The Medicare Advance Care Planning Benefit
Since Jan. 1, Medicare covers advance care planning (ACP) as a separate service when provided by physicians and other health professionals (such as nurse practitioners who bill Medicare using the...
View ArticleFluid Administration Is Part of Operative Procedures
The CPT® codebook includes codes to report administration of fluids and drugs, but you should not report these administration services when they occur as part of an operative procedure. The National...
View ArticleCoding Uncertain Diagnoses
Accurate diagnosis coding is crucial for patient care and compliant, optimal reimbursement. In the outpatient setting, you should never assign a diagnosis unless that diagnosis has been confirmed by...
View ArticleHIV: ICD-10 Dx. Coding
HIV infection/illness is coded as a diagnosis only for confirmed cases. Confirmation does not require documentation of a positive blood test or culture for HIV; the physician’s diagnostic statement...
View ArticleOperative Report Coding Tips
Diagnosis code reporting—Use the post-operative diagnosis for coding unless there are further defined diagnoses or additional diagnoses found in the body of the operative report. If a pathology report...
View ArticleHemorrhoid Coding Made Easy
Hemorrhoids are simply blood vessels, which require attention only if they become inflamed. Correct hemorrhoid coding depends on documentation that specifies the type (internal, external, or “mixed”)...
View ArticleCMS Releases Proposed IPPS/LTCH Rules for 2017
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS)...
View ArticleVermilionectomy: CPT® Coding in Brief
Vermilionectomy (40500 Vermilionectomy (lip shave), with mucosal advancement) is the shaving or excision of the vermilion border of the lip. This code also includes the repair of the excisional area by...
View ArticleBody Positioning and Planes
When discussing the body planes, we look at the body in anatomical position, which is erect with feet slightly apart and palms facing forward, with thumbs pointing away from the body. Body planes...
View ArticleGet Ready: ICD-10 Code Freeze Ends October 2016
Despite a chilly reception, ICD-10 was successfully implemented on Oct. 1, 2015. Now it’s time to heat things up. At the ICD-10 Coordination and Maintenance Committee meeting, March 9-10, 2016,...
View ArticlePhysicians Are Limited to Providing CLIA-Waived Lab Tests
Physicians are allowed to perform only a limited number of lab tests since 1991. To do so, they must apply for a Clinical Laboratory Improvement Amendment (CLIA) waiver. The Centers for Medicare &...
View ArticleMPFS: April Update Brings New Guidance
Some changes you’ll find in the April 2016 update actually went into effect the first of the year. They are: HCPCS Level II code G0464 Colorectal cancer screening; stool-based dna and fecal occult...
View ArticleMastectomy vs. Breast Excision: Margins Matter
When deciding between 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or...
View ArticleNew Medicare Benefit: HPV Screening
The Centers for Medicare & Medicaid Services (CMS) has added Human Papillomavirus (HPV) testing to the list of Medicare covered preventive services, under specific conditions. Conditions for...
View ArticleICD-10 Continues to Follow Rule of Nines, but Allows Wiggle Room
The 2016 ICD-10-CM Official Guidelines for Coding and Reporting state, “Categories T31 [Burns classified according to extent of body surface involved] and T32 [Corrosions classified according to extent...
View ArticleCalculating Body Surface Area Burned
Codes to report local treatment of burns, and many skin grafting procedure codes, specify the total body surface area (TBSA) treated. For example, 16020 describes, “Dressing and/or debridement of...
View Article“New” or “Established” Status Travels with the Patient
Most professional coders—even relative beginners—are familiar with the “three-year rule” to determine whether a patient is “new” or “established” with a provider. One common conundrum is how to...
View ArticleGlobal Period: What it Does (and Does Not) Include
The CPT® codebook defines the following as “always included” in the global fee (global period) for a surgery or procedure: Subsequent to the decision for surgery (procedure), one related E/M encounter...
View ArticleCoding Same-day Sick and Well Visit
When reporting the preventive visit (well visit) and a problem-focused visit (sick visit) on the same day, you must append modifier 25 Significant, separately identifiable evaluation and management...
View ArticleCMS Drug Testing Codes for 2016
The Centers for Medicare and Medicaid Services (CMS) currently does not recognize AMA CPT® drug testing codes (80300-80377). Rather, Medicare payers require that you submit claims for drug testing with...
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