Develop a plan to transition to and implement ICD-11.
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Tag Archives: Transition
Tip Sheet: Transition Coding and Reimbursement
Got Transition™ and the American Academy of Pediatrics have released the new 2019 Transition Coding and Reimbursement Tip Sheet which supports the delivery of recommended transition services in pediatric and adult primary and specialty care settings. The tip sheet includes: An updated list of transition-related CPT® codes, including new codes relating to chronic care management and interprofessional […]
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Transition of Care
It has always been my understanding that unless a patient is actively having a CVA you always bill History of CVA. So if a patient comes in for a Transition of Care visit from being admitted for a CVA..do you use the diagnosis of CVA or History of?
Transition of Care
We are a primary care office. We had a patient who was admitted to the hospital. They had a 2 day stay and then signed themselves out AMA. There is not a discharge summary that I have seen. She has been in the office for her transition of care. Can we bill for the transition if she was AMA? All the other requirement have been met per CPT guidelines. My concern is the AMA part and I don’t have a discharge summary. The hospitalist admitted her. I haven’t had this come up before. Thanks for all your help!:confused:
Resources for a smooth transition to PDPM
Transition Care Management Code w/ Well Baby
Do you know if a TCM code 99495 can be billed with 99392?
Tip: Check claims submitted during the ICD-10 transition
Providers should also make sure claims submitted over the ICD-10 transition date of October 1 are properly submitted. If a patient came in September 30 and left October 1, that needs to be on two claims.
Providers should split the claims so that services provided before October 1 are submitted on one claim with only ICD-9-CM codes. Services provided on or after October 1 should be on a different claim with only ICD-10-CM codes.
CMS added two ICD-10-CM codes to the list of male diagnoses:
- Z87.430, personal history of prostatic dysplasia
- Z87.438, personal history of other diseases of male genital organs
CMS removed two ICD-10-CM codes from the list of male diagnoses:
- Z80.42, family history of malignant neoplasm of prostate
- Z80.43, family history of malignant neoplasm of testis
CMS removed one ICD-10-CM code from the list of female diagnoses: Z80.41 (family history of malignant neoplasm of ovary).
For a full list of ICD-10-CM code edit changes, see the October I/OCE release. All changes involving these ICD-10-CM codes have an effective date of October 1, 2015.
This tip is adapted from “NCCI logic could lead to no payment for claims including comprehensive APCs” in the December issue of Briefings on APCs.
Healthcare News: Majority of industry stakeholders find smooth transition to ICD-10, according to survey
ICD-10 implementation has gone smoothly for approximately 80% of attendees who responded to a survey during a recent webcast from audit, tax, and advisory firm KPMG.
For 28.3% of the 298 respondents to the November survey, the ICD-10 transition has been smooth, while 51.4% reported a few technical issues, but overall success with the new code set since October 1.
Another 11.1% reported complete failure since implementation and 8.6% said serious work was needed but they are surviving the transition. Respondents included healthcare staff related to IT, finance, and the clinical side.
While the transition has been relatively smooth for the majority of industry stakeholders, providers will need to dedicate more attention to the quality and specificity of clinical documentation to reduce rejected medical insurance claims, said Catherine O’Leary, KPMG managing director, in a press release.
KPMG asked attendees which of the following was the largest challenge they faced with ICD-10 implementation:
- Clinical documentation improvement and continuous physician education
- Increase in denials or rejected claims
- Reduced revenue due to coding delays or coding errors
- System testing and information technology fixes
Approximately 42% of the respondents noted all of the issues remain a challenge at their facility, while 11.1% said none of the issues would be their largest challenge.
Respondents are tracking a variety of key performance indicators following implementation, with many focusing on denials and rejections (18%) and accounts receivable (11.1%). Facilities are also tracking discharged not final billed accounts (5.6%) and CC and MCC capture (4.9%). A majority of respondents (60.8%) are tracking all four of these key performance indicators.
Palmetto Offers a Smooth Transition from Cahaba
Palmetto GBA is preparing to become the A/B Medicare administrative contractor (MAC) for Jurisdiction J (JJ), which includes the states of Alabama, Georgia, and Tennessee — and so should you if you submit Medicare claims for healthcare providers who practice in those states. Part A providers will transition from Cahaba GBA effective Jan. 29, 2018, and Part […]
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