Billing for end-of-life care talks grows, but barriers remain

Published: Mon, 07/29/19

Advance-care planning (ACP) is the keystone of goal-concordant care, enabling patients to state their treatment preferences while they still have the mental capacity to do so. The Centers for Medicare & Medicaid Services has acknowledged this by accepting two Current Procedural Terminology (CPT®) reimbursement codes for these essential conversations.

It’s No Longer Just a Threat: Shared Decision-Making for Defibrillators

Many readers may remember the Centers for Medicare & Medicaid Services (CMS) Transmittal 534. This was released in early August 2014, and it would have given Medicare contractors the ability to automatically deny associated physician claims when a hospital claim was denied. As written, if an inpatient admission was denied for...

New ICD-10 codes will help physicians tackle social barriers to care

A new collaboration between the AMA and UnitedHealthcare will work to address the social and environmental factors that affect patients’ health by standardizing data collection on their social determinants of health (SDOH) to help address individuals’ unique needs that often go unmet.

CCI Modifiers: July 1 Update to Modifier 59 Rule Is Now in Force … and More

Modifiers are the key to overriding Correct Coding Initiative (CCI) edits, so let’s give them the attention they deserve. We’ll start with a recent rule update and move on to helpful hints about CCI-associated modifiers in general. Which CCI edits? Our focus here will be Medicare CCI Procedure-to-Procedure (PTP) edits for physicians and practitioners.

ICD-10-CM used to document diagnoses but also affects payment

Although International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) took effect on Oct. 1, 2015, there still are many gaps in the understanding and use of the code set. ICD-10-CM is the standard transaction code set for diagnostic purposes under the Health Insurance...