Improved Acute Myocardial Infarction (AMI) Guidelines

Improved Acute Myocardial Infarction (AMI) GuidelinesICD-10-CM implementation brought several significant changes to the OCG (Official Guidelines for Coding and Reporting) with regard to Chapter 9 (Diseases of the Circulatory System) I.C.9.e Acute myocardial infarction (AMI). Preparing yourself for coding updates based on MI type is not sufficient. You also must learn how to apply these new codes using OGC for Coding and Reporting.

Here’s how the guidelines update for 2018:

  1. Codes from between I21.0 – (ST elevation (STEMI) myocardial infarction of anterior wall) – I21.2 – (ST elevation (STEMI) myocardial infarction of other sites), as well as I21.3 (ST elevation (STEMI) myocardial infarction of unspecified site), are for Type 1 STEMI heart attacks. Code I21.4 (Non -ST elevation (NSTEMI) myocardial infarction) captures a Type 1 NSTEMI heart attack and nontransmural heart attack. [I.C.9.e.1]
  2. If a patient has a Type 1 NSTEMI and it evolves into a STEMI, code it as a STEMI. If a Type 1 STEMI converts to an NSTEMI due to thrombolytic therapy, code it as a STEMI. [I.C.9.e.1]
  3. Code I21.3 for a heart attack documented as a Type 1 STEMI or a transmural heart attack of unspecified site. [I.C.9.e.2]
  4. Codes between I21.1 – (ST elevation (STEMI) myocardial infarction of inferior wall) and I21.4 are only for type 1 heart attack. [I.C.9.e.5]
  5. Code I21.A1 (Myocardial infarction type 2) along with a second code for the underlying cause of the demand ischemia or ischemic imbalance for a type 2 heart attack. Sequence the two codes according to the focus of care. Use I21.A1 whether the Type 2 heart attack is described as STEMI or NSTEMI. Do not use I24.8 (Other forms of acute ischemic heart disease) to capture demand ischemia in these scenarios. [I.C.9.e.5]
  6. Use I21.A9 (Other myocardial infarction types) for type 3, 4a, 4b, 4c, and 5 heart attacks. Follow tabular instruction contained in “code also” and “code first” notes for associated complications, and for postprocedural myocardial infarctions during or following cardiac surgery. [I.C.9.e.5]
  7. Codes in the I22. – Category (Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction) should not be used for myocardial infarctions other than type 1 or unspecified. For subsequent type 2 heart attacks, assign only I21.A1. For subsequent type 4 or type 5 heart attacks, assign only I21.A9. [I.C.9.e.4]

If you have been coding inpatient records since the implementation of ICD-10-CM, you may have noticed that the OCG for Subsequent acute myocardial infarctions has been evolving. For codes, effective October 1, 2018, additions were made to this guideline referring to Type 2 myocardial infarctions for the first time.

The codes for Type 2 myocardial infarctions, Subcategory I21. The Other type of myocardial infarction, were new codes as of October 1, 2018. Prior to this, there were no unique codes for Type 2 myocardial infarctions. With new codes, new or revised guidelines or clarifications often follow.

It becomes very essential to thoroughly review the 2018 OGs. It’s the only way to be sure you’re using the new codes correctly. Spending a little time on the OGs now will save your practice from costly denials and hours of rework in the future.

Source: 2018 ICD-10 CM and GEMs

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3 ways for health care providers to get patients’ MBIs

3 ways for health care providers to get patients' MBIsMedicare has come up with new revelation this time. It is taking steps to remove Social Security numbers from Medicare cards.

The initiative from Medicare, the Centers for Medicare & Medicaid Services will help prevent the fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of the Medicare beneficiaries.

CMS will be issuing the new Medicare cards – MBI cards which will have a unique, randomly-assigned number called a Medicare Beneficiary Identifier to replace the existing Social Security-based Health Insurance Claim Number both on the cards and in various CMS systems.

MBC the professional medical billing and coding company suggest practices to take care of certain things with the new transition, explaining here.

