2011 ICD-10-CM Draft Update
by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC - December 29, 2010
On December 22, 2010, the Center for Medicare and Medicaid Services (CMS) posted the updated ICD-10-CM code set to their website. Included in these updates are 487 new codes, 2858 changed codes, and 220 deleted codes, now making the code set a total of 69,368 diagnostic code options. Although this is not the code set that will be implemented (it is still in the Draft stages), training and education for individuals should involve the updates.
Tip of the Week: CPT Code 48160
by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC - December 29, 2010
When coding CPT code 48160, it is performed primarily for chronic pancreatitis and may be considered experimental or investigational if performed for other medical conditions. Check with individual payers to verify coverage.
Durable Medical Equipment Medicare Administrative Contractors
by Lori Becks, RHIA - December 22, 2010
History and Overview
Section 911 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003 mandated that the Secretary of Health and Human Services replace the current contracting authority at the time under Title XVIII of the Social Security Act with the Medicare Administrative Contractor (MAC) authority. The MMA was intended to make contracting dynamic, competitive and performance-based. Contracting reform required that CMS use competitive procedures to replace its current fiscal intermediaries (FIs) and carriers with a uniform type of administrative entity, referred to as Medicare Administrative Contractors (MACs). The FIs handled claims processing and benefit payment functions for institutional providers under Part A and Part B of the Medicare program, while carriers performed the same functions for professional providers under Part B of the program. The MMA also stated that the Secretary must re-compete its Medicare Administrative Contractors contracts every 5 years.
Tip of the Week: Durable Medical Equipment
by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC - December 22, 2010
When reporting durable medical equipment to a DME MAC, most payers require the use of HCPCS Level II codes. Most DME supplies are codes K0001-K0899, and codes L0112-L4631 and L5000-L9900 for orthotics and prosthetics, but there are other codes for different types of supplies. Check with each payer to determine their coding and billing requirements.
Occupational Safety and Health
by Lauri Gray, CPC, RHIT - December 16, 2010
Another Component of a Medical Office Compliance Plan
Congress passed the Occupational Safety and Health (OSH) Act in 1970 and the Occupational Safety and Health Administration (OSHA) was created in 1971 as a result of this legislation. OSHA’s stated mission is “to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.” OSHA is part of the Department of Labor and the administrator of OSHA is the Assistant Secretary of Labor for Occupational Safety and Health. OSHA’s administrator answers to the Secretary of Labor who is appointed by the President and is a member of the President’s cabinet.
The OSH Act covers employees either directly through federal OSHA or through an OSHA approved state program that meets or exceeds federal standards for workplace safety and health.
Tip of the Week: CPT® Modifier
by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC - December 16, 2010
For 2011, the description for the CPT® modifier has changed. It now reads, ‘Bilateral procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5-digit code.
Revenue Cycle Management
by Lauri Gray, CPC, RHIT - December 9, 2010
Revenue cycle management as defined by the Healthcare Financial Management Association (HFMA) is all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.
Reimbursement for patients covered by third-party payers is a combination of payments from the patient in the form of deductibles and copayments and payments from the payer for covered services. Physician practices must develop policies and procedures for collecting the amounts due from both the patient and the payer. Many health plans have increased the levels of patient responsibility for first dollar costs. This combined with the advent and growth of consumer driven and high deductible plans several years ago has resulted in many patients being responsible for more of the initial costs of health care. Physician practices must adopt policies to ensure that full reimbursement is received regardless of whether the payment is from the patient or payer. Exceptions should be made only for clearly documented financial hardship.
Tip of the Week: Infusion Coding
by Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC - December 9, 2010
According to CPT we can report 96374 and 96361, but we cannot report 96360 and 96375 so 96374 is primary to 96360.
In infusion coding, hydration (CPT codes 96360-96361) may be billed separately only if it is given prior to or subsequent to drug infusion (CPT codes 96365-96376). If it is given concurrently to facilitate drug delivery, it is considered included in the drug infusion.
November Coder’s Quiz Recap
by Elena Wellard - December 3, 2010
We understand that you are busy and might not have time to read Coder’s Voice every Thursday. That’s why we’ve put together a recap of Coder’s Quizzes for you. Take a quick look to see what you may have missed.
How many drug representatives visit your organization every week, on average?
Less than 5 – 57%
Between 5 and 10 – 25%
More than 10 – 17%
Medicare Initial Preventative Physical Examination
by Sarah Reed - December 2, 2010
New subscribers to Medicare are entitled to an initial evaluation called a “Welcome to Medicare Visit” or “Initial Preventive Physical Examination” (IPPE). It is coded G0402. This is a service that was established by Medicare on January 1, 2005 to be performed during the 1st year of Part B eligibility. It is not a physical examination but a provider evaluation. It is a screening for certain diseases and aging processes and will help determine risk factors so that physicians can treat Medicare patients appropriately.
This special evaluation does not apply toward deductible but some of the tests and lab may. Patients will still have a 20% co-pay on this service. It is not a “free physical”.
- First Drug to Target Cause of Cystic Fibrosis Approved
- Bridging the Gap on CDI
- Medication Errors In Hospitals Reduced By e-Prescribing
- Providers stress over looming Medicare prepayment audits
- Health system sues OIG over alleged Medicaid overpayments
- 5010 Ready or Not, Here It Comes (Part 3 of 3)
- Small businesses and the Affordable Care Act. What do they need to know?
- What Should You Look For When Your EHR Product is Acquired by Another EHR Vendor?
- AHIMA Encourages the Health Care Community to “Keep Moving on ICD-10 Transition”
- A National Universal Health Record (UHR) Database – Doable Any Time Soon?
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