Glasgow Coma Scale – July 2021 Coding Tip

The Glasgow Coma Scale (GCS) is a clinical scale used to measure a person’s level of consciousness after a brain injury. The scoring is determined by three factors: amount of eye opening, verbal responsiveness, and motor responsiveness. The Glasgow Coma Scale has an adult version and a pediatric version. The pediatric version is also composed…

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Critical Limb Ischemia – June 2021 Coding Tip

Critical limb ischemia, also known as chronic limb-threatening ischemia, is a clinical syndrome of peripheral artery disease of the lower limbs with ischemic pain at rest and ischemic tissue such as nonhealing ulcers or gangrene. Critical limb ischemia (CLI) does not happen overnight and does occur over time. Patients are at a much higher risk…

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CERT (Comprehensive Error Rate Testing) – May 2021 Coding Tip

Effective August 11, 2020, the Centers for Medicare & Medicaid Services resumed the Comprehensive Error Rate Testing program activities that were temporarily suspended in response to the public health emergency for the 2019-Novel Coronavirus (COVID-19) pandemic. CMS uses Comprehensive Error Rate Testing to verify Medicare Administrator Contractors are properly paying claims. CERT audits coding and…

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Leading Cause of Death in America – April 2021 Coding Tip

UASI Solutions

Medical claims denials in 2019 approached $9 billion. The denial rate in 2020 increased by 23%. Coding/billing errors accounted for approximately 15% of all denials. Specificity of coding was one of the reasons claims were denied. In 2019, stroke was the leading cause of death and killed approximately 140,000 Americans. Three Simple Questions to Ask…

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Inpatient Only List – March 2021 Coding Tip

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The inpatient only list is composed of procedures for which Medicare will only pay for when performed in the hospital inpatient setting. CMS has determined this list to be an area of concern in that it restricts patient choice when it comes to surgery. CMS has proposed to eliminate the list over the next three…

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COVID-19 POA Indicators – February 2021 Coding Tip

COVID-19 is a complex disease with a wide spectrum of clinical patterns. COVID-19 was initially viewed as primarily a respiratory disease, but is now recognized as a complex disorder affecting many body systems. Coding professionals need to be knowledgeable of the testing of COVID-19 (e.g., diagnostic and antibody tests) and the COVID-19 disease processes (e.g.,…

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Coding Tip of the Month – January 2021

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New Add-On-Code 57465 Computer-Aided Mapping of Cervix Uteri New  to Current Procedural Terminology 2021 is the add-on-code 57465. This code was created for the Female Genital System/Endoscopy subsection of the Surgery section to report computer-aided mapping of cervix uteri during colposcopy. +57465  Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and…

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Coding Tip of the Month – December 2020

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CPT Coding Changes for 2021 Effective January 1, 2021 shoulder debridement codes 29822 and 29833 will be revised. Currently codes 29822 and 29823 only describe shoulder arthroscopy with limited and extensive debridement. Starting in January these codes will be revised to specify the number of “discrete” structures debrided and include anatomical examples.* 29822: Arthroscopy, shoulder,…

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Coding Tip of the Month – September 2020

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NEW CPT codes for COVID-19 Pandemic Published September 8th by the AMA Two new CPT codes as published by the AMA for novel coronavirus (COVID-19) related services. The first is CPT code 99072, Additional supplies, materials,  and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when…

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