Archive for September, 2011

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September 30, 2011

CMS ramps up help for 5010 transition

CMS has released tools and information in the past week or so to help with the 5010 transition:

  • The agency has chosen 3M’s ICD-10 Code Translation Tool to convert its own systems, applications and reports to the new codes.
  • Eagerly anticipating, or dreading the change? Download CMS’s timeline widget to keep track of the, well, timeline! The agency has set up other widgets and information to help agencies prepare.
  • And I can’t believe I missed it, but the agency declared two 5010 Testing Days, one in June and one in August.

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September 28, 2011

Time for our annual date dance

As codes change Oct. 1, we need to think about which set of codes, 2011 or 2012, we need to use for our patients whose episodes cross over the code change period.

Actually, we need to look at what episodes or assessments cross the code change period. The choice of codes, and CMS confirmed this to me, is based on M0090, the completion of assessment. Soooo…

If the assessment is not complete by Oct. 1, we use 2011 codes for the RAP and EOE. If the assessment is complete by Oct. 1, use the 2012 codes.

What about payment changes over the fiscal year change? CMS has a formula that factors in payment issues. It’s not something for us to worry about.

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September 26, 2011

Skin neoplasm codes go the way of 5th digits

All 173 codes are now 5th digits, following the recent trend in neoplasm codes. The bigger issue with these five-digit codes is that CMS has only designated 173.09 as a case-mix code, not the other codes. This takes away our case-mix codes. Almost all neoplasm 173 codes were all case-mix before the 2012 list came out. That should not be done without rulemaking, so there are may queries in to CMS about this issue.

Remember that the codes follow a patter with the 5th digit:

0 = unspecified

9 = other specified (and this is the case-mix code)

Also remember that the codes affected are not melanoma codes.

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September 22, 2011

Coding education comes to Texas!

If you haven’t gotten your coding education lately, including 2012 codes, book in one of my seminars in Houston, Dallas, or McAllen.

 

Advanced Coders, I’ll see you in November!

November 4, McAllen: Club At Cimarron, 1200 South Shary Road, Mission, TX 78572-7426
November 11, Dallas: Holiday Inn Express 6055 LBJ Freeway @ Preston, Dallas, TX 75240
November 28, Houston: Holiday Inn Houston Westchase 10609 Westpark Drive Houston, TX 77042

The advanced classes are approved for HCS-D CEUs and nursing continuing education credits.

Beginning coders, join me in October!

October 14, Houston: Holiday Inn Houston Westchase 10609 Westpark Drive Houston, TX 77042
October 17, Dallas: Holiday Inn Express 6055 LBJ Freeway @ Preston Dallas, TX 75240

The beginning courses are approved for nursing continuing education credits.

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September 20, 2011

Pssssstt … Medicare open enrollment is early this year

CMS is holding a dial-in education call Thursday, Sept. 22, 3-4pm ET, to talk about open enrollment which runs from Oct. 15 – Dec. 7, 2011.

Here is the information:

Dial: 1-866-501-5502 & Reference Conference ID: 11763777.

TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-800-642-1687; Conference ID: 11763777.

Encore is an audio recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conference ID. This recording will be accessible beginning 4 hours after the Listening Session ends and expires Thursday, October 6, 2011.

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September 19, 2011

Read up on PT assessment exceptions

CMS has answered issues with single therapy visits …

Question: Can you please clarify this for me? If we are only doing physical therapy (PT) and the 30-day re-evaluation not only falls on the 12 visit and on a Friday and then come Monday is the 13 visit, do I have to send out the PT for another re-evaluation? We are concerned that a 30-day reassessment conducted on the 12th PT visit in single therapy cases will not suffice to meet the 13th therapy visit assessment. If it doesn’t meet requirements, there would be a large financial impact based on non-coverage of subsequent PT visits.

CMS Response: You are correct that for a single therapy case, the therapist must do the reassessment visit exactly on the 13th and 19th visits, unless the rural or documented circumstances outside the control of the therapist exceptions apply as stated in 42 CFR 409.44(C)(2)(i)(C). If neither exception applies, the PT would need to do the reassessment on the 13th visit as required by the regulations.

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September 8, 2011

Four months to the 5010 conversion

The Version 5010 transition is less than four months away, and your transition should be well under way.

Where are you in your preparedness?

You should:

•     Continue to coordinate the transition to the new formats and testing with providers, clearinghouses, billing services, and other business partners

•     Complete external testing and your Version 5010 transition by December 31, 2011, to achieve Level II compliance

See the CMS 5010 website for more information about Version 5010.

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