July 25, 2023

Part 1 – Section GG Expansion to OBRA Assessments July 1, 2021

Nursing Facilities (NFs) in Pennsylvania are in for a change effective July 1, 2021. Section GG coding is required for the Omnibus Budget Reconciliation Act (OBRA) assessments. If your facility is not in Pennsylvania, don’t stop reading now. Some other states have already made the change to require Section GG coding for OBRA assessments. States have the option to require the completion of specific sections of the MDS since October 1, 2020. LW Consulting Inc…

Supporting Medical Necessity of CPT Code 97016

On December 14, 2018, Noridian provided an update within their “Fees and News Update,” which was published on December 17, 2018 regarding billing of CPT code 97016 for Vasopnuematic devices. Noridian reported multiple outpatient reviews have noted insufficient documentation to support use and billing for the use of vasopnuematic devices to apply pressure to an extremity to reduce swelling.Noridian provided informational guidelines and documentation expectations to meet Medicare’s coverage to support 97016.  Here are the findings/guidelines from…

PDPM ICD-10 Code Mappings Fiscal Year 2023: What’s New?

The Patient-Driven Payment Model (PDPM) has been the reimbursement methodology for Medicare Part A in the Skilled Nursing Facility (SNF) since October 1, 2019, with updated regulations effective every October 1st. Each fiscal year, the Centers for Medicare & Medicaid Services (CMS) releases the updated ICD-10 CM guidance for the new fiscal year, the ICD-10-CM Official Guidelines for Coding and Reporting. In addition to these ICD-10 coding changes or updates, SNFs must be aware of the changes in…