J ENAN C USTER CPC, CCS, CDIP AHIMA A PPROVED ICD-10-CM/PCS T RAINER AND A MBASSADOR D IRECTOR OF C ODING H EALTHCARE C ODING AND C ONSULTING S ERVICES (HCCS) 1 Home Town Health - HCCS Medicare Updates 2015 Healthcare Coding & Consulting Services A GENDA Comprehensive Care for Joint Replacement payment model- What you need to know Coding Zika Virus- CMS Guidance released Modifier -52 Compliancy Audits 2 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 3 Comprehensive Care for Joint Replacement payment model What is it What is the purpose What Measures are looked at? 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 4 ComplicationTime Frame for Occurrence Acute myocardial infarctionWithin seven days of index admission date PneumoniaSame as above Sepsis/septicemia/shockSame as above Surgical site bleedingDuring the index admission or within 30 days of admission date DeathDuring the index admission or within 30 days of admission date Mechanical complicationsDuring the index admission or within 90 days of admission date Peri-prosthetic joint/wound infection Same as above 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 5 Quality Outcomes Cost Outcomes CCJR Participant 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 6 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES M ODIFIER What is Modifier -52 Definition Coding Tips Discontinued radiology procedures Modifier -73/-74 what's the difference? 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 8 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 9 Examples -52 Modifier 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 10 CPT Assistant December 2015 Page 19 2015 Healthcare Coding & Consulting Services H OME T OWN H EALTH - HCCS M EDICARE U PDATES 11 CPT Assistant July 2015 Page 10 2015 Healthcare Coding & Consulting Services L EARNING O UTCOMES Comprehensive Care for Joint Replacement payment model- What you need to know Coding Zika Virus- CMS Guidance released Modifier 2015 Healthcare Coding & Consulting Services R EFERENCES 13for-joint-replacement-payment-model-for-acute-care-hospitals https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/downloads/MM3507.pdf 2015 Healthcare Coding & Consulting Services 14 THANK YOU FOR YOUR TIME We welcome all questions! Quality Value