Catch Up on the Latest HCPCS 2017 Updates for Ob-Gyn

Tue, Aug 8, 2017


ob gyn practice

In “Learn the ABCs (and Zs) of IUD Coding” we covered HCPCS codes available for the supply of the IUD. But coding is ever-changing, and there’s a new option as of July 1 for Kyleena®. Check out that new option and other HCPCS changes effective July 1 relevant to ob-gyn.

Tip: Want to see all the changes? Try the CMS HCPCS Quarterly Update page.

Start With Kyleena IUD

As of July 1, you have this new code for the supply of Kyleena IUD:

  • Q9984, …
Continue reading...

Add ICD-10-CM Accuracy to Your Repeat Pap Smear Claims

Fri, Jul 28, 2017

1 Comment

Right about now it feels like all eyes are on ICD-10-CM 2018 (and there are plenty of changes to deal with). But we’ve got to be sure codes for our current claims are accurate, too. Today let’s get back to basics with a look at how to handle diagnosis coding for repeat Pap smears.

Zero In on R87.61- Subcategory

When the provider repeats a Pap smear because of an inadequate sample or abnormal results, you’ll report a code from R87.61- (Abnormal cytological findings …

Continue reading...

Ups and Downs, MACRA Modifiers, and E/M DGs in MPFS 2018 Proposed Rule

Tue, Jul 25, 2017


EHR documentation

Part 3 of our proposed rule extravaganza is about the Medicare Physician Fee Schedule (MPFS) 2018 proposed rule. (Part 1 was QPP and Part 2 was OPPS). Let’s get down to business, checking out some highlights explained in recent issues of Medicare Compliance and Reimbursement.

Plusses and Minuses

The proposed 2018 conversion factor is 35.99, up 0.1 from the 2017 CF of about 35.89. CMS estimates the overall update to payments is +0.31 percent. That’s the 0.5 percent increase established under …

Continue reading...

4 Things to Watch From the OPPS 2018 Proposed Rule

Fri, Jul 21, 2017


outpatient hospital

We’re back for another installment of “what does 2018 (maybe) have in store”? We just covered the QPP proposed rule, and now we’ll take a look at the 2018 hospital outpatient prospective payment system (OPPS) proposed rule. CMS expects an overall 2 percent payment increase in 2018 (except for the changes mentioned in question 3 below). What has people talking?

1. Are Joint Replacements Moving to Outpatient?

The proposed rule takes total knee replacement off the inpatient-only list, opening the …

Continue reading...

Transition and Flexibility Are the Buzzwords for QPP 2018 Proposed Rule

Tue, Jul 18, 2017


flexibility in QPP 2018

CMS released the proposed 2018 Quality Payment Program (QPP) rule on June 20. To sum up the 1,000+ pages, 2018 will be something of a transition year like 2017 was for QPP, which was established under MACRA. If you read through the various summaries available, you’ll see the term “flexibility” used quite often, with specialty groups adding the warning that they need time to get through the complete rule before coming to a final verdict.

Here are some areas to watch:

  • Small provider exemption and low-volume threshold: The 2017 low-volume threshold was set at $30,000 in Medicare Part B allowed charges, …
Continue reading...

Learn the ABCs (and Zs) of IUD Coding

Fri, Jun 30, 2017



Intrauterine devices (IUDs) for birth control are fairly common, but somehow the coding for IUD-related services isn’t as clear-cut as it could be. In today’s post, get to know the codes and a common coding hurdle to watch for.

Go Through All the Code Sets to Find the Codes

CPT® provides these codes for IUD services:

  • 58300 (Insertion of intrauterine device (IUD))
  • 58301 (Removal of intrauterine device (IUD)).

ICD-10-CM offers codes specific to IUD encounters, too:

  • Z30.430 (Encounter for insertion of intrauterine contraceptive device)
  • Z30.431 (Encounter for routine checking of intrauterine contraceptive device)
  • Z30.432 (Encounter for removal …
Continue reading...

Don’t Let EHR Tempt You to Upcode E/M Services

Tue, Jun 27, 2017


Don’t Let EHR Tempt You to Upcode E/M Services

EHRs can assist with many aspects of E/M coding (like tracking for coding based on time), but the problem of reporting higher-level E/M codes without medical necessity is still around.

A recent article in Ophthalmology Coding Alert discussed the example of a doctor who billed almost all level-four and level-five E/M codes for established patients. He followed the prompts of his EHR to fill in information, leading to detailed or comprehensive histories and exams even when the patient’s case didn’t require that level of service. Here’s why …

Continue reading...

Don’t Get Too Comfortable With That Meaningful Use Payment – Here’s Why

Tue, Jun 20, 2017


MU overpayment news

When the title of an OIG report is about Medicare paying out hundreds of millions it shouldn’t have, that’s not great news for Medicare or the providers who got those funds. But that’s exactly what a report released June 12, 2017, says: “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements.”

Short version: From May 2011 to June 2014, the OIG estimates CMS paid about $729.4 million in EHR incentive payments to eligible professionals (EPs) who didn’t meet meaningful use requirements. A big part of the problem was that …

Continue reading...

ICD-10-CM 2018 Posted! Let the Update Games Begin

Fri, Jun 16, 2017

1 Comment

2018 codes are coming

ICD-10-CM 2018 files are up on the CMS site! Here’s a quick overview of what’s coming when the new version goes into effect Oct. 1, 2017. (Looking for PCS? Click here.)

Check Changes by the Numbers

Based on the files posted, it looks like we’ll be dealing with more than 700 updates:

  • 360 additions
  • 142 deletions
  • 226 revisions
  • 71,704 codes total.

Single Our Your Specialty

Here are some changes from the chapters that will see …

Continue reading...

3 Things You Can Do Today to Prepare for a RAC Audit

Wed, Jun 7, 2017

1 Comment

face audits by being prepared

What’s the first think you think of when you hear Recovery Audit Contractor? RACs have been around for a while (and not without controversy) as part of a Medicare program to find and correct past improper payments. Even folks who don’t get nervous at the thought of an audit probably don’t look forward to the extra work involved and the lengthy appeals process. There are some small steps you can take now to help make that mountain of an audit less intimidating.

1. Monitor Approved RAC Issues

If you haven’t checked your RAC’s approved issues in a while, it’s time to make a date with the contractor’s website. Some <...

Continue reading...
Older Entries Newer Entries