Dive Brief: In the first two years diagnostic codes specific to social determinants of health were available in Medicare fee-for-service claims, they were used for only 1.4% of the total beneficiary population, according to a new report from CMS. Use of the Z codes, first implemented for Medicare FFS in 2016, increased slightly from that […]
Confusion and apprehension surround new guidelines for deep-tissue pressure injury. The release of the 2020 Official Guidelines for Coding and Reporting (OCG) has resulted in confusion and apprehension surrounding the intent of the new guideline related to the new ICD-10-CM codes for pressure-induced deep-tissue damage, or deep-tissue pressure injury (L89.-6). The ambiguity stems from what […]
Quite a few code changes and revisions were made to the Radiology Code section of CPT Code for 2020. Less confusing language and expanded code categories will make life easier for medical coders. Here’s a quick review. Gastrointestinal System A mini overhaul of the gastrointestinal system codes removed the confusing language of “with or without […]
The number of conditions a patient has is now going to factor into the risk adjustment score (RAS). In March, I make my annual pilgrimage to Columbus, Ohio to speak at the Ohio Health Information Management Association (OHIMA) conference, and this year, my remarks are titled, “The Hierarchical Condition Categories Model: Risk Adjustment isn’t just […]
New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
With an election year just about upon us, there are a number of changes coming from the current administration that are going to impact healthcare in 2020. Changes in allowable benefits, home health, hospice carve-ins, and new CPT codes for remote home monitoring are just a sample of these. There are an additional set of fundamental […]
The Centers for Medicare and Medicaid Services has taken steps to overhaul codes used for Evaluation and Management (EM) office visit codes. The initiative aims to reduce documentation burdens that interfere with patient care, the American Medical Association says. The professional organization for the nation’s physicians is providing a series of educational materials to support […]
Consideration of several factors, such as the type of removal, lesion size and location, pathologic results, intent, etc., is key to accurately coding dermatological lesion removal procedures. Let’s review the codes and guidelines for lesion removal by excision and how to avoid common mistakes when coding these skin procedures. Excision – Benign/Malignant Lesions (11400-11646) Excision […]
HBI data reveals that the rate of hospitals or health systems that have implemented artificial intelligence for any revenue cycle function has not widely increased over the past year, but automation in healthcare has shown some forward movement in comparison. Based on the conversations revenue cycle analysts have conducted with HBI members over the past […]
Among the proposed new rules is one intended to clarify the contentious “Stark Law” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”). The law prohibits physicians from making referrals for […]









