Outpatient Facility Coding Alert - 2016 Issue 13
Compliance: CMS: Stop Reporting Diagnostic Colonoscopies for Screenings
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Article Overview
This article summarizes CMS compliance reminders for providers and billing teams on several Medicare coding and documentation topics. It discusses screening versus diagnostic colonoscopy reporting, observation care recordkeeping, and nerve conduction study claim support, with references to Medicare compliance materials and NCCI edits. The piece is aimed at coders, compliance staff, and clinicians who need to align documentation with Medicare audit expectations.
Why This Topic Matters
It helps readers understand which Medicare compliance areas are being scrutinized and what broad documentation and reporting subjects are addressed in the agency guidance.
Article Sections
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Screening vs. diagnostic colonoscopy compliance
CMS compliance reminders on colonoscopy reporting and documentation are discussed, including screening scenarios and related Medicare guidance. The section also references associated billing and audit concerns.
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Keep Thorough Notes for Observation Care
This section addresses observation care documentation issues identified in audits and the general recordkeeping elements CMS expects to see. It focuses on support for observation service reporting.
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Nerve Conduction Studies Require Orders
This section covers documentation problems found in nerve conduction study claims and general compliance concerns related to ordering and reporting. It also mentions Medicare coding review activity and bundled testing edits.
What You Will Learn
- How CMS frames screening colonoscopy compliance concerns
- What kinds of documentation issues have been cited for observation care
- Why nerve conduction study claims are being scrutinized in audits
- What broad compliance topics are covered in Medicare quarterly guidance
Who Should Read This
- Medical coders
- Compliance officers
- Billing staff
- Physicians
- Revenue cycle staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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