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2023 ICD-10-CM update expands F01-F03 code categories to allow providers to indicate disease stage and symptoms. The 2023 update to ICD-10-CM finally provided an expansion of the dementia codes, which has been needed for a very long time. Previously, we were only able to report with/without behavioral disturbance and a code option for wandering (Z91.83) […]
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Payer-specific rules — especially rules that vary for every claim — not only make collecting revenue difficult, but also add to the cost of collection of monies earned by the physicians. A blog clarifies Novitas’ instructions for reporting modifier 50 when bilateral procedures are performed. The instructions from Novitas state that bilateral services should be […]
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Since the physician sees the patient a week after the testing to go over the results for one hour we would bill out the 96132/96130 (depending on which type they are doing) and then bill 96131/96133 for each hour of selecting the tests, writing the report, etc outside of the patient being seen face to face, correct?
Thank you for the help, this is very confusing to get into.
Rob
can be coded like the below:
1. PDx – L03.116, L02.416 (Local Infection)
2. B96.20 ( Reason for cellulitis)
3. A41.51 ( sepsis due to cellulitis due to E.coli )
4. R65.21
5. N17.9
6. G93.41
please help me with sequencing and concept of infectious agent coding
thanks,
Uma ,CPC,CIC
NOTICE Act confusion continued into the summer
Learning objective
At the completion of this educational activity, the learner will be able to:
Hospitals were struggling this summer to comply with the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which was signed by President Barack Obama August 6, requiring hospitals to provide a verbal and written notice of outpatient status to any patient in observation who has been in the hospital for more than 24 hours.
With only a preliminary form on the PRA website to guide them (http://ow.ly/7TPE302eSiM), many organizations were finding more questions than answers in their quest to comply with the regulation.
"[The preliminary form] does not have an Office of Management and Budget approval number, so it is not finalized," says Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at Accretive Health in Chicago. "And there are several comments that it is not written to the federal standard for understanding by someone with limited education, so it may not even be approved in its present form. CMS has also said they will give further guidance on the requirement for verbal explanation so it is hard to know who will be allowed to present and explain the form."
In July, Janet Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, C-ASWCM, ACSW, the manager of case management at Washington Adventist Hospital in Takoma Park, Maryland, was still looking to have a number of questions about the rule answered.
"I contacted the Maryland Hospital Association who researched this issue," she says. "The staff at MHA are conferring with experts at the Maryland Department of Health and Mental Hygiene about my questions and concerns and expect to have a response soon."
This lingering uncertainty not only was making it difficult for hospitals to start planning for compliance, but also led some to speculate that the compliance date would be extended.
The Ohio Hospital Association (OHA) in June told its members that the requirement date could be pushed back until October.
"The implementation of the Medicare Outpatient Observation Notice, or MOON, was set for August 6, 2016. However, as hospitals await the details of the federal fiscal year 2017 inpatient prospective payment system final rule, CMS is now stating that the MOON requirement date may be pushed back to October. Stay tuned for a final decision on the MOON implementation date," the OHA stated in a written release (http://ow.ly/z0qZ302fmvH). But as of mid-summer this talk still amounted to unsubstantiated rumors, says Hirsch.
"Unless someone knows someone at CMS, there is no official word. I did read many of the comments to the rule and many asked for a six-month delay. My guess is that they cannot delay the implementation since it is a law but they will delay enforcement for three months," he says.
In the meantime, organizations were trying to do what they could to get ready.
The NOTICE Act stipulates hospitals must inform patients within 36 hours from the start of the service, or at the time of discharge, about their status.
The goal of the legislation is to ensure patients are aware of their status and what it might mean for them financially?in particular, how it might affect their post-acute care options.
Patients often (wrongly) assume that if they’re in a hospital bed, they are an inpatient.
They also don’t understand the implications of outpatient billing status.
One of the biggest issues that can crop up when a patient’s care orders place him or her on observation status is that he or she will not be eligible for Medicare coverage for a post-acute stay in a skilled nursing facility (SNF), and instead may need to pay more out of pocket. Medicare currently only covers SNF extended care rehabilitation services for patients who have three consecutive inpatient days in a hospital. For example, one day in observation and two days as inpatient equals three days in the hospital, but does not meet the three-day inpatient day stay requirement because it only includes two inpatient days.
