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Coding, Regulations and Reimbursement

We frequently field questions on coding and regulations & reimbursement issues related to chest medicine. Please refer to the following resources to help manage your practice operations:

Coding

NEW! Coding for Chest Medicine 2016: A Coding and Billing Update

The new 2016 edition of Coding for Chest Medicine: A Coding and Billing Update. Important updates for pulmonologists, pediatricians, and interventional bronchoscopists are included, along with many examples of ICD-10-CM coding provided.

New in the 2016 edition:

  • Complex Chronic Care Services
  • Advance Care Planning Services
  • EBUS Services
  • ECMO Services
  • Clarification for 94640 inhalation treatments

Available as a Softcover book or PDF eBook for $160
Order Coding for Chest Medicine 2016

Coding for Chest Medicine 2013: Pulmonary, Critical Care, Sleep - Specialty Medicine and Codes

Purchase the 2013 edition of Coding for CHEST Medicine at a reduced price. This edition contains practice management content that is largely unchanged and not reproduced in the new 2016 edition. Many of the chapters contain valuable information and resources, including chapters on Revenue Cycle Management, Modifiers, Correct Coding Edits, Advanced Practice Providers (Nurse Practitioners and PhysicianAssistants), Facility Reimbursements, Allergy Services, Teaching Physician Regulations, and When Legal Advice is Advisable. This 2013 edition is a useful companion to the new 2016 edition.

Available as PDF eBook or Softcover book for $25
Order Coding for Chest Medicine 2013

Regulations and Reimbursement

Regulations and Reimbursement-Related Resources and Updates

  • Updates: Final Rule 2014
    • OPP – Outpatient Prospective Payment System
    • IPPS – Inpatient Prospective Payment System
    • MPFS – Medicare Physician Fee Schedule
    • CMS Fact Sheets
    • Medicare Carrier/FI Submitted Comments and LCDs

Position Statement for Coverage and Payment of Bronchial Thermoplast

Bronchial thermoplasty offers treatment for patients with severe asthma who continue to be symptomatic despite maximal medical treatment. We believe the literature supports bronchial thermoplasty as a therapeutic option for patients with severe asthma. Therefore, we recommend that all public and private insurers provide coverage and payment for bronchial thermoplasty for those adult patients with severe persistent, poorly-controlled asthma who continue to experience asthma exacerbations, emergency department visits and hospitalizations despite maximal medical treatment.

Coverage and Payment for Bronchial Thermoplasty for Severe Persistent Asthma

CMS Changes for Calendar Year 2014

On October 30, 2015, CMS issued the final rule that updates the payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after January 1, 2016. The rule changes several of the quality reporting initiatives associated with MPFS payments, including the Physician Quality Reporting System (PQRS). The final rule was published in the Federal Register on November 16, 2015.

Survey Participation is Integral to Your Success

Have you ever received an e-mail from us requesting your participation in an RUC or CPT survey? Would you like to better understand the RUC and CPT survey process?

If you answered yes to either of these questions, please take a look at the “Survey Participation Is Integral to Your Success” PowerPoint, and note that survey participation only takes approximately 20 minutes. 

Survey Participation Is Integral to Your Success: AMA/Specialty Society RVS Update Committee (RUC) Survey

ICD-10

On October 1st, 2015, the ICD-10 diagnostic code set went live. Now, medical professionals have nearly 70,000 codes to choose from. Please refer to the following resources to help facilitate this transition:

ICD-10 Background
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

  1. ICD-10-CM for diagnosis coding
    Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

  2. ICD-10-PCS for inpatient procedure coding
    ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding. ICD-10-PCS has a multi-axial code structure that provides a unique code for all substantially different procedures and allows new procedures to be easily incorporated as new codes.

Development of the ICD-10 Procedure Coding System (ICD-10-PCS) 

ICD-10 Implementation Resources

  1. Top 200 Chest Medicine ICD-9 Codes Mapped to ICD-10
    CHEST has mapped the top 200 ICD-9 codes used by chest medicine clinicians to ICD-10. Please use the following mapping tool to help with this transition.

    Top 100 Inpatient ICD-9 Codes Mapped to ICD-10
    Top 100 Outpatient ICD-9 Codes Mapped to ICD-10

  2. ICD-10-CM/PCS Implementation Toolkit
    Having access to helpful tools and documents can assist with a successful implementation of ICD-10-CM/PCS. Please use the following toolkit to help form an implementation plan for using the new code sets.

    ICD-10-CM/PCS Implementation Toolkit

Additional ICD-10 Resources