Category: Medical Coding

Exploring the 2022 Updates to the Hospital Outpatient Quality Reporting Program

Exploring the 2022 Updates to the Hospital Outpatient Quality Reporting Program

  Coding professionals should familiarize themselves with three new measures in particular. In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented a quality data reporting program for hospital outpatient services. The Hospital Outpatient Quality Reporting Program (Hospital OQR) is a pay-for-quality data reporting program mandated by the Tax Relief and Health Care Act […]
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Selecting the Principal Diagnosis Lies at the Heart of Inpatient Coding

Selecting the Principal Diagnosis Lies at the Heart of Inpatient Coding

The heart of the principal diagnosis selection is pivotal to accuracy and compliance. Since February is known as “National Heart Month,” a discussion on the heart of inpatient coding is appropriate, that being the “principal diagnosis.” When learning inpatient coding, a large amount of time is spent on understanding the guidelines, conventions, and application of […]
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AMA Updates CPT Codes for Pediatric COVID-19 Vaccine

AMA Updates CPT Codes for Pediatric COVID-19 Vaccine

The organization released new CPT codes for Pfizer’s pediatric COVID-19 vaccine once FDA grants emergency use authorization for children between six months and five years of age. The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a new code for administering pediatric doses of Pfizer’s COVID-19 vaccine in […]
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9 New Introduction Codes Added to ICD-10-PCS

9 New Introduction Codes Added to ICD-10-PCS

Effective April 1, 2022, hospitals will have nine new procedure codes to describe the introduction or infusion of therapeutics, including the additional COVID-19 vaccines recently authorized for emergency use by the Food and Drug Administration. April Update The Centers for Medicare & Medicaid Services first introduced seven new ICD-10-PCS codes for the second quarter of […]
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Medical decision making and coding

Medical decision making and coding

MDM elements during a preventive visit Q: Is it appropriate to count laboratory tests and other tests ordered during a preventive medicine service (99381-99397) visit in medical decision making (MDM) selection? No, because the 2021 revisions to the E/M office or other outpatient MDM do not apply to codes 99381-99397 (preventive services). These codes are […]
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How CPT codes help track COVID-19 vaccine life cycle

How CPT codes help track COVID-19 vaccine life cycle

  The ability to rapidly and accurately report such granular detail requires a robust data infrastructure. Instrumental to this infrastructure are the specific AMA Current Procedural Terminology (CPT®) product and administrative codes related to COVID-19 vaccines. Long described as the “common language of medicine,” the CPT code set is kept current through the work of the CPT Editorial […]
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Health Equity and SDOH: A Payer Perspective / Update

Health Equity and SDOH: A Payer Perspective / Update

As part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This strategy is intended to change the trajectory of health disparities and reimagine a more equitable health care […]
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When To Report an Incidental Finding

When To Report an Incidental Finding

DOJ lawsuits may be your road map to risk adjustment compliance. The growing prevalence of risk adjustment in healthcare has forged new processes in documentation practices that have resulted in many organizations adopting practices that bend the cast iron rules for ICD-10-CM coding. We are starting to see some of the long-term dangers of ambitiously […]
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Understand Critical Care Before You Code

Understand Critical Care Before You Code

A solid understanding of guidelines and COVID-19-related complexities will limit claim denials and audits. Deciphering documentation to determine what qualifies as critical care services can be challenging for medical coders and auditors. With limited critical care codes available for assignment, reporting may appear relatively straightforward at first glance. However, there are many considerations that coders […]
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