Coding

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?

Correct coding of sequelae depends upon the source of the acute phase of the illness or injury. Refresh your skills with these common examples.

Proper use of modifier -59 remains a common pain point. Use these tips to improve coding and reduce claim edits.

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.

Regular monitoring and internal auditing are critical to ensure compliance throughout the revenue cycle and protect revenue integrity. Consider the different strategies that can be applied to documentation and chart audits, coding audits, and more.

Medical decision-making is one of the key components of E/M code selection. Review the guidelines to ensure correct coding and to improve internal audits.

North Mississippi Medical Center (North Mississippi) submitted Medicare claims for polysomnography services that did not comply with Medicare billing requirements, resulting in an estimated $67,038 in overpayments for polysomnography services submitted over a two-year period, according to a recent Office of Inspector General (OIG) report.