Top 10 ICD-10-CM Official Guideline Updates for 2020

Mon, Aug 19, 2019


The FY2020 ICD-10-CM Official Guidelines for Coding and Reporting (OGs) are available now so you can prepare for the 2020 diagnosis code changes and rule changes at the same time.

Some revisions involved adding a missing word that was already obvious from context, so we won’t cover every change here. But this overview will give you a good idea of the significant changes to come, effective Oct. 1, 2019.

1. Watch for Swap From ‘Physician’ to ‘Provider’

In a few places, the OGs replace “physician” with “provider.” All of the quotes below show the 2020 wording. The bold word shows where the 2019 OGs used the term physician instead of …

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Catch Radiation and Home Visit Changes Coming Soon to Medicare Manual

Thu, Aug 15, 2019


Medicare has announced two updates to the Medicare Claims Processing Manual (MCPM). The implementation date is set for Aug. 27, 2019, but they’re effective all the way back to Jan. 1, 2019. If your physician performs home visits or superficial radiation treatment, you’ll want to be sure your knowledge is up to date.

1. Eliminate Home Visit Documentation Requirement

If you’ve been keeping up with E/M documentation requirement changes, you know that Medicare removed the requirement for the medical record to include medical necessity for a home visit in place of an office or outpatient E/M in 2019. Now the MCPM is …

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Add These AUC-Related Modifiers to Your Imaging Claims in 2020

Mon, Aug 12, 2019


At the end of July, Medicare released a set of modifiers that you need to know if you’re involved in ordering or coding for imaging. The modifiers, effective Jan. 1, 2020, are part of Medicare’s changes related to Appropriate Use Criteria (AUC) for advanced diagnostic imaging services. Check out the AUC-related modifiers below and then read on to brush up on this program.

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Urology: Prevent Claim Problems by Applying New BCG Code

Thu, Aug 8, 2019


HCPCS code for BCG to treat bladder cancer

Urology coders who report BCG had an important code update July 1, 2019. Make sure you’ve made this important code swap and understand the new rules for accurate reporting of this bacteria-based immunotherapy.

Replace J9031 With J9030 for BCG

One use of Bacillus Calmette-Guérin, more commonly known as BCG, is bladder cancer treatment. The provider instills this immunotherapy into the bladder via a tube or catheter. BCG uses Mycobacterium bovis, which is bovine tuberculosis. The bacteria are reduced to minimize harm to the patient, but the bacteria are still live.

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MPFS 2020 Proposed Rule: E/M Blended Payment for 2021 Is Dead

Mon, Aug 5, 2019


Medicare physician fee schedule proposed rule 2020

Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to revise E/M coding in 2021. But what does the MPFS say about Medicare payment for office/outpatient visits in 2021? Here’s the scoop.

Know What to Expect for E/M Payment in 2021

First, let’s repeat that although we’re talking about the 2020 proposed MPFS, the changes below won’t take effect until Jan. 1, 2021. Plus, these are proposed rules at this point, and as you’re about to see, even items that make it …

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Patient Nervous About Doctors? Update Medicare Coverage Rules for ABPM

Tue, Jul 30, 2019


Medicare coverage of blood pressure monitoring

A recent update brought Medicare coverage changes for both suspected white coat hypertension and suspected masked hypertension. Here’s your chance to get a handle on the new rules, including a change to the threshold for hypertension.

Keep Patients Calm With New ABPM Coverage

Medicare coverage of ambulatory blood pressure monitoring (ABPM) for patients with suspected white coat hypertension is not new, but the recently released Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) makes changes to the numbers involved. Let’s …

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Reporting Trastuzumab? Here Are All the Codes You Need to Know

Thu, Jul 25, 2019


trastuzumab HCPCS updates practices need to know

Trastuzumab HCPCS codes have been multiplying lately. The July 2019 HCPCS updates brought five changes. And there are two more planned for Oct. 1, 2019, implementation. Make sure your coding for this monoclonal antibody is up to date with these tips.

Know the Trastuzumab Codes You Have Right Now

Oncology coders need to know about trastuzumab because doctors use it to treat breast cancer and, in some cases, gastric cancer. The current HCPCS code set, effective July 1, 2019, made one revision to an existing code, added three temporary Q codes, and added a J code, too, all related to trastuzumab.

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Get a Sneak Peek at CPT® 2020 Additions, Deletions, and Revisions

Tue, Jul 23, 2019


CPT 2020 updates

With all the excitement about Medicare and AMA plans for E/M in 2021, don’t forget that the CPT® code set will have changes in 2020, too. The official code set will be out soon, but, in the meantime, here are some hints from the AMA about the changes you’ll have to know for Jan. 1. We’ll stick to Category I codes in this post.

Ace Add-On Coding for Bilateral Procedures

You’ll want to watch for a revision to instructions for bilateral procedures. The CPT<...

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Smash 3 Myths to Upgrade Your Mammography Coding and Coverage Knowledge

Thu, Jul 18, 2019


Medicare mammography coding and coverage

Mammography is a common service, but radiology coders need to learn some not-so-common rules. Take your know-how to the next level by getting to the truth about these myths.

Myth 1: Mammography Is for Women Only

Medicare’s National Coverage Determination (NCD) for Mammograms states that “diagnostic mammography is a radiologic procedure furnished to a man or woman with …

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CCI Modifiers: July 1 Update to Modifier 59 Rule Is Now in Force … and More

Tue, Jul 16, 2019


procedure coding and Medicare modifier 59 rule for CCI

Modifiers are the key to overriding Correct Coding Initiative (CCI) edits, so let’s give them the attention they deserve. We’ll start with a recent rule update and move on to helpful hints about CCI-associated modifiers in general.

Which CCI edits? Our focus here will be Medicare CCI Procedure-to-Procedure (PTP) edits for physicians and practitioners.

Do You Dare to Put Modifier 59 on Column 1 Code?

First up, did you remember that Medicare no longer requires you to append modifier 59 or X{EPSU} modifiers to the column 2 code in a CCI edit pair?

Details: Effective July 1, 2019, the Multi-Carrier …

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