How will this impact doctors and medical office managers’ billing and compliance services?

Currently, the new Medicare cards are already being mailed and distributed to recipients.

This means that cardholders will soon be visiting medical offices with their new cards, asking for further clarification about the changes, and seeking assistance for its use.

With this in mind, here are the top 3 ways that you need to take note to get new patients:

Eligibility Verification of the New Medicare ID Card

With the new card, one of the primary concerns that you will have to face will be verifying its authenticity and validity.

The new card shares the same white, blue and red color like the previous one. However, take note of the new Medicare Number and how it is comprised of uppercase letters and numbers alone. Thus, it is most important for doctors and medical office managers to learn how to identify a valid Medicare ID card from a fraudulent one.

This sounds simple, right? But wait a minute. This is just the tip of the iceberg. There is more information pertaining to the patient’s screening process that has to be verified.

This includes:

  • Effective dates
  • Benefits and calculations
  • Administration, follow-up and plan execution

Synchronization of Benefits with the New Medicare ID card

The major change happening with the new Medicare ID card is the use of the MBI number. CMS is not expecting any other major changes aside from this, unless there are disputes on an individual’s account.

Another issue you may encounter is – your patients not being able to receive their new Medicare ID card due to a change of address. How should you handle this, if they visit your office and continue to hand-over the old Medicare ID card?

To that end, doctors and medical office managers should be proactive and update their records. This is to easily and quickly claim their payment while avoiding unwanted mishandling of client records in the future.

Submitting of medical claims using the MBI

The issuance of new cards was driven by a need to protect users from potential identity theft and fraud. This basically means that the new Medicare IDs will still require doctors and medical office managers to thoroughly process claims. It’s important, therefore, to ensure that the process and submission of these medical claims are accurate; otherwise you will leave yourself vulnerable to payment delays.

Bottom line

To help you with this transition, you need to have an efficient medical billing and coding partner like MBC to handle new information, securely handle data, and manage operational efficiencies easily.

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2019 NCCI update impact on medical billing and coding

2019 NCCI update impact on medical billing and codingNCCI – National Correct Coding Initiative promotes the correct coding methodologies. Furthermore, it controls inappropriate coding leading to wrong payments in Part B claims. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services. The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits. Further, read more about 2019 NCCI update impact on medical billing and coding.

CMS recently happens to release 2019 NCCI policy manual for Medicare services. The updates are all about new payment policies, coding methodologies as well as changes that will impact billing and coding for spinal surgeries and laboratory services.

The new changes made by CMS added new guidance to chapter 4 for spinal procedures that clarify the reporting of CPT codes 22600-22634 for spinal arthrodesis.

The New NCCI Update

CMS also revised this section to include a procedure-to-procedure (PTP) edit with column one CPT code 22630 which includes arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace and other than for decompression, single interspace; lumbar and column two CPT code 63056 includes arthrodesis, transpedicular approach with decompression of spinal cord, and/or nerve root, single segment; lumbar.

As per the updated manual, the two procedures cannot be reported together at the same spinal level for the same patient encounter.

A Tier 1 or Tier 2 molecular pathology procedure CPT code should not be reported with a genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis. CPT code descriptors for Tier 1 and Tier 2 molecular pathology codes include testing for the analyte.

The update includes guidance for reporting laboratory procedures to evaluate multiple genes utilizing the next-generation sequencing procedure:

  • If only one procedure is performed, only one unit of service should be reported for the genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code.
  • If no CPT code accurately describes the procedure, the lab must report CPT code 81479 i.e. unlisted molecular pathology procedures with one unit of service.

MBC – One-stop shop for a coding & billing skills upgrade

Navigating the medical coding and compliance world gets easier with expert guidance. MBC is one of the known knowledgeable healthcare industry’s most expert veterans to outsource your medical billing and coding requirements.

