ICD-10 bill proposal
ICD-10 implementation is 110 days away. Coders, HIM professionals, and providers have spent...
Q&A: Which new HCPCS codes are effective July 1?
Q: You previously wrote about new code Q5101 for Zarxio®. Are there any additional...
Tip: Modifier ?PO remains voluntary until 2016
As part of the April quarterly OPPS update, CMS revised the Medicare Claims Processing...
Pay-per-view: ICD-10 implementation requires organizationwide education and awareness
Organizations must continue to educate and train staff throughout the transition to ICD-10...
Trivia
What was the original name of the Statue of Liberty?
The week in Medicare updates
The week in Medicare updates

Issue 21, June 5, 2015

CMS completes another round of successful ICD-10 end-to-end testing
CMS has completed another round of successful ICD-10 end-to-end testing, with the acceptance rate...
Q&A: What are biosimilar products?
Q: We are receiving requests from our physicians regarding administration of a new drug...
Tip: Assess payer readiness before ICD-10 implementation
Provider/payer integration is essential for successful ICD-10 implementation. Contracts will need...
Pay-per-view: IPPS rule: Long outpatient stays with observation services to be discussed in 2016 OPPS rule
The 2016 OPPS proposed rule is likely to continue CMS' trend of expanded packaging and feature...
Trivia
Which of the following territorial acquisitions did the U.S. pay the least for, in 2015 dollars?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 20, May 29, 2015

ICD-10 misinformation campaign continues in university study
While the AMA has focused on scaremongering instead of educating physicians ahead of the rapidly...
Q&A: Is there a C code for sinus stents?
Q: We are have a debate about reporting sinus stents. Specific HCPCS C codes represent...
Tip: Determining comprehensive APC reimbursement
Providers need to take multiple steps to determine the reimbursement for a comprehensive APC...
Pay-per-view: Apply CMS’ new -X{EPSU} modifiers
When CMS introduced the -X{EPSU} modifiers in August 2014 to be used in specific instances to...
Trivia
A total of 12 astronauts have walked on the moon's surface since the first moon landing in 1969...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 19, May 22, 2015

ICD-10 opponents mount last-ditch roadblocks to implementation
Congress appears to have finally acknowledged the inevitability of ICD-10 implementation in 2015...
Q&A: Why do we receive an edit when reporting fluoroscopy?
Q: We have started receiving an edit for our pain management procedures reported with CPT®...
Tip: Reporting tobacco use in ICD-10-CM
Tobacco use and dependence can increase a patient's risk of developing respiratory illness...
Pay-per-view: CMS releases update to correct and clarify comprehensive APC payments
CMS released updated I/OCE specifications in January with several changes that could require...
Trivia
The first Memorial Day observance was held May 30, 1868, at Arlington National Cemetery. Before...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 18, May 15, 2015

The inevitability of ICD-10 is slowly dawning on Congress
As Congress' latest attempt to delay, or permanently derail, ICD-10 languishes in committees with...
Q&A: We included a procedure on an inpatient claim before the patient was admitted
Q: We erroneously included a surgical inpatient-only procedure on an inpatient Medicare claim and...
Tip: Apply CMS’ new -X{EPSU} modifiers
Providers have asked many questions about how to use the –X{EPSU} modifiers due to a lack...
Pay-per-view: Start resolving ICD-10-CM questions
Many coders rely on the AHA's Coding Clinic advice to resolve sticky situations with ICD-9-CM...
Trivia
Which of the following can be calculated from the frequency of cricket chirps?
The week in Medicare updates
The week in Medicare updates

