Category Archives: Coding & Billing
2024 ICD-10-CM Changes Are Weeks Away
Every year, CMS issues clarifications, additions and deletions to diagnosis codes that become effective on October 1st. For 2024, CMS announced 395 new diagnosis codes, 25 deletions and 13 revisions. Although there are many changes in wording, synonyms and instructional … Read Full Post
Just Following Orders isn’t a Defense to Fraud
A case from North Carolina highlights what we see too often: healthcare entrepreneurs and providers committing fraud, paying monetary penalties and even facing incarceration. But rarely do we see the penalties travel down the ladder to a company’s employees. A … Read Full Post
Medical Practice Owes for COPD & Morbid Obesity False Claims
Over the years, we’ve written many a blog post on risk adjustment compliance, advising our readers on ways to work successfully with this payment paradigm. And yet, almost every week, the Office of Inspector General (OIG) publishes notices regarding false … Read Full Post
CMS Issues Revised ABN for Use by June 30th
The Centers for Medicare and Medicaid Services (CMS) has issued a revised advance beneficiary notice (ABN) form. The new form has an expiration date of 1-31-26 and will be mandatory on 6-30-23. You may continue to use the ABN form with … Read Full Post
Primary Diagnosis Quiz
Let’s play a game…. I am going to list the diagnoses on the Assessment section of a specialist’s consult note in the order he listed them, and you try to guess the provider’s medical specialty: Paroxysmal atrial fibrillation Coronary artery … Read Full Post
ICD-10-CM Adds 1468 Codes for 2023
Every year, we’re curious to learn about the changes to ICD-10-CM codes that become effective on October 1st, and this year, there are many interesting additions. Of course, our company looks at codes primarily through the risk adjusted payment lens, … Read Full Post
HEDIS Reminder: Medication reconciliation
HEDIS, or the Healthcare Effectiveness Data and Information Set, is a collection of statistics that reflects health plan (and provider) performance in meeting specific quality metrics. One important metric is the post discharge medication reconciliation (Category II code 1111F). Obviously, … Read Full Post
Fractures & Coding the 7th Character
ICD-10-CM turned coding on its head when implemented in October 2015. The coding convention was so unlike the mostly numeric, five-character codes we were accustomed to in ICD-9. Now I wonder how we ever got along without the coding upgrade! … Read Full Post
Principal Care Management
Although chronic care management has been a CMS-covered care model for managing patients with multiple chronic conditions, this year, codes for a similar program were created. Principal care management (PCM) is a “sister” model – if you will – geared … Read Full Post
Do I Really Need Billing Policies?
Call us nerds but we’re fans of having policies & procedures. They’re not a magic bullet by any means, but they do provide a framework for operating that accomplishes two things: P&P force practice leaders to consider and document business … Read Full Post