Billing & Coding

Psychiatric Partial Hospitalization Programs

BACKGROUND

According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:

Diagnostic Criteria for Behavioral Health

In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include:

The final list of the new ICD-10- CM codes that become effective October 1, 2016 has been released. There are approximately 1600 changes to the code set, making up for the four years the ICD-10- CM codes have not had a complete update. For fiscal year (FY) 2017, updates to the 2017 ICD-10- CM gynecology codes include more detailed codes, laterality, revision of postprocedural and other complications, such as problems with genitourinary implants and prostheses.

Breast Inflammatory Disorders of the Breast

The 2017 ICD-10-CM and ICD-10-PCS code updates, including a complete list of code titles, are available on the 2017 ICD-

Billing Units

When submitting a claim for payment, it is important to bill the correct amount of units. Entering the CPT or HCPCS procedure code that identifies the service provided is the first step. However, in many cases, a procedure or supply has a specified number of units as part of the definition of the code. It is important to correctly report the units within the guidelines for the code as well as the requirements of the payer.

The following are some important considerations when billing units:

The scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set are available on the 

CMS has noted that several high volume procedure codes are typically reported with a modifier that unbundles payment for visits from the procedure, even though the modifier should only be used for reporting services beyond those usually provided. Therefore, CMS believes the services may be misvalued. As a result, CMS is proposing to prioritize 83 services for review as potentially misvalued.

 

CMS.gov Fact sheet

The final version of the 2017 ICD-10- PCS codes has been released by the Center for Medicare and Medicaid Services. Beginning on October 1, 2016, the first day of the federal fiscal year, the use of these codes will become mandatory for hospital inpatient services.

CNN reported an astounding number of individuals charged with false billing. There was about $900 million in false billing that involved Medicare and Medicaid fraud. Along with the $900 in false billing, $36 million in Detroit involved a front for a narcotics diversion scheme. There were 301 defendants charged in the United States involving 61 medical professionals’ 36 Federal Judicial districts and 28 doctors were charged.

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