"All Specialties" & "Code Updates" Articles
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April 20th, 2021
ICD-11 — What’s Happening?
| Published April 20th, 2021
ICD-11 is officially released, but what does that mean for diagnosis coding in the United States? What's really different? This article discusses what has been happening with ICD-11, some interesting things to note about it, as well as links to other important information.
April 19th, 2021
Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?
| Published April 19th, 2021
Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source?
Answer: This is a great question and one that has been asked by many coders and auditors.
April 1st, 2021
Why Will Medicare Administrative Contractors be Holding Claims Up?
| Published April 1st, 2021
When Congress passed the expansive American Rescue Plan Act last month, most Americans were focused on the direct payment provision of the bill. However healthcare administrators and policymakers had their attention on another aspect: cuts to Medicare payments. Why would Congress be cutting Medicare payments during the COVID-19 Public Health ...
April 1st, 2021
Evaluation & Management (E/M) Webinar Q/A
| Published April 1st, 2021
Find answers to some questions asked by attendees of our recent webinar regarding the changes released by the AMA in their March 9, 2021 Errata and Technical Corrections document in relation to Evaluation & Management (E/M).
March 18th, 2021
How Reporting E/M Based on Time May Lose Money
| Published March 18th, 2021
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
March 16th, 2021
Critical Evaluation and Management Changes Recently Announced by AMA
| Published March 16th, 2021 - Last Review/Update March 17th, 2021
On March 9, 2021, the American Medical Association (AMA) announced some pretty significant changes in relation to reporting Evaluation and Management (E/M) services, particularly for Office or Other Outpatient Services (99202-99215). The AMA Editorial Panel had previously met to discuss how to address concerns and made changes surrounding Office or Other Outpatient Services which are retroactive to January 1, 2021. Learn more about those changes in this article.
March 10th, 2021
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
| Published March 10th, 2021
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
February 22nd, 2021
COVID Vaccinations — FREE Legal and Ethical Considerations Webinar
| Published February 22nd, 2021
Learn about legal and ethical implications of the COVID-19 vaccine with this free webinar held on Wednesday, February, 24, 2021.
February 17th, 2021
Why CMS Created G2212 for Prolonged Services Instead of 99417
| Published February 17th, 2021 - Last Review/Update February 22nd, 2021
This article discusses WHY CMS decided to create code G2212 to be used with prolonged office Evaluation and Management (E/M) services instead of code 99417 as of January 1, 2021. The proposed Medicare Physician Fee Schedule stated that code 99417 would be used so it is essential to understand why they made this change to avoid potential problems with billing these services.
February 3rd, 2021
How To Properly Report Prolonged Services Using 99417 or G2212
| Published February 3rd, 2021
Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215. While Medicare has agreed to accept the AMA's CPT E/M coding changes, they have formulated an opinion contrary to how CPT calculates time specific ...
February 1st, 2021
New Procedure Codes for the Janssen COVID-19 Vaccine
| Published February 1st, 2021
On January 19, 2021, the AMA announced two new CPT codes for reporting the Janssen Pharmaceutica (a division of Johnson & Johnson) COVID-19 vaccine. Of course, just as with the other COVID-19 vaccines, they must be given FDA approval for Emergency Use Authorization (EUA) to be administered before the codes can be reported.
As is ...
January 21st, 2021
Looking Beyond an Employee's Coding Credentials
| Published January 21st, 2021
In today's ever-changing healthcare environment, it is important that organizations hire coding and reimbursement personnel who enjoy learning. Each year changes are made in how healthcare services are coded and reported from federal and state laws, the code sets themselves, and varying payer policies. During the public health emergency (PHE) ...
January 15th, 2021
AMA Announcement of Additional COVID Vaccine Codes and Guideline Changes in December
| Published January 15th, 2021 - Last Review/Update January 19th, 2021
On Friday, December 17, 2020, the AMA announced several changes in relation to the addition of new codes for the COVID-19 vaccine under development by AstraZeneca and University of Oxford. Codes 91302, 0021A, and 0022A were published on the AMA website and will be effective once they have received Emergency Use Authorization (EUA) from the FDA.
January 11th, 2021
HIPAA Penalty Changes
| Published January 11th, 2021
On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.
January 11th, 2021
ICD-10 Code Updates for January 1st
| Published January 11th, 2021
Be aware that new ICD-10-CM and ICD-10-PCS codes took effect on January 1, 2021. Rarely have ICD-10-CM codes been released in January, but as you may have guessed, these changes are in relation to COVID-19. The information in this article will help your organization understand these changes.
December 7th, 2020
Updated Stark Law and Anti-Kickback Statute Regulations Aimed at Improving Coordinated Care
| Published December 7th, 2020
The transformation of the American healthcare system from a primarily fee-for-service system to one based on value has been one of astonishing speed and scope, touching every aspect of health care. Changes of this scale inevitably have ripple effects that impact other laws and regulations, outdating them or highlighting inadequacies ...
November 11th, 2020
COVID Vaccine Codes Announced
| Published November 11th, 2020 - Last Review/Update November 12th, 2020
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
October 20th, 2020
CMS Expands Telehealth Again
| Published October 20th, 2020
On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.
