According to ICD-10-CM official guidelines for FY 2019, a joint effort between the healthcare provider and the coder is essential to achieve and complete an accurate documentation, code assignment, and reporting of diagnoses and procedures. Because coding and billing claims are susceptible to human error, a thorough review of the medical record is important. Without review, accurate coding may not be achieved.
CMS has regarded CPT Code 99211 (a level 1 established patient encounter code) as an overused code that is commonly accompanied by many errors. In this CodingAlert, we review when it is proper to bill CPT 99211.
This CodingAlert provides a summary of Modifier 59 and changes to X Modifiers. This Distinct Procedural Services modifier helps healthcare providers identify procedures and services that are not normally reported together but may be reported together under certain circumstances.
This CodingAlert provides a brief summary of some of the recent modifications to the Current Procedural Terminology (CPT) code set. Every year the code set undergoes a number of updates and changes in an effort to capture and describe the latest scientific and technological advances in medical, surgical and diagnostic services.
This CodingAlert offers some reminders for Healthcare providers to help them properly document and bill Medicare for a Modifier 25 code [significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service]. It is not always the case that a notable medical record finding during a patient encounter warrants appending a Modifier 25.
It happens—a patient’s simple visit turns into an extended appointment. In this situation, it is critical for providers to properly document and bill for prolonged services in the office or outpatient setting. Providers must understand and follow the applicable coding/reimbursement standards and ensure services are accurately documented to support a prolonged services billing/claim.
In the last CodingAlert, LW Consulting, Inc. identified specific proposed changes to the Physician Fee Schedule (PFS) for CY 2019. Highlighted below is the Centers for Medicare & Medicaid Services (CMS) proposed guidance for Evaluation and Management coding in the educational environment. Additionally, we have included corresponding links for you to voice comments to CMS (accepted on/before 9/10/18).
The ground has shifted for physician services coding. The proposed Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) represents a fundamental shift in payment. Mid-July 2018, CMS released the PFS Proposed Rule which, when goes into effect, will change the current way evaluation and management codes in the office setting are selected and reimbursed.
In March 2018, LW Consulting, Inc. provided a CodingAlert outlining the components needed to credibly submit a level 4 new patient visit for billing. Because the topic spirited a great response, and approximately 40% of all our audit results are demonstrating a need for education on new and established patient encounter requirements, we decided to expand level 4 details to this topic.
Fraud has become a growing concern under the Medicare program. LW Consulting, Inc. (LWCI) can help medical practices identify areas of potential risk and what to be mindful of in their medical record documentation.
LW Consulting, Inc. (LWCI) has identified that within the components of Evaluation and Management (E&M) leveling, there are those that are more difficult than others to understand and apply. One component that, in our experience, has the most difficulty is in medical decision-making.
In calendar year 2010, the Centers for Medicare and Medicaid Services (CMS) made revisions to the payment policies under the physician fee schedule (CMS-1413-FC), eliminating the use of all consultation codes for office/outpatient (99241-99245) and inpatient (99251-99255).
As with so many forms of healthcare delivery, coding for a new vs. an established patient can be confusing. In this month's CodingAlert, we will review how to properly code for each type of patient visit.
It's that time of year again, when the new CPT codes become effective. Make sure to get the current year’s CPT book or you could be coding inappropriately since this year, among other changes, observation codes have been revised and five new evaluation and management codes were added.
It’s that time of year again when patients are coming in for their annual flu vaccines. Before selecting the proper code administration of a vaccine, make sure your practice knows what to check for.
Now that more medical practices and health care facilities are utilizing electronic medical records (EMRs), regulators are finding that many records look identical in wording and elements. This can be cause for suspicion, leading to audits and claim denials. Are your medical records cloned? You should be on the look out for these documentation shortcuts and avoid them at all costs.
Are your physicians and coders ready for October 1, 2017 when the new diagnosis codes and coding changes take effect? The 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.
Documentation has been under increased scrutiny as the role of the medical record has substantially changed over the past several years. Managed Care, Health Care Reform and the implementation of Electronic Health Records have made chart documentation vital for every service that is being submitted for payment.
As a healthcare professional, we're sure your health system or physician practice provides many annual wellness and preventive visits for Medicare patients. However, are you certain your Initial Preventive Physical Examination (IPPE) documentation meets the necessary requirements?
There are many pitfalls to coding compliance that could jeopardize your hospital or physician practice. Incident to billing is one of those areas many physician groups and hospitals struggle to get right.
Whether your medical record is electronic, paper-based, or a combination of the two, accurate and complete coding is critical to care delivery, appropriate reimbursement and compliance. It's important you understand and adhere only to the codes supported by the clinical documentation.