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Medicare rates cover hospital outpatient services. OPPS covers hospital outpatient X-rays, emergency department visits, and partial hospitalization. Medicare rates determine ASC payment. The ASC Payment System pays for covered surgical procedures and ASC facility services. CMS updates OPPS/ASC regulations annually in one rule, with comment periods before implementation. The ACS is interested in CMS’ OPPS … Read more
The risk adjustment phase-in for Medicare Managed Care Organizations (MCOs) was completed in 2007. Medicare Advantage was created in 1997. Chronic and cumulative “hierarchical condition categories” (HCCs) form the risk adjusted reimbursement model. Physician reimbursement has been fee-for-service. Patients pay doctors. Under this structure, CPT codes and their relative values determine reimbursement, and ICD-9 diagnostic … Read more
Below are the highlighted changes in ICD 10 codes 2023 from 1st April for Medical coders in the ICD 10 coding Guidelines. Please do follow them strictly. Documentation by Clinicians Other than the Patient’s Provider These exceptions include codes for: • Body Mass Index (BMI) • Depth of non-pressure chronic ulcers • Pressure ulcer stage … Read more
Medical coding has different facilities. To be perfect in all facilities is quite difficult. Their will be multiple coders, who can code outpatient charts but very few will be perfect in inpatient coding department. Similarly, if a coder from radiology department to told to code an Emergency department, he or she will not be confident … Read more
Basics of CPT code 93248 , 93245, 93246, 93247 Long-term wearable electrocardiographic monitoring is a diagnostic procedure that provides a record of the heart rhythm during daily activities, including sleep. This procedure can often identify the existence and determine the frequency of clinically significant rhythm disturbances and waveform abnormalities that are missed on a standard … Read more
Basics of Polycythemia ICD 10 code Polycythemia vera is an abnormal increase in blood cells—primarily red blood cells—due to excess production by the bone marrow. This acquired disorder of the bone marrow may also cause overproduction of white blood cells and platelets. ICD-10 code D45 for Polycythemia vera is a medical classification as listed by … Read more
A time-based chronic care management code (CPT 99491) describes the work of a qualified provider to establish, implement, revise, or monitor the care plan for a patient with two or more chronic continuous or episodic health conditions that are expected to last at least 12 months (or until the death of the patient) and put … Read more
The field of diagnostic radiology comprises a diverse range of services, such as diagnostic radiology (plain film), diagnostic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), diagnostic nuclear medicine, positron emission tomography (PET), and mammography. In light of the increasing scrutiny of imaging services by both public and private payers, it is imperative that coders … Read more
Basics of CPT code 93279, 93280 & 93281 Medicare covers a variety of services for the post-implant follow-up and evaluation of implanted cardiac pacemakers. There are two general types of pacemakers in current use – single-chamber pacemakers which sense and pace the ventricles of the heart, and dual-chamber pacemakers which sense and pace both the … Read more
Basics of ICD 10 code for Hepatitis The word “hepatitis” comes from the roots “hepato” meaning liver and “itis” meaning inflammation. It could mean any form of inflammation of the liver, and indeed there are a number of different kinds of hepatitis with their own categories in the ICD-10-CM manual. B17.9 is a billable/specific ICD-10-CM code … Read more