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Coders should take charge when checking a sales rep’s advice

04/18/2022

Remind your providers that coders should fact-check a sales representative’s coding advice before the practice purchases a new product or device.

Unreliable ‘source’? Try others, and document the disagreement

04/18/2022

by: Roy Edroso

Question: One of our providers had an office visit with a cognitively impaired patient and her adult daughter, whom he considers the “historian” in the encounter for E/M level selection purposes. However, the provider suspects the daughter’s version of events may be incorrect. What should he do? And can the daughter’s testimony still be used to calculate E/M levels?

Unpack ICD-10-CM coding for open wounds and superficial injuries

04/18/2022

by: Sarah Gould

From common injuries to burns and poisonings, your coding staff must be familiar with Chapter 19 of the ICD-10-CM manual to ensure coding compliance. Review integumentary anatomy and ICD-10-CM coding for burns and other external injuries to accurately capture your patients’ conditions.

Information please: Follow 6 tips for independent historians

04/18/2022

by: Julia Kyles, CPC

You can use information a provider receives from family members and caretakers to calculate the amount and/or complexity of data to be reviewed and analyzed of an E/M office visit that is coded based on medical decision-making (MDM). But make sure practitioners and coders know how to capture the data element.

Practices keep X modifiers over 6M threshold, beating 59’s denial rates

04/18/2022

by: Roy Edroso

While use of modifier 59 (Distinct procedural service) dropped during the first COVID year of 2020, practices reported the four X modifiers that can be used in place of 59 at a similar clip as in 2019, and denials stayed comparatively lower.

As liability premiums rise, focus on 3 protective tactics to derail lawsuits

04/11/2022

by: Roy Edroso

With medical malpractice insurance rates experiencing a growth spurt not seen in many years, practices should make an extra effort to shore up documentation and guard against possible malpractice suits, even if your providers are otherwise doing everything right.

Consent, consumer protection rules control patient e-signatures

04/11/2022

by: Julia Kyles, CPC

Include patients’ electronic signatures the next time you review compliance for signature requirements at your practice. In addition to security risks like protected health information breaches and forgery, patient electronic signatures, or e-signatures, can lead to patient consent disputes and they are subject to laws that create additional requirements for practices.

With deadlines coming, make sure you have data chops to handle Shared Savings

04/11/2022

by: Roy Edroso

As the Medicare Shared Savings Program (MSSP) application deadlines approach, practices thinking about entering should consider the direction in which the program is going — toward more payer sources, electronic reporting and health equity data — and whether they have what it takes to keep up.

Ready for Round 2? Expect early release of 2023 E/M guidelines

04/11/2022

by: Laura Evans, CPC

Practices will be breaking in a new set of E/M guidelines for their visits in a facility starting in January of 2023, according to an AMA official. But you can expect to see the coding and guideline changes sooner than that: CMS wants to have a first look at them by early summer of 2022.

Claiming provider confusion, AMA, others call for PRF deadline delay

04/11/2022

by: Roy Edroso

A deadline for the Provider Relief Fund (PRF) passed on Nov. 30, 2021, but several major health care organizations are asking authorities to reopen the reporting process, claiming many providers were misled as to their responsibilities.

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