Resource AAPC articles

CMS Releases ICD-10 MS-DRG V38.1. For ICD-10-CM, this version includes new Covid 19 codes that went into effect on October 1, 2020. For ICD-10-PCS, this version includes 21 new codes for introduction or infusion of therapeutics and includes monoclonal antibodies and vaccines for COVID-19 treatment which is effective January 1, 2021.

CMS Releases ICD-10 MS-DRG V38.1

Latest update includes assignments for new COVID-19-related diagnoses and procedures. The ICD-10 Medicare Severity-Diagnosis Related Group (MS-DRG) V38.1

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[Lori]

Waivers, NCDs, and POS

Take 5 to stay up to date on medical coding news.

COVID-19 Waiver Update

New telehealth POS

NCD for Chronic, Non-healing Wounds

Check NCDs for Coding Updates

October Update: Waivers, NCDs, and POS

Take 5 to stay up to date on medical coding news. Aside from the annual update to ICD-10-CM, October brought us news of COVID-19 waiver status, a new The October update brought us news of COVID-19 waiver status, a new telehealth place of service code, a new National Coverage Document (NCD)

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[Lori]

CMS Vaccination Mandate Rule Blocked
If you’re leaning toward pausing your vaccination requirement process, be ready to crank it back up on a dime, legal experts stress.
What happened?
What are the options?

CMS Vaccination Mandate Rule Blocked

If you’re leaning toward pausing your vaccination requirement process, be ready to crank it back up on a dime, legal experts stress. After the Biden After the Biden administration issued two COVID-19 vaccine mandates, states mounted legal challenges in federal courts across the country.

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[Lori]

The 2022 OPPS/ASC Final Rule Finalizes a 2% Boost in Payment Rates​

CMS dramatically increases the financial penalties for noncompliance with hospital price transparency rules.​

Here are the Key Takeaways From 2022 OPPS/ASC Final Rule​

2022 OPPS/ASC Final Rule Finalizes 2 Percent Boost in Payment Rates

CMS dramatically increases financial penalties for noncompliance with hospital price transparency rules. On Nov. 2, 2021, the Centers for Medicare &

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[Lori]

2022 HCPCS Level II Code Changes​

In first quarter of 2022, the HCPCS Level II code set will get a refresh with several new, revised, and deleted codes. According to the Centers for Medicare & Medicaid Services (CMS), there are:

• 155 new codes,
• 63 revised codes, and
• 48 deleted codes.

Learn More About 2022 HCPCS Level II Code Changes

In first quarter 2022, the HCPCS Level II code set will get a refresh with several new, revised, and deleted codes. According to the Centers for The HCPCS Level II code set will get a refresh in 2022 with several new, revised, and deleted codes.

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[Lori]

New Cough Codes​

R05.1 Acute cough

R05.2 Subacute cough

R05.3 Chronic cough, Persistent cough, Refractory cough, Unexplained cough

R05.4 Cough syncope

Code first: syncope and collapse (R55)

R05.8 Other specified cough

R05.9 Cough, unspecified

Don’t Choke Over New Cough Codes

Documenting and coding coughs is much more complicated in 2022. Remember the days when a cough was just a cough, coded simply with ICD-10-CM code R05? Documenting and coding coughs is much more complicated in 2022 ICD-10-CM.

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[Lori]

Master CPT® 2022 Coding​

CPT® 2022 includes 249 new codes, 93 revised codes, and 63 deleted codes. All sections of CPT® received changes in codes and guidelines. The most significant changes are to E/M.

Find out what you need to know now!

Master CPT® 2022 Coding With This Expert Overview

AAPC Senior VP of Products Raemarie Jimenez gives you the scoop on the code changes for next year. CPT® 2022 includes 249 new codes, 93 revised codes, and New, revised, and deleted CPT® codes and coding guidelines become effective Jan. 1.

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[Lori]

What is a cosswalk?

How can a crosswalk help me?

These underutilized tools enable coders to work smarter, not harder​

Harness the Power of Crosswalks

These underutilized tools enable coders to work smarter, not harder. As medical coders, we are always looking for tips and tricks — anything to make our Learn how crosswalks enable medical coders to work smarter, not harder.

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[Lori]

Learn the Anatomy.
Coding for Pain Management.
Additional Guidelines.

Sharpen Your Facet Joint Intervention Coding

Understand coding and coverage limitations to avoid inappropriate billing for and overuse of facet joint interventions for pain management.

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[Lori]

Are You Ready to Manage a Remote Workforce?
Find out how to best face the challenges brought on by working from home.
Learn what the Research Tells Us.
What are the management & policy considerations?
How to onboard new employees.
Setting the expectations.
Maintaining production standards.
Effective communication finding out if you have what it takes?

Are You Ready to Manage a Remote Workforce?

Know how to best face the challenges brought on by working from home. How times have changed. In the 1950s, working from home was primarily what women Know how to best face the challenges brought on by managing a remote workforce from home.

