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Not fine: Jail threat in compounded drug HIPAA breach serves warning
10/24/2022
by: Roy Edroso
A doctor faces a year in prison on HIPAA violation charges — a rare but real threat when prosecutors find providers or other health care workers flouting protected health information (PHI) rules in a way that calls for more than the usual fines and sanctions.
Look for severity of dementia to discern ICD-10-CM code selection
10/24/2022
by: Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I
Coders must review updates to the ICD-10-CM code set to stay current, and for 2023 you will find several new codes in the “Mental, Behavioral, and Neurodevelopmental Disorders” chapter for dementia.
‘After-hours’ codes can add dollars, and so can ‘during-hours’ codes
10/24/2022
by: Roy Edroso
Question: One of our commercial payers offers extra payment from the add-on codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [eg, holidays, Saturday or Sunday], in addition to basic service) and 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service). I get the first code, but the second one just sounds like normal service during normal hours. What’s the deal?
Heaps of ‘after-hours’ codes reported, and all denied
10/24/2022
by: Richard Scott
Despite a non-payable status under Medicare, a series of six codes that reflect care provided during irregular or emergency hours garnered hundreds of thousands of claims – and returned zero dollars – in 2021.
CY2023 CPT update ushers in 200-plus new codes
10/17/2022
by: DecisionHealth Staff
Practices can expect nearly 400 code changes in their CPT manuals for 2023, including 224 new codes, 93 revised and 74 deleted codes.
Settlements in Cardinal case a warning that ‘prebates’ are kickback traps
10/17/2022
by: Roy Edroso
A major anti-kickback case involving “prebates” on bulk specialty drug sales is leading to cash settlements with provider groups. It’s a reminder that even established vendors may offer you deals that aren’t strictly legal — and leave you holding the bag.
Emergency medicine groups: Prepare for a ‘once-in-a-generation change’
10/17/2022
by: Julia Kyles, CPC
Emergency medicine groups should be gearing up for the switch from the traditional coding and documentation guidelines for emergency department services (99281-99285) to the new CPT guidelines that will go into effect Jan. 1, 2023.
SCOTUS rejection suggests vaccine mandate will last into 2023, at least
10/17/2022
by: Roy Edroso
The Supreme Court turned away a challenge by 11 states to the HHS health care worker vaccine mandate, signaling that overturn of the staff vaccination requirement is now all but impossible, at least until the public health emergency (PHE) is over.
CDC fixes ICD-10-CM Table of Drugs code error
10/17/2022
by: Richard Scott
The CDC made a coding correction within the official ICD-10-CM Table of Drugs and Chemicals that was part of the FY2023 diagnosis coding update that took effect Oct. 1.
Office visits in ’21: Slight bounce back from the COVID-19 crash, denials stayed flat
10/17/2022
by: Julia Kyles, CPC
Visits in the office/other outpatient setting (99202-99215) started to recover from the COVID-19 slump in 2021 but they didn’t reach pre-2020 levels, according to a review of the latest Medicare Part B claims data.
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