Here’s just a sampling of the 2019 medical billing and coding services available from MBC:

  • Speed on 2019 CPT, ICD-10-CM, and Medicare updates
  • Navigate CPT definition changes
  • Prepare for the 2019 NCCI bundling and unbundling for various procedures
  • Prevent modifier misuse e.g. modifier 59 from ruining claims and causing denials
  • Follow CPT guidelines for using time as a key factor to determine E&M service level
  • HIPAA & Patient Communication: How to handle text, email, and access issues
  • Receive proper NPP reimbursement by avoiding compliance risks
  • Clear up confusion over ‘medical necessity’ documentation
  • Follow CMS guidelines for physician documentation and E&M codes
  • Learn what 2019 has in store: compliance, quality measures, value-based reporting, audit risk areas, and documentation guidelines
  • Gain tips to minimize denials and nip cash flow problems in the bud
  • Make 2019 maximum reimbursement kind of year
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Top 7 Challenges with Wound Care Medical Coding

Top-7-Challenges-with-Wound-Care-Medical-CodingMedical necessity denials traditionally focus on high-dollar MS-DRGs, such as those for hip and knee replacements; other MS-DRGs may also soon become targets. We have identified some of the challenges in Wound Care Medical Coding.

Healthcare providers are likely to perform accurate medical coding under ICD-10 and that is when having an outsourcing medical billing coding partner like MBC will be beneficial.

Documentation lacks the clinical substance necessary to support medical necessity, and it doesn’t capture a physician’s clinical judgment and medical decision-making for performing the procedure. Doctors have been conditioned to document excisional debridement, but if you look at what they need for their own payment, they need to do a lot more than that. To do wound care medical coding for inpatients frequently lacks sufficient documentation.

It has become crucial than ever for wound care providers to make sure that they are doing coding to the utmost specificity and following all the ICD-10 guidelines. While it is still unclear exactly how forgiving CMS was under this grace period, it is possible that some things that were working in the first year of ICD-10 may not continue to be satisfactory.

The Challenges With Wound Care Medical Coding

  1. There is misperception with coding and billing is that if there is a code for a procedure or product, the insurance plan will pay it. This is not necessarily the case. Having a code does not directly translate to the coverage for the procedure, therefore, it becomes imperative to know the rules under which you must operate is a must.
  2. Another common error is not using the add-on codes properly. If removing over 20 cm2 of tissue at a certain depth, he says to use the base code and the add-on code. For example, if removing 28 cm2 of subcutaneous tissue, he notes the coding would be both 11042 and 11045.
  3. Coders are often too cautious when assigning a present on admission (POA) indicator for pressure ulcers, especially when the provider does not document the ulcer until several days after inpatient admission. If signs or symptoms are POA, coders can and should report an ulcer as POA. A query may be necessary without documentation of signs or symptoms.
  4. ICD-10-PCS distinguishes between excisional and non-excisional debridement. The ICD-10-PCS root operations excision and extraction denote excisional debridement and non-excisional debridement, respectively. This doesn’t mean that physicians must use the term extraction, but if documentation shows that the tissue was pulled or stripped away, rather than cut, the debridement is an extraction.ICD-10 will require coders to capture laterality and more specific anatomic wound locations.
  5. There have been disagreements, and debates between what’s considered to be a “wound” versus an “ulcer.” Sometimes, ICD-10 is almost like its own language, and this is one of those situations. Be aware of ICD-10 semantic, that medical staff often make mistakes. While many clinicians may interchange the terms “ulcer” and “wound” as if they are substitutes, they are not other words when it comes to ICD-10 medical coding.
  6. Physicians respond to the documents during their administrative hours. Because manual physicians query delay in medical coding and billing and don’t have a great response rate from physicians, providers should consider automated physician queries.
  7. Understand the difference between wound debridement, open fracture debridement, and active wound care coding. Also; there are errors in coding correctly when skin grafting/replacement is involved.

The billing of wound care services usually involves a thorough evaluation of the patient’s medical record for the wound, including wound dimensions, chronic diseases which includes diabetes, chronic ulcers, quadriplegia, etc. procedures offered to manage the wound, follow-up, first visit, photographs of the wound, and wound progress. To have MBC as your wound care medical billing and coding partner can help overcome the above-mentioned challenges.

