Questions, questions, some answers, but more questions as I reflect on the 2010 ICD-10 AHIMA Summit that I attended earlier this week. One of the big questions is are YOU ready for this big change in healthcare and have you started to PREPARE? ICD-10 will affect all aspects in healthcare (payers, providers, vendors, clearinghouses, third party administrators, independent laboratories, employers, and researchers) to name a few. 

It has been a few months since Medicare officially announced they would no longer allow payment for the inpatient (99251-99255) or outpatient (99241-99245) consultation codes. The works RVUs for the consultation codes have been distributed to increase the work RVUs for the new and established outpatient, initial hospital and initial nursing facility visit codes.

CMS issues its changes to the Physician Fee Schedule quarterly, but how often do you have the chance to analyze it and review it? With over 15000 lines filling a spreadsheet, comparing each quarter’s changes can be a daunting and time consuming task. Are you aware that MediRegs does this for you? They issue a difference report every quarter that highlights the changes between the current version and the last quarter’s version. Look for the file called “Difference Report” and “MediRegs created.”

While attending the AMA Symposium this week there was a HUGE uproar about eliminating payments for consults.  I thought one physician was going to take the head off of the guy from CMS!  Whoa baby, talk about hot!  Then you have the coders who are gunning for bear.  The AMA left the CPT consult codes in for 2010 but CMS says they won’t pay!  In light of this, the attending physicians are going to have to bill the initial hospital care day with a modifier.  Then the consultants come along and they have to use the

Within the listing of 2010 HCPCS posted by CMS on November 2nd laboratorians will see two new G-codes that redefine coding of qualitative drug analysis billed to Medicare.

In part 1 of this modifier series we identified and discussed the largest category—Global Package Modifiers, and the following modifier categories: GP, BUN, E/M only, #, Anes, Lab, and OTH. In part 2, we will explore the other categories of modifiers starting with the “BUN” grouping. 

The following are the modifiers that relate to the bundling of CPT codes or related CCI edits:

In a previous blog I wrote, "Seeing the “Gray” in Evaluation and Management Coding – Chief Complaint and History of Present Illness," I had started a dialogue related to Chief Complaint (CC) and History of Present Illness (HPI) gray areas. In this edition I hope to continue the conversation as it relates to review of systems (ROS) and past family social history (PFSH).

One of the more difficult issues facing hospitals today is related to the timely claim filing rules associated with re-billing ancillary charges for denied inpatient stays.

Under the RAC demonstration project, CMS allowed hospitals to re-bill their RAC denied inpatient short stay hospitalization cases as outpatient claims. The UB-04 claim type used to submit these claims for benefits was the traditional 13x; and Medicare Part B hospital benefit policies dictated coverage of services and payments.

Home Health and Durable Medical Equipment (“DME”) can’t seem to get out of the spotlight and who can blame the government for scrutiny. Back in the day when Home Health charged on a “per visit” basis, we saw independent Home Health agencies in abundance across the United States, company CEOs using Medicare dollars to purchase airplanes and living in mansions as they reaped the benefits of what was found to be Home Health fraud and abuse. In the late 90’s  an “interim payment system” was implemented pri

Let’s take a look at the definition of a consultation. A consultation is a type of service provided by a physician or qualified provider whose opinion or advice regarding the evaluation and/or management of a specific problem is requested by another physician or provider. Another way of defining a consultation is a rendering of advice of your professional opinion, followed by a report of your findings to the referring physician.