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Outpatient Facility Coding Alert

CPT® 2018:
CPT® 2018 Brings Numerous Diagnostic Radiology Coding Updates
Hint: Codes 71045 and 71046 will join your coding arsenal for 2018. CPT® update season i... Read more
CPT® 2018:
Get Ready for These New 2018 CPT® Otolaryngology Codes
CPT® gives coders five new options for coding nasal/sinus endoscopic procedures. From si... Read more
Outpatient Reimbursement:
Get up to Speed on 2018 Final Rules for OPPS and MPFS
Remember: CMS will definitely remove TKA from IPO list. CMS recently announced its final ... Read more
Reader Question:
Decode This Pupilloplasty Coding Puzzle
Question: If the physician performed a pupilloplasty, which CPT® code should I report? C... Read more
Reader Question:
Look to This Advice When Appending Modifier 22
Question: We recently submitted a claim where we appended modifier 22 because the surgeon ... Read more
Reader Question:
Choose the Correct Malignant Neoplasm Code for Cauda Equina
Question: The physician documented a malignant neoplasm in the tuft of nerves at the termi... Read more
Reader Question:
Append Modifier 74 in This Case
Question: The surgeon treated a Medicare patient with a torn meniscus in our ASC. After th... Read more
You Be the Coder:
Determine Correct ICD-10 Code for Polyps
Question: When the gastroenterologist documents a polyp removal, how do we know which diag... Read more
CDI 101:
Answered: All Your Burning Questions about Physician Queries
Remember: Query forms should never indicate any financial impact. Physician queries, and ... Read more
Test Yourself: Can You Spot the Mistakes That Lead to Leading Queries?
Learn writing techniques that transform a leading query into a non-leading query. "Leadin... Read more
Replacing Medical Devices at No Cost? Report 'FD' Plus Condition Code 40 or 50
Failing to correctly report value and condition codes led to overpayments of $2.7 million ... Read more
Reader Question:
It's Not Just Wound Care—It's HBO
Question: I work for a hospital system that has an outpatient wound care center. I un... Read more
Reader Question:
Cataract Coding Face-Off: Physician Practice vs. Surgery Center
Question: I code for a surgery center and an associated physician clinic. Most of our... Read more
You Be the Coder:
3 Tips for Revising Documentation Templates Quickly
Question: The new ICD-10 codes have been here since October 1, 2107, and we haven't g... Read more
Your Quick-Start Guide to Coding TKAs
27447 leaves the IPO List in 2018. Here's what outpatient coders need to know. The 2018 O... Read more
RACs Flag Shoulder Debridement, Complex Cataract Procedures
Is a Recovery Audit Contractor data-mining your claims? Here's how to tell. We hear about... Read more
HOPD Compliance:
Don't Use Modifier 59 to Unbundle 93505 and 93454
CMS wants you to avoid the problems outlined in the OIG report. Does your hospital outpat... Read more
Revenue Cycle Management:
7 Ways to Prevent Embezzlement in Your Business Office
Tip: Conduct outside audits every three years. A former administrator at a surgical eye c... Read more
Reader Question:
Unspecified ICD-10 Codes: Sometimes the Best Choice, but Not Often
Question: I've read a lot of advice that says never to use unspecified codes because ... Read more
Reader Question:
To Allocate Your Technology Dollars, Stick to a Strategy
Question: The administration at our center is finally working on a strategic plan, bu... Read more
Reader Question:
Choosing Between 41010 and 41520? Focus on the Incision
Question: I'm having trouble distinguishing between codes 41010 and 41520. In what ci... Read more
You Be the Coder:
Here's Help Selecting the Correct Achilles Repair Code
Question: Operative notes indicate that the surgeon repaired a patient's Achilles ten... Read more
ICD-10 2018 Updates:
New Codes for AMIs, Intestinal Obstructions, Non-Pressure Ulcers, Spinal Stenosis, Breast Lumps & More
It's time to update your systems and templates to get ready for the new and revised ICD-10... Read more
ICD-10 2018 Updates:
Your Guide to ICD-10 Changes for Diabetes Coding
Here's how to tell when you should use codes from the Z79 series. When the new ICD-10 cod... Read more
Diagnosis Coding:
ICD-10's Little Words Make Big Differences
Watch out for these changes to ICD-10's general coding guidelines for FY 2018. Looking to... Read more
ASC Coding:
Master Modifier Madness to Present ASC Claims Denials
Here are the tools you need to use SG, 73, 74 If you're new to ASC coding and have previo... Read more
Reader Question:
Avoid Medicare Compliance Traps When Billing for Premium IOLs
