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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, 2014 - VIEW THE FULL ISSUE

• Providers lagging in ICD-10 training should not be tempted to rely on GEMs

  The ICD-10 implementation delay mandated by Congress this spring granted providers an extra year to...

• Catch up on endocrine system anatomy and coding in ICD-10-CM

  The endocrine system, which consists of many glands located throughout the body, is responsible...

• Training tool: ICD-10-CM quiz

  Use this 10-question quiz to determine how well you understand ICD-10-CM coding for disease of the...

• An up-to-date charge description master requires a team effort

  With quarterly code updates and other regulatory changes from CMS throughout the year, the...

• This Month's Coding Q&A

  Our experts answer questions about Comprehensive APCs, modifier -59, and more.

Issue 11, November 1, 2014 - VIEW THE FULL ISSUE

• Consider expanding CDI to outpatient departments

  Even before ICD-10-CM was delayed until October 1, 2015, the quality of physician documentation to...

• House passes bill to extend CAH supervision enforcement moratorium

   Congress may be stepping in to once again delay a policy that CMS ensured would not face any...

• ICD-10-CM anatomy refresher: Thoracic cage

  Editor's note: With the increased specificity required for ICD-10-CM coding, coders need a solid...

• Training tool: ICD-10-CM quiz

  Use this 10-question quiz to determine how well you understand ICD-10-CM coding for injuries to the...

• CMS introduces four new subsets of modifier -59

  Editor's note: Jugna Shah, MPH, president and founder of Nimitt Consulting, writes a bimonthly...

• This Month's Coding Q&A

  Our experts answer questions about wound care documentation, reporting drugs, and more...

Issue 10, October 1, 2014 - VIEW THE FULL ISSUE

• Collaboration with physicians and payers key to ICD-10-CM readiness

  CMS officially declared October 1, 2015, the new ICD-10 implementation date with the publication of...

• MACs to reprocess radiosurgery claims due to copayment miscalculation

  CMS has instructed MACs to reprocess claims and providers to reimburse beneficiaries due to a...

• To be or not to be: Billing labs with CMS' new modifier

  Editor's note: Andrea Clark-Rubinowitz, RHIA, CCS, CPCH, has more than 30 years of experience...

• This Month's Coding Q&A

  Our experts answer questions about esophagoscopies, ICD-10-CM terminology, and more.  

• ICD-10-CM code crossword answers

  Click on PDF below for the answers to the ICD-10-CM crossword puzzle on p. 12.

Issue 9, September 1, 2014 - VIEW THE FULL ISSUE

• CMS reintroduces Comprehensive APCs along with complexity adjustments

  CMS refined and updated its Comprehensive APC policy in the 2015 OPPS proposed rule released July...

• Comment on the 2015 OPPS proposed rule

  CMS wants your thoughts on the 2015 OPPS proposed rule changes. In various places in the proposed...

• OPPS Advisor: Comparing addenda reveals OPPS changes beyond the narrative

  When CMS releases rules, the length can be intimidating. But even at a relatively slim 700 pages...

• Update on hospital observation reporting and billing

  Modifier -25 (significant, separately identifiable E/M service by the same physician on the day of...

• Coding skin ulcers in ICD-10-CM

  As the largest organ in the body, the skin is subject to a number of diseases and conditions. With...

• This month's coding Q&A

  Our experts answer questions about dual coding and CMS' schedule for updating payment rates.

Issue 8, August 1, 2014 - VIEW THE FULL ISSUE

• CMS introduces modifier -L1 for lab tests in July quarterly I/OCE update

  The July quarterly I/OCE update from CMS brought few new APCs or edit updates, but did deliver new...

• ICD-10-CM anatomy refresher: Lower leg

  Coders have only two options for reporting fractures of the patella in ICD-9-CM, closed (822.0...

• Disrupting the status quo: Hospital outpatient and ICD-10-PCS

  "Sometimes the questions are complicated and the answers are simple." ?Dr. Seuss This...

• This Month's Coding Q&A

  Our experts answer questions on coding chronic illnesses, reporting screw removals...

Issue 7, July 1, 2014 - VIEW THE FULL ISSUE

• Provider documentation critical for correctly billing 2014 observation changes

  Documentation and billing for observation stays has come under increased scrutiny from the OIG...

• ICD-10 anatomy refresher: Feet

  Editor's note: With the increased specificity required for ICD-10-CM coding, coders need a solid...

• Identify modifier misuse with case studies

  Adding modifiers to CPT® codes can bypass NCCI edits for Medicare payments, but they're often...

