CMS proposes significant changes to E&M services. There has been much confusion over the years regarding documenting for evaluation and management (E&M) services since the 1997 Official Guidelines were released. The Centers for Medicare & Medicaid Services (CMS) kept promising revised guidelines for years without delivering results.  During that time,…
Major E&M changes on the horizon. Probably the biggest change in healthcare in two decades is the Centers for Medicare & Medicaid Services (CMS) proposal to redefine the documentation requirements for evaluation and management (E&M) coding in 2019. The agency is proposing to forego the 1995 and 1997 guidelines for…
CMS proposed major changes to E&M coding but still solicits feedback from stakeholders. The Centers for Medicare & Medicaid Services (CMS) wants to simplify outpatient E&M coding by letting providers choose an office visit code level based on the most important component, medical decision making (MDM), or face time spent…
More than physician payment rules in the CMS IPPS proposal The physician fee schedule rule is one of many payment system rules that the Centers for Medicare & Medicaid Services (CMS) issues each year. There are also rules for the Inpatient Prospective Payment System (IPPS), Outpatient PPS, Skilled Nursing Facilities…
Preparing for the 2019 IPPS final rule marks a busy time for healthcare professionals. While the Centers for Medicare & Medicaid Services (CMS) posted the 2019 Inpatient Prospective Payment System (IPPS) proposed rule back in April, the move continues to generate controversy and confusion. Of particular note is the agency’s…
Reporting bronchoalveolar lavage is all about location, location, location Reporting bronchoalveolar lavage (BAL) has historically been a documentation nightmare for physicians and a quandary among coders. Physicians often use the right and left lung lobe sections to geographically indicate where the bronchoscope was advanced in the bronchial tree during BAL…
CMS proposes to change physician evaluation and management (E&M) coding with a drastic overhaul. EDITOR’S NOTE: The following report first appeared on RACmonitor on July 13, 2018 After soliciting comments from many stakeholders in the last year, the Centers for Medicare & Medicaid Services (CMS) has just proposed sweeping changes…
Accounting for socioeconomic factors is critical to the sustainability of healthcare. A recent blog headline in the American Council of Science and Health captured the healthcare industry’s attention. The headline read, Medicare Could Cover Food, Air Conditioners...Is Sex Next? The focus was on recent action by the Centers for Medicare…
“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…
Healthcare can incorporate SDoH data into daily workflows and operations. Earlier in June I wrote about that necessary marriage of costs, coding, and the Social Determinants of Health (SDoH). I was proud to be a guest on ICD10monitor’s Talk-Ten-Tuesdays to continue this dialogue. The interest and response was powerful, and…