Part 3: Learn from commonly under-coded conditions and documentation. Accuracy and specificity in diagnosis coding and medical documentation are critical in risk adjustment models. Over the past couple of months, we’ve looked at several under-coded conditions in the Medicare hierarchical condition category (HCC) risk adjustment model and discussed documentation strategies to improve coding. There’s...
In Billing
May 11th, 2012
The Centers for Medicare & Medicaid Services (CMS) now covers transcatheter aortic valve replacement (TAVR) for Medicare patients, under certain conditions. According to CMS, coverage for TAVR is approved under Coverage with Evidence Development (CED) only for the treatment of severe symptomatic aortic valve stenosis when all of the following five conditions are met: The procedure is ...
May 1st, 2012
Consult guidance when coding these studies to ensure proper reporting. By Lori M. Shore, CPC, RCC Radiology has arguably had more than its share of bundling recently. Computed tomography (CT) scans of certain separate body parts are no longer separately payable; endovascular revascularization studies are now grouped into all-inclusive territories; and several renal angiography procedures ...
Feb 1st, 2011
Changes make it quicker and easier to code these complex procedures. By David Zielske, MD, CPC-H, CCIRC, CCC, CCS, RCC Dramatic coding changes for lower extremity endovascular revascularization have been implemented for 2011: Sixteen new Category I CPT® codes (37220-37235) apply to combinations of angioplasty, atherectomy, and stent placement (interventions) performed in lower extremity arteries. ...
In Audit
Oct 1st, 2010
The Centers for Medicare & Medicaid Services (CMS) recently released two special edition MLN Matters articles that disseminate high dollar improper payment and coding vulnerabilities identified during the Recovery Audit Contractor (RAC) demonstration. With the expansion of the RAC program and the initiation of complex medical necessity review in all four RAC regions, inpatient hospitals ...