Category: Medical Coding

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FY 2022 ICD-10-CM Codes Now Available

New codes are effective Oct. 1, 2021. Highly anticipated, the fiscal year 2022 ICD-10-CM codes have been released by the Centers for Disease Control and Prevention (CDC), although still pending are the 2022 Official Coding and Reporting Guidelines which were not included in the package of new codes. We are still waiting for the release […]
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Prolonged Services in CPT versus Medicare

  The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from […]
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Ensuring Data Integrity and Protecting Your Organization’s Bottom Line

Part IV in this series discusses expanding HIM’s visibility and enhancing organizational processes via authorization denial management. In my prior article, I discussed the value of payer policy management, and mentioned that “no authorization” denials represent 10-15 percent of all denials. This focused denial category presents another opportunity for health information management (HIM) professionals. HIM […]
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CMS Updates Medicare Part B Drug Prices

Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
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CMS Releases PCS Codes Final Rule

The final rule contains 78,220 code changes, up by 117 from FY 2021. The Centers for Medicare & Medicaid Services (CMS) has released the final ICD-10-PCS codes and guidelines for the 2022 fiscal year (FY). The files included in the release include the Addenda File, Code Tables and Index file, FY 2022 PCS Version Update […]
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Medical/Legal Impact of 2021 E&M Changes

Without detailed documentation, providers may face an uphill battle in defending themselves from quality audits and even malpractice issues. Up until 2021, at least for the prior two decades, coders and clinicians relied upon the established Evaluation and Management (E&M) guidelines to determine which E&M code was appropriate for each specific encounter. The 1995 guidelines […]
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Who’s Auditing Your Coders?

  Implement periodic external audits to ensure your claims are accurate and will hold up to payer scrutiny. The year 2020 was unequivocally the year of healthcare changes. We had multiple ICD-10-CM, CPT®, and payer coding guideline changes associated with the COVID-19 pandemic. We had the new American Medical Association (AMA) and Centers for Medicare […]
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new-em-coding-for-2021

E/M Coding for 2021: What’s New and Different

After three years of policy proposals, the American Medical Association Current Procedural Terminology (CPT) panel responses, and substantial guidance from gastroenterology and other specialty societies, changes to the office/outpatient evaluation and management (E/M) codes became effective as of January 2021. Some aspects of these revisions took effect for telehealth services since spring 2020 for Medicare, […]
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CPT Codes Created for Novavax COVID-19 Vaccine

The CPT code is the fifth created for providers to document and bill for the administration of COVID-19 vaccines, AMA announced. The American Medical Association (AMA) has created unique Current Procedural Terminology (CPT) codes for the Novavax COVID-19 vaccine and its administration. The vaccine from Novavax Inc. has yet to receive authorization for use in […]
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