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Editor's e-Note
Evaluation and Management (E&M) documentation is undergoing a facelift. Always a point of contention for often-confused medical professionals, E&M codes are bound to test the nerves of coders even more now that the Centers for Medicare & Medicaid Services has issued new guidelines.

This month’s E-News Exclusive doesn’t dare tackle all of the E&M changes. Instead, the focus is on modifiers 24 and 25, each of which factors into the global period for procedures.

Lee DeOrio, editor
e-News Exclusive
Proper Use of Modifiers 24 and 25 in E&M Coding
By Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS

The Centers for Medicare & Medicaid Services recently issued new guidelines for the appropriate use of modifiers 24 and 25 in evaluation and management (E&M) coding. Understanding the global period for procedures is a key element in assigning modifiers 24 and 25. Global periods are typically zero, 10, or 90 days after the procedure and may include additional preoperative days.

Proper Use of Modifier 24
Use modifier 24 with the appropriate level of E&M service in the following instances:
  • an unrelated E&M service is performed beginning the day after the procedure, by the same physician, during the 10- or 90-day postoperative period;
  • documentation indicates the service was exclusively for treatment of the underlying condition and not for postoperative care;
  • the same physician is managing immunosuppressant therapy during the postoperative period of a transplant;
  • the same physician is managing chemotherapy during the postoperative period of a procedure;
  • unrelated critical care is performed by the same physician during the postoperative period; and
  • the same diagnosis as the original procedure could be used for the new E&M service if the problem occurs at a different anatomical site.
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Tweets From #AMIA2018

“Larva rearing robots.” Had no idea this was a thing. #amia2018

@AMIAinformatics year in review — packed room for Jim Cimino at #AMIA2018 first ever livestream

Is it illegal to yell “FHIR” in a crowded informatics presentation? #AMIA2018

Outstanding talk by @shefali_h on understanding needs for and designing tools to support hospitalized patients helping each other have safe and high-quality care. #AMIA2018

Read more »
Industry Insight
Medical Records Study Links Dementia-Related Brain Changes to Hospital Stays for Critical Illness

Researchers at Johns Hopkins report that a novel analysis of more than a thousand patients adds to evidence that hospitalization, critical illness, and major infection may diminish brain structures that are most commonly affected by Alzheimer’s disease.

Results of the study, published in the Journal of the American Geriatrics Society, suggest—but do not prove—that critical illness and major infection can promote such brain structure changes and accelerate the process of cognitive decline, the researchers say.

Keenan Walker, PhD, of the department of neurology at the Johns Hopkins University School of Medicine, the study’s lead author, cautions that the findings may be limited due to undetected or misclassified billing codes that define diagnosis in the medical records, a lack of information about potentially relevant comorbidities such as delirium, and the “observational” nature of the study, which was not designed to—and cannot—determine or prove cause and effect.

Read more »
Products & Services
New ZHealth Software Improves Both Documentation and Coding Accuracy
ZHealth recently unveiled Etch, a software platform that addresses both the documentation and the coding challenges of complex cardiovascular procedures, and helps improve coding accuracy and time to billing. ZHealth worked to create a way to document procedures that not only is physician friendly but also captures 100% of the essential information needed for proper coding. The interactive anatomical maps make the system faster and clearer than traditional voice dictation alone. ZHealth built in an expert system to automatically code these cardiovascular procedures and give more power to the reviewer. The software interfaces directly with hospital hemodynamic systems, inventory systems, lab scheduling, and patient records to minimize documentation time and avoid redundant entry. In addition to the cardiovascular version, an interventional radiology version is expected to launch next year. Learn more »

MRO Launches Medical Record Attachment Solution
MRO has announced the general availability of its business office medical record attachment solution. Specialized services and technology enable health care providers to streamline processes for sharing patient records with payers to support insurance claim payments. The solution can help improve efficiency, cost savings, and compliance. MRO’s ROI Online—Business Office Edition sits on the ROI Online platform, with modifications to support requirements for attaching medical records to insurance claims and distributing documentation in the format requested by a payer. Delivery is trackable with electronic options, and custom workflows and service models are available based on provider needs. Learn more »

Texas Health Information Legal Manual Updated
The Texas Health Information Management Association Board has published updates to the Texas Health Information Legal Manual. Updated topics include HIPAA Penalties; Health Information Exchange and Interoperability; Handling Sensitive Information; Consent, Authorization and the Notice of Privacy Practices; Applicable Laws: Implementation & Compliance; and SB11 — DNR Changes to the Texas Health and Safety Code. Learn more »
In this e-Newsletter
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Patient Matching: Are We Any Closer to a Solution?
Industry chips away at the patient matching problem instead of waiting for a national strategy to materialize. Read more »

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Other News
Children’s Mercy Using App to Update Parents During Surgery
Like a medical version of Snapchat, the EASE app allows providers to keep waiting families in the loop during procedures by sending updates that disappear a minute later, according to

New York Oncology Hematology Victim of E‑Mail Phishing Attack
Several of New York Oncology Hematology’s employee e-mail accounts, which contained protected health information and other personal information of patients and employees, were targeted by phishing e-mails earlier this year, reports The Record.
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