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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, 2011 - VIEW THE FULL ISSUE

• Report condition code 51 for nondiagnostic services unrelated to inpatient stay

  CMS created condition code 51 (attestation of unrelated outpatient nondiagnostic services) as a way...

• Unscramble the complexities of ABNs

  Just because a physician considers a service or procedure medically necessary doesn't mean...

• ICD-10 anatomy refresher: Eyes

  The human eye may be small-only 1 inch in diameter on average-but it is a very complex sensory...

• This Month's Coding Q&A

  Our experts answer your coding questions about billing for IV hydration in the absence of a stop...

Issue 11, November 1, 2011 - VIEW THE FULL ISSUE

• Correctly bill for free, reduced-cost devices

  Most devices are considered integral to the procedure being performed, which means that without the...

• CMS adds new radiopharmaceutical, modifier

  CMS reclassified HCPCS code C9406 (iodine I-123 ioflupane, diagnostic, per study dose, up to 5...

• ICD-10 anatomy refresher: Heart

  The heart is the center of the circulatory system, and it pumps blood throughout the body. It...

• This Month's Coding Q&A

  Q When a patient requires an intrathecal pump ­refill in the hospital outpatient infusion...

Issue 10, October 1, 2011 - VIEW THE FULL ISSUE

• Final regular ICD-9-CM code update ­continues trend of increased specificity

  Beginning October 1, coders will have 17 additional V codes to report personal history of various...

• APC Panel debates requiring codes for packaged services

  Should CMS require hospitals to report HCPCS codes for all packaged services that have HCPCS codes...

• Proposed IPPS-based payment cap raises concerns

  CMS' plan to cap payment for cardiac resynchronization therapy (CRT) based on Medicare severity...

• ICD-10-CM anatomy refresher: Spine

  With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in...

• This Month's Coding Q&A

  Our experts answer your coding questions about charging for triage only ED visits, timing of status...

Issue 9, September 1, 2011 - VIEW THE FULL ISSUE

• CMS proposes new APCs for combination CT codes

  Providers complained and CMS listened, at least a little. As part of the 2012 OPPS proposed rule...

• CMS to revise conversion factor, physician supervision

  CMS proposed no changes to E/M visit coding ­guidelines, nor did it discuss drug administration...

• Comment on the 2012 OPPS proposed rule

  Have something to say about the 2012 OPPS proposed rule? You may submit comments to CMS until...

• Keep an eye on three-day payment window clarification

  HIM staff in hospitals might not pay attention to the Medicare Physician Fee Schedule (MPFS...

• CMS may rescind lab requisition signature requirement

  After 10 years, the requirements for signatures on lab requisitions are still in flux.

• This Month's Coding Q&A

  Our experts answer your coding questions about neurostimulator codes, billing for psychiatric...

Issue 8, August 1, 2011 - VIEW THE FULL ISSUE

• Correctly count observation time for outpatients

  Counting time for observation isn't always straightforward under OPPS. Coders and billers need to...

• CMS revises counting for observation hours in OPPS update

  As part of the July quarterly update to OPPS, which became effective July 1, CMS introduced a new...

• CMS clarifies modifier -PT use, adds new codes to I/OCE

  CMS continues to clarify the use of modifier -PT (colorectal screening test converted to diagnostic...

• Conduct a risk assessment for E/M service coding

  A risk assessment allows a practice to take inventory of risk areas and identify current and...

• This Month's Coding Q&A

  Our experts answer your coding questions about transesophageal echocardiogram for pre- and...

Issue 7, July 1, 2011 - VIEW THE FULL ISSUE

• Decision tree helps guide appropriate use of modifier -59

  Dr. Cooper attempts to repair a rotator cuff tear using an arthroscopic approach, but she is unable...

• Review documentation for correct hysteroscopy coding

  A hysteroscopy is not the same as a hysterectomy. The two words sound similar but refer to two very...

• ICD-10-CM prep: Determine documentation trouble spots

  Each facility faces different challenges as it prepares for the transition to ICD-10-CM based on...

