Jun 16, 2017 | Uncategorized
CMS proposed a final set of codes in April’s hospital IPPS rule, including over three hundred changes.nnStarting Oct. 1, it will be possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis, and nicotine.nnThose nine new codes are among 360 new, 142 deleted, and 226 revised diagnosis codes in the final 2018 update posted by the Centers for Medicare & Medicaid Services to its website on June 13. The final 2018 ICD-10-CM codes include 322 more changes than what was proposed by CMS for the hospital IPPS rule in April.nnExplanatory information included with the substance abuse remission codes will classify the severity of the use as mild, moderate, or severe to better coordinate ICD-10-CM coding with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).n
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nThis article originally posted on HealthLeadersMedia.com.
Jun 9, 2017 | Uncategorized
As part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, 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 StudynnPreoperative Diagnosis:n
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- Loculated empyema.
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nPostoperative Diagnosis:n
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- Loculated empyema, a trapped lung, a necrotic lung, with severe inflammatory rinds surrounding the entire right lung.
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nProcedure Performed:n
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- VATS converted to open thoracotomy.
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- Partial lobectomy.
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- Diaphragm.
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- Decortication.
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- Partial rib resection.
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nComplications: None.nnFindings: Significantly trapped, necrotic lung with empyema, loculated fluid collections, and a significant inflammatory rind.nnIndications: The patient is a 63-year-old female who has been in the hospital for 2 weeks with IR drainage of different fluid collections in the lung. Repeat CT scan shows continued loculated fluid collection, and white count continued to be elevated despite antibiotic therapy. Risks and benefits discussed with the patient, who agree with the treatment plan.n
Correct CPT and ICD-10 Codes:
n32320 / Modifier 22 / Dx: J86.9, J84.89, D72.829nn32484 / Dx: J86.9, J84.89, D72.829nn21600 / Dx: J86.9, J84.89, D72.829nnBreakdown:nn32320: Decortication and parietal pleurectomynnModifier 22 added due to, “Significant amount of adhesions to the point where they could not bennloosened”. Multiple tries for VATS approach. Decision made to convert to open procedure.nn32484: Removal of lung, other than pneumonectomy; single segment (segmentectomy)nn21600: Excision of rib, partialnnJ86.9, Empyema (chest) (lung) (pleura)nnJ84.89: Interstitial pneumonitisnnD72.829: Elevated leukocytes, unspecifiedn
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Jun 9, 2017 | Uncategorized
In an email cyber notice, the U.S. Department of Health and Human Services (HHS) is warning healthcare provider organizations that there are ongoing impacts to the U.S. healthcare sector from the WannaCry malware. 
nnThe Wanna Cry or Wanna Decryptor ransomware virus swept the globe last month and virtually shut down several dozen regional health authorities within the National Health Service of the United Kingdom, while simultaneously impacting the operations of such diverse entities as Spain’s national telephone service, La Telefónica; Germany’s railway system, Deutsche Bahn; automotive plants of the French car manufacturer, Renault; the Russian Interior Ministry; and universities in China and Taiwan.nnIn its notice sent out as part of Office of the National Coordinator for Health IT (ONC) and the Office for Civil Rights (OCR) list serves, HHS stated that the department is aware of two, large, multi-state hospitals systems in the U.S. that are continuing to face significant challenges to operations because of the WannaCry malware. HHS specifically notes that this not a new WannaCry attack.nnThe virus can persist even on a machine that has been patched, however, the virus will not spread to a patched machine, but the attempt to scan can disrupt Windows operating systems when it executes. The particular effect varies according to the version of Windows on the device, HHS stated.nnWannaCry ransomware is a fast-propagating worm which exploits Windows’ Server Message Block version 1 (SMBv1) protocol to move through a network or infect other systems on the Internet. However, according to HHS in its notice, SMBv1 might not be the only vector of infection for WannaCry, so even patched systems could still be infected if the malware is introduced to the system in a different manner.n
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This article was originally posted on Healthcare-Informatics.com.
Jun 2, 2017 | Uncategorized
Most long-term relationships are built on mutual trust and respect. Valuable relationships are not built on mistrust, fear or intimidation. Same holds true for the relationship your practice has with payers, and especially payer representatives. A little sugar can go a long way when you need help resolving claims issues or credentialing problems. Resist the temptation to beat up on the payer reps you encounter over the phone and don’t ever write a nasty, insulting e-mail. These almost always backfire and once the bullet leaves the gun you can’t bring it back.nnBelieve it or not, you need these people and they have long memories. Having done this for almost 30 years, I have found the payer reps, like me, are not perfect but they really do want to help resolve issues not make them worse. Take the long view, create a relationship!nn
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About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.
Jun 2, 2017 | Uncategorized
Telehealth Services: As of 2017, many payers are now legally required to reimburse providers of various specialties for telehealth services. Billing and Coding reimbursement rules for telemedicine can be extremely cumbersome. Follow these compliance tips and the financial impact for your practice can be significant:n
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- Clinical documentation must support the following: the provider is rendering services to a patient via telehealth (not face-to-face) using interactive audio and video telecommunications software that permits real-time communication between the provider, the distant site, and the beneficiary.
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- The “GT” modifier should be appended to all services provided via telehealth.
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- Place of service code for telehealth services is 2 – The location where health services and health-related services are provided or received, through a telecommunication system.
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- Originating site criteria is met.
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Jun 2, 2017 | Uncategorized
Check out this reminder from CMS about Medicare and the social security number initiative, as well as tips and links to where you can learn more about the announcement.nnAs you know, beginning in April 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to all people with Medicare. The MBI will replace the Social Security Number (SSN)-based Health Insurance Claim Number for transactions like billing, eligibility status, and claim status after a transition period. Make sure your systems are ready:n
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- Visit our Social Security Number Removal Initiative (SSNRI) Home and Provider webpages for the latest details about the transition. Subscribe to the weekly MLN Connects newsletter for updates and new information.
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- Verify your patients’ addresses. Your patients will not get a new card if their address is not correct. If the address you have on file is different than the Medicare address you get in electronic eligibility transaction responses, ask your patients to correct their address in Medicare’s records through Social Security. This may require coordination between your billing and office staff.
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- Attend our quarterly calls to get more information. We will let you know when calls are scheduled in MLN Connects.
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- Work with us to help your Medicare patients with the change to the MBI. This fall (2017), we will be in touch with ways to help.
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- Get ready to use the new MBI Format. Ask your billing and office staff if your system will be ready to accept the 11 digit alpha numeric MBI. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change. Make and internally test changes to your practice management systems and business processes by April 2018, before we mail the new Medicare cards.
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- If you are a vendor who partners with Medicare providers to bill Medicare, communicate with them about your system readiness and what they should expect to see from you beginning April 2018.
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nThis article originally posted on CMS.gov.
