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"Skilled Nursing" & "Hospital" Articles
Click on the title to see the article summary and a link to the full article.
December 22nd, 2020
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020
14. Diseases of the genitourinary system (N00-N99)
Code: Description:N00.A Acute nephritic syndrome with C3 glomerulonephritisN01.A Rapidly progressive nephritic syndrome with C3 glomerulonephritisN02.A Recurrent and persistent hematuria with C3 glomerulonephritisN03.A ...
December 8th, 2020
IPPS and DRG's: What it Means
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
Understanding hospital pricing can get complicated, so we have broken it down according to CMS and the acute Inpatient Prospective Payment System, also known as IPPS. Find-A-Code uses IPPS for inpatient pricing with our MS-DRG grouper. The following information comes from CMS.gov and answers the most common questions regarding DRGs ...
August 10th, 2020
Coding Injections for Pain Management
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2020
Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management.
Trigger Point Injections
Trigger point injections are reported by how many muscles are treated using an ...
August 5th, 2020
Coding with PCS When There is No Code
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 5th, 2020
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
July 20th, 2020
New Grouper Added for Skilled Nursing
By Find-A-Code | Published July 20th, 2020
The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay.
This grouper is included with our Home Health Grouper.
Current groupers/calculators include:
Home Health PDGM (Patient-Driven Grouping Model)
Skilled Nursing Facility PDPM (Patient-Driven Payment Model)
What is it?
According to CMS, In ...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | 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 ...
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
June 15th, 2020
Outpatient Facility Pricing
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020
Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...
April 15th, 2020
New CPT® Codes Approved for COVID-19 Antibody Identification
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | 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.
March 31st, 2020
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2020
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
March 5th, 2020
Who Qualifies for Chronic Care Management Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 5th, 2020
Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services."
Examples of chronic conditions ...
December 19th, 2019
CMS- Patient Driven Payment Model Effective October 01, 2019
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 19th, 2019
According to CMS, In July 2018, CMS finalized a new case-mix classification model, the Patient-Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.
Using the new Patient-Driven ...
October 1st, 2019
Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
August 21st, 2019
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 21st, 2019
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from? It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems. One of the ...
August 16th, 2019
Medical ID Theft
By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019
Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
August 9th, 2019
The OIG Work Plan: What Is It and Why Should I Care?
By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
July 19th, 2019
The Facts of Critical Care
By Namas | Published July 19th, 2019 - Last Review/Update July 30th, 2019
Critical care services remain to not only be an area of confusion for providers, coders, and auditors, but also a constant target for the carriers for audit. We can sit back and look at critical care and think of all of the ways the code descriptor and/or use could be ...
July 12th, 2019
5 Ways to Minimize HIPAA Liabilities
By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ...
June 18th, 2019
How to Properly Report Monitoring Patients Taking Blood-thinning Medications
By Wyn Staheli, Director of Research | Published June 18th, 2019 - Last Review/Update June 19th, 2019
Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.
April 1st, 2019
Spinal Cord Stimulator Used for Chronic Pain
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 1st, 2019
Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes.
ICD-10-CM Diagnosis Codes ...
March 27th, 2019
Pain Codes in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 27th, 2019
When coding with ICD-10-CM, pain codes can be found in different sections:
The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ...
March 20th, 2019
Type of Bill Code Structure (2018-08-30)
By Find-A-Code | Published March 20th, 2019 - Last Review/Update March 25th, 2019
The UB-04 claim form (also known as CMS 1450) is the standard facility and residential claim form used to report health claims. The Type of Bill is reported in Block No. 4 of the UB04 claim form.
Type of bill codes are four-digit codes that describe the type of bill a ...
November 29th, 2018
Errors Billing Outpatient Services When Patient is also Inpatient
By Wyn Staheli, Director of Research | Published November 29th, 2018
The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. CMS suggests using the following resources to ensure compliance:
Medicare Inappropriately Paid Acute-Care Hospitals for ...