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[Lori]

Learn the 5 things AAPC recommends.
Are you doing these?
CCO believes networking is the most helpful tool

Resolve to make your resolutions attainable by setting realistic goals.
1. Learn a new skill or sharpen an old one.
2. Make the most of your AAPC membership.
3. Sharpen your soft skills.
4. Step up your online networking game.
5. Take better care of yourself.
6. Update your resume.
7. Audit your work.
8. Try something new.
9. Give something in return.
10. Forgive and forget.

​

10 Ways To Boost Your Career

Resolve to make your resolutions attainable by setting realistic goals. According to statista.com, losing weight and saving more money were the most Forget resolutions! Set realistic goals for the following 10 career boosting actions.

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[Lori]

Prior Authorization changes & Congressional Act delays Medicare payment adjustment.

Through the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (CMS-1717-FC (PDF)), CMS established a nationwide prior authorization process and requirements for certain hospital outpatient department (OPD) services.

The following hospital OPD services require prior authorization when provided on or after July 1, 2020:

• Blepharoplasty
  • Blepharoptosis repair and brow ptosis repair are added
• Botulinum toxin injections
• Panniculectomy
• Rhinoplasty
• Vein ablation

The following hospital OPD services require prior authorization when provided on or after July 1, 2021:

• Implanted spinal neurostimulators
• Cervical fusion with disc removal

CMS also revised the exemption process for hospital OPD providers and extended the exemption cycle. See CMS’ operational guide for complete details.

The Act extended the 2 percent Medicare sequester moratorium through March 31.

The Act also delayed the Clinical Laboratory Fee Schedule private payer reporting requirement.

• The next data reporting period is now Jan. 1, 2023 – March 31, 2023.
• Reporting will be based on the original data collection period, Jan. 1, 2019 – June 30, 2019.

The Act also extended the statutory phase-in of payment reductions resulting from private payer rate implementation:

• No payment reductions for CYs 2021 and 2022.
• Payment won’t be reduced by more than 15 percent for CYs 2023 through 2025.

Read more here:

Take 5: Get Caught Up on Coding and Billing News

New COVID-19 vaccine status codes, changes and corrections to the 2022 CPT code set, Medicare Physician Fee Schedule (MPFS) payment changes, and prior New codes, codes changes and corrections, and Medicare payment changes take effect Jan. 1, 2022.

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[Lori]

Ground Ambulances were left out of the No Surprises Act that went into effect on the first day of 2022.

It protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers and establishes an independent dispute resolution process for payment disputes between plans and providers and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

4 reasons you may still get a surprise bill if you take a ride in a ground ambulance.

• No choice of ambulance service when dialing 911
• In an emergency situation, there is no time to check ambulance choices in advance
• No opportunity to choose a service if sedated or unconscious
• No choice available at all: Only one ambulance contract for the region

The variety of ways that ground ambulances are owned, operated, and paid for makes it impossible to regulate the service as a single entity at this time.

There are 10 states that provide some level of protection against balance bills: Colorado, Delaware, Florida, Illinois, Maine, Maryland, New York, Ohio, Vermont, and West Virginia but not all provide protection for both public and private providers and only half regulate reimbursement rates for out-of-network providers.

Ground Ambulances Left Out of No Surprises Act

The recently enacted No Surprises Act protects against most surprise billing — but not ground ambulances. The No Surprises Act (NSA), which went into The recently enacted No Surprises Act protects against most surprise billing — but not ground ambulances.

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[Lori]

New Medicaid Option Promotes Mobile Crisis Intervention Care​

This new option will allow Medicaid recipients to receive crisis intervention services quickly in crisis situations with individual assessment and crisis resolution by trained professionals unlike now where it is usually law enforcement responding first to a crisis.

This can provide immediate and appropriate care to someone in crisis which may also reduce the need for costly inpatient services and emergency room (ER) visits.

The new option requires that crisis response teams include one qualified behavioral health care professional who is able to provide an assessment within the scope of practice requirements under state law with the states ability to add other professionals and paraprofessionals with expertise in substance use and/or mental health crisis response to the team.

New Medicaid Option Promotes Mobile Crisis Intervention Care

Mobile crisis intervention services deliver fast, appropriate care to individuals in crisis and help to avoid unnecessary, costly ER visits and Mobile crisis intervention services deliver fast, appropriate care to individuals in crisis and help to avoid unnecessary, costly ER visits and...

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[Lori]

OIG & Hospice Eligibility​

OIG agency plans on focusing on those hospice beneficiaries that haven’t had an inpatient hospital stay or an emergency room (ER) visit in certain periods prior to their start of hospice care suggesting an audit may focus to a large degree on the beneficiary population with diagnoses such as dementia, chronic kidney failure, and heart disease.

Several past compliance audits identified findings related to beneficiary eligibility with terminal illness tends to be of particular concern.

A nationwide audit likely will entail requests to hospices nationwide for individual Medicare hospice claims and supporting hospice records.

OIG says it plans to issue a report on the topic in 2023.

Read more here:

OIG Shines Spotlight on Hospice Eligibility

New Work Plan item bodes ill for hospices. Hospices should get ready to defend their industry’s reputation all over again. Why? The HHS Office of

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[Lori]

January 2022 ASC Payment System Changes​

Two new device pass-through categories are now in effect

C1832 Autograft suspension, including cell processing and application, and all system components; J7 ASC payment indicator (PI)
0525T
0526T
0527T

C1833 Monitor, cardiac, including intracardiac lead and all system components (implantable); J7 ASC PI
15110
15115
15100
15120

CMS is reinstating the criteria for adding procedures to the ASC Covered Procedures List (ASC CPL) that were in place in CY 2020.

2022 OPPS/ASC Final Rule:

• Keep six procedures on the ASC CPL; three were already on the ASC CPL; three were proposed for removal (0499T, 54650, 60512).
• Remove 255 of the 258 procedures proposed for removal.

Read more here:

ASC Payment System Updates: January 2022

Weeks after finalizing payment rates and policy changes for CY 2022, CMS released updates to the ASC payment system, effective Jan. 1, 2022.

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[Lori]

New Rural Health Clinic Policies revised.

Learn what's new.

On Jan. 1, CMS implemented the following updates affecting RHCs:

• RHCs can now bill Transitional Care Management (TCM) and general care management services furnished to the same patient during the same service period, provided the RHC meets the billing requirements for each code.
• As of April 1, 2021, RHCs will receive a prescribed national statutory payment limit per visit increase over an eight-year period for each year from 2021 through 2028.
• In addition to flu, pneumococcal, and COVID-19 shots, Medicare now covers COVID-19 monoclonal antibody products and their administration at 100 percent of reasonable cost.
• RHCs can report and get paid for mental health visits furnished via real-time telecommunication technology.
• RHCs are eligible to get paid for hospice attending physician services when provided by an RHC physician, nurse practitioner, or physician assistant who’s employed or working under contract for an RHC but isn’t employed by a hospice program.
• Addition of hospice to the list of locations where RHC visits can take place.
• Specification that the bundled payment, or All-Inclusive Rate (AIR), Medicare pays RHCs is per visit, for qualified primary care and preventive health services provided by an RHC practitioner.

Read more here:

Rural Health Clinic Policies Revised

Don't send another Rural Health Clinic (RHC) claim until you've reviewed these key updates for 2022. Learn about payment, visit, and service changes that went into effect Jan. 1.

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[Lori]

AAPC 2021 salary survey results are in!

Where do you stand?

Do you feel this is an accurate portrayal?

2021 Salary Survey Shows Market Rebound

AAPC’s 2021 Salary Survey shows that our members are resilient, forward-thinking leaders in the business of healthcare

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[Lori]

New ICD-10-PCS codes

The Centers for Medicare & Medicaid Services first introduced seven new codes for the second quarter of 2022.

All new technology group 7.

XW013V7 Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach

XW013W7 Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach

XW023V7 Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous approach

XW023W7 Introduction of COVID-19 vaccine booster into muscle, percutaneous approach

XW0DXR7 Introduction of fostamatinib into mouth and pharynx, external approach

XW0G7R7 Introduction of fostamatinib into upper GI, via natural or artificial opening

XW0H7R7 Introduction of fostamatinib into lower GI, via natural or artificial opening

XW023X7 Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach

XW023Y7 Introduction of other new technology monoclonal antibody into muscle, percutaneous approach

9 New Introduction Codes Added to ICD-10-PCS

Effective April 1, 2022, hospitals will have nine new procedure codes to describe the introduction or infusion of therapeutics, including the additional Effective April 1, 2022, hospitals will have nine new procedure codes to describe the introduction or infusion of therapeutics

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[Lori]

Monoclonal antibody (mAb) products and administration.

Medicare will no longer pay for COVID-19 vaccines and mAbs provided to MA patients (except MA hospice patients, but excluding MA plans that participate in the Hospice Benefit Component of the Value-Based Insurance Design Model).

Providers should now bill the patient’s MA plan directly.

COVID-19 Monoclonal Antibody Billing

Medicare reminds healthcare providers of an important coverage change through claims denials. Ever since a public health emergency (PHE) for COVID-19 was effective Jan. 1, 2022, Original Medicare will no longer pay for COVID-19 vaccines and mAb infusions provided to MA patients

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[Lori]

Unrelated Critical Care Services Append Modifier FT.

To report an unrelated evaluation and management (E/M) service during the global period of a procedure or on the same day as another E/M service indicates that the E/M service performed is not related to either the operative procedure or to the other E/M service provided on that same day.

CMS allows payment for preoperative/postoperative critical care “in addition to the procedure if the patient is critically ill (meets the definition of critical care) and requires the full attention of the physician, and the critical care is above and beyond and unrelated to the specific anatomic injury or general surgical procedure performed

Append Modifier FT for Unrelated Critical Care Services

On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT. While the new modifier took effect Jan. 1, CMS only recently provided some specifics about its application.

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HCPCS Level II Deletions and Revisions Effective Q2​

The five deleted codes include chemotherapy injection codes C9084-C9087 and clinical decision support mechanism code G1009.

Also, the descriptor for modifier FT is revised to clarify its use is to identify a service that is unrelated to an evaluation and management (E/M) visit during a global procedure:

Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated)