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Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules and how they impact hospital health information management systems and processes, coding, billing, and reimbursement.

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

• RAC audits are not just an inpatient issue

  Although a lot of attention is being given to the RACs’ focus on diagnosis-related groups...

• Switch to ICD-10 will change more than just coding

  The upcoming conversion to the ICD-10-CM coding system will change more than just the codes placed...

• Are you meeting CMS? physician supervision requirements for cardiac and pulmonary rehabilitation services?

  CMS’ changing requirements for physician supervision of therapeutic and diagnostic services...

• Combination codes simplify complexity of IR coding

  Interventional radiology (IR) coding is often quite complex. Determining which procedure the...

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

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

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

• Learn what areas require more physician documentation

  A number of diagnoses in ICD-9-CM require more documentation from physicians to be accurately...

• Look for medical necessity, signs and symptoms, and time units when coding abuse and brief intervention services

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

• October I/OCE update brings minor changes

  CMS added 130 new ICD-9-CM codes to the I/OCE as part of the October updates but made few other...

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

• Fewer new ICD-9-CM codes for 2011

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

• Consistent criteria critical for assigning ED visit levels

  No national standard exists for selecting an E/M level for ED visits, so each facility must create...

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

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

• Messy modifiers: -25, -52, -58, -78, and -59 explained

  Looking for a starting point in your quest to clean up modifier usage at your organization? Begin...

• CMS modifies I/OCE to include additional diagnosis codes

  Outpatient coders can now enter up to three diagnosis codes on the claim form after CMS updated the...

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

• CMS proposes additional changes to physician  supervision for 2011

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

• CMS proposes few changes for 2011 OPPS

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

• Differentiate between dialysis access procedures

  When a patient needs long-term dialysis, his or her physician can choose between various options to...

• Five myths about correct use of modifier -59 busted

  Correct use of modifier -59 (distinct procedural service) can confuse novice and veteran coders...

• How should you bill for outpatients in beds?

  Q. Please help me understand this scenario: A patient is admitted as an inpatient at 10 a.m. The...

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

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

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

• Get to the heart of percutaneous coronary procedures

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

• Use internal guidelines to ensure consistent E/M coding

  A visit is defined as direct personal contact between a registered hospital outpatient and a...

• Simplify the complexities of urodynamics coding

  Urodynamic studies are a coding challenge. Differing physician terminology, unique documentation...

• CMS addresses three-day payment window, wage index

  During the May 27 Hospital Open Door Forum call, a CMS representative reminded the audience that...

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

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

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

• Cure what ails your pain management coding

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

• Build a base for comprehensive review of procedure data

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

• Q&A: Resolve confusion around injection, infusion coding

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

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

• Check off requirements for hyperbaric oxygen therapy before treatment

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

• CAHs get a break on physician supervision rules for 2010

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

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

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

• CMS makes few changes to I/OCE edits for April

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

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

• Complex compendia rules complicate reimbursement

  In a perfect world, CMS and other payers would reimburse facilities and physicians for every...

• Now on the to-track list: medically unlike edit appeals

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

• Improve coding quality and reimbursement

  Coders know that, with few exceptions, they may not report something that a physician has not...

• Check the total time to report correct units of therapy

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

• CMS discusses the three-day rule, pulmonary rehab

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

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

• Inpatient to outpatient: Understand requirements of condition code 44

  Mrs. Smith arrives in the ED at 8 a.m. Tuesday. Dr. Jones writes an admission order at 11:45 a.m...

• Observation, physician supervision requirements add  additional complications when coding condition code 44

  As if condition code 44 weren’t confusing enough, observation services and physician...

• Should you override that outpatient therapy NCCI edit?

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

• Audit injections and infusions to ensure correct coding

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

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

• Distinguish between ABNs for covered, noncovered Medicare services

  Starting in April, when a patient receives an ABN, coders and billers will need to determine...

• Correctly code for new cardiac, pulmonary rehab benefits

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

• I/OCE edits result in more HCPCS codes, fewer APCs

  Coders have more HCPCS codes available for use, as Medicare Claims Processing Manual Transmittal...

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

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

  Editor’s note: This is the second article in a two-part series on the 2010 CPT code changes...

• 2010 CPT changes: Rethink revamped radiology codes

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

• Comply with CMS guidelines for cardiac, pulmonary rehab

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

• Prevent and react to outpatient never events

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

• CMS clarifies physician signatures needed on all lab orders

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

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

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

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

• CMS finalizes changes to physician supervision requirements

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

• Understand challenges, opportunities with PET coverage

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

• Briefings on APCs 2009 index

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