ICD-10-CM used to document diagnoses but also affects payment

Although International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) took effect on Oct. 1, 2015, there still are many gaps in the understanding and use of the code set.…

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ICD-10-CM changes: The 21 codes deleted for FY 2020

CMS has provided ICD-10-CM coding updates for fiscal year 2020 that include 273 additions 21 deletions and 30 revisions, according to the American Health Information Management Association. The 21 deletions for the fiscal year…

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Is it possible to make OB coding less complicated?

Just like our patients, proper coding and billing for obstetric patients can be…complicated. As a coding instructor and compliance auditor, I field a lot of questions from new students and…

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Actinic Keratosis – Coding, Billing and Clinical Information

In an era of value-based reimbursements, rising overheads, changing codes, and increased scrutiny of claims by health insurance companies, dermatology medical billing and coding has become quite complex. Dermatology practices…

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Split/Shared E&M Policy Found to be in Error

You might think that you could rely on the accuracy of a Medicare Administrative Contractor (MAC) policy, but apparently, you can’t.  First, I’d like to extend thanks to my colleague…

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The ICD-11 Transition Timeline

After the tumultuous transition to the 10th International Classification of Diseases, simply saying the phrase “ICD-11″ is liable to strike fear in the hearts of medical providers across the country.…

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Seven Incident-to Billing Requirements

Incident to billing allows non-physician providers (NPPs) to report services “as if” they were performed by a physician. The advantage is that, under Medicare rules, covered services provided by NPPs…

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ICD-11 takes on burnout and gaming addiction

Are you exhausted? Feel cynical toward your job? Tell your boss that you are part of an occupational phenomenon called burnout. But maybe don’t mention it’s in the same category…

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CMS Removes Two HCPCS Codes from New Competitive Bidding

The Centers for Medicare & Medicaid Services (CMS) has removed two Healthcare Common Procedure Coding System (HCPCS) codes just days before the bid window opens. Codes E0992 and K0056 have…

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Understanding the Basics of Bundled Payments in Healthcare

The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away,…

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Documenting Carpal Tunnel Syndrome with ICD-10 and CPT Codes

Carpal Tunnel Syndrome (CTS) refers to the painful condition caused by pressure on the median nerve in the wrist. The median nerve passes through the carpal tunnel, a narrow passageway…

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Innovaccer research shows how AI could improve cost of care models

Innovaccer, which develops data tools to help health systems with accountable care and population health management, has published a new research paper focused on the ways advanced machine learning algorithms…

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CMS Expands Coverage of Ambulatory Blood Pressure Monitoring (ABPM)

Today the Centers for Medicare & Medicaid Services (CMS) finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM).  ABPM is a non-invasive diagnostic test that uses a device…

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Medicare can save millions on lab tests by creating panel codes

Clinical diagnostic laboratory tests range from routine chemical measurements like blood glucose or sodium to complex examinations for cancer, infectious diseases, or rare inherited disorders. The information they provide is…

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