Coders must ensure documentation supports the service, either moderate sedation or MAC. Coding moderate sedation (or conscious sedation) and monitored anesthesia care (MAC) is not difficult; however, distinguishing what the services provided are and deciphering conflicted information about which physicians can report what codes can be confusing for some coders…

“Medical necessity” is a much-used but often-misunderstood concept. After our recent four-part series on the “Pitfalls of an Audit” and our last Talk Ten Tuesdays segment on the series, I had taken a position on medical decision-making (MDM) of the evaluation and management (E&M) record being the overarching criteria for…

Frustrations arise over inconsistent guidance from MACs and CMS. Every single day, I get numerous email notices from the Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractor (MAC) for our jurisdiction on a wide variety of “priorities:” correct coding, quality measures, new reporting initiatives, and a…

The author believes that it is more compliant to assign total knee replacements as outpatient services and then reassess the patient’s progress the next day to determine if there is a need for inpatient status. First of all, in five years I believe what follows will all be a non…

CDI programs are viewed by most physicians as hospital-led initiatives geared towards increasing reimbursement for the hospital.The majority of clinical documentation improvement (CDI) programs fail to effectively engage physicians as willing participants in the push to accurately capture patient care provided through clear, concise, and contextually consistent reporting. Clinical documentation…

The long-awaited update to the CT lung screening national coverage determination (NCD) was finally released this month. As you may recall, current smokers who were otherwise eligible were omitted from the NCD-covered codes released last year. That is the really good news. The really bad news is that at least…

What many of us are learning lately is that no news is not necessarily good news. It seems that no news about ICD-10 has simply been disguising some of the lurking problems just waiting to surface. Problems are just starting to appear as payers add edits and issues with electronic health…

In December, the movie “Concussion” was released.  It tells the intriguing story of an investigation into repetitive concussion injuries and the National Football League (NFL).

Although ICD-10 implementation has gone amazingly well, there are specialty-specific challenges arising for some practices and groups. For example, orthopedics has an incredibly large list of extremely specific codes. That can be very frustrating for physicians who must treat patients when it is not their primary or only specialty, and they may…

Claims appear to be moving along the I-10 with little congestion in the early going following implementation of the new code set. This week’s update will cover Wisconsin Physician Services (WPS), First Coast Service Options, and CGS Medicare and its local coverage determination (LCD) issues and resolutions. Overall, it appears…