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Top 5 Outpatient reimbursement questions for Wound Care

Top-5-Outpatient-reimbursement-questions-for-Wound-CareDo outpatient reimbursement challenges frustrate you a lot? Medicare reimbursement regulations that are currently impacting wound care practices. Wound care professionals still have to follow the coding, payment, and coverage regulations for submitting claims to traditional Medicare.

Below are top 5 questions that clarify outpatient reimbursement questions for wound care:

  1. Why it is crucial to know whether the outpatient wound clinic is a hospital-based outpatient wound care department or just a wound clinic?

When patients are examined in a hospital-based outpatient wound care clinic they receive 2 bills i.e. one from HOPD and another from QHP.

Hence; the patients are seen by a QHP in his or her office, the patients and Medicare only receive one bill. Patients should be informed about whether they should expect one or two bills.

  1. There’s always a coding confusion and diagnoses typically needs to be updated – how to do that?

Codes for products, procedures/services, and diagnoses are typically updated on an annual basis, although some codes for drugs/biologics and coding edits (see below) may be modified on a quarterly basis. Two major coding regulations are impacting the wound care industry and deserve special attention from wound care professionals:

  • Define patients’ clinical status and to treat their complex medical conditions
  • Coordinate care among providers, and support new payment methods that drive quality of care
  1. If an LCD is not written about a particular service, procedure, or product, Medicare does not cover it?

No, it doesn’t. If a MAC has not released an LCD, it means the Medicare administrative contractor has not found a reason to control the utilization of the particular service, procedure, or product.

In this case, coverage will be based on medical necessity as proven by the patient’s diagnosis and the documentation in the medical record.

  1. How often should wound care professionals look for updates to LCDs?

Medicare administrative contractors may update LCDs as often as they deem necessary. However; some LCDs were updated 5 or 6 times a year.

Therefore, wound care professionals should assign someone to review LCDs on a monthly basis. When LCDs are revised, all wound care professionals should read them carefully.

  1. Why do all wound care professionals require reading the NCDs and LCDs that pertain to the wound care work they perform?

Wound care professionals must know these coverage rules. If a Medicare patient’s medical condition aligns with the coverage rules, the service/product/procedure has a good chance of Medicare payment.

If not, the wound care professional should explain the coverage situation to the Medicare beneficiary and give the beneficiary the opportunity to receive and personally pay for the necessary care.

That is achieved by the wound care professional providing the Medicare beneficiary with an Advance Beneficiary Notice of Non-coverage and by the beneficiary signing the notice and agreeing to pay for the care.

If you wish to learn more about these and other reimbursement topics, you and your revenue cycle team may connect with MBC experts – the only professional medical billing and coding service provider that you can trust.

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Why documentation of procedure holds the key in Radiology Medical Billing?

Why-documentation-of-procedure-holds-the-key-in-Radiology-medical-BillingThe brilliant principle for therapeutic charging has dependably been “If it’s not archived, it wasn’t finished.” For demonstrative imaging focuses, that is particularly valid, where exact repayment relies on very exact documentation and coding.

What’s more, in case you’re not hitting the nail on the head, you’re leaving cash on the table—as refusals and underpayments, also staff hours revising claims for inadequate or mistaken documentation. Not reporting the real number and explicit perspectives in an investigation.

A knee test has four distinctive CPT codes dependent on the number and sort of perspectives—and on the off chance that you aren’t reporting the exact number as well as explicit perspectives, you need to code to the most minimal dimension. It’s insufficient for your office to have a rundown of standard perspectives for every test, the imaging report must determine what was done as such that the coder can pick the best possible codes. “Four perspectives of the knee” is adequate dialect in the medicinal report, yet it’s shockingly better if the radiologist can give subtleties, for example, “AP, horizontal, and the two obliques” to help the CPT code.

Overlooking fundamental segments in the imaging report.

