Coding & Documentation

Ordering Psychotherapy

When a Psychiatric Diagnostic Evaluation results in an order for psychotherapy, simply stating “individual psychotherapy” is not appropriate.  It should be clear and concise as to what it is being order and why.  This will also assist in supporting the billing of psychotherapy session as “incident-to” (providing the other requirements for incident-to are met).  To properly document the order of psychotherapy the following should be noted:

No April Fool's Joke: House & Senate Delay ICD-10 for 1 Year

Yesterday, the United States Senate passed HR 4302, the Protecting Access to Medicare Act. If signed into law by President Obama, which is expected, then this bill will delay ICD-10 and shift required implementation from October 1, 2014 to as early as October 1, 2015. The act also extends the “doc fix” for Medicare’s Sustainable Growth Rate (SGR) payments for a year.

2014 Changes for Impacted Cerumen

AMA has clarified the CPT Code for impacted cerumen for 2014.  CPT 69210 will now be reported as a “unilateral” code.  Another noteworthy revision is that, physicians must use some type of instrumentation and may not remove ear wax solely by irrigation or lavage.  This follows the guidance given to AMA from American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) many years ago.

CMS Announces ICD-10 Concessions

The Centers for Medicare & Medicaid Services (CMS) announced, on July 7th, that it is making several critical changes to the transition period to ICD-10. They published a document that covers the concessions and how they will affect your practice: 

In an article that focused on concessions by CMS, the AMA notes the following changes to implementation:

  • Claim denials. For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.

    This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.

    Both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow this policy.
  • Quality-reporting penalties. Similar to claim denials, CMS will not subject physicians to penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.

    In addition, penalties will not be applied if CMS experiences difficulties calculating quality scores for these programs as a result of ICD-10 implementation.
  • Payment disruptions. If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
  • Navigating transition problems. CMS has said it will establish a communication center to monitor issues and resolve them as quickly as possible. This will include an “ICD-10 ombudsman” devoted to triaging physician issues.

What you need to do to prepare

They say these concessions should serve to ease the pain of the transition, but there is concern that many will see this as another delay and not place the proper priority on preparation. Preparation is still a high priority.  Zetter HealthCare is assisting clients with the most important aspect of preparation for ICD-10 and that is provider education on proper documentation to meet medical necessity and to ensure that the ICD-10 code(s) chose(n) to submit on the claim is documented properly in your HPI, exam and assessment from the notes of the patient encounter. 

We suggest that you also visit the CMS website for additional tips on ICD-10 preparation.CMS Frequently Asked Question on ICD-10 Preparation.

If you have any additional questions please feel free to send us an email at

CMS-1500 Claim Form Updates: Medicare to Accept Revised Form Starting January 2014

The CMS-1500 Claim Form has been recently revised with changes including those to more adequately support the use of the ICD-10 diagnosis code set.The revised CMS-1500 form (version 02/12) will replace version 08/05. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows for additional diagnosis codes, expanding from 4 possible codes to 12. 

Read more: CMS-1500 Claim Form Updates: Medicare to Accept Revised Form Starting January 2014