Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top left corner of this page

Practice Exam

2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Briefings on Accreditation and Quality, June 2017

Editor’s Note: Click the PDF button for a full edition of the May 2017 edition of Briefings on Accreditation and Quality

SAFER in practice; Thoughts on Joint Commission’s new scoring matrix

Unless you happened to be one of the facilities surveyed in the last four months, you still haven’t seen The Joint Commission’s new scoring system, the Survey Analysis for Evaluating Risk (SAFER) matrix put into practice. So what are people saying about the new system? Is it better or worse than the one that came before? Victoria Fennel, PhD, RN-BC, CPHQ, director of accreditation and clinical compliance at Compass Clinical Consulting, says Compass has heard from clients who’ve experienced the matrix and most of the feedback has been very positive.

Joint Commission EC and LS chapter revisions in the works for 2018

After a year of anticipation, Joint Commission surveyors finally started checking for compliance with the 2012 Life Safety Code® (LSC) and Health Care Facilities Code. The changes apply to the accreditor’s Environment of Care (EC) and Life Safety (LS) chapters. One set of chapter revisions took effect in January, with additional revisions to be implemented in July 2017 and in early 2018.

Make the most of CMS’ surveyor IC worksheets

On May 18, 2012, CMS initiated the Patient Safety Initiative which included surveyor worksheets for assessing compliance with three hospital Conditions of Participation (CoP): Quality Assessment and Performance Improvement, Infection Control, and Discharge Planning. The goal of these was to reduce hospital-acquired conditions, including healthcare infections and preventable readmissions. Maria Del Pilar Messner, corporate director of accreditation, regulations, and licensing at Adventist Health says that this a huge gift for accreditors. If CMS was sharing the surveyor worksheets, why not use them?

Q&A: Navigating the telemedicine requirements

This is the first year that Medicaid in all 50 states has adopted some form of telemedicine coverage. While technology has allowed for new and creative ways to connect patients and providers, deciphering the laws surrounding them can be difficult. The rules for what we can use telemedicine for and where vary greatly on a state by state level. The following is an edited Q&A with Sue Dill Calloway, RN, Esq., AD, BA, BSN, MSN, JD, CPHRM, CCMSCP, president of Patient Safety and Healthcare Consulting and Education, on the need to know about telemedicine. 
 

HCPro.com – Briefings on Accreditation and Quality

CPC-A 2017 seeking entry level job in Triangle, NC (Cary,Raleigh,Durham,Chapel Hill)

CPC-A 2017 seeking entry level job in Triangle (Cary, Raleigh, Durham, Chapel Hill), NC Area

Please contact me if you have any openings for a entry level medical coder or for medical documentation.

Email: [email protected]

Medical Billing and Coding Forum

2017 Salary Survey: Right on the Money

AAPC credentials pave the way for many paths to success. With almost 12,000 responses to AAPC’s 2017 Salary Survey, and the data indicating overall higher pay for healthcare business professionals than the year before, 2017 was a good year. For all employed respondents, the average salary climbed nearly 6 percent, to $ 52,648. Even better, the […]
AAPC Knowledge Center

HHS-OIG Cracks Down on Healthcare Fraud in 2017

The Office of Inspector General (OIG) was busy in 2017. In the video, Eye on Oversight – 2017 Year in Review, released Dec. 20, the agency charged with protecting the integrity of U.S. Department of Health and Human Services (HHS) healthcare programs reflects on its accomplishments throughout the year. Summarizing the video, the OIG reports for […]
AAPC Knowledge Center

ICD 10 CM New Changes Effective from October 1, 2017


The 2018 ICD 10 CM codes has been published and it is effective from October 1, 2017. These 2018 ICD-10-CM codes are to be used for discharges occurring from October 1, 2017 through September 30, 2018 and for patient encounters occurring from October 1, 2017 through September 30, 2018. There is an increase in the total number of ICD 10 codes for the year 2018 compared to 2017. The total number of ICD 10 codes for the year 2017 is 71486 and for the year 2018 is 71704.

2018 ICD 10 CM updates:

Additions – 360 
Deletions – 142 
Revisions – 226 



Coding Ahead

Briefings on Accreditation and Quality, December 2017

Editor’s Note: Click the PDF button above for a full edition of the December 2017 edition of Briefings on Accreditation and Quality

Joint Commission elaborates on accreditation reports, suicide risks, and toilet seats

The 2017 Chicago session of The Joint Commission’s annual Executive Briefings saw a far-ranging discussion on the future of accreditation. Attendees from around the country came and listened to the latest news on risk assessments, the SAFER Matrix, documentation, and suicide prevention.