The American College of Radiology necessitates that all imaging reports incorporate the accompanying data so as to be finished:

  1. Exam Name
  1. Clinical sign/purpose behind the test
  1. Description of test, successions, and additionally strategy
  1. Comparison ponders if the material
  1. Findings
  1. Conclusion and suggestions whenever showed
  1. Physician’s mark

Other fundamental segments from a coding viewpoint incorporate laterality where appropriate and subtleties, for example, regardless of whether the examination is a rehash of an earlier report. Skirt any of these components and your repayment can be deferred or diminished.

  1. Neglecting to recognize and report scout films.

A recumbent gut or scout KUB is normally performed with an upper GI arrangement and so as to help the right code, the KUB and discoveries must be directed independently from the upper GI. Just saying “Starter films were acquired” does not meet documentation necessities.

Also, an esophagram is commonly packaged into the upper GI arrangement, however now and again, numerous perspectives or a cine esophagram might be performed. In the event that the documentation bolsters the medicinal need for the different esophagram, it tends to be coded independently with a modifier – 59.

  1. Not archiving each segment of an “entire” ultrasound test.

There are strict criteria for what establishes a total stomach ultrasound or renal ultrasound, and every organ or structure must be archived in the restorative answer to legitimize the “entire” code. On the off chance that any anatomical structure is missing, you should down-code to a restricted report. Bear in mind that there must be a lasting record and estimations for demonstrative ultrasound ponders.

  1. Not completely or inaccurately reporting and coding contrast ponders.

CT sweeps and MRIs are possibly viewed as differentiation examines if the difference is managed intravenously; oral and rectal complexity doesn’t consider a complexity think about. Past that, ensure the documentation precisely reflects whether the investigation was performed without IV differentiate, with IV differentiates, or without pursued by with complexity. Watch out for coding parentheticals to search for extra coding chances on difference thinks about.

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Radiology Billing and Coding: Best Practices and Changes for 2019

Radiology-Billing-and-Coding-Best-Practices-and-Changes-for-2019Radiology practices involve complex billing and coding. Practices find it tough to stay up to date. Radiology practices, like other specialty practices, offer a variety of different services like intrusive procedures, and other incursions to the patients in a variety of different settings.

The charges for the services are dealt differently depending on where the services were provided – in same-day surgery centers, in a hospital setting, or in the doctor’s office. Accurate Radiology billing and coding require an excellent working knowledge of current coding rules, cardiology specific codes, and compliance standards. Even small mistakes in cardiology billing and coding can result in denials that lower your practice revenue.

The coding for Breast MRI has been changed by the deletion of two codes and their expansion into 4 new codes, as follows:

  • MRI Breast, without contrast, unilateral which has a new code 77046 replacing 77058
  • MRI Breast, without contrast, bilateral has a new code 77047 replace the old one i.e. 77059
  • MRI Breast, without and with contrast, unilateral has a new code given i.e. 77048  replacing the old one 77058
  • MRI Breast, without and with contrast, bilateral has the new code which is 77049 replacing the 77059

New Gastrostomy Tube Change Coding

  • Percutaneous change of the gastrostomy tube, without imaging or endoscopic guidance; do not require revision of the gastrostomy tract with the new code 43762
  • Require revision of gastronomy tract 43763

New Renal Pelvic Catheter Coding

  • Percutaneous dilation of the existing tract for an endourologic procedure has a new code 50436
  • Percutaneous dilation of the existing tract for an endourologic procedure, including new access into the renal collection system, has a new code 50437
  • Dilation of ureter or urethra, radiological supervision and interpretation has a new code 74485

Biopsy Coding

  • FNA biopsy without imaging guidance; first lesion with the new code 10021
  • FNA biopsy, including ultrasound guidance; the first lesion has a new code 10005
  • FNA biopsy, including fluoroscopic guidance; first lesion, has a new code 10007
  • FNA biopsy, including CT guidance; the first lesion has the new code 10009
  • FNA biopsy, including MRI guidance; first lesion with the new code 10011

MBC is a professional medical billing and coder service provider who knows what’s working with all their clients. Partnering with a vendor and tapping into their real-time knowledge will pay big dividends.

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