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Coding

ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update

Effective Date: August 7 & October 1, 2023

Implementation Date: August 7 & October 2, 2023

CR 13166 is a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

The translations from ICD-9 to ICD-10 aren't consistent one-to-one matches, nor are all ICD-10 codes appearing in a complete General Equivalence Mappings (GEMs) guide or other mapping guides appropriate when reviewed against individual NCD policies.

Relevant NCD coding changes in CR 13166 include:

NCD 20.20-External Counterpulsation Therapy (ECP) for Severe Angina, effective August 7, 2023
NCD 90.2-Next Generation Sequencing (NGS), effective August 7, 2023
NCD 210.1-Prostate Screening Tests, effective October 1, 2023

Previous NCD coding changes are available. Also, see the NCD spreadsheets attached to CR 13166.

CMS isn't including any policy changes in this ICD-10 quarterly update. We cover NCD policy changes using the current, longstanding NCD process.

Your MAC will adjust any claims processed in error associated with CR 13166 that you bring to their attention.

Source: CMS

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E/M Scoring Questions

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Medical Necessity and Data Under the E/M Documentation Guidelines

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Coding Critical Care Services in 2023

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PSQIA, PSWP, and HIPAA Compliance

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ICD-10 Codes to Report Cataracts:Cataracts, a leading cause of vision loss in the United States, occur when the normally clear lens of the eye becomes clouded. This clouding obstructs or alters the passage of light into the eye, resulting in impaired vision. Ophthalmic surgeons perform safe and effective surgery to treat cataracts. Professional medical billing and coding companies can assist physicians with coding and claims submission tasks.

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Understanding Skin Biopsy CPT Codes: A Comprehensive Guide:Skin biopsy plays a crucial role in the diagnosis and management of various dermatological conditions. To accurately report and bill for these procedures, healthcare providers rely on Current Procedural Terminology (CPT) codes. CPT codes are standardized numerical codes used to describe medical procedures and services. In this article, we will delve into the world of skin biopsy CPT codes. Understanding these codes can help family physicians code and bill skin biopsy procedures correctly, ensuring optimal reimbursement and proper documentation.

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The Transition to ICD-11: A Major Step Forward for Global Health:During the late 1800s, a physician from France named Jacques Bertillon was developing a method to create a consistent way of categorizing diseases. His goal was to simplify the process of monitoring and comparing mortality rates across various nations. In 1893, he released the inaugural version of the International Statistical Classification of Diseases, which is currently recognized as the International Classification of Diseases - ICD.

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Overcoding: Putting a Strategic Stop to a Silent Revenue Killer:Overcoding is in the crosshairs as the Centers for Medicare and Medicaid Services (CMS) continues its quest to ferret out fraud and abuse and recoup improper reimbursements-a focus that returns $8 for every $1 spent on audits. There are no signs that they are letting up any time in the future, as the federal government has increased funding for audits and fraud investigations.

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Identifying the Admitting, Principal, Primary, and Secondary Diagnoses:Knowing how to differentiate the admitting, principal, primary, and secondary diagnoses for reporting and sequencing purposes can be intimidating and confusing. The following are some commonly asked questions related to reporting diagnoses in the facility setting.

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Combination Codes Provide Greater Detail for Complicated Conditions:When ICD-10-CM was initially implemented, it was like watching the Discovery Channel, where new codes and guidelines seemed to appear, along with new guidelines for how to report them.

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Identifying the Components of a High-Risk Evaluation and Management Service:Since 2021, when the Office and Other Outpatient Evaluation and Management (E/M) services coding guidelines changed to require only scoring by time or medical decision making (MDM), coders, providers, and facilities have worked hard to implement changes that would facilitate correct coding through clear documentation and well-formatted templates.

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Defining Modifier 25:Yes! Considering the recent uproar caused by one payer's plan to implement a policy requiring prepayment review of documentation for all visits billed with 99212-99215, modifier 25, and a minor procedure, it is clear there is still a need to discuss this often-misused modifier.

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Are You Properly Reporting Radiology Services?:It's probably not surprising that the most commonly billed imaging services are radiologic examinations of the humerus, spine, fingers, and abdomen (codes 72070, 73060, 73140, and 74019).

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If a Procedure Was Not Documented, Was It Performed?:Most of us, if not all of us, have heard the statement, "If it isn't documented, then it wasn't performed." While I know this is often the perspective of payers, I cringe when I hear this, thinking about all the providers that I work with and the fact that it may not be a true statement that the procedure was not done.

