SuperCoder Blog

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 …

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 <...

CCI Edits Checker is one of the tools SuperCoder subscribers use the most, so here’s a quick instructional guide to help users make the most of this resource, including the color-coded results and RVU options.
 
Note: This guide is specific to the CCI Edits Checker for Medicare PTP practitioner edits, but Outpatient Facility Coder subscribers will find that using our OPPS CCI Checker doesn’t vary too much from what you’ll find here.

Step 1: Access CCI Edits Checker

Once you’re logged into an account that includes tools, you can access CCI Edits Checker in several different ways. Start on the Coding Tools page, then choose …

It’s only June of 2017, but for coders that means it’s time to start watching for 2018 updates. ICD-10-PCS files are already available for review. This inpatient coding system, which changes to the 2018 version on Oct. 1, 2017, will see 3,562 new codes and 646 deletions for a total of 78,705 codes in the next version. There will be 1,821 revisions, too. What’s changing? Here are some highlights.

Get Clued In to Code Set Changes

CMS helpfully offers an update summary. It pulls out three main changes to watch:

• Revisions for clarity and usefulness in the Medical and Surgical …
  

How many of the 15 pages on Z codes have you read in the ICD-10-CM Official Guidelines for Coding and Reporting? More than a page is devoted to aftercare visit codes in Section I.C.21.c.7. Here’s a quick refresher on what you should know about aftercare coding, including the ICD-10 twist for injury codes.

The Basic Rule: Apply Aftercare Codes for Recovery Phase

The Official Guidelines (OGs) tell you to look at Z42-Z51 for aftercare Z codes. The general rule is that you use these codes when the patient has had initial treatment and the patient needs care for recovery or for consequences of the disease. Put another way, the codes aren’t …

MACRA and its shift to a value-based payment model has people in the business of healthcare talking. While most of us may be thinking about the MIPS (Merit-Based Incentive Payment System) track for the Quality Payment Program, there is another option: Alternative Payment Models (APMs). An APM offers incentive payments for high quality, cost-efficient care.

Will Physician or Hospital Payment See Bigger Changes?

A team from RAND Corporation looked into the effects of APMs by using the RAND Health Care Payment and Delivery Simulation Model (PADSIM), which provides …

Check out these bullet points for highlights from the 2018 Medicare Advantage and Part D payment and policy updates posted by CMS.

Medicare Advantage

Medicare Advantage (MA) plans, sometimes called Medicare Part C, are private plans approved by Medicare for people enrolled in Medicare. Medicare pays a fixed amount to the MA plan company, and the company provides Medicare Part A (hospital) and Part B (medical) coverage. The plans often offer Part D (prescription drug) coverage, too.

• The expected total change in revenue is 2.95 percent for Medicare Advantage. That’s 0.45 percent for the expected average change in revenue plus 2.5 percent for coding trends. That’s a bit above the 2.75 percent total listed in the …
  

If you ever take the “throw everything out there and see what sticks” approach to coding, it’s time to rethink that strategy. Carefully choosing the wrong codes to bring in more money is no way to code either. Next time you need inspiration to steer clear of these methods, reach for these four reasons coding correctly really is worth the effort.

1. ‘Them’s the Rules’

Choose any code set or a payer, and it likely won’t take you long to find a rule saying that you must assign a code based on what the documentation supports and what the reporting guidelines require. Simply put, a big part of being good at our …

When I first entered the coding world, printed coding manuals were the home of medical codes. Fast forward to today, and there are a lot of options if you prefer to find a code online instead. Here are some ideas on what to look for when choosing an online code search (don’t miss #6).

1. Does It Have the Code Sets You Need?

Let’s start with the obvious. Useful medical coding software (sometimes called encoder software for medical coding) will combine all the code sets you need.

For instance (shameless plug alert!) SuperCoder Code Search lets you search CPT®, HCPCS, ICD-10-CM, and ICD-9-CM. But if you want access to code sets used exclusively by outpatient or inpatient facilities, …