December 2, 2022 | By Jill Young, CPC, CEDC, CIMC While listening to the virtual AMA CPT/RBRVS Annual Symposium lecture by Gift Tee, BS, MPH, Director of the Division of Practitioner Services in the Hospital and Ambulatory Policy Group (HAPG) of CMS on the Update from Centers for Medicare and Medicaid Services (CMS), I…
Details
Tough topics and gray guidelines are what we like to cover in these “Takes,” and this one is no exception. Independent Historian did get cleared up somewhat with 2021 guidelines, but there are still some nuances there. 2021 guidelines did bring about a definition for Independent Historian. It cleared up some of that grayness that…
Details
November 25, 2022 | By Grant Huang, CPMA, CPC It’s been two years since CMS collaborated with the AMA to revamp Evaluation & Management (E&M) coding guidelines, including a rework of prolonged services codes in the office/outpatient setting. This process culminated in a disagreement between the AMA’s CPT manual and CMS’ fee schedule final…
Details
As we begin the new year and our focused training for the 2023 E&M changes and revisions, I’d like to encourage everyone to refocus their efforts on column three of medical decision-making. The header of column three is very specific, and it’s wordy. I think sometimes we fail to notice that because we’re stuck in…
Details
November 18, 2022 | By Rhonda Buckholtz, Owner, Coding and Reimbursement Experts Determining risk is important for having an effective compliance program. Policies need to be developed to your specific needs. Depending on your specialty, your geographic area, your risk areas, etc. For example, yours might be diagnostic testing, modifiers, emergency evacuations, ASC rules,…
Details
I can’t remember if I’ve recently covered this topic, so one of us (or maybe both of us) may have Deja vu today. We’re still getting inundated with questions about Problems Addressed regardless of the place or type of service, so whether I’ve already covered this topic or not, it bears addressing it again. Cheryl,…
Details
Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness.…
Details
June 10, 2022 | By Scott Kraft, CPMA, CPC I regularly see E11.22 coded, followed by the stage of chronic kidney disease when a patient has diabetes with chronic kidney disease. I’m not sure if I’m unlucky, but I rarely see the same correct diagnosis coding when it comes to hypertension and chronic kidney…
Details
Acute uncomplicated illness or injury requiring hospital inpatient or observation level care As 2021 documentation guidelines are moving into other types and places of service, it’s time to start taking a deep dive! I want to start by looking at some of the implementations that have changed. There were two major new adaptions in the…
Details
October 28, 2022 | By Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS We are all excited about the upcoming 2023 E/M changes, aren’t we? Well, I can say, as a coder and auditor, I am! I’ve been in this E/M world for about 35 years. Things were easy prior to 1995,…
Details