Smash 3 Myths to Upgrade Your Mammography Coding and Coverage Knowledge

Thu, Jul 18, 2019

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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

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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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Part 3: Cross the ICD-10-CM 2020 Update Finish Line With Chapters 18-21

Wed, Jul 10, 2019

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ICD-10-CM 2020 update finish line!

Feeling energized for the last post in our ICD-10-CM 2020 update blog marathon? Today we’ll wrap up our overview of the main changes in each chapter of the diagnosis code set by covering symptoms, fractures, and more.

Read Part 1 for news about Chapters 1-10 and Part 2 for Chapters 11-17.

Chapter 18: Pick Up on New Code for Pyuria

In Part 1, you already read about R11.15 (Cyclical vomiting syndrome unrelated to migraine) being added to Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00…

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Part 2: Tackle ICD-10-CM 2020 Updates for Chapters 11-17

Mon, Jul 8, 2019

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You know the highlights of ICD-10-CM 2020 updates for Chapters 1-10 from our last blog post. Now let’s dig in to some of the big points from Chapters 11-17. We’ll wrap up with Chapters 18-21 in Part 3.

Remember: These updates are effective Oct. 1, 2019. Be sure your ICD-10-CM resource has the latest codes in case there are corrections or changes before implementation.

Chapter 11: Check Digestive Chapter Note Changes

Remember how many of the updates in ICD-10-CM 2020 Chapters 1-10 were …

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Part 1: What’s New in ICD-10-CM 2020, Chapters 1-10?

Wed, Jul 3, 2019

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cardiology ICD-10 2020 updates

ICD-10-CM 2020 is out now so you can prepare to start using the new code set Oct. 1, 2019. The Tabular List addenda PDF is 36 pages long to fit in 273 new reportable codes along with new subcategories, deletions, revisions, and some very important instruction changes.

We’ll cover major points from each ICD-10-CM chapter, with Chapter 1 to Chapter 10 in this Part 1 post. You can find complete lists of the changes on the ICD-10-CM sites of the CDC or CMS. And …

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PDPM: Snap Up This ICD-10-CM Knowledge for Your SNF

Mon, Jun 17, 2019

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ICD-10 coding for SNF

The Patient Driven Payment Model is bringing new importance to the ICD-10-CM code set for SNFs. Here’s where the diagnosis codes will come into play.

Get a Quick Overview of the PDPM

The Patient Driven Payment Model (PDPM) is a new case-mix classification system that will replace the Resource Utilization Group, Version IV (RUG-IV), effective Oct. 1, 2019. The PDPM will classify skilled nursing facility (SNF) patients in a Medicare Part A stay into payment groups as part of the SNF Prospective Payment System. RUG IV primarily uses therapy service volume as the basis for payment. The stated intent of PDPM is to classify patients into payment groups based largely on patient characteristics and conditions.

There …

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Modifier 51 Hints: Your Go-To Guide for the MPFS Multiple Procedure Column

Thu, Jun 13, 2019

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understand modifier 51 payment adjustments

There are nine different Multiple Procedure indicators on the Medicare Physician Fee Schedule (MPFS), meaning there are a lot of payment adjustment possibilities you need to know. Here’s each indicator, an example of a code with that indicator, and a quick look at where modifier 51 comes into play.

What Is Modifier 51?

The basic idea behind modifier 51 (Multiple procedures) is that it alerts a payer that there’s a potential overlap between services and therefore RVUs. Knowing that, the payer can adjust payment to better reflect the resources used.

For instance, way back in

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2020 Foresight: The Next ICD-10-PCS Code Set Is Here

Mon, Jun 10, 2019

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ICD-10-PCS inpatient coding 2020

Code update season is a marathon, not a sprint. It’s June, and we’re already talking 2020 changes, so you’ve got to pace yourself. Below is a light warm-up to ease you into the coming ICD-10-PCS updates.

Remember: ICD-10-PCS, like ICD-10-CM, has its annual update October 1, the beginning of the fiscal year (FY). So the FY2020 code set, typically called just ICD-10-PCS 2020, is effective for dates of service Oct. 1, 2019, to Sept. 30, 2020.

Take In ICD-10-PCS 2019 by the Numbers

Knowing the numbers of codes may not help much with applying them, but the overview does offer a sense of perspective about how large the code set is and how many …

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Coding Smarts: Be a Diabetic Neuropathy Vocab Champ

Wed, Jun 5, 2019

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ICD-10 codes for diabetic neuropathy

Roughly 25 percent of people over 65 in the U.S. have diabetes, and about half of people with diabetes have some form of nerve damage. So there’s a good chance you’ll need to know the terms used for diabetic neuropathy ICD-10-CM codes at some point. Be ready with this quick list of medical definitions.

Are Any of These Diabetes Code Terms Unfamiliar?

Our focus here will be type 2 diabetes because …

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Site, Timing, Trauma: 3 Top Areas to Watch for Osteoporotic Fracture

Mon, Jun 3, 2019

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ICD-10 coding for osteoporosis fracture

Before you report an ICD-10-CM code for a patient with osteoporosis who has broken a bone, take a moment to make sure you’ve applied these three (and a half) tips for more accurate coding.

1. Take a Break From Coding Site (Unless There’s a Break)

Site is not a component of M81.- (Osteoporosis without current pathological fracture) because osteoporosis is a systemic condition, meaning it isn’t limited to just one site.

In contrast, M80.- (Osteoporosis with current pathological fracture) does list sites, but the site tells you where the fracture is.

Source: You’…

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