Update your facility-specific guidelines accordingly for 2023.

Although the new calendar year is not the beginning of the federal fiscal year, there are coding classifications and terminologies that changed on Jan. 1, 2023. Current Procedural Terminology® (CPT) and Healthcare Current Procedure Coding System (HCPCS) have releases that went out on Jan. 1.

There are also reimbursement methodologies that annually update on Jan. 1, such as the Outpatient Prospective Payment System (OPPS) and the Medicare Physician Fee Schedule (MPFS).

It is important to keep your facility-specific coding guidelines up-to-date with these changes. For example, here are some new HCPCS codes that can be used for procedures:

  1. C7550 – Cystourethroscopy with biopsy(ies), with adjuctive blue light cystoscopy with fluorescent imaging agent;
  2. C7543 – Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s); and
  3. C7539 – Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual-chamber system).

It is important that facility-specific guidelines are updated so that coders can assign the correct codes for each situation. Another part of such a review would be to consider if each code can be assigned as a “hard code,” handled via the chargemaster, or a “soft code,” which is assigned by the coder. Another part of this consideration is that some payers may accept HCPCS codes, while others may want CPT codes to be reported for outpatient encounters. Have these codes been reviewed for your facility, and have your facility guidelines have been updated?

Another topic for the facility-specific coding guidelines is the social determinants of health (SDoH). Many payers have developed programs for SDoH topics, but they need the identification of patients for them to be included. The payers also need data to determine what SDoH areas have been identified in the area. Suggested steps to consider include:

  1. Review ICD-10-CM codes in the SDoH range (Z55 – Z65);
  2. Determine which topics are the higher priority by most frequent payers;
  3. Develop a questionnaire for the areas to be collected;
  4. Determine if the questionnaire will be part of the permanent record; and
  5. Educate coders regarding the SDoH codes to be assigned.

The determination of the SDoH topics may include collaboration with physicians, case managers, nursing staff, rehabilitation services, etc. The person who handles contracts with payers at your facility may be of assistance in determining which payers have an interest in the SDoH.

The update process to the facility-specific coding guidelines is a process meant to promote dialogue between the facility caretakers, billing specialists, care managers, and the coders. The facility leadership will appreciate having the data to assist them in making decisions.

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Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an AHIMA-approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays

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