Coding and Documentation

A Comprehensive Error Rate Testing (CERT) study showed that insufficient documentation causes most improper payments for observation and inpatient care services, according to the January 2019 Medicare Quarterly Compliance Newsletter.

Overcome E/M obstacles with a collaborative internal audit process.

CMS released additional instructions to the Medicare Claims Processing Manual for the accurate interpretation of claim edits and assignment of modifiers -59 and -91 on Medicare Part B claims.

Put these practices into place to overcome clinical validation denials for these services.

Check your processes to implement E/M documentation changes, code updates, and expanded laboratory reporting requirements.

Understand how payment policy changes, C-APC changes, and more will impact your organization.

CMS recently released the 2019 NCCI Policy Manual for Medicare Services, which includes updates to payment policies and coding methodologies effective January 1.

Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. cm and documented 20 sq. cm of skin substitute application (15271). My coder says that 11043/11046 is included in 15271 and we can't separately bill for them with 15271. Do we bill 15271 as the size of the debridement documented or only the size of the skin substitute?

Ease the EHR transition and prevent revenue loss by working with IT and revenue cycle leaders to create reporting solutions.