HCC Blog by Caridad

ICD-10-CM Official Guidelines for Coding and Reporting FY 2016 "The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).  These guidelines should be used as a companion document to the official version of the ICD-10CM as published on the NCHS website. The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings.  The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO). " These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions...

From the World Health Organization (WHO) International Classification of Diseases (ICD) This webpage gives a description of the diagnostic tool known as ICD. ICD-10 came into use in WHO Member States starting in 1994. The United States adopted its use in October 2015. WHO plans to release ICD-11 in 2018. The current, searchable version of ICD-10 online can be found at http://apps.who.int/classifications/icd10/browse/2016/en Also on this page are the following: ICD-10 Interactive Self Learning Tool Scroll down to the ICD Training section. There is an ICD-10 Interactive Self Learning Tool. There are two version of the training tool:  ‘Full ICD-10 training’ and a ‘Cause of death certificate version’. ICD Adaptations There are five different sections ·          Oncology ·          External Causes of Injury ·          Primary Care · ...

http://oig.hhs.gov/newsroom/podcasts/updates.asp#update1215

Medicare offers participants an Annual Wellness Visit (AWV) which is not an appointment for a "physical", although it is easy to see why some may think it is. It should be thought of more like a "getting to know you" or "interview" visit.  It can be thought of setting a base line of information. Beneficiaries can qualify for this if they: ■ Are not within the first 12 months of their first Medicare Part B coverage period; and ■ Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months.   Translated that means : if they have not had one of these done already AND that they haven't had a IPPE either, in the last year.  It is possible to check a data base to see if they have already had any of these services.  Inquiry with your employer. This document is divided into two sections: the first explains the elements of a beneficiary’s initial AWV; the second explains the elements of all subsequent AWVs....

The purpose of the NCD Manual is to describes whether specific medical items, services, treatment procedures, or technologies can be paid for under Medicare.  On this website you will find Coverage Determinations divided by Chapter 1 and four Parts. Part 1 Sections 10 - 80 Part 2 Sections 90-160.26 Part 3 Sections 170-190.34 Part 4 Sections 200-310.1 There is also a Crosswalk from NCD Manual to Coverage Issues Manual and a Crosswalk from Coverage Issues Manual to NCD                                                                                    ...

you can find guidance about coverage and billing for preventive and screening serves in Chapter 18 of the Medicare Claims Processing Manual Chapter 18 - Preventive and Screening Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf Major Category IV: Excluded Preventive and Screening Services Preventive and screening services are excluded from the Part A payment made under the SNF PPS, but are subject to SNF CB. As such, they are separately payable under Medicare Part B, but only to the SNF. The SNF must bill the services listed on the next page for beneficiaries in a Part A stay with Part B eligibility on TOB 22X. ===== The first two files list codes that physicians, nonphysician practitioners, and suppliers (other than ambulance suppliers) can bill separately to the Part B MAC . If neither file lists the code for the service, the service is subject to SNF consolidated billing and the physician, nonphysician practitioner, or s...

The Office of Inspector General (OIG) report “The Hospital of Central Connecticut Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor” dated June 2015.    The OIG was looking to determine if the Hospital was complying with Medicare billing requirements for Kwashiorkor.   Kwashiorkor is a type of severe protein malnutrition. It generally is found in children living in parts of the world without and adequate food supply or due to a famine. Since Medicare is primarily covering people 65 years or older, it is doubtful this condition would be prominent. The following link leads to the finds of their investigation.   http://oig.hhs.gov/oas/reports/region9/91402036.pdf