ICD-10-CM: Don’t Give Up Too Soon When Coding Flank Pain

Mon, Feb 18, 2019


Flank pain is a complaint a lot of general practices and specialties see. Here are some pointers on how to code correctly for this common condition.

Find Flank Under Abdominal in the Index

The flank is the side area of the torso below the ribs. To code for flank pain, start by looking at the ICD-10-CM index. Under the entry for “Pain, flank,” the ICD-10-CM index points you to “Pain, abdominal.” And that instruction opens up a lot of possibilities.

Next to the entry for “Pain, abdominal,” there is the code R10.9 (Unspecified abdominal pain). If “flank pain” is all you have to work with from the …

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Do You Know About Medicare Add-On Code Edits? You Should!

Mon, Feb 11, 2019


Medicare add-on code edits

Pairing an add-on code with an appropriate primary code is a key factor in bringing in that extra add-on reimbursement. The CPT® manual often provides a listing of appropriate primary codes for an add-on code, but not always. In those cases, you may find answers in Medicare’s Add-On Code Edits, our topic for today.

Know Where to Find Add-On Code Edits

When you see the term National Correct Coding Initiative edits, you probably think of column 2 codes getting bundled into column 1 codes. But if you want to be specific (and as a coder of course you do), those column 1/column 2 edits are Procedure to Procedure (PTP) …

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Bring in Correct Bilateral Procedure Pay With These Pro Pointers

Thu, Feb 7, 2019


report bilateral surgeries using codes and modifiers

Choosing medical codes and modifiers for bilateral services can be confusing. Here are a few questions you can ask to help ensure accurate coding and reimbursement for physician claims.

Does the Code Descriptor Specify Bilateral?

“Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day,” states the Medicare Claims Processing Manual (MCPM), chapter 12, section 40.7.

One of the first steps in deciding how to report a bilateral service is to see whether the code itself represents a bilateral service. The …

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Update Your Knowledge of MIPS Promoting Interoperability for 2019

Mon, Feb 4, 2019


EHR use for MIPS 2019

In 2019, there are some changes to the Promoting Interoperability performance category of MIPS. Here’s what you need to know about CEHRT and scoring news for this performance year.

Background: MACRA requires the Quality Payment Program (QPP) to include a MIPS performance category on meaningful use of certified EHR technology, the QPP 2019 rule states. You may recall that Medicare changed the category name from Advancing Care Information (ACI) to Promoting Interoperability (PI) last year.

What Is Interoperability?

Medicare defines interoperability as “health information …

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Primary Care and Specialists Need to Know These Twin Add-On Codes by 2021

Mon, Jan 28, 2019


coding for E/M visit complexity

The 2019 MPFS proposed rule discussed potential add-on G codes to represent E/M visit complexity. Here’s a quick look at the intent of the proposed codes and what the final rule had to say about their implementation in 2021.

See What Happens to This Code for Specialists

In the 2019 Medicare Physician Fee Schedule (MPFS) proposed rule, CMS included possible creation of a G code certain specialists could add on to an E/M service code to capture reimbursement for visit complexity. Remember that the proposed rule also discussed the (now transformed and delayed until 2021) plan to pay the same for multiple E/M office/…

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Here’s How Medical Documentation Can Help or Hurt for Reimbursement

Thu, Jan 24, 2019


clinician documentation to support accurate coding

The 2018 CERT report estimates 58 percent of Medicare improper payments were caused by insufficient documentation (and this is an ongoing trend). More than half is nothing to sneeze at, especially when you consider that those documentation problems could lead to having to repay Medicare or having to spend time working on underpayments. Here’s a quick look at the top issues and a reminder about how having adequate documentation from the get-go is important to efficient billing.

See Which Documentation Category Caused Most Problems

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Outpatient Coders: Are These C Codes on Your Procedure Reporting List?

Tue, Jan 22, 2019


2019 HCPCS codes for outpatient reporting

The HCPCS 2019 code set features several new C codes related to reporting procedures. If you use C codes, make sure you’ve got these updates on your radar.

Reminder: HCPCS C codes are intended for use by Outpatient Prospective Payment System (OPPS) hospitals. The codes are used to report device categories, new technology procedures, and also drugs, biologicals, and radiopharmaceuticals that don’t have other specific HCPCS codes that apply to them. Other facilities may use C codes at their discretion, specifically non-OPPS hospitals; Critical Access Hospitals; Indian Health Service Hospitals; hospitals in American Samoa, Guam, Saipan, and …

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Say Cheese! Medicare Is Paying for Photo and Video Evals in 2019

Thu, Jan 17, 2019


If a picture is worth 1,000 words, how much is evaluating a picture worth? Medicare has taken a stance on that. As of Jan. 1, 2019, Medicare is paying for remote evaluation of pre-recorded patient videos and images reported using G2010. Here’s what we know from the Medicare Physician Fee Schedule Final Rule.

Compare Our Code G2010 to G2012

The code introduced to represent this image/video eval service is the descriptive G2010 (Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M …

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Take the Mystery Out of the MPFS Conversion Factor and Calculations

Mon, Jan 14, 2019


In the 2019 Medicare Physician Fee Schedule (MPFS), the conversion factor is 36.0391 compared to 35.9996 in 2018. But that sort of information helps only if you know what a conversion factor is and what to do with it. Here’s a primer you can turn to when you need to brush up on your MPFS calculation skills.

Get a Handle on RVUs

The MPFS conversion factor (CF) helps you translate Medicare relative value units (RVUs) into dollar amounts. RVUs represent the relative resources used to provide a service. There are work RVUs, practice expense (PE) RVUs, and malpractice (MP) expense RVUs.

The practice expense RVUs may vary based on the setting of non-facility or …

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Here’s How MIPS Participation Eligibility Shrinks and Grows in 2019

Thu, Jan 10, 2019


MIPS eligibility 2019

We’re in the third year of the Quality Payment Program (QPP), which includes the Merit-based Incentive Payment System (MIPS). The QPP is connected to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Because MIPS may result in Medicare payment adjustments up or down, knowing whether you’re required to participate is an essential first step. Here’s what the MIPS participation eligibility criteria look like in 2019. (For info on some terminology changes in MIPS 2019, read this blog post.)

See How the List of Eligible Clinician Types Grows

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