November 26th, 2018
Present on Admission POA Indicator
By | Published November 26th, 2018 - Last Review/Update November 29th, 2018
This article will focus on the Present on Admission (POA) indicator which is used as a method of reporting whether a patient’s diagnoses are present at the time they are admitted to a facility. We’ll look at a few scenarios to determine the correct reporting of POA and the impact...
October 17th, 2018
Wolters Kluwer Drug Pricing
By Find-A-Code | Published October 17th, 2018
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...
October 2nd, 2018
Tools and Resources for Life Care Planners
By Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS | Published October 2nd, 2018
Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on...
August 27th, 2018
Pricing for ASC’s and APC’s
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 27th, 2018
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
July 9th, 2018
Documentation: Face to Face for Home Health Certification
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018
As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...
May 14th, 2018
TKAs to Outpatient What We Have Learned with Q1
By Shannon Cameron, MBA, MHIIM, CPC | Published May 14th, 2018 - Last Review/Update May 24th, 2018
The release of the 2018 Final Rule for the Outpatient Prospective Payment System (OPPS) in November 2017 has created quite a stir across the orthopedic healthcare community. In what has been deemed a questionable decision, the Centers for Medicare and Medicaid Services (CMS) decided to remove Total Knee Arthroplasty...
March 9th, 2018
Documentation for Urological Supplies
By Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for urological supplies.
March 8th, 2018
Documentation for Manual Wheelchairs
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018
The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases....
March 8th, 2018
Documentation for Home Health Services (Part A non DRG)
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medical Learning Network provides coverage guidance, which should be documented, for home health services.
March 8th, 2018
Documentation and Orders for Respiratory Assistive Device
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines.
March 8th, 2018
Documentation for Skilled Nursing Facilities
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF).
March 8th, 2018
Documentation for Inpatient Rehabilitation Facilities
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).
February 12th, 2018
The Coder as the Last, Best Hope for the Right DRG
By Dr. Erica Remer | Published February 12th, 2018 - Last Review/Update April 12th, 2018
f the story doesn't make sense, there is probably something missing. There are a variety of reasons why the DRG might not tell the story of the patient encounter....
January 31st, 2018
Influenza, Are You Billing Correctly?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 31st, 2018
With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.
Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ...
January 29th, 2018
Anesthesia and Fee Calculation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018 - Last Review/Update April 16th, 2020
Fees for anesthesia services are not calculated the same as for other types of procedures. There are four elements to consider when calculating anesthesia fees. Medicare accepts base units and time units; however, depending on the third party payer, they may or may not accept physical status units and/or qualifying circumstances units.
Base Unit (of the CPT code)
Time (in ...
January 9th, 2018
ICD-10-PCS Coding the Approach
By Find-A-Code | Published January 9th, 2018
When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using.
There are seven approaches. They are listed below with their ...
January 4th, 2018
Special Skilled Nursing Facility (SNF) Billing Exceptions for Laboratory Tests PUB-100 40.4
By Find-A-Code | Published January 4th, 2018
When a SNF furnishes laboratory services directly, it must have a Clinical Laboratory Improvement Act (CLIA) number or a CLIA certificate of waiver, and the laboratory itself must be in the portion of the facility so certified. Normally the A/B MAC (A) makes payment under Part B for clinical laboratory ...
January 4th, 2018
Billing Negative Pressure Wound Therapy (NPWT) (disposable device)
By Find-A-Code | Published January 4th, 2018
Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes:
97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ...
November 24th, 2017
Inpatient critical care: When is it ok to question the medical necessity?
By Stephanie Allard, CPC, CEMA, RHIT | Published November 24th, 2017 - Last Review/Update January 31st, 2018
While critical care may be easily identifiable within documentation it is not always clear if it is medically necessary.....
November 10th, 2017
Escharotomy Procedural Cross-Walking CPT to ICD-10-PCS
By Brandon Dee Leavitt QCC, CMCS, CPC, EMT | Published November 10th, 2017 - Last Review/Update November 17th, 2017
An Escharotomy is used for "local treatment of burned surface" per the AMA Guidelines, when incisions are performed on the burn site. Notice, when cross-walking 16035 or 16036 to inpatient codes, Find-A-Code crosswalks lead to Body System H, Operation 8 - Division of the skin, and Operation N - Release of the skin.
