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Walk staff through the intersection of diagnosis coding, medical necessity

07/01/2024

Include a refresher on the connection between medical necessity and diagnosis coding when you train your team on the FY2025 update to the ICD-10-CM code set. The Centers for Disease Control and Prevention (CDC) typically releases the final code list in mid- to late June, and will include 250 new codes if the CDC adopts all of the proposed changes.

Cover CPT critical care basics for accurate E/M reporting

07/01/2024

by: Hamilton Lempert, M.D., FACEP, CEDC,

The emergency department (ED) is a demanding setting that challenges coders and providers alike. Information must be synthesized quickly to make life-or-death decisions. Therefore, in a field in which accomplishing thorough documentation can be challenging, representing the rendered services accurately can be even more difficult. To get it right, review the basics of critical care coding and check out common questions coders may have about the topic.

Pinpoint high-rate denials for modifier 25; some E/Ms top the list

07/01/2024

by: Richard Scott

Watch out for turbulence when turning to modifier 25 (Significant, separately identifiable E/M service) for E/M services submitted on the same date as a procedure. Several of the most frequently reported E/M codes, including level one established visit code 99211, garnered double-digit denial rates.

Check your telehealth compliance, align POS codes to avoid costly denials

06/24/2024

by: Julia Kyles, CPC

Double check Medicare’s telehealth services list before you use a telehealth place of service (POS) code on a claim — or risk an automatic denial. A recent change request from CMS serves as a reminder to make sure you’re complying with Medicare’s current telehealth requirements.

Forced to close temporarily? Mind your patient, payment responsibilities

06/24/2024

by: Roy Edroso

If your practice has to temporarily suspend operations for more than a short duration, you may have to approach patients as if the practice were closing for good and provide recommendations for alternative treatment. You may also have to give providers paid on productivity some bad news.

While bird flu crossover risk remains low, take easy steps to be ready

06/24/2024

by: Roy Edroso

You and your patients almost certainly haven’t had any contact with bird flu (H5N1), but given recent global and national concerns over the possibility of animal-to-human transmission now is a good time to give your staff a heads-up on it.

Make sure anticoagulation management visits show medical necessity

06/24/2024

by: Julia Kyles, CPC

Question: Can we bill 99211 for an anticoagulation monitoring check when the patient does not see the provider during the visit?

Be proactive, follow procedures when grappling with cyberattacks

06/24/2024

by: Rebecca Herold

Question: In the event of a cyberattack, how should health care entities document their response efforts to demonstrate compliance with HIPAA regulations to OCR?

HCPCS codes released for COVID-19 prophylaxis after FDA approval

06/24/2024

by: Savannah Schmidt

The Food and Drug Administration (FDA) recently announced an emergency use authorization for Pemgarda, a pre-exposure prophylaxis for COVID-19, leading to the release of HCPCS Level II codes for the drug and its administration.

Providers favored the on-campus setting for outpatient services in 2022

06/24/2024

by: Julia Kyles, CPC

Outpatient services performed on a hospital’s main campus dominated the incidence of total outpatient services in 2022, encompassing a far greater share of visits than their off-campus counterparts.

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