Jul 22, 2020 | Uncategorized
There are big changes coming to the E/M codes in 2021! These updates will help to ease the processes that medical office workers handle daily. Ginger Avery, CPC, CPMA, CRC, is the Coding and Compliance Manager at Welter Healthcare Partners, Inc. Below, she is providing fourteen tips on how to plan ahead in order to be ready for these code changes!nnThe 2021 E/M code changes are set to deliver a powerful mix of updates to help streamline documentation practices and reduce administrative burden. Medical practices are encouraged to start planning now for operational and administrative workflow adjustments that will be a result of this momentous occasion.nn1. Identify/Assign Project Lead. This transition will affect everyone in the organization including coders, billers, other non-clinical staff, clinical staff, and clinicians. A designated project lead will help assure your clinic is prepared to streamline processes before the changes take effect on January 1, 2021.nn2. Make Time for Meetings. Schedule time for meetings to review the changes and address questions. Track goals and milestones during the transition process. Organizations are encouraged to recognize the significance of this event and prioritize time to prepare for changes.nn3. Make a List of Necessary Changes. Forms, templates, and contracts need updated, electronic health records and practice management systems need upgraded, several experts will be noted.nn4. Update Policies, Procedures, Practice Protocols & Compliance Plan. Policies, Procedures, Protocols should all be in alignment with the new guidelines.nn5. Review Medical Malpractice Liability. Although the “counted” documentation requirements have lessened with the updates, clinicians are reminded to tell clear stories, documenting the clinically relevant details of each encounter. The new guidelines state that office visits include “a medically appropriate history and/or physical examination when performed.” Regardless of the changes, it is important to remember that the burden of proof lies within the documented details. Supportive documentation will help guard against fraud & abuse law infractions.nn6. Assess Financial Impact. Guard against an unanticipated financial impact by understanding the rules in advance and performing a prospective payment analysis. Be prepared to adjust business practices depending on practice needs.nn7. Check with EHR vendors. Check with EHR vendors to assure their systems are updated appropriately prior to Jan 1st.nn8. Consider Coding Support. Establish strong coding/auditing resources and expertise early in the planning process.nn9. Conduct Current Coding/Documentation Assessment. Review current documentation practices and system functionality to address specific areas of interest for education development. This small audit sample should be conducted by an outside auditing source to provide an unbiased evaluation with appropriate recommendations.nn10. Provide Education. Educate clinicians appropriately about documentation that impacts medical decision making and how to become proficient with recognizing complexity in alignment with the new guidelines. The new guidelines provide definitions and descriptions that clarify many details that were previously left subject to interpretation. For example, an Undiagnosed new problem with uncertain prognosis is defined in the 2021 guidelines as, “A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. An example may be a lump in the breast.”nn11. Conduct a Time Study. Have clinicians track the total time related to each patient encounter for the day to determine whether current processes are set to capture total encounter time appropriately.nn12. Understand Employer and Payor Requirements. Employers or payors may still require documentation of additional information above and beyond the new E/M office visit coding guidelines. Careful evaluation of the flexibilities allowed under the new guidelines will ensure that the documentation satisfies any other obligations and requirements that they may be expected to fulfill within their contracts.nn13. Consider How the New E/M Guidelines Impact Your Specialty. For example, pain management practices will use the new E/M guidelines for office visits, but they’ll need to stick to the current guidelines for codes such as subsequent hospital visit code 99232 and subsequent nursing facility code 99308, which were among the top 10 E/M visit codes for the specialty according to the latest Medicare Part B utilization data.nn14. Download and study the materials the AMA has published. The guidance includes a new medical decision making (MDM) table, new coding guidelines for office visits and prolonged service codes and a detailed list of relevant definitions.nnResourcesnnImplementing CPT® Evaluation and Management (E/M) revisions nnTable 2 – CPT E/M Office Revisions Level of Medical Decision Making (MDM)nn10 tips to prepare your practice for E/M office visit changes
Jul 16, 2020 | Uncategorized
For the upcoming year, the FY 2021 ICD-10-CM Official Guidelines have made over 500 significant changes. These updates, set to take effect on October 1, 2020, include 490 new codes, 47 revised codes, and 58 codes deemed invalid. The upcoming changes are some of the biggest yet, as they address hundreds of new policies. See Welter Healthcare Partners’s summary of these changes in the information below!nnWith over 500 diagnosis coding changes just around the corner, the FY 2021 ICD10CM Official Guidelines bring updates that are set to be significantly larger than the FY2020 update brought to us last year. nnUpdates that are set to take effect October 1st, 2020 include: 490 new codes, 47 revised codes and 58 codes deemed invalid (see table below), additional instructions on reporting manifestations of COVID-19, as well as new guidance on social determinants of health, insulin use and acute kidney failure, among several other changes. nnBelow is a summary of the anticipated FY2021 ICD10CM Updates by Chapter: nnChapter 1: Certain Infectious & Parasitic Disease brings a new section 1.g for reporting Coronavirus infections. nnChapter 3: Diseases of Blood & Blood-forming organs has eighteen new, detailed codes available for sickle cell anemia. These new codes describe complications associated with sickle- cell and hemoglobin-C (Hb-C) diseases. For example, a note for new sickle-cell thalassemia code D57.418 (Sickle-cell thalassemia, unspecified, with crisis with other specified complication) instructs the coder to code any identified complications such as cholelithiasis (K80.