3 Coding Updates this Month

Almost every month new updates are made in healthcare. You can keep up-to-date with the latest coding updates, thanks to Healthcare Information Services (HIS).  Here are the 3 coding updates you need to know this month to prevent inaccuracies and/or inefficiencies.


1. Comprehensive Care for Joint Replacement Model Launched


A major step was taken in transforming care delivery for Medicare. The Comprehensive Care for Joint Replacement Model has launched. This model will work to improve the quality of care and support for hip and knee replacements – the most common procedures for Medicare beneficiaries. In fact, in 2014 alone there were 400,000 of these procedures.


Now, 800 hospitals located in 67 selected markets will be accounted for the costs related to care from the time of the hip or knee replacement, all the way through the post-hospitalization period. The changes were made to this proposed rule after 400 comments from the public were made. These comments from the public helped shape the new changes outlined above.


2. United Healthcare Requires Full Drug Description

United Healthcare has been seemingly targeting several physicians when reporting the knee injection with ultrasound. When a request for the medical records is received by United, they are auditing the complete record. Then, they are denying administration of the drug if complete dosage information is not provided.


It is important to note that dosage information must be provided according to the Healthcare Common Procedure Coding System (HCPCS) otherwise it will be denied. For example, prescribing 2ml Depo-medrol mixed with Marcaine would not be accepted, as Depo-medrol has HCPCS code for 20,40, and 80mg.


3. Laterality Reminder

Starting October 1st, 2016 it is important to be prepared for an update in ICD-10-CM. Any condition or injury that requires specification of left or right will require a diagnosis with laterality included. Unspecified laterality will not be accepted starting in October, so begin getting in the habit of including it.


Have any questions about this month’s coding updates? Feel free to contact Healthcare Information Services for more information and guidance.