Aug 21, 2020 | Uncategorized
nnCMS got a jumpstart on the 2021 ICD-10-CM guidelines regarding COVID-19, releasing these new regulations just a few weeks ago. The guidelines cover reporting COVID cases that are respiratory, non-respiratory, in pregnancy, and in newborns. Keep reading for more details on these guidelines.nnCMS released the 2021 ICD-10-CM Official Guidelines for Coding and Reporting on July 8, several weeks earlier than usual. The coding guidelines, which take effect October 1, include new instructions for reporting manifestations of the novel coronavirus (COVID-19), among other changes.nnThe guidelines include a new section for COVID-19 that expands on the temporary coding guidelines posted in April by the ICD-10-CM Coordination and Maintenance Committee. Coders should note that the temporary guidelines will expire September 30.nnNew instructions for reporting ICD-10-CM code U07.1 (2019-nCoV acute respiratory disease) include the following:nnAcute respiratory manifestations of COVID-19.n
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- Code U07.1 should be assigned as the principal diagnosis if the reason for the encounter or visit is a respiratory manifestation of COVID-19. Codes for the respiratory manifestations should be assigned as additional diagnoses.
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- Code J96.0 (acute respiratory failure) was added as another respiratory manifestation that may be coded secondary to U07.1.
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nThe non-respiratory manifestation of COVID-19n
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- If the reason for the encounter or admission is a non-respiratory manifestation of COVID-19, code U07.1 should be assigned as the principal diagnosis and codes for the manifestations should be assigned as additional diagnoses.
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nCOVID-19 in pregnancyn
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- According to new guidance in Chapter 15: Pregnancy, Childbirth, and the Puerperium, if a patient tests positive for COVID-19 during an encounter that is unrelated to the disease, the reason for the encounter should be coded first, 098.5 (other viral diseases complicating pregnancy, childbirth, and the puerperium). The coder would then report U07.1 and any appropriate COVID-19 manifestation codes.
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nCOVID-19 in newbornsn
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- If a newborn tests positive for COVID-19 and a specific method of transmission is not documented, U07.1 should be assigned and any appropriate codes for associated manifestations, according to a new section in Certain Conditions Originating in Perinatal Period. If a newborn tests positive for COVID-19 and the provider documents that the newborn contracted the disease in utero or during birth, P35.8 (other congenital viral diseases) should be coded followed by U07.1. The guidance clarifies that Z38 (liveborn infants according to place of birth and type of delivery) is the principal diagnosis when coding the birth episode in a newborn record.
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nA section on coding “presumptive positive” COVID-19 cases was not included in the 2021 guidelines because it refers to cases awaiting a second, confirmatory CDC laboratory test—a practice that is no longer required.nnOriginal article published on healthleadersmedia.com
Aug 21, 2020 | Uncategorized
CMS is looking for public comments on the changes of the 2021 E/M codes. The added code focuses on services and resources suited to individual patients regarding ongoing and long-term illness. Keep reading to learn more about the addition of this code.nnWith the proposed 2021 Evaluation & Management (E/M) changes final rule on track to be released November 1, 2020, CMS is currently seeking public comment regarding the addition of code GPC1X [Complex visit w med care svs].nnCMS is looking for comment on the codes intended use as previous descriptions were found to be “unclear”. This code was created with the intent of supporting the longitudinal care of patients, however, CMS has received several concerns that the description could be interpreted as applicable to every office or outpatient E/M visit.nnIn the proposed rule, the agency states “We continue to believe that the time, intensity, and PE involved in furnishing services to patients on an ongoing basis that result in a comprehensive, longitudinal, and continuous relationship with the patient and involves the delivery of team-based care that is accessible, coordinated with other practitioners and providers, and integrated with the broader health care landscape, are not adequately described by the revised office/outpatient E/M visit code set. We believe the inclusion of HCPCS add-on code GPC1X appropriately recognizes the resources involved when practitioners furnish services that are best suited to patients’ ongoing care needs and potentially evolving illness. We also believe the work reflected in HCPCS add-on code GPC1X is inherently distinct from existing coding that describes preventive and cares management services.”nnSubmissions are due before 11:59 PM on October 5, 2020.nnClick here for more information on code GPC1X.
