- HCC Webinar
- ED visits
- CPT coding changes, 2018
- New! Prolonged services
   HCPCS codes

Nicoletti Notes

December 2017

Dear friends and colleagues,
HCC Webinar
This is absolutely the last chance to sign up for my webinar on Thursday, Dec 14 on risk adjusted diagnosis coding in the medical practices.  Do it right now, here. It is free to CodingIntel members and has one AAPC credit.
ED visits, front and center
Two national payers are warning us that ED visit denials will certainly increase in 2018.  The first is Anthem, which is going to roll out a policy that denies ED visits based on the final diagnosis on the claim.  Currently, most insurers use a prudent layperson criterion to evaluate if a claim is medically necessary.  A prudent layperson would think that “slurred speech” was a reason to go to emergency room, even if the discharge diagnosis was R47.81, slurred speech, not stroke.  Anthem is going to look at the discharge diagnosis and deny ED claims that aren’t medically necessary.  Not mad enough? UHC is going to use proprietary (AKA secret, we won’t tell you how we came to the decision) software to downcode facility claims, without reviewing a single note.  Let’s hope our specialty societies are advocating for us.
CPT coding changes, 2018
I’ve written an article that will post Dec. 19 that summarizes coding changes for 2018.  Check back to the CodingIntel site then to read it.  And, in February, I’ll do a coding changes webinar that provides an overview of CPT changes and Medicare Final Rule changes.  We’ll post the date for that on the website before the end of the year.
NEW! Prolonged services HCPCS codes for Medicare preventive care
CMS has developed two HCPCS codes effective 2018 to be used with preventive care services. They are time-based codes, G0513 and G0514. They can be used in very specific situations.  As you start to use them, please let me know if your MACs are processing them and paying them correctly.
All the best in the New Year!


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