-) or priapism (N48.32). nnChapter 4: Endocrine, Nutritional & Metabolic Disease includes new coding instructions to follow for diabetic patients treated with insulin, oral hypoglycemics and injectable non-insulin drugs. For example, if the patient is taking both insulin and an injectable non-insulin antidiabetic drug, assign both Z79.4 (Long term [current] use of insulin) and Z79.899 (Other long term [current] drug therapy). If the patient is taking oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign code Z79.84 (Long term [current] use of oral hypoglycemic drugs) in addition to code Z79.899. nnChapter 5: Mental, Behavioral and Neurodevelopmental Disorders contains twenty-one new codes that describe withdrawal from substances including alcohol, cocaine, and opioids. For example, F10.932 (Alcohol use, unspecified with withdrawal with perceptual disturbance). nnChapter 6: Diseases of the Nervous System has added “pseudotumor” as a clarifying term to G93.2 (Benign intracranial hypertension) and coders are instructed to code G98.81- (intracranial hypotension) with G96.0 (Cerebrospinal fluid leak) when applicable. nnChapter 9: Diseases of the Circulatory System contains many revisions to the includes and excludes notes for existing codes. For example: Atherosclerosis of native arteries of the legs with ulceration (I70.2-) now includes both critical and chronic ischemia of native arteries with ulceration. Hypertensive Heart Disease (I11) has been revised to exclude Takotsubo Syndrome (I51.81), also known as “broken heart” syndrome. nnA new hypertension guideline provides instruction that when a patient has hypertensive chronic kidney disease and acute renal failure, code both conditions and sequence the codes based on the reason for the encounter. nnChapter 10: Diseases of the Respiratory System now has code also instructions for cases of acute laryngitis and tracheitis (J04) and acute obstructive laryngitis (croup) and epiglottitis (J05). Coders are instructed to code also influenza if present, including influenza due to identified novel influenza A virus with other respiratory manifestations (J10.1). This chapter also has a new section 10.e specifically for vaping-related disorders. nnChapter 13: Musculoskeletal System found several updates this year including twelve new codes to capture other pathological fractures (M80.8AX- and M80.0AX-). Updates include an expanded list of codes for rheumatoid arthritis, as well as primary and secondary arthritis, and arthritis caused by trauma. New codes in the M24 category for other articular cartilage disorders, disorders of ligament, pathological dislocation, recurrent dislocation, contracture and ankylosis. nnChapter 14: Disease of Genitourinary brings two new sub-stages to Stage 3 chronic kidney disease (CKD). The new codes are: N18.30 (Chronic kidney disease, stage 3 unspecified), N18.31 (Chronic kidney disease, stage 3a) and N18.32 (Chronic kidney disease, stage 3b). nnChapter 15: Pregnancy, Childbirth, and the Puerperium contain new language that warns coders they should not report O85 for sepsis that follows an obstetrical procedure. A note nnpoints them to the Sepsis due to a postprocedural infection of Chapter 1 Certain Infectious and Parasitic Diseases (A00-B99), U07.1. nnA new section 15.s provides instruction on reporting COVID-19 infections in pregnancy, childbirth, and the puerperium. E.g. when a newborn tests positive for COVID-19 and the provider has not documented a specific method of transmission, assign code U07.1 and the appropriate codes for associated manifestations. Code P35.8 (Other congenital viral diseases) followed by U07.1 when the provider documents that the newborn contracted the disease in utero or during birth. nnChapter 16: Certain Conditions Originating in the Perinatal Period has a new section 16.h for reporting COVID-19 Infections in Newborn. nnChapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified contains several changes. Code R51 (Headache) will be split into two codes: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified). nnAnother source of new headache coding will come from five new codes for intracranial hypotension – the severe orthostatic headache that is a common symptom of a cerebral spinal fluid (CSF) leak: For example, G96.810 (Intracranial hypotension, unspecified), G97.83 (Intracranial hypotension following lumbar cerebrospinal fluid shunting) and G97.84 (Intracranial hypotension following other procedure). Five new codes for CSF leaks can now be found in place of the current code G96.0 (CSF leak). nnChapter 19: Injury, poisoning & certain other consequences holds 128 additions that include new codes for adverse effects and poisoning by fentanyl and tramadol as well as other synthetic narcotics. nnChapter 21: Factors influencing health status and contact with health services include new observation language. The new language creates a second exception to the rule that observation codes are primary. The GL state, “An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis.” nnNEW Chapter 22: Codes for Special Purposes (U00-U85) includes just two codes: U07.0 Vaping- related disorder and U07.1 COVID-19, these codes took effect in the earlier this year. nnDeletions from the 2021 ICD-10-CM code set include Q51.20 (Other doubling of uterus, unspecified), and the entire code family of T40.4X- (Poisoning by the adverse effect of and underdosing of other synthetic narcotics). nnThe general coding guidelines clarify that social determinants of health may be coded if self- reported by patients, “as long as the patient self-reported information is signed off by and incorporated into the health record by either a clinician or provider.” Social determinants of health, found in code categories Z55-Z65, report potential health hazards related to socioeconomic and psychosocial circumstances that may complicate the care of the patient (e.g., the patient is unemployed).nn