A division or release of the skin would be a ...
September 29th, 2017
Big Data & Facility Audit Complex Reviews
By Shannon Cameron, MBA, MHIIM, CPC | Published September 29th, 2017 - Last Review/Update January 31st, 2018
Big data and its use in the healthcare spectrum has proven to be an incredible source of the knowledge and has rapidly abetted progress in seemingly all areas of healthcare......
September 1st, 2017
Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCT
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT)....
August 29th, 2017
Elderly Abuse Discovered by the OIG - Early Alert
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 29th, 2017
The OIG sent out an early alert in an effort to create awareness to potential abuse or neglect of Medicare Beneficiaries in skilled nursing facilities. The OIG identified 134 Medicare beneficiaries whose injuries may have been the result of potential abuse or neglect. The beneficiaries reported were treated at the ...
August 4th, 2017
Increased Medicare payment rates for FY 2018!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 4th, 2017
We can look forward to a few prospective payments for Skilled Nursing Facilities, Hospice and Inpatient Rehab; CMS released their final rule and reported on key highlights of the new FY 2018 Medicare payment rules.
CMS States, “The 2018 Skilled Nursing Facility (SNF) Prospective Payment System Final Rule increases Medicare payment rates ...
April 12th, 2017
Definitions for Character #3 of PCS Codes Medical and Surgical Root Operations
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 12th, 2017
Character #3 of PCS codes Medical and Surgical Root operations definitions
Alteration
Modifying the anatomic structure of a body part without affecting the function of the body part
Bypass
Altering the route of passage of the contents of a tubular body part
Change
Taking out or off a device from a body part, and putting back an ...
March 28th, 2017
Respiratory Assist Devices (RAD) E0470 and E0471 - Billing Reminders
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 28th, 2017 - Last Review/Update July 28th, 2017
Add the KX modifier to all claims for RADs and accessories for the first through third months if all thecoverage criteria have been met.
Add the KX modifier to all claims for the fourth month and thereafter if all the coverage criteria have been met and if the physician signed and dated a ...
February 27th, 2017
Documentation: Face to Face for Home Health Certification
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 27th, 2017 - Last Review/Update August 16th, 2017
As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. ...
August 16th, 2016
2017 ICD-10-CM and ICD-10-PCS Code Updates
By | Published August 16th, 2016
The 2017 ICD-10-CM and ICD-10-PCS code updates, including a complete list of code titles, are available on the 2017 ICD-10-CM and GEMs and 2017 ICD-10-PCS and GEMs webpages.
August 3rd, 2016
ICD-10 Changes for 2017
By Wyn Staheli, Director of Research | Published August 3rd, 2016
The Centers for Medicare & Medicaid Services (CMS) recently released the Proposed Rule regarding the updates to the ICD-10-CM and ICD-10-PCS code sets for Fiscal Year 2017 which begins October 1, 2016. Comments regarding the proposed ICD changes are due May 6th and CMS has stated that the Final Rule ...
July 13th, 2016
Procedure code set for Procedures ICD-10-PCS to ICD-9-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 13th, 2016
There are some PCS codes that have a GEMS mapping and is available on Find-A-Code, such as ICD-9-CM Vol 3. 02.11, the GEMS mapping can be found in out Map-a-code tool.
See this code mapping to the following PCS codes
CodeDescription00Q20ZZ
Repair Dura Mater, Open Approach
00Q23ZZ
Repair Dura Mater, Percutaneous Approach
00Q24ZZ
Repair Dura Mater, Percutaneous Endoscopic ...
June 27th, 2016
2017 ICD-10- PCS Updates
By | Published June 27th, 2016
The final version of the 2017 ICD-10- PCS codes has been released by the Center for Medicare and Medicaid Services. Beginning on October 1, 2016, the first day of the federal fiscal year, the use of these codes will become mandatory for hospital inpatient services. The updates for the 2017...