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How Can Radiology Networking Improve Your Practice?:A large metropolitan-area radiology group covers several departments within a hospital system. They have on-site staff daily at each location to handle all modalities, including sub-specialists to be sure pediatric, neuro, and body imaging are handled with the right expertise.

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May Is Clean Air Month: Spread the Word About Air Pollution and Health:Summary: Clean Air Month in May is a nationwide campaign to encourage people to preserve the environment and make the world a more sustainable, healthy planet.

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Let's Talk Prolonged Services! Did you report all of your time?:Prolonged preventive services are provided in outpatient settings and can be provided via telehealth. Annual wellness visits and the Welcome to Medicare visit include a thorough review of the patient's health and medical history. The physician performs an exam that consists of a blood pressure check, height and weight assessment, and a vision screen. Depending on the medical history information provided by the patient and the results of the physical examination, the physician orders or performs additional tests as medically necessary.

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New ICD-10-PCS procedure codes - Effective April 1, 2023:To download all of the new files, go to this CMS website: https://www.cms.gov/medicare/icd-10/2023-icd-10-pcs or see below.

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2023 release of ICD-10-CM - Effective April 1, 2023:The FY2023 ICD-10-CM codes are to be used from April 1, 2023 through September 30, 2023.

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Keys to Correct Embolization Coding: CPT® Codes 37241-37244:It is no secret that interventional radiology is one of the most difficult specialties for coders and auditors to master. In particular, coding correctly for embolization procedures can be tricky due to the multiple coding considerations involved. This article provides tips that will have you coding and auditing some of the most common embolization procedures like a pro!

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What's Going on With the COVID Vaccines Now?:Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride, and we now have two new twists to this exciting ride. Twist one comes from the FDA who recently pulled the emergency use authorization (EUA) for the monovalent Moderna and Pfizer-BioNTech mRNA vaccines, and instead authorized the bivalent boosters for all doses starting at age 6 months. Twist two is found in the changes taking place as part of the official end to the COVID Public Health Emergency (PHE), beginning May 11, 2023. Buckle up, and let's look at how this changes things.

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Men's Health Awareness Month: Catch Prostate Cancer Early with Routine Screening:Summary: Men's Health Awareness Month is the ideal time to spread information about preventable health problems and encourage early detection and treatment of diseases such as prostate cancer.

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What Is the Impact of the 2023 Medicare Fee Schedule on Your Radiology Practice?:The Medicare Physician Fee Schedule (MPFS) was lowered for 2023 due to a cut of 2.08% in the Conversion Factor (CF) used to determine payment rates. We reported that the CF could have been reduced as much as 4.47% had Congress not intervened at the last minute to adjust it, along with waiving the 4% PAYGO reduction that was supposed to occur in 2023.

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Second Quarter 2023 Updates Are Different This Year:The second quarter of 2023 is not business as usual, so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023).

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Dermatology CPT® Codes and Tips for 2023:Your dermatology practice performs medical and surgical services for your clients; as such, your medical billing strategy needs an understanding of both medical and surgical dermatology CPT codes.

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How to Bill Mental Health Telehealth:Billing for mental health telehealth services can be challenging due to various factors. Mental health providers must navigate different payer coverage and reimbursement policies, choose the correct CPT codes and modifiers, document telehealth services properly, comply with regulations related to telehealth, and educate patients about insurance coverage.

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2023 Emergency Care Physician Changes:Welcome to 2023 - so far, an interesting year. This year, CPT made many changes to Evaluation and Management (E/M) services, including emergency care physician changes. Emergency care CPT codes are simply a different form of E/M CPT codes.

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Facility Outpatient E/M Coding:Reporting outpatient E/M services in a facility setting is a little different than other outpatient services. It is important to follow payer guidance. Novitas has provided some guidance on which codes to report based on the type of service provided. They have an FAQ page that covers both emergency department (99281-99285, G0380-G0384) and clinic visits, which states the following:

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Cervical Dysplasia: Risk Factors, Diagnosis, and Treatment:Summary: Mild cervical dysplasia usually resolves on its own but should be monitored as it can progress to moderate or severe dysplasia, which, if not treated, could become cancerous.

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Overcoming Code Denials in Healthcare:Denial rates are rising because of numerous factors, including the increasing complexity of coding guidelines, increased workloads and staff shortage, adoption of AI and automation in payor claim reviews, increasingly sophisticated remittance processes, and more. However, taking a more granular review of your claims may help avoid significant revenue hurdles or other more serious headaches, like audits.

