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The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.

COVID Code Consolidation, Spanish-Language Options, RSV Highlight Looming Code Changes

by  Angela Jordan, CPC, CPMS, COBGC

This past Friday, the American Medical Association (AMA) announced the much-anticipated release of the 2024 CPT® code set; however, there’s a bit of a catch.  The code set is only available on the AMA’s Intelligent Platform to those in the healthcare industry that are licensed to use the CPT...

Documenting and Reporting Postoperative Visits

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period? 

When Is a Shared Visit Not a Shared Visit?

by  David M. Glaser, Esq.

Can you do a “shared visit” in a physician clinic, site of service 11? The most common answer to this question seems to be “no,” and while that is technically correct, it is so misleading that it is effectively entirely wrong. To understand this confusion, we need to dig...

CMS Announced the 2024 ICD-10-CM Updates Includes 395 NEW Codes

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The CY 2024 ICD-10-CM updates are here and waiting to be reviewed. This year there are a good number of newly added codes and minimal revisions and deletions but the additions are beneficial in expanding the reporting options for many common diseases. Two common conditions, acute appendicitis and Parkinson's disease, have been expanded to provide greater specificity in reporting.

Answers to Evaluation & Management Questions From Webinar Attendees

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Following every Evaluation & Management (E/M) webinar, we receive questions from attendees reflecting the specific circumstances they have identified within their individual organizations. We wanted to take some time to address some individual questions for the benefit of others who have some of the same questions. These questions are related to scoring Medical Decision Making (MDM) in the E/M coding guidelines.

Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.

Reporting Drug Wastage with Modifier JW and NEW Modifier JZ

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Modifier JW has been around since 2003 with changes in Medicare policies to ensure standard utilization in 2017; however, because of a continued lack of reporting consistency, Medicare has created and implemented policy related to reporting a new modifier, JZ. How does this impact Medicare reimbursement and why is this modifier so important?

Finding Patterns of Complexity in the Medical Decision Making (MDM) Table

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Changes to the Medical Decision Making (MDM) Table in 2023 reflect the work performed in the facility setting in addition to the work involved in Evaluation and Management (E/M) scoring in other places of service. Taking the time to really look closely at the MDM Table and identify patterns in wording and scoring helps coders to understand scoring in an easier way.

Coding Critical Care Services in 2023

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Critical care service coding has always had its unique set of challenges but with the 2023 Evaluation and Management changes and updates to the Medicare Final Rule, it is probably critical that we review how these services should be documented and reported to ensure compliance whether for commercial payers or Medicare.

De Quervain's Tenosynovitis - Diagnosis, Treatment, and ICD-10-CM Reporting

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

One of the more common forms of tenosynovitis is when the sheath that covers the two tendons connecting the forearm muscles to the bones of the thumb and wrist becomes inflamed from overuse or injury. De Quervain's tenosynovitis can be treated conservatively with physical therapy, nonsteroidal anti-inflammatories (e.g., ibuprofen), and bracing and if or when that fails, may require surgery.

E/M Scoring Questions

by  Wyn Staheli, Director of Content - innoviHealth

Evaluation and Management visits are often the “bread and butter” of an organization. Thus, correctly scoring encounters is essential to ensuring proper reimbursement. The element of “Risk” is only one of the three elements of Medical Decision Making (MDM), but understanding what is meant by all the definitions within each element is critical.

Seven Reasons to Standardize Medical Records

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The standardization of medical records offers numerous benefits for healthcare systems, providers, and patients. By ensuring interoperability, improved workflows, better patient safety, supporting research endeavors, and optimizing resource allocation, standardized records contribute to improved efficiency, quality of care and especially patient outcomes. Here are seven reasons to standardize medical records.

CMS Unveils 2024 Medicare PFS, OPPS Proposed Rules

by  Mark Spivey

The OPPS proposal did not feature reference to several high-profile issues industry leaders have been awaiting reform on. Federal officials yesterday unveiled a pair of proposed rules, featuring potential adjustments to the Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) for the 2024 calendar year....

Advancements in Coding Hospital Observation Care Services in 2023

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Hospitals are increasingly adopting innovative solutions to improve patient care and optimize processes and many of these solutions follow immediately the recent CPT and Medicare coding changes.  In 2023 coding of hospital observation care services underwent significant changes enabling healthcare providers to accurately document and bill for the sick or injured patient that requires a higher level of medical services between the emergency room care and hospital admission. This article explores the key changes in coding hospital observation care services and their impact on healthcare delivery.

Medicare’s New ABN for 2023

by  Wyn Staheli, Director of Content - innoviHealth

Medicare’s Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) had changes that became effective on June 30, 2023. This article summarizes the changes for this essential form. You know you have the right one by looking at the bottom left corner. The new form says (Exp.01/31/2026).

Computer-Assisted Medical Coding (CAC) vs Autonomous Medical Coding to Strike the Perfect Balance Between Automation and Human Coder Expertise

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Healthcare is witnessing a digital revolution of sorts with advancements in technology that seem to transform many aspects of patient care. An example of this transformation involves the evolution of medical coding, where computer-assisted medical coding (CAC) and the use of artificial intelligence (AI) in medical coding are revolutionizing the way healthcare organizations document, process, and ensure medical necessity for healthcare services.

Be Aware — Emergency Department Visits Under OIG Scrutiny

by  Wyn Staheli, Director of Content - innoviHealth

Every year the Department of Health & Human Services Office of Inspector General (OIG) creates an official work plan giving everyone a heads up as to what they are going to be reviewing. The 2022 Work Plan stated that they would be reviewing claims for Evaluation & Management services provided in an emergency department (ED) setting.

OIG Audit Reveals Diagnosis Reporting Problems Affecting Risk Adjustment Scoring

by  Wyn Staheli, Director of Content - innoviHealth

The Office of the Inspector General (OIG) recently published their Spring 2023 Semiannual Report to Congress. This report contained some diagnoses reporting issues that all providers need to be aware of. They focused on several groups of diagnoses that they considered “High-Risk” for being miscoded. Several states were included in the report and the types of errors for all can be generally grouped into several categories.

Combination Codes Provide Greater Detail for Complicated Conditions

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The use of combination codes became well-known to the medical coding world with the implementation of ICD-10-CM coding. Combination codes describe a main diagnosis along with either an associated manifestation or complication. Rather than assigning multiple diagnosis codes, the ICD-10-CM guidelines instruct us to report the code that more specifically describes the condition documented in the medical record and by doing so, we are more clearly defining and describing the disease processes and injuries the patient is dealing with. But what happens when a coder reports both of the conditions described in the combination code independently of each other instead of reporting the combination code?

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