Friday, August 23, 2013

Coding BMI

We've gotten several questions lately about the requirements for coding BMI, asking why BMI can't be coded if documented, but there is no documentation by the physician regarding obesity/morbid obesity, etc.

The Official ICD-9 instructions have been revised to indicate that the BMI may be documented by someone who cannot make a diagnosis, such as a dietitian.  However, they go on to state that the BMI is always a secondary diagnosis, and the physician must document the related diagnosis, such as overweight, obesity, etc.

This is further supported by Coding Clinic, Q2, 2010 which confirms that the BMI may be recorded by non-physician clinicians, like nurses or dieticians, but it cannot be reported (coded) unless there is also documentation by the physician of the related condition, such as overweight or obesity.

Therefore, it is not appropriate to assign the code for BMI unless the related diagnosis is also documented and reported.

We hope this helps understand the Official ICD-9 Guidelines for reporting BMI.

Thursday, August 15, 2013

New ICD-10 Resources Available!

CMS has published the new version of the ICD-10 CM and GEMs (the General Equivalence Mappings).  In addition, they have posted some new ICD-10 tools, for providers to use:

These three new CMS publications should help you in developing new superbills and coding sheets for your office.

Wednesday, August 7, 2013

More Full Encounter Data Tips

Issues in Encounter Submission

Remember that Full Encounter Data (FED) submission closely mirrors Fee-for-Service (FFS) claims submission.  Therefore, you should run reports against encounters submitted under FED that were rejected by CMS:

·        While the Companion Guides help with creating and submitting an EDI transaction, there are a number of billing guides produced by Medicare Administrative Contractors that give advice on claim submission.

·        In addition, the website also has instructions for claim submissions as well.  Check the Claims Processing Manual chapter(s) that relates to your type of service.

·        The focus of the guidelines on the CMS website is more on claims submission and payer processing of claims/encounters for adjudication.  Following the instructions on both of these websites will help you produce encounters which can be processed successfully.

The following websites have billing information to help you file correctly:


DMEPOS and PEN Submission                                                  


Possible Systemic Issues to Identify and Correct

·        Incorrect modifier for HCPCS/CPT code (e.g. surgical modifier on an E/M code).

·        Incorrect dates of service - Many DMEPOS services require a span of dates of service—for example, rentals and a month’s worth of supplies.  The dates of service should be the 30 day span that represents the rental or supply period.

o   Note that the number of services should reflect the number of days for a rental, or the number of units for supplies.  Do not default to “1” in these situations.

·        Use the correct place of service.  The place of service for DME must be the patient’s home  (POS 12).  Rarely, a Skilled Nursing Facility or Nursing Facility is appropriate (POS 31 or 32)

·        Some services have specific diagnosis requirements—“CPAP” or “BiPAP” machines require specific diagnoses.   All services except the few screening services allowed require a specific diagnosis related to the service.

·        Incorrect number of services (e.g., 1 service for 30 day span). Number of services should be evenly divisible by the date span.

·        Missing critical information—e.g. ordering provider, rendering provider on a medical group or DME claim/encounter.

·        Incompatible place of service (i.e.  Outpatient service like 99214 billed with Place of service 21, 31 or 32).

·        Incorrect or missing origin/destination for ambulance claims.


We hope that this information helps you in your goal of submitting clean FED claims/encounters.