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2018 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

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COVID-19 Causes CMS to Issue Nonessential Surgery Guidelines

 CMS wants all providers to cancel or postpone all low-acuity surgeries. The Centers for Medicare & Medicaid Services (CMS) is limiting “all non-essential planned surgeries and procedures, including dental, until further notice,” according to statement the agency released March 18. This measure is designed to have a twofold effect: increase the amount of ventilators and […]

The post COVID-19 Causes CMS to Issue Nonessential Surgery Guidelines appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Tips from this month’s issue

Tips from this month’s issue

Small breaches could become a big problem (p. 1)

1.Regional offices were advised to increase investigations of breaches affecting fewer than 500 individuals. Investigators will look for evidence of systemic noncompliance, such as multiple small breaches and common root causes.

2.Implementing OCR’s directive may be a tall order for resource-strapped regional offices, and it’s difficult to predict what the outcome will be.

3.Because small breaches weren’t investigated on the same scale as large breaches, OCR has much less data on them. Stepping up small breach investigations will mitigate that and may lead to improved guidance on key HIPAA pain points.

4.Although large breaches grab attention, they’re statistically less likely than small breaches.

5.But even a breach involving a single patient’s records can have serious consequences for the individual and even impact his or her safety if the medical record becomes compromised as a result.

6.Large health systems may lose sight of the details and brush off small breaches, but it’s the duty of privacy and security officers to take every breach, no matter how large or small, seriously and ensure the organization does so as well.

 

The cost of a data breach (p. 4)

7.Data breach costs vary between industries but healthcare, a highly regulated industry, sees especially high data breach costs.

8.Direct costs include remediation efforts and possible fines, but indirect costs are sometimes more difficult to identify and quantify.

9.Breach notification costs are the highest in the U.S.?first class postage adds up fast.

10.The more quickly a breach is identified and contained, the lower the cost. A well-prepared security incident response team is a smart investment that will pay off.

11.Participating in threat sharing may also be linked to lower data breach costs, but executive leaders may be concerned that sharing information on cybersecurity threats will put confidential information at risk. But no sensitive business information needs to be disclosed to participate.

12.Direct breach costs may be significant on their own but may not stack up against other risks an organization faces. Remember that one of the indirect costs of a data breach can be bad debt via medical identity theft. Bad debt is a top financial risk, and any measures that can bring that risk down are worth investing in.

 

Is HIPAA enough? (p. 8)

13.The rise of ransomware and other threats has led some stakeholders and lawmakers to question whether HIPAA is robust enough to provide even a reasonable bare minimum of security.

14.OCR has pointed fingers at executives for failing to support strong security programs, but the agency has no power to hold those executives accountable.

15.OCR recommends that CEs and BAs follow NIST’s cybersecurity framework, but that standard is only optional?not required?and many organizations may choose to not spend more resources on security than required.

16.Failure to complete an organizationwide risk analysis will land a CE or BA in hot water if a breach happens, but other federal agencies are critical of OCR’s risk analysis guidance, calling it inadequate.

17.HIPAA is designed to work with state laws. CEs and BAs must follow all applicable state privacy and security laws. In some cases, state laws may be stricter than HIPAA and provide stronger security requirements or clearer guidance.

HCPro.com – Briefings on HIPAA

Complicated Coding issue involving Cataract surgery on a juvenile for PCS Cataract su

I would like some Coding help in determining What CPT’s and what current ICD-10 Codes can be billed for cataract surgery with sulcus lens placement, pars plana vitrectomy, with lens implant retrieval of implant that dropped into the vitreous space during surgery, right eye. This is complicated in that the cataract surgery was performed by the Primary Ophthalmologist on a juvenile patient for PSC cataract OD and then this patient experienced a posterior capsule rupture during I & A necessitating pars plana vitrectomy with lens implant retrieval by another Ophthalmologist, who is the Retinal Surgeon in the same Ophthalmology Practice. Also, can this be coded as a Two-Surgery Case with a -62 modifier on each surgery? Also, the CPT Codes the Retinal Surgery said to use for his portion of the surgery were 67036, 67121, and 66986.

Which modifiers would I use for each surgery for each provider?

Medical Billing and Coding Forum

Compliance Issue: NP and Physician E/M Services

Per CMS new patient services must be personally performed by a physician with the exception of history obtained by ancillary staff.
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as “personally performed?”
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?

Medical Billing and Coding Forum

Ethics Issue?

I work for a billing company, and one of the clinics that I code for has recently started to perform a new procedure in the office. Prior to beginning this, the office manager emailed me regarding the suggested coding that was provided by the device manufacturer. In my professional opinion, this code was not fitting AT ALL, and I suggested that they use an unlisted code. I explained this in every way I knew how, and the manager/doctor refused to listen. They performed this procedure for the first time on Monday, and sent me the note yesterday. I then emailed the office manager again and explained that we CANNOT use this code, and asked if she wanted me to proceed with the proper, unlisted code. She then stated that they wanted to use the coding recommended by the manufacturer.

I feel extremely uncomfortable submitting this claim that I know will be fraudulent. The office even made the procedure note documentation match the CPT code that they are wanting to use, when in all reality it was not what was done. I explained to my employer that I would be putting myself (certification) at risk by knowingly submitting false claims and I was not going to do that.

What would you do to "cover yourself?"

Elysia York, CPC

Medical Billing and Coding Forum

20610 DX Issue

I might be overthinking this, but I can’t wrap my brain around it to save my life. Our guidelines are crystal clear that if we have a definitive diagnosis, we are NOT to code any symptoms that are considered to be associated with the definitive diagnosis.

My issue: Payers are denying the 20610 when we use anything other than a pain diagnosis.

Example: pt has right rotator cuff tear and provider decides to give them an injection to alleviate the pain

My thoughts: the rotator cuff tear is the correct dx, but it will not pass through the edits based on the dx being inappropriate for the procedure.

Can anyone please tell me how they are handling this?

Medical Billing and Coding Forum

Place of service issue

One of the neurosurgeons I bill for performed a procedure in an ambulance. I am having issues with the billing…..Per Medicare guidelines you would use the 41 place of service. When we bill this, it is asking ambulance specific questions. We however, are not billing for the ambulance services just the physicians professional fee. Has anyone ran into this before? How do you bill for a physician performing procedures in an ambulance place of service?

Medical Billing and Coding Forum

62368 POS12 issue

We have a patient with an intrathecal pump that needed to be seen at home. The doctor analyzed and reprogrammed the pump. We billed 62368 and Medicare denied saying that the home (POS12) is an inappropriate place of service. The pumps are often refilled at home and we bill 62370 without any issues. Not quite sure why Medicare says it’s an inappropriate POS. It’s considered a surgical code, but so is 62370. Anyone have any ideas? And does anyone know if you can appeal with Medicare and actually get paid?

Medical Billing and Coding Forum

51/59 Nerve Block Modifiers – bundling issue

Hello-

I work for a neurology office – having some difficulty with a bundling issue.
On an extreme case I could bill for one patient:

64450
64405
20553
64615
96372

How i was trained – typically I would use:
64450 – 50, 59
64405 – 59
20553
64615
96372 – 59

BCBS – pays for all minus 20553 – UHC pays for 64615/96372 and 64405 – but not 20553/64450
We have a lot of UHC patients so i’m wondering if anyone has any advice
I’ve tried leaving 64450/64405/20553 blank as i’ve seen suggested for someone else – they bundled – i’ve tried using 51 modifier, which then 20553/64450 was paid but not 64405

Appreciate any advice – thanks so much!

Medical Billing and Coding Forum