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Top medical coding issues to watch for in 2018

By Chris Harrop
December 6, 2017
Body of Knowledge Domain(s): Financial Management

Constant changes to quality-reporting programs and alternative payment methods for physician practices as the new year approaches require medical coders to understand how their work affects a practice's bottom line, according to Susan Whitney, CPC, CPC-I, CRC, CMPE, senior content manager, MGMA Organizational Content Development.

Whitney says that while practice leaders may understand changes associated with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the implementation of alternative payment models (APMs), the value-/quality-based incentives in those programs and contracts with commercial payers must be communicated to coders.

“I see over and over that practices are evolving — with MACRA, APMs and other value-based programs — but they forget to involve the coding department,” Whitney says. “Many coders are still under the impression that risk-adjustment coding doesn’t involve them — most likely an incorrect assumption.

“In the future, there will be more reimbursement contracts that include risk than not. … There’s probably not any practice out there that’s not affected by risk,” Whitney says. “However, an astounding amount of coders aren’t aware of those contracts and the implications they have on their daily roles.”

A Dec. 5 MGMA Stat poll of practice leaders found that 45% said they expect value-/quality-based reimbursement to increase in 2018, while 24% said they think the amount will stay the same and 14% responded that they think it will decrease. Another 17% were unsure. The poll had 1,083 applicable responses.

Practice leaders polled noted that many of their commercial payers are beginning to follow the standards found in MACRA and MIPS, with incentives tied to cost, quality and Patient-Centered Medical Home status. Other practice leaders who already operate in an accountable care organization (ACO) within Medicare also look to begin a Medicaid ACO in 2018.

In Whitney’s work talking to practices regarding audits recently, she noted that many administrators lament not getting shared savings from various companies because the practice does not show adequate risk to receive that reimbursement.

Whitney says that with quality-based care and other coding changes for 2018, it comes down to having awareness across the practice. “It’s not just a coder’s role, it’s not just an administrator’s role. Every entity in your practice needs to be educated on what this means,” Whitney says.

Beyond the move toward value in reimbursement, Whitney noted that various coding changes may catch many providers and coders by surprise.

For example: There are five new types of acute myocardial infarctions to code for in 2018.

“I’ve never seen a doctor put in his documentation ‘myocardial infarction, type 3.’ They either put acute, sub-acute, pending … this is a huge educational opportunity to go back to your providers because they can’t code it if it’s not documented.”

Another major area that practices need to look out for in 2018 is in Category 3 codes related to emerging technologies, according to Whitney. Many of those once-temporary codes have been deleted and evolved to Category 1 with their own CPT codes.

Whitney also recommends that practices pay attention to coding changes in the areas of:

  • Behavioral health, especially for primary care practices that have integrated those services recently
  • X-rays, where many familiar chest x-ray codes have been deleted and replaced with new codes
  • Teleheath services, which continue to expand for many practices with new opportunities for reimbursement
  • The roll-out of the Medicare Diabetes Prevention Program, due to take effect in April 2018

Accurate documentation and proper coding that reflects these changes for 2018 remains the key for practices to be reimbursed for the care being provided, Whitney says.

“If we want to get paid for the complexity of our patients, it’s important to send that data to the payers.”

Learn more:

  • 2018 Anesthesia Coding Updates webinar: Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, president, Perfect Office Solutions Inc., Leesburg, Fla., draws upon her 34 years of experience in anesthesia billing to discuss significant changes to colonoscopy coding and changes in the PQRS to MIPS for 2018 during this live webinar Dec. 12.
  • Coding Updates for 2018 webinar: Susan Whitney, CPC, CPC-I, CRC, CMPE, senior content manager, MGMA Organizational Content Development, will review chapter-by-chapter CPT code additions, deletions and revisions for 2018 to help practices avoid denials and payment delays in the new year during this live webinar Dec. 14.
  • 2018 Cardiology and Medicare Coding and Reimbursement Update webinar: Terry Fletcher, ICD-10-CM, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMCS, CMC, coding and reimbursement educator, author and consultant, Terry Fletcher Consulting Inc., will identify the most important updates to the new CPT and ICD-10-CM codes and tips for billable services in cardiology, peripheral cardiology and electrophysiology during this live webinar Dec. 19.

Chris Harrop, senior editorial manager, Publications, MGMA

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