• Will hospitals take the new ICD-10 implementation date seriously?

  After a month of silence following the Congress-imposed delay of ICD-10 in its Medicare payment...

• This Month's Coding Q&A

  Our experts answer questions on cyst excisions, observation timing, MUEs, and more.

Issue 6, June 1, 2014 - VIEW THE FULL ISSUE

• Congress forces providers to adapt after unanticipated ICD-10 delay

  April 1 was supposed to mark the final six months providers, payers, and CMS had to prepare for...

• Viewpoints on the ICD-10 implementation delay

  Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of coding and HIM at HCPro in...

• CMS refines skin substitute packaging

  CMS made relatively few changes in the April quarterly I/OCE update, introducing four new APCs...

• Hospital Outpatient Payment Panel makes recommendations to CMS

  Hospital outpatient therapeutic services, such as ED or clinic visits, that are paid under the...

• This Month's Q & A

  Our experts answer questions on billing self-administered drugs, necessary documentation for spinal...

Issue 5, May 1, 2014 - VIEW THE FULL ISSUE

• Facilities consider using CPT and ICD-10-PCS to improve data collection

  When outpatient hospitals and physicians switch to ICD-10-CM diagnosis codes October 1, they will...

• ICD-10-CM anatomy refresher: Ears

  The ears--more formally, the auditory system--have their own chapter in ICD-10-CM, no longer...

• CMS and AMA offer conflicting instructions in 2014 releases

  Since January, providers have been struggling to reconcile conflicts between CMS' rules and...

• CMS' attempts at clarification continue to confuse

  In January, I wrote about the perfect storm that led to the release of the 2014 OPPS final...

• This Month's Coding Q&A

  Our experts answer questions on ED reimbursement, charging for self-administered drugs, critical...

Issue 4, April 1, 2014 - VIEW THE FULL ISSUE

• CMS' packaging trend has major impact on January I/OCE update

  The January 2014 quarterly I/OCE update included nearly 400 new HCPCS Level II codes, but the most...

• ICD-10-CM anatomy refresher: Thigh

  Editor's note: With the increased specificity required for ICD-10-CM coding, coders need a solid...

• CMS seeks information on episode-based specialty payment models

  The CMS Innovation Center released a request for information (RFI) in February for input from...

• AMA updates CPT codes for new technology and drugs in 2014

  While many of the code changes in the 2014 CPT® Manual surgical sections involve bundling...

• This month's coding Q&A

  Our experts answer questions on payment rates for scans, bronchodilator treatment, the...

Issue 3, March 1, 2014 - VIEW THE FULL ISSUE

• Parenthetical note changes dominate 2014 CPT updates

    Although the AMA changed hundreds of codes in the 2014 CPT® Manual, most of the changes...

• Understanding the value of MUEs

    When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and...

• ICD-10 anatomy refresher: Wrists and hands

    Coders are aware that ICD-10-CM will allow much more specificity than ICD-9-CM, and that is...

• Packaging labs under 2014 OPPS

    CMS has been making it clear over the years that packaging would become a larger and larger...

• This month’s coding Q&A

  How does CPT® define “final examination” for code 99238 (hospital discharge day...

Issue 2, February 1, 2014 - VIEW THE FULL ISSUE

• CMS dramatically increases packaging in 2014 OPPS Final Rule

  In the 2014 OPPS Final Rule, CMS has dramatically increased packaged services and made clear that...

• Billing packaged lab tests in 2014

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• CMS replaces clinic E/M visit levels with single G-code, collapses EAM levels

  One of the most radical changes CMS proposed in this year’s OPPS was to collapse the five...

• CMS adds cost centers, inpatient-only ?procedures for 2014

  In addition to increased packaging and collapsing of E/M clinic visit level CPT® codes in the...

• Exploring the relationship between documentation and coding

  The U.S. healthcare system is and will continue to be dependent on clinical codes and is thus...

• This Month’s Coding Q&A

  Q. I’ve heard that the time frame for an acute myocardial infarction (AMI) is changing in...

Issue 1, January 1, 2014 - VIEW THE FULL ISSUE

• Accounting for HCCs

  The number of patients using Medicare Advantage (MA) is rapidly growing, making Hierarchical...

• Getting caught in the perfect storm

  Jugna Shah, MPH, writes about the perfect storm that led to the release of the 2014 OPPS Final Rule.

• This month's coding Q&A

  Our experts answer questions on port reassessment, laparoscopies, reporting multiple biopsies...

• 2013 Briefings on APCs index

  Use this index to find articles we published in 2013.