Question: Our ambulatory surgery center performs cataract procedures. Sometimes surge... Read more
Reader Question:
'Limited' vs. 'Extensive' Debridement for Shoulder Arthroscopy
Question: A shoulder surgeon in my HOPD performed a labral debridement, articular sha... Read more
You Be the Coder:
Here's When You Can Correctly Report 43277 In Addition to 43264
Question: During an ERCP procedure, the surgeon removed three stones. How should we c... Read more
Outpatient Reimbursement:
Proposed OPPS Rule Removes TKA from IPO List
HOPDs brace for lower payments for 340B drugs & services provided in off-campus facili... Read more
Outpatient Coding:
The Facility Coder's Guide to Infusions and Medications
Confused about the difference between an injection and an infusion? Here’s help. Ju... Read more
ASC Medicare Reimbursement:
CMS Makes OAS CAHPS Mandatory for 2018
Here’s what you must do to avoid a 2-percent cut to your Medicare reimbursements. A... Read more
Quick-Start Guide To Reducing Denials In Your Outpatient Facility
Use this step-by-step system for how to spot, solve and stop revenue leaks. In June, Outp... Read more
Reader Question:
Use This Handy Checklist When Shopping for an EHR
Question: Our ASC is looking into buying an EHR so that we can gear ourselves up to c... Read more
Reader Question:
How to Code Overlapping Infusions
Question: I’ve been noticing a lot of situations where nurses schedule infusion... Read more
You Be the Coder:
Here's When You Can Bill Hernia Repair & Mesh Separately
Question: Some of our surgeons want to be able to bill hernia repairs separately when... Read more
Reimbursement Update:
Update Your Systems To Handle OPPS, ASC Changes That Take Effect July 1, 2017
2 drugs get pass-through status. Attention HOPDs and ASCs: It’s time to read up on ... Read more
Regulatory Update:
OIG Takes Aim at HOPD Reimbursement Policy
HOPD/ASC reimbursement disparity, 2-midnight policy make the list of ‘Top 25 Unimple... Read more
The In's and Out's of OON Billing
Check out these best practices for reducing your FCA risk if you bill OON. Should your fa... Read more
Reader Question:
When Can We Report Debridement and Shoulder Arthroscopy Separately?
Question: We’ve heard you can report 29822 and 29823 separately when performed ... Read more
Reader Question:
Preventing Aranesp® Denials
Question: Our hospital outpatient department is seeing an increase in Aranesp® de... Read more
Reader Question:
Tips for Coding Turbinates Procedures
Question: “Dr. Johns documented that he used a blade to submucosally excise tis... Read more
You Be the Coder:
Unbundling a No-Go for Breast Procedures
Question: A new breast surgeon in our hospital outpatient department wants to bill 19... Read more
7 Revenue Busters That Are Destroying Your Facility's Profits
Plus, experts reveal the 9 most common reasons for claims denials. Is your business offic... Read more
Is Your Patient Registration Desk an Untapped Revenue Source? Find Out
Warning: If your front desk staffers are asking this question, they are potentially sabota... Read more
Coding Update:
Don't Miss These Reinstated Drugs on the ASC-Payable List
Sometimes systems “go beserk,” so make sure you’re prepared. The latest... Read more
Survey Strategies:
ASCs: Did Your Surveyor Find Shortcomings?
Ace Your Plan of Correction with 4 Simple Steps If you read about survey strategies in ou... Read more
Reader Question:
Don't Miss the New CCI Edits for Vaginal Mesh
Question: We’re seeing more denials than usual for procedures involving vaginal... Read more
Reader Question:
Why Am I Getting Denials for 77003?
Question: How can we report fluoroscopic guidance with epidural injections in 2017? I... Read more
Reader Question:
Coding for Bilateral Procedures in ASC Setting
Question: I am new to ASC coding, having worked previously in hospital outpatient dep... Read more
You Be the Coder:
Coding for Blepharoptosis
Question: Our ophthalmologist performed a blepharoptosis repair using the frontalis m... Read more
Coding Update:
Your Top 5 Outpatient Coding Problems...Solved!
Safeguard your reimbursement with these fast fixes Like most ASCs, chances are that a sma... Read more
Compliance Alert:
Use MOON to Increase Transparency
Getting inpatient/outpatient explanation right is key step in compliance, patient engageme... Read more
ASC Management Strategies:
Supply Costs Too High? It's Time to Rethink Your Supply Chain
Cutting supply costs will increase profit margins. Supplies are your ASC’s highest ... Read more
Do Your Surgeons Know Their Case Costs? Survey Says 'No.'
