8 Great Ways to Keep Your 2017 Coding On Target

multiple scope rule

Hello, 2017! The year we’ve been talking about for so long is finally here. Try these eight helpful hints to keep your claims clean and on track from the start.

1. Post Major CPT® Updates Front and Center

Long-time coders may remember the days when Medicare offered a 90-day grace period to adjust to new codes. But these days, if you’ve got a Jan. 1 date of service, then you need to be using the code set effective for the new year.

To help remember changes to the codes you know by heart, use whatever means work best for you, like putting a sticky note on your monitor that you can’t miss.

With changes to common codes for mammography and spinal injections — not to mention the moderate sedation coding revolution — plan ahead to keep your brain from going on cruise control when you code.

2. Check Those HCPCS Units

If you’ve got new HCPCS codes to report, then make sure you double check your units before you finalize your claim. Getting the number of units wrong is costly, but it’s fairly common because you have to remember to calculate the units based on the amount listed in the code descriptor.

For example, for new code J9145 (Injection, daratumumab, 10 mg), 1 unit of J9145 covers up to 10 mg of daratumumab administered.

Important: Don’t forget that Medicare has a new national rule requiring use of modifier JW to report wasted drugs on a separate line. Take the time to confirm you’ve reported all units appropriately, in line with the new rule.

3. Pay a Visit to LCD Policies

When new codes come into play, your payers update their policies. It may take a while for policies to catch up to the updates, but it’s a smart move to check the coverage rules for your common procedures. In particular, note how CPT® 2017, HCPCS 2017, and ICD-10-CM 2017 changes affected the covered code combinations.

4. Keep Tabs on Denials

Checking for policy changes goes hand in hand with watching your denials. For example, if any of your codes changed in a way that affects the number of services covered by a single unit of the code, you will definitely want to watch for denials to be sure your payer has updated coverage policies in line with the changes. Checking denials also can help catch any patterns in errors in case you missed an update.

5. Check Errata for Important Corrections

The AMA posts corrections to CPT® throughout the year as needed. Checking the errata and corrections document regularly is especially important if you use a paper manual that won’t receive updates the way an online coder will.

6. Scan MPFS Indicators

The Medicare Physician Fee Schedule (MPFS) database provides a lot of information beyond RVUs. Before you submit a claim, scan through the MPFS indicators to be sure things like global days and bilateral indicators have stayed the same for the new year.

7. Prevent CCI-Related Denials

We got nearly 100, 000 new Correct Coding Initiative (CCI) edits on Jan. 1, 2017, adding to the already impressively long list. Trying to remember on your own whether two codes are bundled is a guaranteed road to denial. Check your claims for CCI edit issues to stop denials before they happen.

8. Focus on Today, Plan for Tomorrow

The January updates are big, but they’re not alone. Updates to CCI, MPFS, HCPCS, and more will be here in just a few months on April 1, followed by the July and October 2017 updates. We’ll be getting our first glimpse of 2018 updates before we know it.

Mark your calendars now for when you want to start preparing for each new round of updates, whether that means catching up on your Coding Alerts or ensuring your team will have the data they need when the updates go into effect.

How About You?

Share your tips for staying up to date on the changes that affect coding.


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

, , , , ,

Leave a Reply