RMC’s Blog
AMA CPT ® 2022 Codes Are Announced
The American Medical Association (AMA) has announced their 2022 Current Procedure Terminology (CPT ®) new codes and changes. For 2022, there are 405 editorial changes in the 2022 CPT code set, including 249 new codes, 63 deletions and 93 revisions. So, for the coding...
DOJ: Medical Unnecessary Stent and Ablation Procedures Back in the News
We’ve heard about government investigations into unnecessary cardiac stent placement and cardiac ablation procedures in the past. On September 15, 2021, the Department of Justice (DOJ) announced a settlement was reached in a case involving unnecessary cardiac...
OIG Reports: Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments to Disproportionately Drive Payments
The Office of Inspector General (OIG) released another Medicare Advantage (MA) report, this time indicating the several Medicare Advantage companies were/are leveraging chart reviews and health risk assessments (HRAs) to drive up MA hierarchical condition category...
Sepsis Awareness Month: Information Abounds
It’s September so that means it’s the beginning of Fall AND it’s Sepsis Awareness Month. Who would have thought we needed a month dedicated to this topic? But we do! Over the past 20 or so years the topic of Sepsis, Septicemia, Septic Shock and alike has...
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...