CODING CORNER APRIL 2017….

By Betsy Priest, Coding Manager

Did you know?

You can bill for both an E/M with a vaccination code when the visit warrants it.  Guidelines are below:

  • the presenting problem or problems should be minimal
  • five minutes are spent performing or supervising services such as blood pressure checks
  • There needs to be a diagnosis other than the vaccine itself (Z code) – Rash, reason for vaccine, chronic conditions, etc.
  • These services do not need to be performed by an MD or midlevel, they can be performed by a nurse.

Modifier 25 must be appended to the service and submitted without the vaccine diagnosis code. If done by time it is a 5 minute visit.

If the patient is coming in strictly for an immunization, and there is no counseling or work up for any other issue or side effect, only the Immunization code should be submitted.

If you are counseling the patient on the immunization itself there are codes for the administration with counseling (they may reimburse at a higher level than the regular admin codes). The codes are: 90460 and 90461.

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfirst.com

CODING CORNER… JANUARY 2017

By Becky Priest, Coding Manager

Effective February 1, 2017 coders will begin using the following:

  • For new patients, 8 organ systems is STILL a comprehensive exam.
  • Established patients: This will be VERY important on your established level 4’s (Office/ED settings) and subsequent level 3’s (Inpatient/OBS setting).
    • Instead of needing 2-7 body areas/organ systems, you will now need to document 6-7 BODY AREAS/ORGAN SYSTEMS (Expanded documentation of the areas and/or systems examined; requires more than checklists; it needs to have normal/abnormal findings documented upon

  • For an expanded problem focused exam the requirement now is 2-5 BODY AREAS/ORGAN SYSTEMS (Minimal detail for areas and/or systems examined: check list type documentation without any expansion of findings)

To summarize: The new exam scoring change and the E&M codes it affects, please refer to the table below:

Type of Exam OLD SCORING NEW SCORING A MUST for the following E/M levels:
EXPANDED PROBLEM FOCUSED 2-7 BODY AREAS/ORG SYSTEMS (minimal detail)

 

2-5 BODY AREAS/ORGAN SYSTEMS Office established Patient 99213

Office New Patient 99202 & 99203
ED Patient 99282 & 99283

Hospital subsequent patient 99232 (Inpatient), 99225 (Obs)

 

DETAILED 2-7 BODY AREAS/ORG SYSTEMS (minimal detail) 6-7 BODY AREAS/ORGAN SYSTEMS Office Established Patient 99214

Office New Patient 99203

ED Patient 99284

Hospital subsequent patient 99233 (Inpatient), 99226 (Obs)

COMPREHENSIVE 8 ORGAN SYSTEMS NO CHANGE-STILL 8 ORGAN SYSTEMS Office Established Patient 99215

Office New Patient 99204

ED Patient 99285

New Hospital patient 99222, 99223 (Inpatient), 99219 and 99220 (Obs)

 

If you would like more information please feel free to reach out to us.

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfirst.com

CODING CORNER… NOVEMBER 2016

By Betsy Priest, Coding Manager

As of Oct 1, 2016, updates to the ICD-10 codes were put in to effect.  Some areas that may be of interest to you are:

  • Code assignment/Clinical criteria – A diagnosis will be added when a provider states that a condition exists. It is no longer dependent on showing the clinical criteria that brings the Physician to that diagnosis.
  • Laterality – The laterality of any injury needs to be documented to assign a code. If one side is treated and no longer is an issue, then the documentation needs to change from bilateral to the side that is now affected (cataracts are a good example).
  • Pathologic Fractures – 7th character A is for when the patient is receiving active treatment – not whether the provider has seen the patient before. 7th character D is for after the patient has completed active treatment.
  • Long Term use of Insulin – This needs to be documented so that it can be coded.

In addition to the above bullets, some diagnoses have been added, now requiring a 4th, 5th and 6th digit. It is important to look at any and all code lists that you use to ensure that they include all of the most up to date codes.

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfir

CODING CORNER…FEBRUARY 2016

By Betsy Priest, Coding Manager

ADVANCED CARE PLANNING

Two new codes are available to help capture a patient’s advanced care planning.  These can be used in any setting, regardless of the specialty.

99497: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.

99498: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

These codes will be used to capture the time you spend in addition to what is already being done with the patient.  If you have a regular visit with the patient, code that visit with a modifier 25 and then the above codes. If you are only seeing the patient for Advanced Care Planning, you would only use these codes.

These are time based codes.  99497 is for the first 30 minutes of Face to Face time with the patient and the 99498 is for each additional 30 minutes. This is only face to face time with the patient.

The documentation needs to clearly state the total time, that it was face to face, and what was discussed.  (The providers do not need to re-write parts of their note if this information is elsewhere. We need to be able to clearly see what was discussed and that it was advanced care planning).

Reimbursement amounts have not been determined yet. CMS states that in 2016, they will reimburse these services, but no payment amount has been established. This was open for discussion through December 31, 2015 and no final decision regarding the reimbursement amount has been published as of yet.

