logo
ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update

Coding

ICD-10 & Other Coding Revisions to National Coverage Determinations: October 2023 Update
Effective Date: August 7 & October 1, 2023
Implementation Date: August 7 & October 2, 2023


CR 13166 is a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

The translations from ICD-9 to ICD-10 aren't consistent one-to-one matches, nor are all ICD-10 codes appearing in a complete General Equivalence Mappings (GEMs) guide or other mapping guides appropriate when reviewed against individual NCD policies.

Relevant NCD coding changes in CR 13166 include: 
  • NCD 20.20-External Counterpulsation Therapy (ECP) for Severe Angina, effective August 7, 2023
  • NCD 90.2-Next Generation Sequencing (NGS), effective August 7, 2023
  • NCD 210.1-Prostate Screening Tests, effective October 1, 2023

Previous NCD coding changes are available. Also, see the NCD spreadsheets attached to CR 13166. 

CMS isn't including any policy changes in this ICD-10 quarterly update. We cover NCD policy changes using the current, longstanding NCD process.

Your MAC will adjust any claims processed in error associated with CR 13166 that you bring to their attention.

Source: CMS


The Role of Artificial Intelligence in Revolutionizing Medical Billing Services for Physicians

Practice Management

The Role of Artificial Intelligence in Revolutionizing Medical Billing Services for Physicians:In today's rapidly advancing healthcare landscape, medical billing has become a critical aspect of running a successful medical practice. Efficient and accurate billing processes are essential for healthcare providers to receive timely payments for their services. With the advent of artificial intelligence (AI) technology, medical billing services have undergone a revolutionary transformation. This article explores the role of artificial intelligence in revolutionizing medical billing services for physicians, highlighting the benefits and advancements brought about by this innovative technology.
Navigating Carrier Guidelines for Optimal Practice Reimbursement

Practice Management

Navigating Carrier Guidelines for Optimal Practice Reimbursement:When a Medicare patient has multiple sources of insurance coverage, Medicare will only pay for services after the primary payor has processed the claim and made their payment.  Medical office staff must always verify the patient's insurance coverage thoroughly-gathering all necessary information from the primary insurance, such as policy numbers, claim submission instructions, and any preauthorization requirements, etc.
E/M Scoring Questions

Coding

E/M Scoring Questions:Evaluation and Management visits are often the "bread and butter" of an organization. Thus, correctly scoring encounters is essential to ensuring proper reimbursement. The element of "Risk" is only one of the three elements of Medical Decision Making (MDM) but understanding what is meant by all the definitions within each element is critical. 
Two HIPAA Enforcement Actions Underscore the Importance of the Confidentiality, Integrity, and Availability of Patient Information and the Consequences

Security

Two HIPAA Enforcement Actions Underscore the Importance of the Confidentiality, Integrity, and Availability of Patient Information and the Consequences:In March 2023, the current Presidential Administration announced its national cybersecurity strategy. Prior to its release, the President issued two Executive Orders, which underscored the importance of privacy of individuals' health information, tracking data without the knowledge or consent of a consumer/patient, and coordination among federal government agencies to implement initiatives or strengthen existing initiatives.
The Evolution of MIPS and Understanding the Upcoming Changes

Practice Management

The Evolution of MIPS and Understanding the Upcoming Changes:In the world of healthcare, the Merit-Based Incentive Payment System (MIPS) plays an instrumental role in incentivizing providers to deliver high-quality, efficient patient care. However, staying up to date with MIPS can be a challenge as the program is subject to continuous changes and updates. 
The Audit Process

Auditing

The Audit Process :I hold a LinkedIn Live broadcast called Health Care Happenings that also airs on Facebook and YouTube every other Thursday, in which I discuss different healthcare topics.  I recently did a three-part series on auditing: Preparing for the Audit, Performing the Audit, and Providing the Audit Results.  This article will expand on that series to discuss the audit process.
Proposed Rule for Medicare Physician Fee Schedule CY 2024 Sees Continued Decrease in Reimbursement

Practice Management

Proposed Rule for Medicare Physician Fee Schedule CY 2024 Sees Continued Decrease in Reimbursement:The Medicare Physician Fee Schedule (MPFS) Proposed Rule (PR) for Calendar Year (CY) 2024 was released on July 13, 2023. The PDF is available for review. Public comments are accepted for a sixty (60) day period through September 11, 2023.
Maximize Duplex Doppler Ultrasound Documentation and Reimbursement

Auditing

Maximize Duplex Doppler Ultrasound Documentation and Reimbursement:Complete documentation of any radiology procedure is the key to appropriate reimbursement.  This is especially true for venous duplex Doppler ultrasound exams, where including fewer than the required number of elements for a complete procedure will result in reimbursement for a limited study.  
Medical Necessity and Data Under the E/M Documentation Guidelines

Coding

Medical Necessity and Data Under the E/M Documentation Guidelines:Whenever I audit charts under the 2021 E/M Documentation Guidelines, which now apply in all places of service, I like to start by reviewing the first and third columns. The first column is Number and Complexity of the Presenting Problem, and the third column is Risk of Complications and/or Morbidity or Mortality of Patient Management.
Medicare Proposed Rule for 2024 Will Not Improve Radiology Reimbursement

Billing

Medicare Proposed Rule for 2024 Will Not Improve Radiology Reimbursement :The Centers for Medicare and Medicaid Services (CMS) announced its proposed Medicare Physician Fee Schedule (MPFS) rules for 2024, including provisions for the Quality Payment Program (QPP).  While not a done deal until the final rule is issued toward the end of the year, the Proposed Rule gives an indication of where CMS is headed with regard to payment policy.  In recent history, even the Final Rule isn’t final because Congress has had to intervene to stave off significant reimbursement reductions.  Here are the highlights of the 2024 Proposed Rule.
Monthly Spotlight on Fraud, Waste, and Abuse

Practice Management

Monthly Spotlight on Fraud, Waste, and Abuse:A physician was sentenced to two and a half years in prison for fraudulently obtaining and misappropriating approximately $250,000 from two separate COVID-19 relief programs.
Texas HHSC-OIG is Ramping Up Its Investigations of Medicaid Pediatric Telemedicine Claims

Practice Management

Texas HHSC-OIG is Ramping Up Its Investigations of Medicaid Pediatric Telemedicine Claims:In the state of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million Texans1  (approximately 18.9% of the current population2) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40 billion.

 

 

 

 

 

 

 

 

 

 

 

 

Get More - BC Magazine

Subscribe now to access more resources than ever before!

Magazine | CEUs | Webinars