Test your knowledge of the new emergency prep CoPs

CMS is offering providers a version of its online training for surveyors on the new emergency preparedness Conditions of Participation (CoP), set to go into effect November 15. Use this test—taken from the course material—to see how well you do before and after taking the training.

Being compliant isn’t hard when you have a library card

Starting on January 1, 2018, healthcare organizations will need to create and maintain an accessible library of service manuals, instructions for use, technical bulletins, and other information manufacturers provide, and keep it as rigorously updated as other required documentation of tests, inspections, and maintenance.

Bringing innovation to your facility

Taking a good idea for your own seems like it ought to be simple. But in reality, many facilities struggle to adopt new innovations—or worse, they give up on ideas they didn’t come up with themselves. So how do you go about taking someone else’s innovation and incorporating it at your facility? How do you get staff and leadership to buy into a new way of doing things?

Joint Commission updates EM standards to match CMS

In response to CMS’ final emergency preparedness rule issued earlier this month, The Joint Commission announced revisions to its Emergency Management (EM) standards. CMS is expected to approve the updated standards before they go into effect November 15.

USP deadline on hazardous drug handling postponed until 2019

The U.S. Pharmacopeial Convention (USP) has announced it intends to push back the compliance deadline for USP Chapter <800> “Hazardous Drugs; Handling in Healthcare Settings” from July 1, 2018, to December 1, 2019.

HCPro.com – Briefings on Accreditation and Quality

10060 vs 10061 using coding clinic second quarter 2017

:confused:from the AHA coding clinic second Quarter 2017
Ask the Editor–and I apologize if this is a rehash.

A patient underwent an incision and drainage procedure at our facility. According to the operative report, an incision was made over the lesion and purulent material was expressed. Loculations were broken up using forceps and more of the material was expressed. The drainage cavity was then irrigated, packed and dressed with sterile gauze.

Would it be appropriate to code an incision and drainage (I&D) as complicated based on documentation that a drain or packing was used? There are many articles available that provide varying opinions and we would appreciate an official response. Should the term complicated be documented or may the coder use the drain or packing as an indicator of a complicated procedure?

ANSWER

No, it would be inappropriate for the coder to assume that the incision and drainage is complicated based on the use of a drain or packing without confirmation from the physician. When the documentation is unclear the coder should query the physician for clarification.

With that said my question is- If I’m not basing a complex I&D on whether the provider used packing or a drain, can use the fact that they probed for loculations, or explored the abscess further to come to a 10061(complex; multiple) for a more complex procedure? I’m asking in the absence of a query would probing and/or breaking up loculations be evidence of a complex I&D? According to the coding clinic we just can’t assume placement of a wick or drain is evidence of the complexity but it says nothing about probing, or breaking anything up shouldn’t be used to determine the complexity. I know it’s at the discretion of the provider, but unless they state it was complex OR if there was more than one abscess then what other indication is there to code a 10061 for the (complicated;multiple except for the obvious more than one)?
Do we call everything a simple I&D unless the provider states it’s complex?

Thank you!

Medical Billing and Coding Forum

2017 OPPS proposed rule looks to implement provider-based changes

2017 OPPS proposed rule looks to implement provider-based changes

CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) by January 1, 2017, according to the 2017 OPPS proposed rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-16098.pdf). The agency is proposing to pay the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount to the performing/supervising physician and preclude hospitals from billing on a UB-04 form or receiving OPPS payment for services performed at these locations for 2017, but plans to explore other options for 2018 and beyond.

Physicians would be paid at the higher nonfacility rate of the MPFS, but only hospitals that have employed or contracted physicians that reassign their billing to the hospital would get paid under the MPFS for these services.

Hospitals would be able to bill claims on CMS-1500 forms for physicians who have already reassigned their billing to the hospital, as in the case of employed physicians. Otherwise, hospitals would have the option of enrolling the location as the type of provider or supplier it wishes to bill to meet the requirements of that payment system (e.g., ambulatory surgery center or group practice).

"This proposal will be very challenging for hospitals that have community physicians practice at their off-campus outpatient departments that will no longer be paid under OPPS," says Valerie Rinkle, MPA, lead regulatory specialist and instructor for HCPro, a division of BLR, in Middleton, Massachusetts.

"These physicians would bill with the office place of service code and the hospital would have to figure out how to get compensated," she says. "This will likely require hospitals to rewrite their agreements with these physicians."

CMS’ proposal for operationalizing Section 603 comes as somewhat of a surprise since the burden is being placed squarely on providers, with CMS’ own systems not ready to allow existing billing practices, says Jugna Shah, MPH, president and founder of Nimitt Consulting, Inc.

"Some providers hoped CMS would delay implementation and others speculated that modifier ?PO might get repurposed for CY 2017," says Shah. "Perhaps commenters will be able to offer CMS solutions that will minimize provider operational burden."

CMS writes in the proposed rule:

We intend the policy we are proposing in this proposed rule to be a temporary, 1-year solution until we can adapt our systems to accommodate payment to off-campus PBDs for the non-excepted items and services they furnish under the applicable payment system, other than OPPS.

 

CMS would allow certain excepted items and services to still be billed under the OPPS:

  • All items and services furnished in a dedicated emergency department
  • Items and services furnished in a hospital department within 250 yards of a remote location of the hospital and within 250 yards of the main hospital (i.e., on-campus)
  • Items and services that were furnished and billed by an off-campus PBD prior to November 2, 2015

Hospitals could also continue to bill for services at these facilities that are not paid under the OPPS, such as laboratory services.

Off-campus PBDs built and billing before November 2, 2015, would retain grandfathered status or what CMS calls "excepted" status and continue billing under the OPPS, but the proposed rule includes some caveats. While the agency proposes that a change in ownership would not change an off-campus PBD’s excepted status as long as the new owner assumes the same provider agreement, a change in location would. However, CMS is requesting comments on this provision and whether certain exceptions should apply for situations beyond a hospital’s control such as a natural disaster.

Off-campus PBDs that expand services beyond those offered and billed before November 2, 2015, will not be allowed to bill them under the OPPS. CMS has proposed clinical families based on APCs that would determine whether those expanded services would continue to be excepted (see Table 21 on page 342 of the proposed rule).

CMS also proposed a 90-day Medicare EHR incentive program reporting period in 2016 for all eligible professionals, eligible hospitals, and critical access hospitals (CAH). If passed, the reporting period would be 90 continuous days between January 1, 2016, and December 31, 2016. CMS proposed the elimination of clinical decision support and computerized order entry objectives and measures for eligible hospitals and CAHs attesting under the program. The thresholds for the modified stage 2 for 2017 and stage 3 for 2017 and 2018 would be reduced. These proposed changes do not apply to the Medicaid EHR incentive program.

CMS proposed that EHR incentive program participants that have not yet demonstrated meaningful use attest to the modified stage 2 by October 1, 2017. This is in part due to the fact that after publishing the 2015 EHR Incentive Programs Final Rule, CMS realized it was not possible for new incentive program participants to attest to stage 3. However, any eligible hospital, eligible professional, or CAH that has attested to meaningful use in the past will report to different systems.

The proposed rule states that some eligible professionals who have not demonstrated meaningful use but intend to attest in 2017 and transition to MIPS should be granted a hardship exception.

CMS also proposed modifying the measure calculations for the EHR incentive program. Under the proposal, actions in the numerator must occur during the reporting period when the period is a full calendar year. If the reporting period is not a full calendar year, the numerator must be reported in the same calendar year as the reporting year.

CMS also proposed removing six procedures from its inpatient-only list, including four spine procedures as well as two laryngoplasty procedures. CMS is requesting comments on whether to remove total knee arthroplasty from the inpatient-only list in the future.

"The deletion of procedures from the inpatient-only list is long overdue," says Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, chief operating officer and founder, First Class Solutions, Inc., in Maryland Heights, Missouri. "It’s unfortunate that the knee arthroplasty wasn’t included. I question whether there is value to the inpatient-only list any longer."

Some conditional packaging status indicators are currently based on the date of service, while others package based on the claim’s from and through dates, meaning packaging crosses all dates encompassed in those fields (FL6) of the claim. For CY 2017, CMS proposes to change its packaging logic for all conditional packaging status indicators so that it occurs at the claim level.

The proposal would change the logic for status indicators Q1 and Q2, which currently package items or services provided on the same date of service as those assigned status indicator S, T, and V. CMS also proposes deleting modifier ?L1 (separately reportable laboratory test), which had been operationally burdensome and confusing to report, led to a billion dollar CMS miscalculation, and was subsequently replaced in functionality with status indicator Q4. If CMS finalizes its proposal, all laboratory tests that appear on a claim with other hospital services would be packaged, even if ordered by a different provider for a different diagnosis than the other services.

For more information, see CMS’ fact sheet, available at: www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-06.html.

HCPro.com – HIM Briefings