Issue 17, May 8, 2015

Congress continues tone-deaf approach to ICD-10
Several members of Congress showed a fundamental misunderstanding of ICD-10 during a subcommittee...
Q&A: Reporting drug codes with no G code crosswalk
Q: I have a question about reporting drug tests to CMS for CPT® codes that do not have a...
Tip: CMS updates comprehensive APC logic for add-on codes
A change CMS made to the I/OCE specifications earlier this year corrects the processing for...
Pay-per-view: HOP Panel discusses site parity, drug administration at latest meeting
The policies that CMS publishes each year in the OPPS proposed rule don't always come as a...
Trivia
How long is a standard bowling lane from the foul line to the head pin?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 16, May 1, 2015

Learn strategies to reduce the burden of Part B rebilling
New regulations allow hospitals to bill Part B services for inpatient cases that are internally...
Q&A: Requirements for drug panels ordered in the ED
Q: When a patient presents to the ED and the physician there orders a drug panel, we perform the...
Tip: Classifications changing in ICD-10-CM
Not all classifications remain the same in ICD-10-CM. Hemoptysis (coughing up blood or...
Pay-per-view: Apply CMS’ new ?X {EPSU} modifiers
When CMS introduced the –X {EPSU} modifiers in August 2014 to be used in specific instances...
Trivia
Richard II was the first British monarch to demand this title, which comes from the Latin for...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 15, April 24, 2015

CMS to address long outpatient stays with observation services in OPPS rule
Since nearly the moment it was announced, CMS' 2-midnight rule—created to help define...
Q&A: Rejections for codes without internal edits
Q: We are receiving rejections for HCPCS codes J0365 (injection, aprotonin, 10,000 kiu) and J7180...
Tip: Reporting anxiety disorders in ICD-10-CM
According to the National Institute of Mental Health (NIMH), anxiety disorders affect...
Pay-per-view: CPT Medicine section updates reflect new products and technologies to report
Each year, the AMA updates the Vaccines, Toxoids section of the Medicine chapter in the CPT®...
Trivia
Which city's airport is identified with the code PIE?
The week in Medicare updates
The week in Medicare updates

Issue 14, April 17, 2015

SGR reform passes with no ICD-10 delay, so what’s next?
Congress finally repealed the Sustainable Growth Rate (SGR) this week. The fix ends more...
Q&A: We now receive edits on certain skin substitutes
Q: We have been reporting skin substitutes with the appropriate procedure codes (either CPT®...
Tip: Remember to check AMA website for new vaccine product codes
Each year, the AMA updates the Vaccines, Toxoids section of the Medicine chapter in the CPT®...
Pay-per-view: Reporting mental disorders in ICD-10-CM
Mental health disorders are common in the United States, with an estimated 19% of Americans 18 or...
Trivia
The word "senator" is a Roman term derived from the Latin senex, which means what?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 13, April 10, 2015

Providers’ greatest obstacle to ICD-10 preparations could soon be removed
If the Senate manages to pass the bipartisan Sustainable Growth Reform (SGR) reform bill...
Q&A: Drug payments updated for April
Q: Did CMS make any changes to drug payments for April?
Tip: Reporting vascular dementia in ICD-10-CM
Vascular dementia is caused by impaired blood flow to the brain, which damages the brain's blood...
Pay-per-view: Majority of industry stakeholders support ICD-10 at House hearing
When Congress delayed ICD-10 implementation in 2014 by inserting language into an unrelated...
Trivia
Which of the following condiments was originally patented as a medicine and sold as a pill?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 12, March 27, 2015

Congress poised to finally fix the SGR
Congress is closing in on a permanent fix to the Sustainable Growth Rate (SGR) formula...
Q&A: CMS updates pass-through device list
Q: Did CMS grant pass-through status for any new devices in April?
Tip: Coding kidney stones in ICD-10-CM
Urolithiasis (ICD-10-CM categories N20-N22) is a condition in which hard masses, or calculi...
Pay-per-view: Analyze the impact of comprehensive APCs
For 2015, CMS identified 219 HCPCS/CPT codes as good candidates for comprehensive APCs (C-APC...
Trivia
Which of the following animals has the largest eyes (in total size)?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 11, March 20, 2015