These services can be performed by physicians as well as mid-levels

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfirst.com

CODING CORNER… JANUARY 2016

By Betsy Priest, Coding Manager

2016 NEW, DELETED, AND REVISED CPT AND HCPCS CODES:

Revisions, addition and deletions to the CPT and HCPCS code set are effective January 1, 2016. Use of deleted codes will delay payment, as we will need to “Chart Return” the charge slips to your office for the correct code.

To determine which clients will be impacted by the 2016 changes, we have compared these changes to each client’s procedures performed in 2015.

We will be faxing, mailing or delivering customized reports to our Clients that are impacted by the 2016 CPT changes.

If you would like a complete listing of all the Deleted, New, and Revised Codes, we can provide that upon request.

DOCUMENTING TIME FOR E&M LEVELING:

During some visits you may spend a lot of time with a patient counseling them or coordinating their care.  If this happens, and you have the correct documentation in your note, leveling of your Evaluation and Management codes can be captured by time in lieu of the 3 main components.

It is a good tool for those patients that use a lot of your time, knowledge and resources and wind up with a very straight forward problem.

A good example of documentation needs for coding by time is: “This encounter was 30 minutes long and over half of that time was spent on counseling and coordination of care”.  You can also give a brief overview of what was discussed, if you would like.  But it will not be needed in this statement if the rest of your note supports that.

Your visit can be coded by time if the statement above is listed in the body of the note.  “This was a 45 minute visit” or “I spent 45 minutes with the patient” is not considered to be acceptable by the payers.

If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 or Betsyp@pracfir

CODING CORNER…FOCUS ON ICD-10 DECEMBER 2015

 By Becky Priest, Coding Manager
 
Medical Record Documentation and Coding Tips:

1. State the diagnosis to the highest level of specificity known

  • Document all conditions treated or related to treatment at the time of the visit
  • State the conditions as worsening, improving, stable, acute, etc.
  • Clearly state how the condition is being treated or monitored

2. Create a clear relationship between the diagnoses

  • Use linking verbiage such as “due to”, “because of”, “related to”
  • Coding guidelines prohibit coders from making assumptions

3. Include all conditions related to health status

  • Document chronic and permanent diagnoses as often as they are assessed or treated
  • Document chronic and permanent diagnoses when they are a consideration in the care of the patient
  • Frequently overlooked, but significant conditions include: transplant status, quadriplegia, dialysis status, current ostomies, amputations and asymptomatic HIV infection

4. Abbreviations

  • Only use standard abbreviations
    • This includes  HIV, CHF, AIDS, CABG, HTN, UTI, ENT, and many others
  • Making your own abbreviations can cause coding issues including the wrong procedure or diagnosis being coded
  • If you are using abbreviations only use those that are universally known between other clinical staff, coders as well as the payers
If you would like more information about how we can tailor our services to meet your needs, please contact Betsy Priest, Coding Manager at 716.348.3904 orBetsyp@pracfirst.com

CODING CORNER REMINDER…ICD-10

By Lisa Kropp, Coding and Credentialing Manager

Last Call for ICD-10

  • It is predicted that the ICD-10 transition will make a significant impact on cash flow due to delayed payment and claims adjudication. Although testing occurs, the industry cannot be certain that claims will process as correct and timely as they do now.  Therefore, it is our recommendation that every practice ensure cash reserves and lines of credit are available to keep your practice operational for 3-4 months in the event there is a disruption in cash flow due to delayed payments and/or denials.
  • Billing Clients: Practicefirst will expect all dates of service 10/1/2015 forward to contain ICD10 diagnosis codes on your billing sheets.  Any claims submitted with ICD-9 codes will be returned to the office for correction.
  • Coding Clients: Practicefirst will continue to be a resource for questions. Training has occurred either in person or via telephone.  If you have not received your session, you must contact PF at 716.834.1191.

&nbs

CODING CORNER…FOCUS ON ICD-10 – SEPTEMBER 2015

By Lisa Kropp, Coding and Crredentialing Manager

What to Expect in September:

  • Coding Clients: PF will continue to be a resource for questions.  Training has occurred either in person or via telephone.  If you have not received your session, you must contact PF at 716.834.1191.
  • Billing Clients: PF will expect all dates of service 10/1/2015 forward to contain ICD10 diagnosis codes on your billing sheets.

The BEST Resource at this stage:

  1. CMS’s Road to 10
    1. http://www.roadto10.org/Aligning Clinical Documentation and ICD-10:

DIABETES MELLITUS, HYPOGLYCEMIA AND HYPERGLYCEMIA….Increased Specificity

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.

When documenting diabetes, include the following:

TYPE: e.g. Type 1 or Type 2 disease, drug or chemical induced, due to underlying condition, gestational

  1. COMPLICATIONS: What (if any) other body systems are affected by the diabetes condition? e.g. Foot ulcer related to diabetes
  2. TREATMENT: Is the patient on insulin?
  • A second important change is the concept of “hypoglycemia” and “hyperglycemia.”
  • It is now possible to document and code for these conditions without using “diabetes mellitus.”
  • You can also specify if the condition is due to a procedure or other cause.
  • The final important change is that the concept of “secondary diabetes mellitus” is no longer used; instead, there are specific secondary options.