October 12th, 2020
What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?
| Published October 12th, 2020
When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ...
October 8th, 2020
Significant COVID-19 Code Changes as of October 6
| Published October 8th, 2020 - Last Review/Update October 13th, 2020
Significant COVID-19 Code Changes as of October 6
October 1st, 2020
New Codes for Cytokine Release Syndrome (CRS)
| Published October 1st, 2020 - Last Review/Update October 6th, 2020
New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.
September 29th, 2020
ICD-10-CM 2021 Coding Updates for Chiropractic
| Published September 29th, 2020
October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. This year there are some interesting changes such as a new headache type, new codes related to TMJ, several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard), and some other changes.
September 15th, 2020
More COVID-19 Codes Added as of September 8, 2020
| Published September 15th, 2020
The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.
August 24th, 2020
2021 Brings Another Risk Adjustment Calculation Change
| Published August 24th, 2020
In 2021, a big change in Risk Adjustment score calculations will take place, which will affect payments to Medicare Advantage (MA) plans for the coming year and take us closer to quality and value-based programs instead of fee-for-service (FFS) or risk-adjusted (RA). Currently, CMS pays a per-enrollee capitated...
August 10th, 2020
Modifier 50 — Four "Must Know" Tips For Getting Paid
| Published August 10th, 2020
Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
| Published July 14th, 2020
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
June 29th, 2020
Additional COVID-19 Testing Codes Announced
| Published June 29th, 2020
New coronavirus antigen testing codes announced. These are effective immediately.
June 10th, 2020
MEGA - NCCI Edit Changes - WHO Knew?
| Published June 10th, 2020
There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included;
291,902 Deleted Procedure to Procedure (PTP) edits
197 Deleted Medically Unlikely ...
May 13th, 2020
Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?
| Published May 13th, 2020
On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states:
“Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...
May 5th, 2020
ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting
| Published May 5th, 2020
The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).
The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.
ICD-10-CM Official Coding Guidelines - ...
May 4th, 2020
Additional Telehealth Changes Announced by CMS
| Published May 4th, 2020
On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.
April 20th, 2020
Clarify the Complexity Please! NDC Codes and Drug Classification Systems
| Published April 20th, 2020
Different Drug classification systems are used to categorize drugs to identify the medication, with each system having their own logic. There are four main drug classification systems used in the United States, not to be confused with a class of drugs or "Drug Class". A drug class is the way drugs ...
April 20th, 2020
Dismal OIG Report on Telemedicine
| Published April 20th, 2020
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
April 16th, 2020
Hypertension ICD-10-CM Coding Table, Guidelines, and Tips
| Published April 16th, 2020
Coding hypertension properly requires knowing all the guidelines. This article summarizes how hypertension is coded using ICD-10-CM and includes tips, definitions and a very helpful coding table summarizing your options.
April 15th, 2020
New CPT® Codes Approved for COVID-19 Antibody Identification
| Published April 15th, 2020
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
April 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
| Published April 15th, 2020
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
April 13th, 2020
CMS Announces Final 2021 HCC Risk Adjustment Changes
| Published April 13th, 2020
On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) published their final Medicare Advantage (MA) and Part D payment methodologies for CY 2021. Read more to be prepared for these upcoming changes.
April 13th, 2020
Financial Impact of CARES Act on Healthcare Providers
| Published April 13th, 2020
The recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act has several provisions to ease the financial burden being faced by healthcare providers who have been impacted by the effect of the coronavirus. Learn more about how the Provider Relief Fund and the Accelerated and Advance Payment Program work.
April 8th, 2020
ICD-10-CM Official Coding and Reporting Guidelines Updated for COVID-19
| Published April 8th, 2020
The ICD-10-CM Official Coding and Reporting Guidelines have just been updated to include COVID reporting. Additional information beyond the previously released interim guidelines are included. These are the rules that should be followed for claims submission. The notice states that this is for April 1, 2020 through September 30, 2020.
March 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
| Published March 24th, 2020
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
March 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
| Published March 21st, 2020
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
March 17th, 2020
Additional Coronavirus Testing Code Announced
| Published March 17th, 2020
On March 13, 2020, a new CPT code was announced by the American Medical Association (AMA) who maintains the CPT code set. This early release of a CPT code is rare and is effective immediately.
February 20th, 2020
New HCPCS Code for Coronavirus Testing Announced
| Published February 20th, 2020 - Last Review/Update February 26th, 2020
Currently, healthcare providers testing patients for Coronavirus must use an unspecified code. To provide better tracking, on February 13, 2020, CMS announced the creation of a new HCPCS code.
January 21st, 2020
Inadequate Exclusion Screenings Could Put Your Practice at Risk
| Published January 21st, 2020
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
January 7th, 2020
Denials due to MUE Usage - This May be Why!
| Published January 7th, 2020
CMS assigns Medically Unlikely Edits (MUE's) for HCPCS/CPT codes, although not every code has an MUE. MUE edits are used to limit tests and treatments provided to a Medicare patient for a single date of service or for a single line item on a claim form. It is important to understand MUE's are ...
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