Aug 12, 2020 | Uncategorized
The Advance Beneficiary Notice of Noncoverage (ABN) is widely used to help out those who will be denied Medicare payments. The renewal deadline has recently been extended as a result of the COVID-19 pandemic. Here you’ll find more information regarding the details of the ABN use extension.nnDue to COVID-19 concerns, CMS is going to expand the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023). At this time, the renewed ABN will be mandatory for use on 1/1/2021. The renewed form may be implemented prior to the mandatory deadline. The ABN form and instructions may be found at cms.gov
Aug 12, 2020 | Uncategorized
The report below describes a patient undergoing spinal surgery. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed. nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. nn– Click Here to Submit Redacted Surgery Case Study –nnOPERATIVE REPORTnnDATE OF OPERATION: 06/XX/2020nnOPERATING SURGEON: A.K. M.D.nnPREOPERATIVE DIAGNOSES:nC4-5 subluxation with spinal cord compression.nC4-5 anterior cervical osteomyelitis and diskitis.nnPOSTOPERATIVE DIAGNOSES:nC4-5 subluxation with spinal cord compression.nC4-5 anterior cervical osteomyelitis and diskitis.nnOPERATION PERFORMED:nC4 and C5 posterior cervical decompression with resection of epidural phlegmon.nC4-C5 posterior cervical arthrodesis with allograft and autograft.nC4-5 posterior cervical instrumentation with lateral mass screws and rods.nnFIRST ASSISTANT: B. J., P.A.nnANESTHESIA: General.nnDESCRIPTION OF OPERATION: The patient was brought into the operating room. He was intubated. Appropriate lines were placed and he was placed into Mayfield head fixation. Using strict log roll precautions, he was then turned prone onto an OR table with gel rolls going across his chest and across the iliac crest. Arms were tucked after pressure points were padded and he was positioned with his neck in a neutral position slightly extended to try to counteract to the subluxation.nnImmediate C-arm imaging was obtained to ensure good positioning. The midline neck was now shaved, prepped, and draped and surgery was begun.nnIncision was marked out over the midline what was felt to be the C4 and C5 spinous processes. Incision was made and carried down through the subcutaneous tissues remaining in the median raphe until the spinous processes were identified.nnC-arm was brought back in to positively identify the C4 and C5 levels. We now continued exposure until we had exposed from inferior C3 to superior C6 encompassing the lateral masses bilaterally of C4 and C5. We first performed the instrumentation using a drill guide and drill with C-arm to guide angle of trajectory. Standard landmarks were used to place lateral mass screws, that is the lateral mass was bisected both in a rostral-caudal and left-right fashion and the entry point 1 mm inferior and lateral was chosen. We then angled approximately 5 to 10 degrees laterally. Rostrally, the angle for the screws was determined by the C-arm. 14 mm pilot hole was drilled and then sounded with a ball probe to make sure we had not perforated, following which the 14 mm polyaxial lateral mass screws were placed. This was done into the bilateral C4 and bilateral C5 lateral masses.nnWe now decorticated. The curette was used to curette out the facet at C4-5, both the inferior articulating facet of C4 and the superior articulating facet of C5 bilaterally. We additionally used the drill to drill the lateral lamina that remained after decompression and a combination of allograft and autograft, which had been harvested with the decompression, were used to fill the facet and do an onlay lateral laminar arthrodesis.nnPrior to the arthrodesis, the decompression was done. Leksell rongeur was used to remove the spinous process of C4 and C5 as well as the lamina, which was further removed with Kerrison rongeurs. The lamina was thinned using the high- speed drill and ligamentum flavum was also removed from the C3-4, C4-5, and C5-6 interspaces.nnOf note, there was an organized vascular collection, which was unusual to see at the level of C4-5. This may have been inflammatory reaction to the infection on the opposite side. Although no clear infection was seen, this phlegmon was adhesed to the dura and had to be removed as a separate piece. It was sent half of it to pathology and half of it to microbiology for evaluation. We also took cultures in this area.nnOnce the decompression was completed, arthrodesis was done as mentioned and finally, the instrumentation was completed by placing rods into the lateral mass screws, which were then affixed with set screws and final tightening done.nnWe now thoroughly irrigated. Bleeding was controlled with Floseal, bipolar, and Bovie as well as bone wax to the bleeding bone edges. Given the patient’s renal failure and cirrhosis and low starting hematocrit, we elected to place a drain, which was tunneled out a separate incision. Finally, the wound was closed in multiple layers, first closing the cervical fascia with interrupted 0 Vicryl sutures, placing some inverted 2-0 and 3-0 Vicryl sutures and then staples were applied to the skin. Wound was cleaned, dressed with Telfa, 4x4s, and Tegaderm. The patient then turned back supine, placed back into a C-collar, extubated, and sent to the recovery room. Estimated blood loss was 20 to 25 cc. Sponge and needle counts were correct. There were no complications.nnSPECIMEN SENT: Epidural phlegmon, half to pathology, half to microbiology and cultures were also obtained.