ICD-10 DIABETES CODE EXAMPLES:

E08.65            Diabetes mellitus due to underlying condition with hyperglycemia

E09.01             Drug or chemical induced diabetes mellitus with hyperosmolarity with coma

R73.9              Transient post-procedural hyperglycemia

R79.9              Hyperglycemia, unspecified

INJURIES….Increased Specificity

ICD-9 used separate “E codes” to record external causes of injury. ICD-10 better incorporates these codes and expands sections on poisonings and toxins.

When documenting INJURIES, include the following:

  • Episode of Care:                     Initial, subsequent, sequelae (late effect)
  • Injury Site:                              Be as specific as possible
  • Etiology:                                 How was the injury sustained?
  • Place of Occurrence:               e.g. School, work, etc.

Initial Encounters may also require, where appropriate:

  • Intent:                                     e.g. Unintentional or accidental, self-harm, etc.
  • Status                                     e.g. Civilian, military, etc.

Injury CODE EXAMPLE:

Example: A left knee strain injury that occurred on a private recreational playground when a child landed incorrectly from a trampoline:

  • Injury: S86.812A, Strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
  • External cause: W09.8xxA, Fall on or from other playground equipment, initial encounter
  • Place of Occurrence: Y92.838, Other recreation area as the place of occurrence of the external cause
  • Activity: Y93.44, Activities involving rhythmic movement, trampoline jumping   

For additional examples, by specialty, please visit: https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.htm

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1191 or tom@pracfirst.com<

CODING CORNER…FOCUS ON ICD-10 – AUGUST 2015

 By Lisa Kropp, Coding and Credentialing Manager
Practicefirst’s Implementation Assistance Plan

  • On or around June 1, 2015, your practice should have received a report containing the 20+ most commonly billed ICD-9’s by your practice in 2014.  We included the ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.
  • If you did not receive a report, please contact Lisa Kropp 716.348.3904 or lisak@pracfirst.com

What to Expect in August:

  • Coding Clients: Scheduling of telephone or on site session to provide specialty specific ICD-10 information.
  • Billing Clients: Contact by a member of the billing team to discuss your practice’s readiness.

New VIDEO ICD-10 resources: https://www.youtube.com/watch?v=_pLwSh09sGo&list=PLw4-yeXdND_pd1Jp_TZmjJb_Wm-ncFQtG
Available Articles:

  1. Road to 10
  2. Introduction to ICD-10 Coding
  3. ICD-10 Coding and Diabetes
  4. ICD-10 Coding Basics & More
  5. ICD-10 and Clinical Documentation

ICD-10 Resource List

  1. http://www.cms.gov/Medicare/Coding/ICD10/
    1. Contains videos for small practices, resource flyers as well as a clinical documentation video.
  2. https://www.aapc.com/icd-10/
    1. Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
  3. https://www.aapc.com/icd-10/crosswalks/
    A.  Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty
    specific)

Below are suggested links you should begin using now as ICD-10 nears:

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com<

CODING CORNER JULY 2015….FOCUS ON ICD-10

By Lisa Kropp, Coding and Credentialing Manager

Practicefirst’s Implementation Assistance Plan

  • On or around June 1, 2015, your practice should have received a report containing the 20+ most commonly billed ICD-9’s by your practice in 2014.  We included the ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.
  • If you did not receive a report, please contact Lisa Kropp 716.348.3904 or lisak@pracfirst.com

What to Expect This Month:

  • Direct contact by Practicefirst to gain more information regarding your implementation readiness.
  • More ICD-10 fun facts!
  • ICD-10 resources

Need ICD-10 Practice?

CMS has launched the following site to provide interactive case studies with questions & answers (e.g. how to assign an ICD-10 for a patient with strep pharyngitis & tonsillitis).

Cases are updated weekly!

Visit: http://www.roadto10.org/ics/

ICD-10 Differences:

  • Injuries are grouped by anatomical site rather than by type of injury
  • Category restructuring and code reorganization occur in a number of ICD-10 chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9
  • Certain diseases are reclassified to different chapters or sections to reflect current medical knowledge
  • New code definitions (for example, definition of AMI is now 4 weeks rather than 8 weeks)
  • The codes corresponding to ICD-9 “V” codes (Factors influencing health status & contact w/health services) and E codes (External causes of injury and poisoning) are incorporated into the main classification (in ICD-9, they were separated into supplementary classifications

ICD-10 Resource List

  1. http://www.cms.gov/Medicare/Coding/ICD10/
    1. Contains videos for small practices, resource flyers as well as a clinical documentation video.
    2. https://www.aapc.com/icd-10/
      1. Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
      2. https://www.aapc.com/icd-10/crosswalks/
        1. Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty specific)

Below are suggested links you should begin using now as ICD-10 nears:

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfir