Coding rules for Colonoscopies are complex, especially those relating to Screening Colonoscopies. The Cologuard test is becoming more popular as a non-invasive colorectal cancer screening test. On January 1, 2023, CMS changed its payment policy regarding Colonoscopy after a positive Cologuard test. This rule change has been widely misinterpreted. This episode explains how the host, Piyush Sheth, MD, resolved the controversy.
CMS Response to Dr. Sheth link:
https://drive.google.com/file/d/1glZ5xEoDhm8ZYvEHZpBzkSwF_4Ch5-Hm/view?usp=sharing
The coding changes to Office / Outpatient Services implemented on January 1, 2021 and the complimentary changes to Hospital Services implemented on January 1, 2023 were designed to minimize documentation burden and allow providers to focus more on patient care. This episode discusses one major unintended consequence of these changes: the shift of the E/M CPT coding bell curves to higher levels.
Topics discussed in this episode: E/M Documentation, Coding, Audit, RVUs.
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NEW: Coding Solutions Evaluation and Management Services, 2024: Coding Solutions Evaluation and Management Services, 2024
Coding Solutions General Surgery, 2024: Coding Solutions General Surgery, 2024
These are our 4 wishes to improve documentation, coding, and healthcare from our hosts Neal Sheth and Dr. Piyush Sheth. There is also a free gift for our listeners.
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This episode discusses the clinical issues, proper coding (using CPT and modifiers), and current payment policies regarding colonoscopies. Unfortunately, because these three aspects are intimately entwined, colonoscopy coding can get quite complex. Hosts Neal Sheth and Dr. Piyush Sheth try to simplify and clarify the concepts behind coding for colonoscopies.
2023 brings a host of changes to medical coding and billing. Dr. Piyush Sheth talks about ICD, CPT, and reimbursement changes including changes to RVU values.
Episode Summary: Medical Documentation has suffered a decline in integrity due to adoption of Electronic Medical Records and an incomplete understanding of Documentation Guidelines. Hosts Neal Sheth and Dr. Piyush Sheth explore this topic and provide solutions that can strengthen your medical record documentation and make them stand up to scrutiny during audits.
Visit our blog: www.unravelingmedicalcoding.com
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CODING SURGERY: General Surgery, 2022 available on Amazon.
Episode Summary: RVU’s (Relative Value Units) are the currency of healthcare. Hosts and General Surgery Certified Coders Neal Sheth and Dr. Piyush Sheth explore the concept of RVU’s and Geographic Practice Cost Indices and how CMS makes payments.
Visit our blog: unravelingmedicalcoding.com
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Coding Solutions: General Surgery, 2022 is available now on Amazon
Episode Summary: Modifiers are two-digit codes that can be appended to a CPT code in special situations to justify payment for the service when payment otherwise would be denied. Understanding the proper use of modifiers can lead to better reimbursement. Hosts Neal Sheth and Dr. Piyush Sheth explore some of the most common modifiers used.
Visit our blog: unravelingmedicalcoding.com
Don’t forget to subscribe to our podcast: Unraveling Medical Coding
Coding Solutions: General Surgery, 2022 is available now on Amazon
Episode Summary: Modifiers are two-digit codes that can be appended to a CPT code in special situations to justify payment for the service when payment otherwise would be denied. Understanding the proper use of modifiers can lead to better reimbursement. Hosts Neal Sheth and Dr. Piyush Sheth explore some of the most common modifiers used.
Show Links:
Full Transcript Available at: www.unravelingmedicalcoding.com
Episode Summary: CMS released their Calendar Year 2022 Medicare Physician Fee Schedule Final Rule on November 2nd. There are significant changes to the PFS conversion factor, billing for Shared/Split inpatient services, Critical Care services, Telehealth services, and Colorectal Screening procedure co-insurance payments among others. Hosts Neal Sheth and Dr. Piyush Sheth try to make sense of these changes and how they affect documentation, coding, and billing.
Show Links:
Summary of CMS CY2022 MPFS Final Rule
Full Transcript Available at www.unravelingmedicalcoding.com
Episode Summary: Our previous episode dealt with EMR issues relating to documentation quality and ease of use. In this follow-up episode, hosts Neal Sheth and Dr. Piyush Sheth explore concepts on creating a better user environment in EMRs and on a more global level, improving EMR infrastructure.
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Topics discussed in this episode: EMR, EHR, EPIC, Infrastructure
Full Transcript available at: unravelingmedicalcoding.com
Episode Summary: Electronic Medical Record software has the potential to facilitate documentation and minimize errors. EPIC is the most widely used EMR in the United States. There are other EMR vendors. Despite their pervasiveness in healthcare, documentation quality in EMRs is often poor and prone to error propagation. A clear understanding of proper documentation is necessary for proper medical coding. Hosts Neal Sheth and Dr. Piyush Sheth explore EMR best practices as they relate to patient care and medical documentation.
Show links:
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Full transcript available at www.unravelingmedicalcoding.com
Episode Summary: Critical Care coding is complicated. There are clearly defined requirements that must be adhered to in order to bill this time-based service. Hosts Neal Sheth and Dr. Piyush Sheth explore the intricacies involved with Critical Care coding.
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Full transcript available at www.unravelingmedicalcoding.com.
Episode Summary: Physician extenders (physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives) can ease the burden of the physician shortage. Coding and billing for utilizing physician extenders in a medical practice can increase reimbursement, but only in certain situations. Hosts Neal Sheth and Dr. Piyush Sheth explore the nuances of using physician extenders.
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Full transcript available at www.unravelingmedicalcoding.com
Episode Summary: Office consultation coding requires three documentation items in addition to fulfilling the standard evaluation and management services documentation of history and physical exam. These three items are: Request, Reason, and Report. The requesting physician must document a request to the consulting physician. There must be a reason for the consultation. And, the consultant must send a report of the consultation back to the requesting physician. If these three criteria are not satisfied or there is a transfer of care, a consultation billing code cannot be billed. Hosts Neal Sheth and Dr. Piyush Sheth explore these requirements in detail and resolve scenarios that highlight grey areas. Of special note is that Medicare no longer recognizes consultation codes.
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Full Transcript Available at www.unravelingmedicalcoding.com
Episode Summary: New medical documentation guidelines for Outpatient Office visits were implemented on January 1, 2021 as part of the “Patient’s over Paperwork” initiative by Medicare with input from the American Medical Association. These new documentation guidelines require a “medically appropriate” history and physical exam and are billed by either Total Time or Medical Decision Making. Host Neal Sheth interviews Dr. Piyush Sheth regarding these guidelines including benefits and pitfalls and their impact on healthcare economics.
Resources:
AMA 2021 E/M Office visit changes:
E/M office visit changes (ama-assn.org)
AMA updated document regarding Outpatient Office visits:
Code and Guideline Changes | AMA (ama-assn.org)
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Full Transcript Available at www.unravelingmedicalcoding.com
Episode Summary: Medical coding and billing is complex. The International Classifications of Diseases version 10 (ICD-10) and the Current Procedural Terminology (CPT®) code sets are expansive. Furthermore, proper medical documentation using the Medicare Evaluation and Management Documentation guidelines from 1995 and 1997 make efficiency challenging. Host Neal Sheth interviews Dr. Piyush Sheth, author of Coding Solutions – General Surgery and Starting Medical Practice, to provide a brief overview of this complexity and his drive towards efficiency.
Resources:
Gallbladder chapter from Coding Solutions – General Surgery
https://drive.google.com/file/d/1KGFBdefXmed8GRB1zTA8MDNGaWPSumwD/view?usp=sharing
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Full Transcript Available at www.unravelingmedicalcoding.com