HCC Blog by Caridad

  ICD-10-CM Official Guidelines for Coding and Reporting FY 20 21 – UPDATED January 1, 2021 (October 1, 2020 - September 30, 2021)  Updates include: I.C.1.g pg 28, Coronavirus infections I.C.10.e p58, Vaping-related disorders I.C.15.s p73, COVID-19 infection in pregnancy, childbirth, and the puerperium I.C.16,h p77, COVID-19 infection in newborn https://www.cms.gov/files/document/2021-coding-guidelines-updated-12162020.pdf

 The focus of this post is links on 1. Telehealth Services (PDF) 2. Medicare Claims Processing Manual Chapter 12 (PDF) 3. Medicare Coverage and Payment of Virtual Services (video) 4. Office of Inspector General (OIG)   1.         1. Telehealth Services Booklet        https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf   2.       2. Medicare Claims Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners (Rev. 10356, 09-18-20) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf Important information is found on the following pages: 30.6.1.1 - Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) (Rev. 3096, Issued: 10-17-14, Effective: 01-27-14, Implementation: 11-18-14) P 32       1. Initial Preventive Physical Examin...

Information on Medicare Wellness Visits is available in the  MLN Educational Tool. Create a free account to access this and other information. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html\   There is information on the three visit types :      IPPE - "Welcome to Medicare" preventive visit      AWV - Initial & Subsequent   and a section on ' Know the Difference' at the time of this release the links are as follows: https://learner.mlnlms.com/Default.aspx Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The...

Listed below are place of service codes and descriptions.  These codes should be used on professional claims to specify the entity where service(s) were rendered.  Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set Place of Service Code Set Place of Service Codes for Professional Claims Database (updated October 2019) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes.  If you would like to comment on a code(s) or description(s), please send your request to  posinfo@cms.hhs.gov . NOTE :  Please direct questions related to billing place of service codes ...

Information on Telemedicine  can be found here:  https://www.healthit.gov/topic/health-it-health-care-settings/health-it-health-care-settings The Office of the National Coordinator for Health Information Technology (ONC)  is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). The Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange ...

Acceptable Physician Specialty Types for 2020 Payment Year (2019 Dates of Service) Risk Adjustment Data Submission   https://www.csscoperations.com/internet/csscw3_files.nsf/F/CSSCAcceptable%20Physician%20Specialty%20Types%20PY2020.pdf/$FILE/Acceptable%20Physician%20Specialty%20Types%20PY2020.pdf Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

  CMS NEWS: Trump Administration Announces Medicare Fee-For-Service Estimated Improper Payments Decline by $15 Billion Since 2016 11/16/2020 CMS NEWS FOR IMMEDIATE RELEASE November 16, 2020 Contact: CMS Media Relations (202) 690-6145 |  CMS Media Inquiries   Trump Administration Announces Medicare Fee-For-Service Estimated Improper Payments Decline by $15 Billion Since 2016 Continued reduction marks fourth year Medicare FFS improper payment rate has been below 10%  The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Fee- For-Service (FFS) improper payment rate has continued to decline, reinforcing the Trump Administration and CMS’ commitment to strengthening Medicare and protecting taxpayer dollars. This translates to less fraud, waste and abuse that can increase the fiscal burden on the nation’s healthcare system. Over the past four years, CMS’ aggressive corrective actions have led to an estimated $15 billion reduction of Medica...

 When coding for cancer diagnosis, here is a handy on line dictionary on cancer terms from National Cancer Institute.  https://www.cancer.gov/publications/dictionaries/cancer-terms Cancer Types tab Select a type of cancer to learn about treatment, causes and prevention, screening, and the latest research. NCI Dictionary of Cancer Terms The NCI Dictionary of Cancer Terms features 8,727 terms related to cancer and medicine. cancer type  https://www.cancer.gov/publications/dictionaries/cancer-terms Chart documentation may include location, site, laterality, specific site on body, including stage (how much has grown and spread).  Document current status of neoplasm, if responding to treatment, or if historical with no active treatment or recurrence Consider using the term  'in remission' in place of 'history of' when describing the cancer, as appropriate. When adjuvant therapy is used, document its purpose if curative, palliative or preventive. Document an referrals...

 This brief 5-minute video from CMS is entitled Annual Wellness Visits (AWV) Video and was released Oct 14, 2020.  The video provides health care professionals with guidance to understand expectations and requirements when submitting documentation for Annual Wellness Visits (AWV) for Medicare beneficiaries. It briefly explains the difference between a 'Routine Physical Checkup', "Initial Preventive Physical Exam' and 'Annual Wellness Visit'.  https://www.youtube.com/watch?v=r7yOUaMJyJU&feature=youtu.be Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purpo...

Expanding Medicare Telehealth Services For the first time using a new expedited process, CMS is  adding 11 new services to the Medicare telehealth  services list since the publication of the May 1, 2020, COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately, and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available at:  https://www.cms.gov/Medicare/ Medicare-General-Information/ Telehealth/Telehealth-Codes . In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth s...