Author: Margaret Maley (Margaret Maley)

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New Procedures Added to Medicare’s Prior Authorization (PA) List Effective 7/1/21

May 26, 2021 Since 7/1/20, when CMS initiated a requirement for specific procedures to be prior authorized, we have sent out two KZAlerts about the PA process Alert 1 Alert 2 CMS says the PA policies are to ensure Medicare patients receive “necessary care” and “reduce unnecessary increases in the volume” of covered outpatient services....

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Is Time on Your Side in 2021?

AAOSNow – November 2020 by Margaret M. Maley In 2021, medical decision making (MDM) or time can be used to select the level of service for evaluation and management (E/M) codes for new or established outpatient visits. Although most physicians will choose the level of new or established patient visits based on MDM, it is important to...

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Medicare’s New Documentation Rules Impact Practices

Medicare’s New Documentation Rules Impact Practices AAOSNow – April 2019  by Margaret M. Maley Surgeons instructing billing staff to bill “insurance only” is a scenario that is all too common in orthopaedic practices. In effect, the practice is waiving the patient’s copay, coinsurance, and deductible amounts and accepting whatever amount the insurance company will pay. In...

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Answers to Five Common Coding Questions

Answers to Five Common Coding Questions AAOS Now – October 2018 by Margaret M. Maley, BSN, MS and Sarah Wiskerchen What orthopaedic surgeons, practice managers, and staff want to know In this article, we discuss five concerns from surgeons and their staff that are currently “trending.” 1. Vendor advice = a flashing yellow light Question: Our orthopaedic...

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Reasons Why Diagnostic Coding Matters in Value-based Care

Reasons Why Diagnostic Coding Matters in Value-based Care AAOS Now – September 2018 by Margaret M. Maley, BSN, MS Payers are great at collecting data. They use the information to develop payment policies, determine reimbursement rates, and, increasingly, to negotiate value-based contracts. Payers profit because they know how much it costs to take care of...

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Documentation Guidelines for Medical Decision Making

Documentation Guidelines for Medical Decision Making – August 2017 by Margaret M. Maley, BSN, MS With a brief history of their development Thousands of pages of regulation have been generated since the American Medical Association (AMA) first introduced Evaluation and Management (E/M) codes to describe inpatient and outpatient visits in 1992. When originally published, the...

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Medicare Sharpens Focus on the Global Surgical Package

Medicare Sharpens Focus on the Global Surgical Package – June 2017 by Margaret M. Maley, BSN, MS The Centers for Medicare & Medicaid Services (CMS) has expressed concern that services with 10- and 90-day postoperative periods are not valued accurately, and follow-up visits included in the value of the global services are not consistently being...

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2017 Medicare Guidelines for Imaging

2017 Medicare Guidelines for Imaging – March 2017 by Margaret M. Maley, BSN, MS Effective Jan. 1, 2017, “FX” is a new Medicare modifier used to indicate that X-ray images were taken using film. The FX modifier is appended to the global radiology code or the radiology code with the modifier TC (technical component) when submitting...

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Don’t Be Intimidated by ICD-10-CM Changes

Don’t Be Intimidated by ICD-10-CM Changes – October 2016 by Margaret M. Maley, BSN, MS A systematic look at the code update in orthopaedics The 2,000 new ICD-10-CM (International Classification of Diseases, 10th edition, Clinical Modification) codes that go into effect Oct. 1, 2016, shouldn’t send you into a panic. The changes, when analyzed and approached...

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“Clean Up” Diagnosis Coding for Staged Revisions

“Clean Up” Diagnosis Coding for Staged Revisions – July 2015 by Margaret M. Maley, BSN, MS Assigning diagnosis codes for joint revision surgery is challenging in both ICD-9-CM and ICD-10-CM. Orthopaedic practices that carefully examine the instructions in both editions may find that they have been reporting staged revisions incorrectly for years. The following side-by-side comparison...

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