nnReferences:nCDC.govnCDC 10 CM GuidelinesnPBN Decision Health
Jul 16, 2020 | Uncategorized
Comprehensive, age-appropriate HPI & Exam support 99396 for preventive reevaluation & management of 1 established chronic problem. OMM of 1 body area is performed supporting code 98925. Questionable use of dx code Z12.4. Consider Z01.419 or Z00.00. Unsupported 99213, documentation does not support a separately identifiable E/M illness code. Possible use of code Q0091 for Pap collection per correct coding regardless of reimbursement. Below is an example of a procedure and notes regarding coding and why our clinician must be queried in order for the claim to be submitted. Do 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. – Click Here to Submit Redacted Surgery Case Study –
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Jul 8, 2020 | Uncategorized
nnMany updates regarding a variety of different healthcare topics have been made by the Center for Disease Control in an attempt to acknowledge missing links within the previous ICD-10-CM codes. These code changes were implemented to help specify past uncertainties regarding a range of conditions. Read below to learn more about each new code that the update consisted of.nnThe Centers for Disease Control (CDC) posted the fiscal year (FY) 2021 ICD-10-CM final code changes last week. There were no changes to the proposed list of 490 new, 47 revised, and 58 invalidated codes that were released in the proposed FY 2021 Inpatient Prospective Payment System rule.nnThe final update includes hundreds of new ICD-10-CM codes including (but not limited to):n
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- 128 additions to Chapter 19: Injury, poisoning and certain other consequences of external causes for adverse effects and poisoning by fentanyl and tramadol as well as other synthetic narcotics.
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- 125 additions to Chapter 20: External causes of morbidity (V00-Y99), including more specific codes for collisions involving electric scooters and other nonmotor vehicle accidents.
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- 57 musculoskeletal codes, including several in category M24.- (other specific joint derangements) for other articular cartilage disorders, disorders of ligament, pathological dislocation, recurrent dislocation, contracture, and ankylosis.
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- 21 codes to describe withdrawal from substances including alcohol, cocaine, and opioids. For example, F10.932 (alcohol use, unspecified with withdrawal with perceptual disturbance).
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- 18 detailed codes for sickle cell anemia. New codes such as D57.213 (sickle-cell/Hb-C disease with cerebral vascular involvement) and D57.431 (sickle-cell thalassemia beta zero with acute chest syndrome) specify complications related to the condition.
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- 3 codes to capture stage 3 chronic kidney disease (CKD) in two new sub-stages. The new codes are: N18.30 (CKD, stage 3 unspecified), N18.31 (CKD, stage 3a), and N18.32 (CKD, stage 3b).
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nThe new Chapter 22: Codes for Special Purposes (U00-U85) so far includes just two codes: U07.0 (vaping-related disorder) and U07.1 (COVID-19), which took effect in the early part of this year.nnThe final update deletes code Q51.20 (other doubling of uterus, unspecified) and all codes within subcategory T40.4X- (poisoning by adverse effect of and underdosing of other synthetic narcotics), without code replacements.nnThe CDC released 23 files for the final FY 2021 ICD-10-CM code set.nnOriginal article published on healthleadersmedia.com
Jul 8, 2020 | Uncategorized
nnNew research shows the findings of how many times Chronic Care Management codes are used within different service environments. CCM codes have been on the rise recently, but denial rates have gone up as well. Read below to find out more.nnChronic Care Management (CCM) code usage has been on the rise recently. CCM codes 99490 [primary CCM], 99487 and 99489 [complex CCM] rose 23%, 78% and 285% respectively between 2017 and 2018. In 2018 CCM code 99490 was reported 4.3 million times with almost 90% of these reported in the Office setting or 3.8 million claims. That may seem like a lot but when we look at the denial rates, Office (POS 11) had only a 4% denial rate. Of the remaining 500,000 claims outside of POS 11, 225,569 claims were submitted with POS 12 (Patient’s Home) with a 7% denial rate.nnAfter the top two reported Place of Service (POS) codes the number of claims per POS drop significantly, however, the denial rate for some POS codes increase significantly. POS 21 (Inpatient Hospital) claims had a denial rate of 19%. Part B News Volume 34, Issue 24 from June 22nd has a great visual of this information in an article by Roy Edroso.nnClick here to read the article from Part B News!
Jul 2, 2020 | Uncategorized
With a true national spirit of courage, integrity, sacrifice, liberty, and independence, we wish you a Happy Independence Day! Joining hand in hand, we celebrate our liberty and thank those in service to the United States.
nWhile spending time with loved ones this weekend, please remember that COVID-19 is still spreading, so social distancing should be practiced. Masks should be worn in spaces where social distancing is not possible.n
We are proud to wish you a happy, safe, and fulfilling Independence Day!