Case costs may point to opportunity to save money. Orthopedics is a profitable specialty ... Read more
Reader Question:
Going Mad Managing Inventory? It Might Be Time To Automate
Question: I manage a large ophthalmic ASC, and every month it seems like I spend more... Read more
Reader Question:
When Billing Unilateral, Bilateral Procedures, Look to Op Note for Clues
Question: Our ophthalmologist resected the lateral rectus muscles of both of the pati... Read more
You Be the Coder:
Cancelled, Postponed, or Discontinued? How to Code an Incomplete Colonoscopy
Question: Our gastroenterologist performed a diagnostic colonoscopy under anesthesia ... Read more
Coding Update:
Navigate Cystourethroscopy and Prostate Surgery Coding With These Tips
Don’t miss these guideline adjustments to 52601 and 55700. Every coder knows that t... Read more
Change Your Game Plan to Prepare for Increased Out-of-Pocket Pay
What you need to do to stay solvent in the age of HDHPs. Sure, your billing staff’s... Read more
The New Revenue Reality:
High-Deductible Health Plans (HDHPs)
230%: Percentage increase in average annual out-of-pocket costs per patient from 2006-2015... Read more
Survey Strategies:
ASCs: 4 Survey Vulnerabilities You'll Want to Address
Train well in these areas and ace your next survey. Where surveys are concerned, an ounce... Read more
Management Strategies:
Efficient Staffing: Try These Fixes and Be Ready for Patient Volume Changes
Per diem staff can come to your rescue. When you’re looking at efficiently staffing... Read more
Reader Question:
Look for Evidence of Surgical Approach Changes
Question: Our ophthalmologist performed a blepharoptosis repair using the frontalis m... Read more
Reader Question:
Don't Make Assumptions About Cancer History
Question: We saw a 36-year-old female patient who had successful treatment of cancer ... Read more
Reader Question:
Make Sure You're Clear on Advance Care Planning Payment
Question: Our physician saw a patient for advance care planning and reported 99497 fo... Read more
You Be the Coder:
Polyp Ablation During Colonoscopy
Question: We encountered a colonoscopy patient recently who required a laser tumor ab... Read more
HOPD/ASC Trends:
Understand How Your Patient Demographics Affect Your Services, Payment
Burdensome HDHPs, migrating physicians—and more—in 2 national studies. Taking... Read more
Catch Your Eye Surgery Coding Errors Before CMS Does
Targets: Overcoding, insufficient documentation for key procedures. Getting your eye surg... Read more
Financial Strategies:
Apply 8 Benchmarks to Assess Your Surgery Center's Financial Health
Start with 2 or 3 key measures—use those to evaluate your top concerns. If you&rsqu... Read more
CPT® 2017:
Wake Up to These Moderate Sedation Changes
Your scope and vascular coding is different this year. Subtle adjustments in coding defin... Read more
Reader Question:
Strapping With Other Procedures?
Question: Can we report 29540 for strapping with other procedures, such as fracture c... Read more
Reader Question:
Missed Excision Measurement
Question: We have an op report for excision of a “subcutaneous mass” of t... Read more
You Be the Coder:
Ultrasound with Prostate Biopsy
Question: Please share if you think that the following note substantiates a diagnosti... Read more
Outpatient Compliance/MOON update:
MOON Launch: How To Handle the New Beneficiary Notice Like a Pro
Master required timelines, HIPAA Guidelines & More It’s official. The Medicare ... Read more
Coding Quiz:
Spring Into Correct Coding With These 5 Brain-Teasers
Can you answer these coding questions about E/M, Pap smear, post-procedural complications ... Read more
ICD-10 Update:
Capture The Cryptic Codes For Cancer Of The Cord, Cauda Equina And Cranial Nerves
Laterality rules for cranial nerve neoplasms, but not the spinal malignancies. How strong... Read more
Reader Question:
Do This When Sinus Infection and Pregnancy Exist Together
Question: An OB patient presents to the office for her routine visit and complains of... Read more
Reader Question:
Choose Well From the Pharyngitis Multiple Code Options
Question: When the provider diagnoses acute pharyngitis, what are the ICD-10 codes po... Read more
Reader Question:
Do This When You Provider Can't Confirm A Glaucoma Dx
Question: The provider suspected glaucoma in a patient with high intraocular pressure... Read more
Reader Question:
Patient's Consciousness Determines Your EEG Coding Choices
Question: An established patient with history of frequent headaches reports to the of... Read more
You Be the Coder:
Amp Up Your Pay For Ankle Sprain
Question: A patient came to the office with severe ankle pain following an injury. Th... Read more
MOON Update:
Brace Yourself for Final MOON Implementation
Document reasons for outpatient status to avoid audit hotspot. Worried about complying wi... Read more
JW Modifier Update:
Have You Met the JW Modifier Usage Mandate?
Learn the do’s and don’ts for reporting discarded drugs. Is your facility pre... Read more
ICD-10 Update:
Your Coding Accuracy Is Under Fire
Take stock, and run a claims audit before it’s too late. Are you finding it hard to... Read more
Reader Question:
Don't Go by Appendix B of AMA's CPT® 2017 For Moderate Sedation
Question: Going by AMA’s CPT® 2017 Appendix B, “Summary of Additions,... Read more
Reader Question:
Sharpen Your I & D Coding Skills
Question: A new patient comes to the office with complaints of acute pain and tendern... Read more
You Be the Coder:
Just How Many Systems' Review Suffices For a Complete ROS
Question: Instead of checking off boxes in the electronic medical record (EMR) for hi... Read more