CMS reverses policy on inpatient-only procedures
This week, CMS released Transmittal 3217, effective April 1, which will allow inpatient-only...
Q&A: Can we code marker placement for a breast biopsy?
Q: An auditor recently told us to code two CPT® codes for a breast biopsy with placement of a...
Tip: CMS moves skin substitutes from low- to high-cost category
In 2014, CMS added skin substitutes to the list of packaged drugs and biologicals, dividing the...
Pay-per-view: ICD-10-CM anatomy refresher: Urinary system
The urinary system, also known as the renal system, provides a variety of bodily functions...
Trivia
Which U.S. president served as an executioner before taking office, earning the nickname...
The week in Medicare updates
The week in Medicare updates

Issue 10, March 13, 2015

ICD-10 opponents may have finally run out of time
ICD-10 opponents have been fighting the code set for 20 years, but in approximately two weeks...
Q&A: When do we report ICD-10-CM category E13 for diabetes?
Q: We see a lot of diabetes diagnoses at our facility, but are confused about when we might...
Tip: Determine the impact of comprehensive APCs on your facility
Addendum J of the 2015 OPPS final rule is a spreadsheet that includes several tabs providers can...
Pay-per-view: CMS adds comprehensive APC logic in January quarterly I/OCE update
The implementation of comprehensive APCs (C-APCs) in the 2015 OPPS final rule likely wasn't a...
Trivia
March 15, the Ides of March, is known as the date Julius Caesar was assassinated. What did the...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 9, March 6, 2015

Support for another ICD-10 delay may be dwindling in Congress
Providers and Congress members largely support ICD-10 implementation on October 1, 2015...
Q&A: Where do we find skin substitute classifications?
Q: We use a lot of skin substitutes. Where do we find a list of the new HCPCS codes and how...
Tip: Modifier -PO remains optional until 2016
CMS added one modifier for 2015, but will not require its use until January 1, 2016...
Pay-per-view: Analyze the impact of comprehensive APCs
The implementation of comprehensive APCs (C-APCs) in the 2015 OPPS final rule likely wasn't a...
Trivia
A panophobe is afraid of what?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 8, February 27, 2015

CMS completes successful first round of end-to-end testing
The main concern of some Congress members regarding ICD-10 implementation during the recent House...
Q&A: Should we report injections during cataract surgery?
Q: Our surgeons have started performing drop-less cataract surgery. Instead of using eye drops...
Tip: Providers still seeking extension of supervision requirements exemption
Non-enforcement of supervision requirements for certain therapeutic services for critical access...
Pay-per-view: Musculoskeletal and nervous system sections get new procedure, combination codes
As new and more effective treatment options are created and evaluated, AMA must update...
Trivia
In America, the most collect calls placed on which day?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 7, February 20, 2015

CMS seeking modifier -59 information from providers
The latest guidance from CMS on modifier -59 (distinct procedural service) did little to help...
Q&A: Why are we receiving denials for so many drug testing codes?
Q: We are receiving denials for many of the new CPT® codes in the laboratory section of...
Tip: Combination codes in ICD-10-CM provide additional information
ICD-10-CM allows coders to report additional detail for many conditions of the male reproductive...
Pay-per-view: CMS updates outpatient supervision level documents
In December 2014, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment (HOP...
Trivia
Which U.S. president once worked as a model, appearing on the cover of Cosmopolitan magazine?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 6, February 13, 2015

Arguments for ICD-10 delay see little support at Congressional hearing
Last year's unexpected ICD-10 delay disappointed countless hospitals, payers, physicians...
Q&A: Why are we seeing so many edits when using modifier -25?
Q: We are seeing an increase in the number of edits we are receiving for modifier -25...
Tip: AMA adds CPT code to report arthrodesis of the sacroiliac joint
A new CPT® code for arthrodesis, a joint fusion technique to relieve pain, of the sacroiliac...
Pay-per-view: ICD-10-CM anatomy refresher: Reproductive system
Since portions of the reproductive system use some of the same structures as the urinary system...
Trivia
A dog is a canine and a cow is bovine, but which of the following animals is ovine?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 5, February 6, 2015

