The IPPS FY 20 was released on April 24, 2019. Below are the highlights of the proposed changes. CC/MCC Summary – Over 1000 codes that are currently CCs will become non-CCs in the proposed rule Proposed Shifts # Non-CC to CC 183 CC to non-CC 1,148 CC to MCC 8...
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Coding Clinic 1st Quarter 2019 – Key Highlights
Below are highlights from Coding Clinic 1st Quarter 2019 – effective with discharges starting March 20th. Human Immunodeficiency Virus and Related Conditions • Code B20, HIV disease, may be reported for cases when AIDS is documented, the patient is treated for any documented HIV-related illness or is described by the...
Coding Clinic – 4th Quarter 2018- Key Highlights
Coding Clinic 4th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a...
Proposed Model to Drive Down Prescription Drug Costs – the potential impact on providers and hospital billing
A recent proposal from the Department of Health and Human Services (HHS) is aimed at reducing prescription drug costs paid under Medicare Part B. The proposed pricing model would gradually shift Part B payments for delineated outpatient drugs to international prices in late 2019/early 2020, starting with providers in randomly...
AHA Coding Clinic 3rd Quarter 2018 – Key Highlights
Below are highlights from Coding Clinic 3rd Quarter 2018 (effective with discharges starting September 24th). Diabetes with necrotic pressure ulcer, diabetic peripheral vascular disease and neuropathy If a provider documents an association between diabetes and a pressure ulcer due to gangrene, the principal diagnosis is gangrene The “code first”...
FY2019 ICD-10-CM/PCS – Official Coding Guidelines and Codeset Update – KEY HIGHLIGHTS
The FY 2019 ICD-10-CM and PCS annual codeset update goes into effect October 1, 2018. See Summary and key highlights below: Summary Codes ICD-10-CM ICD-10-PCS New 279 392 Deleted 51 216 Revised 143 8 ICD-10-CM: MCC/CC Changes Acute respiratory distress syndrome (ARDS) is a MCC – ARDS has finally joined...
AHA Coding Clinic 2nd Quarter 2018 – Key Highlights
Coding Clinic 2nd Quarter 2018 (effective with discharges starting June 6th) Below are highlights from the latest release: Diabetes Combination Codes – Not Elsewhere Classified (NEC) As previously noted in Coding Clinic, 2nd Quarter 2016: Page 36, The subterm “with” in the Index should be interpreted as a link between...
Protect Revenue Through Proactive Compliance Audits
Over the past six months, in our own client work and published settlements, it is evident that the Department of Justice (“DOJ”) is continuing to focus its audit efforts on patient status. Most recently, a Houston-based health system agreed to pay $1.9 million to resolve allegations that three of its...
AHA Coding Clinic 1st Quarter 2018 – Key Highlights
Coding Clinic 1st Quarter 2018 (effective with discharges starting February 18) unsurprisingly did not include any significant changes since the previous Coding Clinic release was more extensive. It is a good sign that many of the controversial and pressing issues like COPD with pneumonia sequencing has been addressed and now...
Telehealth Services – Proactively Assess Your Risk
In a recent review of telehealth services, the Office of Inspector General (OIG) found approximately one-third (31/100) of the claims reviewed did not meet Medicare telehealth requirements. Of the 31 cases, the majority were noncompliant because the patients received care in a location not considered “rural.” Institutions/facilities that provide telehealth...