• This Month's Coding Q&A

  Q If the physician uses lidocaine gel to numb a diabetic foot ulcer and remove a callus from around...

Issue 6, June 1, 2011 - VIEW THE FULL ISSUE

• Coders and billers: It's time to start talking

  A payer sends a claim back to your facility. Who's at fault? Is it the biller? The coder? Or maybe...

• Evaluate charge setting for combination codes

  Combination codes are becoming more common as the AMA continues to combine codes for procedures...

• Medical necessity is key to the E/M visit level

  Medical necessity governs provision of all healthcare services, regardless of reimbursement source...

• Good documentation starts with physician education

  If your ICD-10-CM/PCS readiness plan consists of hoping that CMS will reschedule the go-live date...

• This Month's Coding Q&A

  Q In our hospital-based clinics we use the physician CPT code for billing the facility visit level...

Issue 5, May 1, 2011 - VIEW THE FULL ISSUE

• OPPS vs. CPT: Coding ­injections and infusions

  Coders already know that CMS doesn't always follow the language in the CPT Manual. The most recent...

• Dig into the details of wound care documentation

  Documentation is central to accurate coding and reimbursement. It justifies treatment, supports the...

• Catch errors with second-quarter NCCI edits

  Because the hospital outpatient NCCI edits are one quarter behind the coding changes, coders may...

• I/OCE edits: Look for bilateral status changes, new modifier

  As part of the April update to the I/OCE, CMS added 34 codes to the list of conditions that are...

• This month's coding Q&A

  In this month's coding Q&A, our experts answer reader questions about specimen collection...

Issue 4, April 1, 2011 - VIEW THE FULL ISSUE

• Coming soon to an ED near you: ICD-10-CM

  The transition to ICD-10-CM/PCS will be here sooner than you think, so now is the time to start...

• Significant, separately identifiable E/M: Modifier -25

  A patient comes in for a minor procedure and the physician performs a history, physical...

• Multiple same-day outpatient hospital visits: Modifier -27

  When a patient is seen multiple times on the same day in the ED,  how does your hospital...

• This Month's Coding Q&A

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

Issue 3, March 1, 2011 - VIEW THE FULL ISSUE

• Resolve continuing questions about injection and infusion coding

  Not much has changed with injection and infusion coding in recent years. After all, coders still...

• Brush up on hemorrhoid coding: Know types, treatments

  Hemorrhoids are the great unmentionable in our list of ailments. Some people never suffer from...

• I/OCE edits: CMS switches around packaged, separately payable drugs, changes some APC status indicators

  CMS changed the packaging status of several drugs and reduced the number of HCPCS codes available...

• This Month’s Coding Q&A

  Q I have a question about new CPT code 57156 (insertion of vaginal radiation afterloading...

Issue 2, February 1, 2011 - VIEW THE FULL ISSUE

• 2011 CPT changes feature new time guidelines, subsequent observation care codes

  Coders will have 212 new CPT® codes for 2011 as a result of the AMA’s CPT update. In...

• AMA changes cardiac cath, revascularization coding

  Some of the biggest changes to the CPT codes this year appear in the cardiac catheterization and...

• Wound care coding revisions part of CPT surgery changes

  The AMA added 62 new CPT codes in the surgery section and revised 55 other codes. The 2011...

• This month’s coding Q&A

  Editor’s note: Beginning this month, Briefings on APCs will include a question-and-answer...

Issue 1, January 1, 2011 - VIEW THE FULL ISSUE

• CMS tears down walls for physician supervision

  More physicians should be able to provide supervision for outpatient procedures after CMS finalized...

• CMS expands suspension of physician supervision rules

  The changes CMS made to the supervision requirements will delay but not eliminate the problems...

• CMS finalizes list of 16 extended-duration services

  As part of the 2011 OPPS final rule, CMS identified a limited set of services as...

• Critical care coding changing, cancer center payment isn?t

  As part of the 2011 OPPS final rule, CMS finalized changes to critical care coding and shelved a...

• Briefings on APCs 2010 index

  CMS CMS clarifies physician signatures needed on all lab orders. Feb., p. 11...