icd 10

Did You Know?

The timeframe for coding an acute MI in ICD-10 is 4 weeks. 

The ThinPrep Pap Test is the only pap test that is FDA-approved as “significantly more effective” at detecting precancerous cervical cells.

Hospital neither need to follow 1995 nor 1997 documentation, Each facility must design its own documentation guidelines, based on principles outlined in the 2008 Outpatient Prospective Payment rule.

PPACA requires health care providers to report and return overpayments from governmental payers within 60 days from the time the provider discovers the overpayment. If an overpayment is retained beyond 60 days, it becomes an “obligation” sufficient for reverse false claims liability under the False Claims Act, and may become subject to triple damages and penalties if there is “knowing and improper” failure to return the overpayment.

The American Recovery and Reinvestment Act of 2009 (ARRA) establishes penalties for Medicare and Medicaid providers who do not adopt the EHR, beginning as a 1 percent Medicare or Medicaid payment reduction in 2015 and reaching a maximum of 3 percent in 2017.

You should not report 496 with chronic bronchitis (491.xx), emphysema (492.x), or asthma (493.xx), according to ICD-9-CM instructions.

The typical turnaround time for the completed documentation to be signed by the provider is 24-72 hours

Effective Jan. 1, 2014, CMS requires all hospital outpatient clinic visits to be reported using HCPCS Level II code G0463

Non-face-to-face services included within TCM may be billed by physicians, mid-level providers, or licensed clinical staff under the direction of a physician.

HCPCS / CPT for coding services and surgeries was published in 1966, using four-digit codes. The system expanded to five-digit codes as more services and procedures were added. ICD-9 was developed in 1948 as a diagnosis coding system to collect information about death (mortality) and disease (morbidity).

ICD has been translated into 43 languages and almost 117 countires use this system to report mortality data.

There are five types of CPO defined in the CPT® and HCPCS Level II codebooks: 1. Supervision of a patient under the care of a home health agency (HHA) in a home or equivalent area 2. Supervision of a hospice patient 3. Supervision of a nursing facility patient 4. Supervision of a patient in a home or equivalent area not under the care of an HHA 5. Home ventilator management supervision

CPT® references the following three components for MDM: 1. Number of diagnosis and management options 2. Amount and complexity of data 3. Risk

The nature of the “presenting problem” is not considered a key component of scoring MDM; however, it may provide essential information needed to determine appropriate levels of service.

The overarching criteria for evaluation and management (E/M) level assignment is Medical Necessity

The most significant difference between the initial AWV and the subsequent AWV is that the latter does not include the depression or fall risk screenings. These are relatively easy to complete as part of the evaluation, however, and providers would be well advised to perform and document initial and subsequent AWVs in a similar manner.

Complete physical examination is not a requirement for an annual wellness visit

RACs can perform retroactive audits back three years, and they will expand their scope into Medicare Parts C and D, as well.

Medicaid will not reimburse an attending physician for certifying the home health plan of care. This is considered as already reimbursed to the attending physician through any evaluation and management services provided throughout the period of illness that the recipient is receiving home health care assistance.

Effective April 1, 2012, CMS will no longer publish a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website.  The edits previously contained in the Mutually Exclusive edit file are NOT being deleted but are being moved to the Column One/Column Two Correct Coding edit file.

Medicaid EHR incentives are higher than Medicare EHR incentives

A coder can be convicted of aiding and abetting illegal coding if the government proves that the coder participated by performing some affirmative act to aid the illegal coding.

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