On November 2nd, 2021, the Centers for Medicare, and Medicaid Services (CMS) released their 2022 Physician Fee Schedule (PFS) final rule, which is 2,414 pages in length. Included in this policy ruling was also some other Medicare Part B issues. The PFS rule making is part of the Biden Administration strategy of better accessibility, quality, affordability, empowerment,...
Coding Uncertain Diagnosis in the Pro Fee Setting
As coders we are often torn when it comes to coding a diagnosis when the provider’s documentation isn’t perfectly clear. It may sound elementary, but we must go back to the Official Coding Guidelines and stick to those to ensure we are reporting the correct diagnosis based on the documentation. Per the Official Coding Guidelines, Section IV.H, “Do not code diagnoses...
Hips & Knees: Replacements, Revisions, and Removals
Hip and knee replacements have been around for several decades, in fact, the first recorded attempt for a total hip replacement dates all the way back to 1891 when they created a femoral head replacement out of ivory. Hip and knee replacement procedures and implants have evolved since then of course, and today the implants are made of metal, plastic, or ceramic material. ...
How to Succeed in Coding Diabetes Mellitus Without Really Trying
My first blog on Diabetes Mellitus (DM) covered the pathophysiology of DM Types 1, 1.5, and 2. Read Part 1 Here. Types 1 and 2 (and even 1.5, though not “officially” recognized) are considered primary types of DM. There are other forms of DM that are due to underlying conditions or are “induced” by drugs or chemicals. Complications of primary DM include: hyperglycemia,...
Critical Care Overview
In this article we will highlight some key elements for Critical Care coding since these codes are watched closely by insurance payors. What is the definition of Critical Care? Per American Medical Association (AMA) CPT Professional 2021 codebook, critical care is defined as “…the direct delivery by a physician(s) or other qualified healthcare professional of medical care...
Encounters for general examination - Is it with or without abnormal findings?
When a provider addresses additional conditions at a general examination visit, usually referred to as a Well-Child or Adult Physical encounter, coders are often left to decide whether to assign a “with” or “without” abnormal findings code. So, how can we easily decide which code to assign? Per Coding Clinic First Quarter 2016 “For the purpose of assigning codes from this...
Compliance in the Physician Office setting
Small physician practices may find themselves challenged when managing a practice that has to address billing issues with payors, the adoption of complex workflows, and staying aware of all rules and regulations (Adler, 2015). Developing a Compliance Program may feel like a large task, but a Compliance Program can be an important tool for physician practices of all sizes...
New Codes for Health Behavior Assessment and Intervention for 2020
There were 6 codes deleted for 2020 and 9 new codes were added under the Health Behavior Assessment and Intervention section. These family of codes were first established in 2002. With increased awareness and need for these types of services there was a need for more code revisions. Codes 96150-96155 have been deleted and replaced with the new codes 96156, 96158, 96159,...
Why Pro-Fee Coding Is the Next Great Risk to Your Revenue
As we discussed last week, over the past decade, there has been a tremendous amount of consolidation in healthcare. For hospital-owned physician practices specifically, we have seen the number rise from 35,700 in July 2012 to 80,000 in January 2018. Over the same period, there was over a 70 percent increase in the number of physicians employed by hospitals or health...