June 9th, 2016
Mandatory Submission of Staffing Data via PBJ Begins July 1 for Long – Term care facilities
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 9th, 2016
Electronic submission of staffing data through the Payroll-Based Journal (PBJ) is required of all long-term care facilities starting July 1. The last day to submit data for fiscal quarter four (July 1 through September 30) is November 14, 2016. Nursing homes can register now in the PBJ system to prepare:
Obtain ...
May 19th, 2016
Skilled nursing facilities paid for participating in new program, starting the summer of 2016
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 19th, 2016
Medicare plans to start a Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), beginning fiscal year 2019. This program will be used to promote better clinical outcomes for skilled nursing facility patients and improve care during their stay at a skilled nursing facility. Skilled nursing facilities will be paid for participating. ...
April 25th, 2016
Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP) - Beginning 2019
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 25th, 2016
Medicare plans to start a Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), beginning fiscal year 2019. This program will be used to promote better clinical outcomes for skilled nursing facility patients and improve care during their stay at a skilled nursing facility. Skilled nursing facilities will be paid for participating. ...
March 8th, 2016
Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) Form - Free
By Find-A-Code | Published March 8th, 2016
The purpose of this form is to help you make an informed choice about whether or not you want to receive these items or services, knowing that you might have to pay for them yourself. Before you make a decision about your options, you should read this entire notice carefully.
...
February 26th, 2016
Clear the Smoke on Debridement and Active Wound Care Codes
By | Published February 26th, 2016
Confused about when to choose a debridement code and an active wound code? CPT® 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth. “Depth is...
February 24th, 2016
Nebulizer Therapy Billing Reminders - Modifiers, Dispensing Fees, and Orders
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 24th, 2016 - Last Review/Update August 3rd, 2017
The ICD-10-CM code describing the condition necessitating nebulizer therapy must be included on each claim for equipment, accessories, and/or drugs.
When ever a unit dose code is billed, it must have a KO, KP, or KQ modifier. (Exception: The KO, KP, and KQ modifiers should not be used with code J7620.)
When billing miscellaneous equipment or accessories (E1399), the claim must ...
February 8th, 2016
ICD-10-PCS Coding: Hysterectomy
By Bonnie Schreck | Published February 8th, 2016
When reading through documentation in an operative report for a hysterectomy, for the ‘Procedure Performed’, a ‘TAH-BSO, and Omenectomy’ is performed. As with all operative reports, there are guidelines that should be followed when determining the appropriate ICD-10-PCS codes. The first is identifying ‘TAH-BSO’. These are common abbreviations that are...
December 11th, 2015
Hospital discharge, nursing facility admit billable on same day by same provider in most instances
By | Published December 11th, 2015
Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple...
December 3rd, 2015
How to Manage a Hospital 101
By | Published December 3rd, 2015
CEO - stop "Making decisions." If the data and metrics are correct, the decisions are self evident. Spend time instead developing your team, your culture of communication, and ensuring that you are measuring the right activities. Stop managing departments and start managing patients. The silos...
December 3rd, 2015
Post-operative Hospital Visits
By | Published December 3rd, 2015
In 1992, CMS developed the concept of the Global Surgical Package, which pays for surgical services with a single payment. The full description of services that are included in this payment is described in the Medicare Claims Processing Manual, Chapter 12, Section 40 and...
December 3rd, 2015
The Critical Role Of Hospital CFOs: A Data Driven Answer [Infographic]
By | Published December 3rd, 2015
We know the evolving role of CFOs in the healthcare industry. There are situations which have forced the executives to make such decisions like changing the vendor, attritions and outsourcing one or more of their processes. There could be ample reasons like transition to value-based model, slow payer procedures, low...
November 20th, 2015
Documentation of Pressure Ulcers
By Find-A-Code | Published November 20th, 2015
Documentation of Pressure Ulcers, read entire article by Wound Consultants Inc.
...
October 8th, 2015
DRIP Line ICD-10-CM Did you know... ICD-10-CM/PCS consists of two parts
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 8th, 2015 - Last Review/Update August 9th, 2017
ICD-10-CM – The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all United States health care treatment settings. Diagnosis coding under this system uses 3–7 alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM; ...
August 10th, 2015
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015 - Last Review/Update August 7th, 2017
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech - language pathology services. They should never be used with codes that are not on the list of applicable therapy services. For example, respiratory therapy services, or nutrition therapy ...
August 3rd, 2015
Notice of Election (NOE) - Form CMS - 1450 (Rev. 3118)
By Find-A-Code | Published August 3rd, 2015
When a Medicare beneficiary elects hospice services, hospices must complete form locators identified in section 20.1.2 for the Uniform (Institutional Provider) Bill (Form CMS-1450), which is an election notice.
In addition, the hospice must complete the Form CMS-1450 when the election is for a patient who has changed an election from one ...
August 3rd, 2015
Levels of Care Data Required on the Institutional Claim to Medicare Contractor
By | Published August 3rd, 2015
With the exception of payment for physician services, Medicare payment for hospice care is made at one of four predetermined rates for each day that a Medicare beneficiary is under the care of the hospice. The four rates are prospective rates; there are no retroactive adjustments other than the application ...
July 17th, 2015
FI Service to HHAs and Hospices (Rev. 1, 10-01-03)
By Find-A-Code | Published July 17th, 2015
Under 42 CFR 421.117, CMS is authorized to designate RHHIs to service HHAs and hospices. This provision was implemented through the designation of regional FIs to service all HHAs and hospices. See http://www.cms.hhs.gov/contacts/incardir.asp for RHHI jurisdictions.
An HHA or hospice chain may request to be served under an arrangement involving a ...
June 17th, 2015
ICD-10 PCS - Coding System
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 17th, 2015
ICD-10-PCS has a seven character alphanumeric code structure. Each character contains up to 34 possible values. Each value represents a specific option for the general character definition (e.g., stomach is one of the values for the body part character). The ten digits 0-9 and the 24 letters A-H,J-N and P-Z ...
February 23rd, 2015
10 Things to Know About Turning a Surgery Center Into a Hospital Outpatient Department
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2015 - Last Review/Update February 16th, 2016
Hospitals are investing more in outpatient services, and wisely so. The migration of procedures from inpatient to outpatient settings is steadily increasing, as is the demand — from payers, physicians and patients — for outpatient care. The Agency for Healthcare Research and Quality reported that in 1980, 16 percent of ...
December 4th, 2014
Correct Coding: Braces (Orthoses) Attached to Wheelchairs
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017
Joint DME MAC and PDAC Publication
Recently, claims for braces attached to wheelchairs have been submitted using HCPCS code K0108 - WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED. K0108 is not the correct HCPCS code to use for these items.
CMS has clarified the distinction between braces (orthoses) and durable medical equipment (DME) under Medicare Part ...
November 21st, 2014
Aligning the Way Providers are Paid to Reward Value Rather than Volume (Value Based Modifiers)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 21st, 2014 - Last Review/Update March 1st, 2016
CMS is aligning the way providers are paid to reward value rather than volume.
Paying providers for quality, not quantity of care. In 2015, Medicare is continuing to phase in the Value-based Payment Modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and ...
October 17th, 2014
Patient Discharge Status Codes and Hospital Transfer Policies - Clarification
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 17th, 2014 - Last Review/Update January 30th, 2017
A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a health care facility encounter or at the end time of a billing cycle. It belongs in Form Locator 17 on a UB-04 claim form or its electronic equivalent in the ...
October 16th, 2014
Evaluation and Management (EM) in the Skilled Nursing Facility
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Evaluation and Management (EM) in the Skilled Nursing Facility
The first time I remember visiting a skilled nursing facility was after my grandmother's stroke. She was rehabilitating there, trying to learn to speak again. Once she was back to her normal activities, she returned to our home where she was taken ...
October 16th, 2014
Present on Admission (POA) Indicator
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
To group diagnoses into the proper DRG, CMS needs to capture a Present on Admission (POA) Indicator for all claims involving inpatient admissions to general acute care hospitals. Use the UB-04 Data Specifications Manual and the ICD-9-CM Official Guidelines for Coding and Reporting to facilitate the assignment of the POA indicator ...
October 16th, 2014
Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital-acquired conditions. CMS has titled the provision “Hospital-Acquired Conditions and Present on Admission Indicator Reporting” (HAC & POA).
Read more about it here: Medicare learning network fact sheet, ICN 901045 ...
October 16th, 2014
HACs and Codes List 2012
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
For a list of HACs and Codes
Medicare learning network ICN 901045 October 2012
(This list was current with Medicare when published October 2012)
Affected Hospitals
The Hospital-Acquired Conditions payment provision applies only to IPPS hospitals. At this time, the following hospitals are EXEMPT from the HAC payment provision:
Critical Access Hospitals (CAHs)
Long-Term Care Hospitals ...
October 16th, 2014
Final Hospital - Acquired Conditions ( HACs) FY 2014
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
For a list of the 2014 Final Hospital - Acquired Conditions HACs
Click here: FY 2014 Final Hospital -Acquired Conditions (HACs)
...
October 8th, 2014
#2 DRIP Line ICD-10 -CM Did you know... ICD-10-CM/PCS Examples: Structural Differences
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 8th, 2014 - Last Review/Update August 9th, 2017
The examples below show the structural differences between ICD-9-CM and ICD-10-CM/PCS.
ICD-9-CM Diagnoses Codes:
3–5 digits
First digit is alpha (E or V) or numeric
Digits 2–5 are numeric; and Decimal is after third digit
Examples:
496 – Chronic airway obstruction, Not Elsewhere Classified (NEC)
511.9 – Unspecified pleural effusion
V02.61 – Hepatitis B carrier
ICD-10-CM Diagnoses Codes:
3–7 digits
Digit 1 is ...
August 13th, 2014
Consolidated Billing (CB) for SNF (Skilled Nursing Facilities) - Exceptions
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 13th, 2014 - Last Review/Update August 9th, 2017
SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services listed below). CB for SNF resembles the bundling requirement for Inpatient Hospital Services, assigning the facility responsible for the entire package except for certain services that are specifically excluded.
Physicians' services furnished to ...
July 16th, 2014
Hospital Medical Coders Must Switch To The ICD-10-PCS Codes For Billing Purposes
By David Berky | Published July 16th, 2014 - Last Review/Update January 25th, 2017
For numerous years, United States doctor's offices, medical clinics and hospitals have been using the standard ICD-9-CM on medical forms for inpatient procedures. This code, developed by the World Health Organization (WHO - the "ICD-9") and modified by the use (the "CM"), is used by medical professionals for billing and ...
July 16th, 2014
The Impact of ICD-10 Coding System on Medical Billing
By David Berky | Published July 16th, 2014 - Last Review/Update January 25th, 2017
Learn how the introduction of ICD-10 will impact the coding and billing of medical diagnosis and procedure.
May 2nd, 2014
CMS Makes ICD-10 Announcement
By | Published May 2nd, 2014 - Last Review/Update January 25th, 2017
On the evening of April 30th, the release of the 2015 Inpatient Prospective Payment System Proposed Rule included three separate references to the implementation of ICD-10:
1. "The ICD-10-CM/PCS transition is scheduled to take place on October 1, 2015. After that date, we will collect non-electronic health record-based quality measure data coded only in ICD-10-CM/PCS." - page 648
2. "ICD-10 will officially be implemented on October 1, 2015." - page 1065
3. "ICD-10-CM/PCS will officially be implemented on October 1, 2015." - page 1074
Today, May 2, 2014, CMS released the following statement:
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