SuperCoder Blog

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 …

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

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 …

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 …

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’…

Keeping up with modifier 25 rules can be intimidating, so let’s add a little fun by seeing if you can unearth the answers to these questions at the locations provided. Ready, set, go!

1. Is This a Separate E/M?

You may have the descriptor memorized for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Even if you don’t (the descriptor has gotten lengthier over the years, after all), you should know the basic concept: you use the modifier to identify a significant, separately

The percentage of people who have hepatitis B but don’t know it could be as high as 67 percent, and the opioid epidemic is fueling an increase in infections, according to the Department of Health and Human Services (HHS). That’s one reason screening is so important. Medicare’s coverage rules for hepatitis B screening are specific, though, so let’s nail down the professional coding rules for screening of non-pregnant patients.

Know the Beneficiaries Involved and Frequency Limits

The rules we’re discussing here

A lot of questions have been coming in to us lately about CEUs. Check out this FAQ to get answers about keeping your credential current using TCI SuperCoder resources.

Does TCI SuperCoder Offer Free CEUs?

Yes, TCI SuperCoder offers at least six free educational webinars per year. If you attend a live webinar, you can earn one AAPC-approved CEU (Continuing Education Unit). In some cases, the webinar may offer specialty CEUs, so be sure to check which credits are available from an individual webinar.

Everyone is welcome to attend a free live webinar to earn a CEU. (Please note that “live” means at the …

ICD-10-CM provides more than 20 codes for diverticular disease of the intestine, so you know attention to detail is the key to success! Here are five areas to watch to improve your coding accuracy.

1. Eat Your Wheaties Before You Tackle Documentation

ICD-10-CM includes a lot of codes for diverticular disease under K57.-, so you’ve got to be ready to spend some energy on analyzing the documentation to choose the correct code. (And in case “eat your Wheaties” isn’t in your vocabulary, it means power up before you take on a challenge!)

Here are the main pointers to check for to choose …

Let’s take Medicare’s list of services included in global surgery payment up a notch. If you remember each added tip below, you’ll be more likely to avoid reporting both too many and too few codes.

Read This Booklet to Dive Deeper

The source of the straight-from-Medicare bullet points quoted below is Medicare’s Global Surgery Booklet. As a quick refresher, the global surgical package includes required services typically furnished by a surgeon (or same-specialty physician in the same group) before, during, and after a procedure. The Medicare payment for a surgical code covers all of those typical pre-, intra-, …