CMS’ latest modifier -59 update offers little guidance for providers
After CMS announced four new, more specific replacements for modifier -59 (distinct procedural...
Q&A: Are we coding and billing Comprehensive APCs correctly?
Q: We don’t quite understand the CMS' new Comprehensive APCs (C-APC) and how to code or...
Tip: CMS issues no updates for NSEDTS in 2015
Several years ago, CMS defined a list of nonsurgical extended duration therapeutic services...
Pay-per-view: Musculoskeletal and nervous system sections get new procedure, combination codes
As new and more effective treatment options are created and evaluated, AMA must update the...
Trivia
Which mammal has the longest gestation period, at approximately 660 days?
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 4, January 30, 2015

Medicare unveils alternative payment models
Federal officials announced an accelerated effort to use payment reform to shift Medicare and the...
Q&A: Do we have to report an unlisted code for a laryngoscopy?
Q: We are providing a new service where the ear, note, and throat physician performs a...
Tip: CMS removes procedures from inpatient-only list in 2015 OPPS final rule
CMS removed two add-on procedure codes from the inpatient-only list in the 2015 OPPS final rule...
Pay-per-view: Taking a three-dimensional look at CMS’ finalized policies
As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment...
Trivia
The record for most snowfall in a 24-hour period occurred in Silver Lake, Colorado, beginning...
The week in Medicare updates
The week in Medicare updates
Upcoming CMS events
Upcoming CMS events

Issue 3, January 23, 2015

Congress begins work on latest SGR fix
Congress' Subcommittee on Health met this week to begin discussing legislation that could...
Q&A: Does CMS have a code for new wireless heart sensors?
Q: Our physicians want us to purchase a new wireless sensor to monitor pulmonary artery pressure...
Tip: CMS finalizes quality program changes in 2015 OPPS final rule
CMS finalized several changes to the Hospital Outpatient Quality Reporting (OQR) program in order...
Pay-per-view: CMS finalizes comprehensive APCs with complexity adjustments for 2015
In a concerted effort to move healthcare payments to a system of "quality over...
Trivia
In 1804, Napoleon became king of which country?
The week in Medicare updates
The week in Medicare updates

Issue 2, January 16, 2015

CMS extends deadline to volunteer for ICD-10 end-to-end testing
CMS is giving providers additional time to volunteer for its second wave of ICD-10 end-to-end...
Q&A: Can we report CPT therapy codes for services by non-therapists?
Q: Can we report new CPT® codes 97607 (negative pressure wound therapy, utilizing disposable...
Tip: CMS expands packaging in 2015
CMS finalized changes for conditional packaging of ancillary services in the 2015 OPPS final...
Pay-per-view: CMS adds data collection for services in off-campus, provider-based departments
CMS proposed that a new HCPCS modifier be appended to every code for a service furnished in a...
Trivia
Before Dutch carrot growers began to cultivate orange carrots in the 17th century, the vegetable...
The week in Medicare updates
The week in Medicare updates

Issue 1, January 9, 2015

Does your facility struggle with injection and infusion coding and billing?
We consistently receive questions about coding for injections and infusions, even though the...
Q&A: Should we be reimbursed for corneal tissue for transplants?
Q: Why are we not receiving anything from Medicare to cover the cost of corneal tissue? We...
Tip: CMS makes changes to device edits in 2015
CMS will no longer implement specific procedure-to-device or device-to-procedure edits for any...
Pay-per-view: Taking a three-dimensional look at CMS’ finalized OPPS policies
As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment...
Trivia
The coldest recorded temperature in America occurred January 23, 1971, in Prospect Creek, Alaska...
The week in Medicare updates
The week in Medicare updates