RMC’s Blog
Order Up! The Basics of IR Coding
Do you have trouble with IR coding? It can be difficult to determine code selection but understanding the rules can go a long way to understanding how CPT code assignment works. It’s all about the position of the catheter and the hierarchy of the codes. In a...
Hips & Knees: Replacements, Revisions, and Removals
Hip and knee replacements have been around for several decades, in fact, the first recorded attempt for a total hip replacement dates all the way back to 1891 when they created a femoral head replacement out of ivory. Hip and knee replacement procedures and implants...
Critical Care Overview
In this article we will highlight some key elements for Critical Care coding since these codes are watched closely by insurance payors. What is the definition of Critical Care? Per American Medical Association (AMA) CPT Professional 2021 codebook, critical care is...
The Importance of Risk Analysis
Even after all of these years I still run into covered entities (CEs) and business associates (BAs) who have not conducted a risk analysis, haven’t conducted on for several years or only conducted what OCR calls a gap analysis. Well, that can get you in hot water...
A Refresher to Understanding…Acute & Chronic Respiratory Failure Part 2
We continue with our discussion of “Respiratory Failure, please refer to Part I for information on the clinical aspects and on the ICD-10-CM coding classification of this diagnosis. Often we think of “respiratory failure” as a condition occurring in the inpatient...
National Coverage Determination
You’ve heard of them . . . NCDs or National Coverage Determinations. What are they really? Who do they apply to? And how can I learn more? National Coverage Determinations are specific to the United States healthcare system, and they fall under the Health and...
New Codes for COVID Booster
The Food and Drug Administration’s (FDA) took action in the month of August 2021 to authorize an additional dose of COVID-19 vaccine for immunocompromised individuals, referred to as a “COVID Booster”. Both Pfizer and Moderna have been approved for this the third...
CMS and OIG Focus on Improper ICD-10-PCS Ventilation Coding
The Medicare-Severity Diagnostic Related Groups (MS-DRGs) with ICD-10-PCS mechanical ventilation code(s) have been cited by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector (OIG) as problematic and a compliance risk. In a June 2021...
OIG Reports Overpayment for Chronic Care Management (CCM) Services . . . Time to Check Your CPT® Codes!
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) in early August 2021 published a report titled, ”Medicare Continues to Make Overpayments for Chronic Care Management Services, Costing the Program and Its Beneficiaries Millions of...
FY2022 IPPS Rule (MS-DRGs) is Released and Noteworthy
The Centers for Medicare and Medicaid Services (CMS) released on August 2nd, the Fiscal Year 2022 final rule for both Inpatient Prospective Payment System (IPPS) and the Long Term Care Hospital (LTCH) Prospective Payment System. After receiving more than 6500...