"An Office of Inspector General report found that the average out-of-pocket cost for SNF services not covered by Medicare was more than $ 10,000 per beneficiary," states a press release issued by the congressional leaders who promoted the bill (http://ow.ly/S6JSB).
To comply with the rule, hospitals will now need to designate someone?in some cases it may be the case manager?to provide this notification.
Stefani Daniels, RN, MSNA, ACM, CMAC, founder and managing partner of Phoenix Medical Management, Inc., in Pompano Beach, Florida, says a few of her clients were trying to get the form included in a packet of admission papers that are given to each Medicare patient to sign.
But even so, as of press time most organizations had more questions than answers about compliance. Stay tuned for updates in future issues of CMM.
What if the provider decides to order screening labs during a regular office visit (not at an annual physical) and the patient doesn’t have a diagnosis to associate with those screening labs?
I really appreciate any input! This is a confusing one for me. Thank you!!!;)
Look to documentation for clues that tell you if a patient’s cancer is active or past history. By Emily Bredehoeft, COC, CPC, AAPC Fellow A hot topic in oncology is when to start coding history of cancer rather than active cancer. Luckily, ICD-10-CM Official Guidelines for Coding and Reporting provides an answer. Section 1.C.2 Provides […]
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I have been working at a Cancer Center for close to a year now in billing and have decided to take my CHONC exam. I have the study guide, set up my exam, now I am doing the practice exam. I have gotten each question correct, except for the administration codes. I am having difficulty determining which admin codes to use.
My question is, does anyone have anything they used or have done to become familiar with the admin codes? As of right now, I have sat down with the coding book and am reading the administration codes section from beginning to end, beyond that…I’m not sure what to do.
Just wanted info on how everyone else might have defeated this admin code battle. 
Thanks in advance!!!!
:confused:
JC
When you come face-to-face with multi-provider situation, the last thing you would want is to mess up your coding by assigning the wrong modifier(s). As such, you really need to know how to assign the proper modifiers.
Here’s a scenario: A 70-year-old female patient who presents with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) has a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist teams up with a thoracic surgeon and decides to perform an open operative repair with graft replacement of the diseased segment.
The key in a multi-provider scenario is to treat each physician’s work as a separate activity. But then, deciding when to report a case as co-surgery, assistant surgery — or something else — has more to it than meets the eye. Here are some expert advice:
Modifier 62, 81, 82
In this situation, a modifier is at hand; but then, more importantly you should be able to tell what role each modifier plays so that your procedure codes blend well together. Take a look at these common modifiers used in multi-provider situations:
Modifier 62 (Two surgeons). Use this modifier to each surgeon’s procedure when the physicians perform distinct, separate portions of the same procedure. Also called co-surgery, modifier 62 applies when the skill of two surgeons (normally of different skills) is called for in the management of a special surgical procedure.
Opt between modifier 80 (Assistant surgeon), modifier 81 (minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]) when one surgeon aids the other with multiple portions of the case rather than completing his work independently. What to look for? Ensure your physician indicates in his documentation that he is working with an assistant surgeon, what the assistant surgeon did, and why he or she was used during the case.
When you report a nonphysician practitioner’s (NPP’s) involvement to Medicare, attach modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery).
But remember that not all payers recognize modifier AS. You should verify the proper way to report the NPP’s service before completing your claim.
Stay away from the modifier 51 trap
When you are coding for multiple procedures during the same operative session, it is easy to fall into the lure of using modifier 51 (Multiple procedures). However you could end up in the gutters if you are not careful enough.
Here’s why: Modifier 51 tells you that a surgeon was present carrying out multiple procedures. If a surgeon is not present physically for multiple procedures in a surgical case, it is not proper to indicate that he was busy using modifier 51.
Two surgeons require two echo claims
In the given scenario, both surgeons should bill 33880. (Then, you’d use 441.2 (Thoracic aneurysm without mention of rupture) with 33880 to describe the condition. Finally, you should use modifier 62 to 33880 to show that two surgeons performed the repair.
Catch: You do not use modifier 62 if the physicians are not reporting the same CPT code. If each doctor can represent his work with a separate CPT code, leave out modifier 62. Ensure both surgeons send a claim with the same code and modifier declared or you would end up throwing away about $ 4,000 in reimbursements (56.62 RVUs multiplied by 2011 conversion factor of 33.9764; $ 1,923.74 for each surgeon).
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