Aug 5, 2020 | Uncategorized
CMS proposed changes to expand telehealth which would improve healthcare in rural areas. The proposal will also ensure proper reimbursement times and other important changes. Read the article below for more information on this important update.nnTrump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and Advances Access to Care in Rural AreasnnThe Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed today. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. Additionally, the proposed rule implements a multi-year effort to reduce clinician burden under our Patients Over Paperwork initiative and to ensure appropriate reimbursement for time spent with patients. This proposed rule also takes steps to implement President Trump’s Executive Order on Protecting and Improving Medicare for our Nation’s Seniors and continues our commitment to ensure that the Medicare program is sustainable for future generations.nnExpanding Beneficiary Access to Care through Telehealth nnOver the last three years, as part of the Fostering Innovation and Rethinking Rural Health strategic initiatives, CMS has been working to modernize Medicare by unleashing private-sector innovations and improve beneficiary access to services furnished via telecommunications technology. Starting in 2019, Medicare began paying for virtual check-ins, meaning patients across the country can briefly connect with doctors by phone or video chat to see whether they need to come in for a visit. In response to the COVID-19 pandemic, CMS moved swiftly to significantly expand payment for telehealth services and implement other flexibilities so that Medicare beneficiaries living in all areas of the country can get convenient and high-quality care from the comfort of their home while avoiding unnecessary exposure to the virus. Before the public health emergency (PHE), only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July. For more information on Medicare’s unprecedented increases in telemedicine and its impact on the health care delivery system, visit the CMS Health Affairs blog here.nnAs directed by President Trump’s Executive Order on Improving Rural and Telehealth Access, through this rule, CMS is taking steps to extend the availability of certain telemedicine services after the PHE ends, giving Medicare beneficiaries more convenient ways to access healthcare particularly in rural areas where access to healthcare providers may otherwise be limited Improving Rural and Telehealth Access.nn“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for America’s seniors,” said CMS Administrator Seema Verma. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers.”nnDuring the public health emergency, CMS added 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. CMS is proposing to permanently allow some of those services to be done by telehealth including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments. CMS is seeking public input on other services to permanently add to the telehealth list beyond the PHE in order to give clinicians and patients time as they get ready to provide in-person care again. CMS is also proposing to temporarily extend payment for other telehealth services such as emergency department visits, for a specific time period, through the calendar year in which the PHE ends. This will also give the community time to consider whether these services should be delivered permanently through telehealth outside of the PHE.nnPrioritizing Investment in Preventive Care and Chronic Disease ManagementnnUnder our Patients Over Paperwork initiative, the Trump Administration has taken steps to eliminate burdensome billing and coding requirements for Evaluation and Management (E/M) (or office/outpatient visits) that makeup 20 percent of the spending under the Physician Fee Schedule. These billing and documentation requirements for E/M codes were established 20 years ago and have been subject to longstanding criticism from clinicians that they do not reflect current care practices and needs. After extensive stakeholder collaboration with the American Medical Association and others, simplified coding and billing requirements for E/M visits will go into effect January 1, 2021, saving clinicians 2.3 million hours per year in burden reduction. As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.nnAdditionally, last year, the Trump Administration finalized historic changes to increase payment rates for office/outpatient E/M visits beginning in 2021. The higher payment for E/M visits takes into account the changes in the practice of medicine, recognizing that additional resources are required of clinicians to take care of the Medicare patients, of which two-thirds have multiple chronic conditions. The prevalence of certain chronic conditions in the Medicare population is growing. For example, as of 2018, 68.9% of beneficiaries have 2 or more chronic conditions. In addition, between 2014 and 2018, the percent of beneficiaries with 6 or more chronic conditions has grown from 14.3% to 17.7%.nnIn this rule, CMS is proposing to similarly increase the value of many services that are comparable to or include office/outpatient E/M visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, physical and occupational therapy evaluation services and others. The proposed adjustments, which implement recommendations from the American Medical Association, help to ensure that CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients, like primary care and complex or chronic disease management.nnBolstering the Healthcare Workforce/Patients Over PaperworknnCMS is also taking steps to ensure that healthcare professionals can practice at the top of their professional training. During the COVID-19 public health emergency, CMS announced several temporary changes to expand workforce capacity and reduce clinician burden so that staffing levels remain high in response to the pandemic. As part of its Patients over Paperwork initiative to reduce regulatory burden for providers, CMS is proposing to make some of these temporary changes permanent following the PHE. Such proposed changes include nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives (instead of only physicians) to supervise others performing diagnostic tests consistent with state law and licensure, providing that they maintain the required relationships with supervising/collaborating physicians as required by state law; clarifying that pharmacists can provide services as part of the professional services of a practitioner who bills Medicare; allowing physical and occupational therapy assistants (instead of only physical and occupational therapists) to provide maintenance therapy in outpatient settings; and allowing physical or occupational therapists, speech-language pathologists and other clinicians who directly bill Medicare to review and verify (sign and date), rather than re-document, information already entered by other members of the clinical team into a patient’s medical record.nnPublic comments on the proposed rules are due by October 5, 2020.nnFor a fact sheet on the CY 2021 Physician Fee Schedule proposed rule, click here.nnFor a fact sheet on the CY 2021 Quality Payment Program proposed rule, click here.nnFor a fact sheet Medicare Diabetes Prevention Program, click here.nnTo view the CY 2021 Physician Fee Schedule and Quality Payment Program proposed rule, click here.nnOriginal article published on CMS.govnn
