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How Does the Definition of "Problem Assessed" Change in the 2023 E/M Guideline Updates?

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

The 2023 Evaluation and Management changes have been published and efforts are ongoing to educate coders and provider organizations on the guideline and code description changes that will impact professional coding in the facility setting. These changes required a significant revision to the guidelines and definitions of the various levels of complexity associated with the Number and Complexity of "Problems Addressed" during an encounter, which is the first element of medical decision making (MDM) and the following explanations and examples should provide a greater understanding of the changes headed our way in January.

Modifier FT

by  Wyn Staheli, Director of Content - innoviHealth

As of January 1, 2022, CMS created a new modifier for an unrelated E/M visit during a postoperative period. It was revised as of April 1, 2022. Learn more about the appropriate use of modifier FT.

CMS Updates COVID Vaccine Requirements for Staff

by  Wyn Staheli, Director of Content - innoviHealth

CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements. This new memorandum replaces memoranda QSO 22-07-ALL Revised, QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised.

Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)

by  CMS - MLNConnects

Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...

Four Ways Your Organization Can Benefit from Gathering and Reporting Social Determinants of Health Data

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

Providers who actively engage in collecting and reporting social determinants of health (SDoH) open avenues of identifying and treating their patients' population health trends. Pairing chronic conditions that are difficult to control with identified SDoH circumstances such as transportation or electricity insecurity, can help identify those patients who may wish to be healthier, but who are dealing with circumstances that prevent compliance, such as transportation or access to electricity, for instance.

2023 Evaluation & Management Updates Free Webinar

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

Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.

End-Stage Renal Disease Risk Model Updates for 2023

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

For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

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

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

Significant Changes to Emergency Department E/M Reporting Coming in 2023

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

In just a few short months, major revisions to the remaining Evaluation and Management categories in the Current Procedural Terminology (CPT) code book will go into effect. How many of these changes will affect your organization and how ready are you for them? While the changes to the remaining E/M categories will closely resemble the 2021 changes to the E/M Office and Other Outpatient (99202-99215) codes, there are some major differences that need to be carefully reviewed, such as how E/M will change for the Emergency Department services.

Changes to the 2023 Evaluation & Management (E/M) Definitions for Acute Conditions

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

On January 1, 2023 the Evaluation and Management (E/M) Guidelines will change again but this time with a focus on all other E/M categories. These changes are very similar to the changes that took place in 2021, with scoring of the E/M service level being determined by MDM or time. The original 2021 E/M diagnosis severity definitions changed again, after implementation and with the new changes in 2023, new diagnosis definitions have been added, warranting another look at what is new and how to interpret the changes.

Understanding the Changes to the 2023 Evaluation & Management (E/M) Definitions for Chronic Conditions

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

This will be the third time since 2021 that the diagnosis complexity definitions have undergone significant changes. The initial 2021 changes were specific to Office and Other Outpatient E/M services and due to some confusion surrounding a few of the guidelines, updates to them were published by the AMA in April of 2021 with an effective date of January 1st. Because the 2023 E/M changes are more focused on the remaining E/M categories, especially in the hospital facility, new definitions were added and old definitions changed.

Billing for Incontinence and Urinary Products

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

We all understand anything covered under health insurance must be medically necessary. In other words, it must be essential in treating and managing a patient's condition or to evaluate, diagnose, or treat an illness, injury, disease, or its symptoms. In this article, we will address catheters, urological supplies, and disposable ...

Are Leading Queries Prohibited by Law or Lore?

by  Erica E. Remer, MD CCDS

AHIMA released its CDI Practice Brief Monday. At Yom Kippur services, I found myself thinking about the question Dr. Ronald Hirsch posed to me the day before. My rabbi was talking in her sermon about the difference between halacha and minhag. Halacha is law; it is the prescriptions...

AHIMA Releases New Guidelines for Queries

by  Chuck Buck

The updated guidelines were developed jointly by AHIMA and ACDIS. The American Health Information Management Association (AHIMA), in collaboration with Simplify Compliance’s Association of Clinical Documentation Integrity Specialists (ACDIS), jointly announced a highly anticipated preliminary update to their Guidelines to Achieving a Compliant Query Practice on October 10,...

Z Codes: Understanding Palliative Care and Related Z Codes

by  Gloryanne Bryant, RHIA CDIP CCS CCDS AHIMA-Approved ICD-10-CM/PCS Trainer

Palliative care is often considered to be hospice and comfort care. Palliative care is sometimes used interchangeably with “comfort care” and then again sometimes with “hospice care.”  But these terms do have slightly different meanings and sometimes the meaning varies depending on who is stating it. The National...

2023 ICD-10-CM Code Changes

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...

ICD-10-CM 2023 Code Changes for Chiropractic

by  Wyn Staheli, Director of Content - innoviHealth

There were several changes to the ICD-10-CM codeset for 2023 which went into effect October 1, 2023 and could impact chiropractic. At the time of publication, it was unknown how payers would respond to these changes. This article only discusses some of the changes to the ICD-10-CM codes. Changes to procedure codes such as “Prolonged Services” for office E/M visits are included in the 2023 ChiroCode DeskBook.

Yes, You Have What It Takes To Lead Your Practice And Your Profession

by  Kem Tolliver, CPC CMPE CMOM President - Medical Revenue Cycle Specialists

If you’ve been in any healthcare role for more than two years, you’ve seen quite a bit of change. And guess what, it’s not over. We are living and working in uncertain times. This climate requires each of us to step outside of our comfort zones to lead exactly where we stand. It’s not required of one to have a “title” to lead. What is required, however, is a willingness to trust your instincts, look for answers and rely on your team.

What is the ICD-10 Code for May-Thurner Syndrome?

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

May-Thurner syndrome is not identified in the Alphabetic Index of the ICD-10-CM codebook, so what is the ICD10 code for reporting this condition? Eponymous diseases are conditions, illnesses, syndromes, disorders, or disease named after the person who either discovered it (usually a physician) or in some cases the patient who was diagnosed with the disease (think Lou Gherig's disease). When trying to identify these diseases in the Alphabetic Index you may have to do a little additional research to identify the actual name of the condition rather than the eponymous name. So what exactly is the ICD-10-CM code for May-Thurner syndrome and what other names does it go by?

Emergency Department - APC Reimbursement Method

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...


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