Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, describes how facilities can create internal guidelines and point systems for determining E/M level section.
The fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) proposed rule makes broad efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. The proposed rule, released April 27, also eliminates sweeping changes to MS-DRG rate-setting finalized in the 2021 IPPS final rule.
Q: What revenue code should be attached to HCPCS codes M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring)? We set it up as revenue code 260 but are getting edits to change it to 771. What are your thoughts and suggestions?
The most impactful overhaul to the E/M coding and documentation guidelines in 25 years went live January 1. The updated guidelines eliminate medical history and physical examination as required elements for reporting E/M codes 99202-99215. E/M coding for outpatient visits is now based on documentation of medical decision-making (MDM) or time spent on the encounter.
Q: We're looking for ways to bring our CDI and coding teams together to improve documenation and coding for appropriate Hierarchical Condition Categories (HCC) capture. Are there any recommended models and should other departments or individuals be working alongside them?
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures.
Sunrise Hospital & Medical Center in Winchester, Nevada, submitted Medicare claims for rehabilitative services that did not comply with Medicare billing requirements, resulting in an estimated $23.6 million in overpayments submitted over a two-year period, according to an April Office of Inspector General (OIG) report.
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
