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.”

A conversation was recently had with a CMS representative regarding their policy and billing instructions associated with observation hours and services in situations when a patient is admitted as an inpatient but is subsequently found to be only eligible for observation; thus billed as an outpatient on the UB-04 reporting the Condition code 44.

Coding professionals face increasing challenges to code claims accurately. Facilities can help ensure documentation integrity and coding accuracy by establishing and managing an effective query process. The importance of complete documentation in the patient’s health record cannot be overstated; without such documentation accurate coding cannot be assigned.

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

Fall is here, and along with the change in the weather comes the annual change to CPT codes.

Evaluation and Management: The E/M Guidelines at the beginning of the Evaluation and Management chapter were updated to expand the definition of Concurrent Care to include "Transfer of Care." The new definition reminds users to not use consultation codes when a transfer of care occurs, unless such transfer happens after the initial consultation evaluation.

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).

The 2010 HCPCS Level II update is now available in CCH Coding Comply. The updated data files became available on CMS’ website late Monday Night. It is anticipated that this update will be released in the HCPCS and CPT electronic code book in the Coding Suite and RRS sometime next week. When complete, a link will be provided in the “Hot Topics” box on the Welcome page of the Coding Suite.

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

As we have moved into a new era of CMS compliance measures, the importance of solid hospital coding and documentation is a must to avoid unnecessary audits. With the onslaught of RAC’s aggressively beginning to focus on hospital services around the country, training internal coding staff and physicians will be the key to survival. Criteria for hospital admission services (99221-99223) are frequently under documented by physicians. Further, the use of time (counseling & coordination