Tagged with ICD-10 Diagnosis Coding
eCQM Value Set Update for 2019 Reporting and Performance Periods Published
CMS and the National Library of Medicine (NLM) has published the most recent updates to the electronic clinical quality measure (eCQM) value sets. The updated sets include ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS), SNOMED CT, LOINC, and RxNorm.
Wisconsin – Outpatient Injectable Chemotherapy Notification for UHC MA Plans
Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.
AMA Issues Alternative Payment Model for Opioid Use Disorder Treatment
The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) have announced plans to pilot test a model that includes medications combined with psychosocial support.
CMS Removes Prior Authorization Requirement for DMEPOS
CMS will remove the prior authorization (PA) requirement for certain types of medical equipment that no longer meet standards set forth in a 2015 final rule.
Aetna NPL, Clinical Payment and Coding Policy Changes
Effective July 1, Aetna will implement changes to its clinical payment and coding policies as well as several changes to its National Precertification List (NPL).
UnitedHealthcare Medicare Advantage Notification for Outpatient Injectable Chemotherapy
As of March 1 for UnitedHealthcare (UHC) Medicare Advantage (MA) members in Florida and Georgia and April 1 for plans in Wisconsin, UHC will require care providers to submit a notification for injectable chemotherapy when administrated in an outpatient setting for UHC MA members with a cancer diagnosis.
New Jersey Seeks Inpatient Capacity Expansion for Mental Health and Substance Use
The New Jersey Department of Health is seeking to further expand inpatient treatment capacity for individuals battling mental health issues and drug addiction and has invited providers across the state to submit plans to add up to 53 more inpatient beds in the underserved regions of the state.
Aetna Clinical Payment, Coding and Policy Changes
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
New Diagnostic Codes for Substance Use Disorders and ARFID in 2018
The federal agency responsible for the use of the ICD-10 in the United States, the National Center for Health Statistics (NCHS), has released an updated version of the ICD-10-CM for 2018.
CMS 2019 Medicare Advantage Part I Advance Notice Released
CMS has released Part One of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies, containing proposed changes to the Part C Risk Adjustment Model and the use of encounter data.
Aetna Clinical Payment, Coding and Policy Updates
Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.
Cigna Requirement to Precertify Oncology Medications
Cigna has implemented an integrated oncology management program which requires providers to precertify certain medical oncology medications through a national ancillary provider (instead of Cigna), including primary chemotherapy, and supportive drugs, such as medical injectables and infusions.
UnitedHealthcare Prior Authorization and Coding Policy Updates
UHC has announced two updates for notification and prior authorization on certain procedures, as well as revisions to its emergency department facility evaluation and management (e/m) coding policies.
Humana New and Revised Medical Coverage Policies
Humana has released two new medical coverage policies and several updates to policies effective at the start of the new year.
Florida Outpatient Injectable Chemotherapy Notification for UHC MA Plans
On March 1, 2018, UnitedHealthcare MA will require notification for injectable outpatient chemotherapy drugs given for a cancer diagnosis for members in Florida and Georgia.
Indiana Medicaid Medical Policy Updates
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
Aetna Clinical Payment, Coding and Policy Updates
Aetna has released updated clinical, payment and coding policy positions, including correct coding of hospital observation, critical care, admission and discharge services, changes to the assistant surgeon list and the pass-through billing policy.
IN Health Coverage Programs Annual Update of ICD-10 Codes
Indiana Health Coverage Programs (IHCP) has released their annual update of the ICD-10 diagnosis and procedure codes.
2018 eCQM Value Set Addendum for EPs, ECs Released
CMS has released an addendum to the electronic clinical quality measure (eCQM) annual update specifications originally published in May 2017. This addendum updates eCQM value sets for the 2018 performance period for Eligible Professionals (EPs) and Eligible Clinicians (ECs).
CPT 2018 Update Brings New E/M Codes, Mass Revisions and Revised Guidelines
A total of 314 code changes have been implemented throughout the 2018 CPT manual. Of these changes, Anesthesia will see four changes to observation E/M codes, the addition of five gastro-endoscopic procedure codes, and three low-volume codes have been deleted.
