Author Archives: Rebecca Caux-Harry

New year, new CPT modifications

Another year has come and gone and we are now entering into the most exciting time of year. Yes, that’s right, it’s CPT additions, deletions and modifications time!   Each year, coders across the United States eagerly await our new CPT books. Mine is still leaving paper dust all over my desk as I turn each newly printed page to see the updates.

Because the CPT manual puts the E&M codes in the front, I’ll list those changes first. Continue reading

Coast to coast with ICD-10

We’re now almost two months into ICD-10. I’ve been, literally, coast to coast during that time and have asked everyone how their transition is going. To my surprise, regardless of where physician practices were in their preparation when ICD-10 was delayed last year, everyone that I’ve visited with was well prepared for this year’s Oct. 1 implementation.

Many practices used the extra time to work on dual coding, testing of clearinghouses, reviewing new LCD policies, etc. Some groups were glad the implementation date was pushed back, but equally as many were not, having to retrain coders and providers on the new code set. As mentioned last month, there have been a few bumps, but the only consistent comment I hear is about coder productivity and documentation. Continue reading

ICD-10: One month in

October 1, 2015 has come and gone. I didn’t really expect everything to come to a screeching halt, as warned during the anticipation of Y2K. I did, however, expect that by the middle of this month, we would have some horror stories about claims issues with regard to the transition from ICD-9 to ICD-10. I’m still waiting. I’m sure there have been individual issues, but scanning list serves, web sites, CMS, etc., I haven’t seen any systemic issues with regard to claims payment in the professional, Part B world. Insert sigh of relief here. Continue reading

E&M coding: Incident-to vs. shared visit guidelines

I’ve written in the past about how to score the language within an E&M note. There are a number of ways to arrive at the same code, or in fact, a different code. But, there are also different types of providers and coding/billing rules associated with those different types of providers. In past blogs, I’ve written primarily about physicians as providers of care. But there are other health care members that provider E&M services, and can bill for them, but you have to know all the rules associated with each type of provider. Continue reading

E&M coding: Element-based or time-based?

I went to see one of my physicians today. She at her computer, me in a chair, discussing the multiple medications I’m taking, and the resulting side effects. If you’re a regular reader of my blog, you’re aware of my recent health challenges. I try not to think about what it was like before having a drawer full of medicine bottles but, I’m just whining. I know I’m lucky and I know I’m basically healthy. I’m probably a bit spoiled, too. But, back to the office visit today. My doctor and I talked for a long time. We reviewed my extensive (for me) list of medications and I complained about those side effects. She proposed a different medication regimen, then we discussed the risks associated with this change. I had a lot of questions, she consulted some studies online and we talked some more. At the end of this visit, I was examined and the impression and plan were discussed. Continue reading

Supervision and Incident-to Guidelines

In past blogs, I’ve written about a variety of E&M services and how to code those visits. In case that seemed straightforward, many years ago mid-level providers were added into the mix. You will see these types of providers abbreviated as MLP (mid-level providers), NPP (Non-physician practitioners), NP (Nurse Practitioners), PA (Physician’s Assistants), and some others. For the purpose of this blog, I’ll use MLP. The introduction of these types of providers created a new education opportunity for all of us. CMS created “Incident-to” guidelines and published them in the Medicare Benefit Policy Manual (S60.1-S60.4). This means that an MLP can provide services to a patient and report those services under the physician’s name when those services are provided incident to an established plan of care for that patient. Continue reading

The Client Experience Summit: It’s No Longer Just for Hospitals!

May 5-7 in Salt Lake City was a fantastic time. It has been three years since 3M acquired CodeRyte and it was great to see many CodeRyte customers attending this year. Additionally, we had a full Ambulatory training track. For customers that missed it, look for your invite next year and consider joining us. Continue reading

Where Would We Be Without Clinical Coders?

I’m sitting on a plane today, traveling through the air as a result of some very bright people that enabled this mode of transportation. I’m doing so safely, thanks to strict airport security practices. Many years ago, when more stringent airport security screening was established, I would listen to fellow travelers complain about the invasion of privacy, the maybe not-so-random searches and the added expense tacked on to everything. And the lines in security, oh the lines! However, as a frequent traveler I’m forever thankful for the process we flyers have to go through to ensure the safest passage possible. Continue reading

SGR and ICD-10: Time for Spring Cleaning

It’s that time of year again. For people not working in the healthcare industry, it’s time for flowers to start blooming, windows to be opened to fresh air, swimsuit shopping and, even though we had a short-lived blizzard in Colorado yesterday, I’m ready for spring! Let the spring cleaning begin. However, there is the painful memory of last year, when ICD-10 was delayed “at least until October 1, 2015” via the SGR repeal bill, also known as the doc fix bill. I remember exactly where I was when I heard the news. Continue reading

An Ounce of Prevention When Coding Preventive E&M Services

In previous blogs, I’ve written in detail about the different sets of exam guidelines, scoring of HPI, ROS, MDM and other details. These are the components that make up the supporting documentation for most E&M services.  There are a few exceptions, however, like critical care, facility coding, and preventive medicine.

There are many types of E&M visits, primarily separated into sick versus well visits. They can occur at the same time, but usually don’t.  Patients coming in for their annual physical usually schedule another visit to discuss any acute issues. Continue reading