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Gastroenterology CPT Codes and Tips for 2023:Since gastroenterology practices can perform both medical and surgical services, your gastroenterology medical billing strategy has to take this into account. Billing for this specialty can be challenging, but the friendly experts at NCG want to make it simple for you to boost your healthcare revenue cycle.

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Dawning of a New Era: The Sun Rises on New E/M Standards in 2023 and Beyond:Well, the time is finally here! 2023 has ushered in a new standard for how we look at evaluation and management (E/M) services. Physicians, providers, coders, auditors, educators, and compliance professionals alike are finally able to utilize much more than the "bean-counting" methods set forth by the Centers for Medicare and Medicaid Services' (CMS) 1995 and 1997 ("95" and "97") E/M guidelines.

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Is the End Really Near?:What is going on? We hear rumors that the end is near; well, that depends on what you are talking about - the end of what? The pandemic is not over; we are just making a transition.

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New Modifier Required on all Single Use Drugs:Attention providers and suppliers, there is a new modifier in town! Starting July 1, 2023, Modifier JZ - Zero drug wasted, will be required on all claims to attest there is no drug left over, if applicable. Meaning there is zero drug amount discarded, and there was no leftover drug administered to any patient.

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2023 Coding Conundrums:We have our first bit of 2023 behind us, which means the first of the claims for the new year have been submitted. Here's the $100,000 question: Are your claims paying appropriately with the 2023 Evaluation and Management (E/M) changes that have occurred?

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Top 5 Takeaways From the CMS 2023 Final Rule: Conversion Factor, MIPS, Telehealth, E/M, and Refunds for Discarded Drugs:As we walk into 2023 (or run depending on your enthusiasm for leaving 2022 behind), we are presented with the rules that will govern much of the healthcare industry's regulatory compliance standards and reimbursement guidelines. These rules are published in the Center for Medicare and Medicaid (CMS) Annual Final Rule, which was released on November 18, 2022 for the 2023 calendar year.

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Clean Claims: A New Year's Resolution You Can Keep:Considering that coding errors can cost upwards of $20 billion per year in either delayed or permanently lost reimbursement,² clean claims are essential to the health of any medical organization's bottom line.

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World Cancer Day: Challenges of Working Toward a World Without Cancer:World Cancer Day, started on February 4, 2000 at the World Summit Against Cancer (held in Paris), is an initiative of the Union for International Cancer Control (UICC). This international observance aims to ease the global burden of cancer by raising awareness and education about cancer and promoting more equitable access to care.

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Medicare Fee Schedule Changes In 2023:The internet is ringing with the news of the CMS Updates Final rule for the 2023 Medicare Physician Fee Schedule. The finalized 2023 Medicare Physician Fee Schedule was announced by the Centers for Medicare & Medicaid Services (CMS) on November 1, 2022.

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Evaluation and Management 2023 Updates:Changes to 2023 Evaluation and Management (E/M) coding will impact CDM files, coding, documentation, charge capture processes, and various information systems.

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A Long Time Coming: 2023 Changes to Inpatient Prolonged Service:It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged service codes in the office/outpatient setting.

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How Does the Definition of "Problem Assessed" Change in the 2023 E/M Guideline Updates?:In 2021, the AMA defined certain terms to facilitate better understanding and scoring for MDM. For the purposes of this article, we will focus more specifically on what is meant by "problems addressed" and what that means when scoring E/M services in the hospital inpatient and observation setting.

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Lichen Sclerosus and Vaginal Lichen Planus:Lichen planus and lichen sclerosus are both idiopathic conditions that affect your skin, especially mucus membranes. The difference between lichen planus and lichen sclerosus is that lichen sclerosus rarely affects the mucous membranes in your mouth.

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The Medicare Final Rule Confirms Big Payment Reduction for 2023:When the 2023 Medicare Physician Fee Schedule (MPFS) was proposed in early 2022, it projected a 4.42% cut to the conversion factor (CF), with radiology facing cuts between 3-4% depending on subspecialty. The final rule moves the cut even deeper, with the 2023 CF set 4.47% lower than the 2022 CF.

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2023 E/M Changes: What’s Coming?:When the American Medical Association (AMA) revised the Office/Other Outpatient Services codes in 2021, it was the largest change to E/M codes in decades. The AMA has now turned its attention to the rest of the section, with massive changes coming January 1, 2023.

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2023 Procedure Coding Updates Are Just Weeks Away:Changes to the 2023 CPT code set include 102 new codes, 68 deleted codes, and 87 codes with revised long descriptions, as well as 36 new parent codes.

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Last Minute Congressional Action Reduces Medicare Fee Cuts For 2023:In response to concern expressed across the spectrum of physicians and their representative organizations, the omnibus spending bill, titled the Consolidated Appropriations Act, 2023 (CAA23), passed by Congress on December 23, rolled back a Medicare payment cut of 8.5%. As a result, it is estimated that the conversion factor will still be cut 2.08% for 2023. However, as reported previously, many practices will feel a larger reimbursement reduction due to the annual valuation adjustments within the fee schedule.

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The Role of the History and Examination in 2023 Evaluation and Management Services:While listening to the virtual AMA CPT/RBRVS Annual Symposium lecture by Gift Tee, BS, MPH, Director of the Division of Practitioner Services in the Hospital and Ambulatory Policy Group (HAPG) of CMS on the Update from Centers for Medicare and Medicaid Services (CMS), I was struck by something he said about the revisions to the coding and documentation framework for Evaluation and Management (E/M) Services for the 2023 CPT code descriptors.

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A Long Time Coming: 2023 Changes to Inpatient Prolonged Services:It's been two years since CMS collaborated with the AMA to revamp Evaluation and Management (E/M) coding guidelines, including a rework of prolonged services codes in the office/outpatient setting.

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The Pain of Lichen Planus:This article is written for all those people Joanne knows who are suffering from this autoimmune disease. It is painful and life altering in many ways. After research, we found that many practitioners, coders, and billers know little about this disease. We hope this article will help practitioners document and code this condition correctly, and direct patients with chronic LP for emotional support and refer appropriately to more experienced specialists for treatment.

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Monkeypox: Coding and Documentation for U.S. Cases:Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

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Modifier FT:As of January 1, 2022, CMS created a new modifier for an unrelated E/M visit during a postoperative period. It was revised as of April 1, 2022, quite possibly due to some questions on usage. Modifier FT is described as follows.

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The No Surprises Act Final Rule Changes the IDR Process:The Final Rule related to the No Surprises Act (NSA), issued August 26, 2022, clarifies and modifies the Independent Dispute Resolution (IDR) process but makes no changes to the patient protections and other provider obligations of the NSA, such as notifications and cost estimates for uninsured patients.

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Coding and Documentation for Arterial Embolization:Arterial catheter embolization is an interventional radiology procedure that requires detailed documentation of the steps performed by the physician to maximize coding and reimbursement. The procedure places medications, embolic agents, or a radiopharmaceutical into a blood vessel to prevent abnormal bleeding, close off vessels, eliminate abnormal connections between arteries and veins, or to treat aneurysms or tumors.

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Identifying Common Coding Errors for Lower Extremity Arterial Interventions:Each day, thousands of patients are undergoing one or more therapeutic interventions, the most common ones being angioplasty, stent, and atherectomy of the lower extremity arteries to treat various forms of peripheral vascular disease. This article will highlight the most common coding errors to be on the lookout for when auditing these procedures.

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Chutes and Ladders E/M Style:We are all excited about the upcoming 2023 E/M changes, aren't we? Well, I can say, as a coder and auditor, I am! I've been in this E/M world for about 35 years.

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2023 ICD-10-CM Code Changes:In 2022, there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes - a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from October 1, 2022 through September 30, 2023.

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Significant Changes to Emergency Department E/M Reporting Coming in 2023:In 2021, the American Medical Association (AMA) published significant changes to the evaluation and management (E/M) code descriptions, associated times, and coding guidelines applicable to the largest and most reported code range at the time of 99201-99215.

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Up-Coding and Down-Coding: The Yin-Yang of Coding Evaluation and Management Services:Can I be honest here? I am thrilled that I am finished with the 1995 and 1997 ("95 and 97") evaluation and management (E/M) guidelines for office and outpatient visits.

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The Second Opinion:In the 1960s, I was 13 years old and started having eye problems. My parents were approved to receive Medicaid, so my parents took me to the local mall and had an eye doctor examine me, and the eye doctor said I needed to wear glasses.

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What's In Store for Radiology In The 2023 Medicare Proposed Rule?:The Centers for Medicare and Medicaid Services (CMS) press release announcing the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2023 highlights expanded access to behavioral health services, Accountable Care Organizations (ACO), cancer screening, and dental care.

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Orthopoxvirus and Monkeypox Coding and Guidance:New Current Procedural Terminology (CPT®) codes have been created that streamline the reporting of orthopoxvirus and monkeypox testing and immunizations currently available on the United States market.

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Avoiding Risk When Using Assistant Modifiers:Most of us are very aware of the risks that inappropriate bundling modifier usage can cause, but when is the last time we thought about how other modifiers may put us at risk?

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AMA Announces CPT Update for COVID-19 Boosters Adapted to Omicron :The American Medical Association (AMA) recently announced an editorial update to Current Procedural Terminology (CPT)®, the nation's leading medical terminology code set for describing healthcare procedures and services, that includes eight new codes for the bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech.

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Is the Global Surgical Package in Danger?:The proposed rule for the 2023 Medicare Physician Schedule was released at the beginning of July. It contains 2,066 pages of proposed additions, deletions, and revisions for the Medicare Physician Fee Schedule and other Part B payment policies.

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The CMS Quality Payment Program: Future Impact on the Medicare Physician Fee Schedule:Have you ever wondered how Medicare decides how much to pay for an outpatient office visit? Or the monthly capitated payment we receive for caring for ESRD patients? At a very high level, the process goes something like this:

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Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies:On April 4, 2022, CMS finalized the 2023 MA capitation rates, as well as the Part C and Part D payment policies, in this publication: CMS CY 2023 Rate Announcement.

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CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care:Proposed policies will expand access to behavioral health services, Accountable Care Organizations, cancer care, and dental care, and will advance health equity.

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E/M Revisions to Code Descriptors and Guidelines 2021-2023:Centers for Medicare and Medicaid Services (CMS) finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule.

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Timely Claims Payment/Prompt Pay:I am constantly being asked what can be done when government and commercial payors are slow-walking claims for payment. The simple answer is to know your state and federal law.

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Summer Fun: Be Aware of Sunburns:Summary: As UV rays are strongest during summer months when the sun is directly overhead, spending more time outdoors can result in sunburns.

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Appropriate Use Criteria (AUC) Penalty Phase Set to Begin:Will the requirement to use Clinical Decision Support (CDS) finally become a reality? The current timetable for the penalty phase of the AUC/CDS rule calls for it to begin on the later of January 1, 2023, or the January 1 following the end of the COVID-19 public health emergency (PHE).

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How Much Do You Care About the 2022 Care Management Service Changes?:Care Management Services were developed to improve quality of care and consistency in the treatment of patients with one or more chronic health conditions putting them at risk of significant acute exacerbation, decompensation, hospitalization, or death.

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The Move to Single-Path Coding:Faulty and errant documentation and coding are driving outpatient reimbursement inefficiencies, costing U.S. healthcare about $54 billion annually. Unaddressed, these costs are increasing alongside outpatient revenue, growing at a year-over-year rate of 9%.

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CMS: Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers:CMS finalized regulatory language for mental health visits in RHCs and FQHCs in the CY 2022 Physician Fee Schedule (PFS) final rule. Effective January 1, 2022, you may provide mental health visits using interactive, real-time telecommunications technology.

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AMA Announces CPT Update for Pediatric COVID-19 Vaccine Candidate: Provisional Codes Assigned to Moderna COVID-19 Vaccine for Young Children :The American Medical Association (AMA) recently announced an editorial update to Current Procedural Terminology (CPT)®, the nation's leading medical terminology code set for describing healthcare procedures and services, that includes new product and administration codes assigned to the Moderna COVID-19 vaccine for children 6 months through 5 years old.

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Here Comes the Sun: Know the Difference Between Heat Stroke and Heat Exhaustion:Summary: Heat stroke and heat exhaustion are preventable, and understanding their symptoms is essential for proper management of these conditions.

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Aphasia:Imagine this scenario: John Smith is a healthy 55-year-young man. He likes long walks on the beach, has a Siamese cat named Snuffles, owns his own contracting company, and has a beautiful wife whom he met in college, and he feels like things are going his way.

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Summer Fun: Be Aware of Sunburns - ICD-10:As UV rays are strongest during summer months when the sun is directly overhead, spending more time outdoors can result in sunburns.

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Continuous Glucose Monitors (CGMs) - New Codes:New codes for continuous glucose monitors (CGMs) became effective on April 1, 2022. The following information is excerpted from MLN Matters MM12564 regarding CGMs. Be sure to review this information and implement policies to ensure accurate reporting/billing.

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Concurrent Critical Care:A great deal of time was spent this year with new coding updates focusing on critical care split shared updates, but not much time was given to all of the other red-lined updates in the critical care section of the CMS Claims Processing Manual.

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Staying Dry After Prostate Surgery:When a male patient is diagnosed with prostate cancer and undergoes a radical prostatectomy, he may develop urinary incontinence. This can be a devastating and emotional experience for the patient. The incontinence is caused by the treatment of the prostate and is predictable and possibly preventable.

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Understanding the Long List of Prolonged Services in 2022 and Beyond:Prolonged services have been around for a long time - no pun intended - but in recent years, the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers.

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AMA Announces CPT Update for COVID-19 Booster Candidates:The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT®), the nation's leading medical terminology code set for describing healthcare procedures and services, that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline.

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Substance Use Disorder Treatment Incentive Program Receives Go Ahead from the OIG:Creating incentives for individuals participating in a substance use disorders (SUD) program has always been challenging due to concerns over violating Federal laws such as the Anti-Kickback Statute (AKS) and the Beneficiary Inducements Civil Monetary Penalties.

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Considering the Impact of Diagnosis Codes in the E/M Encounter:It has been nearly seven years since the United States implemented ICD-10-CM, and along the way, we have become better at infusing clinical documentation with the details that allow for assignment of high-specificity ICD-10-CM codes.

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Pinpointing Correct Coding for Anesthesia in Abortions:Medical terminology related to abortions can be puzzling, but it is essential to understand the differences. Having a clear comprehension of several abortion terms is a vital component to achieve successful coding.

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Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM:When x-rays are audited on the same date as an E/M encounter, we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally.

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Are Excludes1 Edits Causing Problems?:We've heard some comments about payer edits that are citing Excludes1 instructional notations as the reason for denials. Excludes1 notations have been around since the beginning of the implementation of ICD-10-CM, but only recently have these types of edits become more common.

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Prolonged Services Billed As a Split/Shared Visit:Previously, prolonged services were not allowed to be billed as a split or shared visit. However, Medicare's 2022 Medicare Physician Fee Schedule Final Rule has updated that ruling to allow add-on codes for prolonged services to be reported as a split or shared visit.

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2022 Acupuncture CPT Codes for Insurance Billing:The world of insurance billing is complex, and even more so for holistic practices. Accurate coding and billing practices ensure a streamlined reimbursement process so your practice can get paid and deliver the best care to your patients.

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March is National Kidney Month: Know How the Kidneys Support Your Health:Summary: National Kidney Month provides the opportunity to spread awareness about kidney disease, tests to detect the condition, and prevention measures.

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SDoH Improves Reimbursement and Risk Scores:Social Determinants of Health (SDoH) refers to the conditions in which people are born, live, and work that continuously shape their specific health outcomes.

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How to Document Split/Shared Visits in 2022:Medicare is making big changes to its policies for billing split/shared visits. While the main policy shifts take place in 2023, there are important changes to the rules for split/shared services in 2022 that must be followed for these services to be covered and billable under the physician.

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Baseline Matters!:In the first article of this series, we present an H&P of a medical record that was downgraded by the payer based on a denial of acute kidney injury or AKI that was added to the claim. The H&P was one of the very few places that AKI was documented; however, it was picked up by the coder because it was in fact part of the documentation.

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2022 E/M Clarifications Continue:I had the pleasure of attending the 2022 CPT Symposium November 17-19. It is a great conference that the AMA puts on each year where the physicians who make the codes discuss the changes coming for the following year.

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AMA Announces CPT Update for Third Dose of the Pfizer Pediatric COVID-19 Vaccine:The American Medical Association (AMA) recently announced an editorial update to Current Procedural Terminology (CPT®), the nation's leading medical terminology code set for describing healthcare procedures and services, that includes a new vaccine administration code for a third dose of the pediatric COVID-19 vaccine developed by Pfizer.

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Auditing Time-Based E/Ms Under 2021 Guidelines:The 2021 E/M guidelines' more permissive rules for time-based coding is a potential watershed moment for physicians who want to spend less of their time documenting E/M notes.

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Pre-Op Visits: Are They Medically Necessary?:Many facilities will require a preoperative history and physical within 30 days of a procedure. Does this requirement from the facility support the medical necessity of an E/M visit? The answer is maybe.