Monthly Coding Update

Medical Coding

Keep up-to-date on the latest industry updates, courtesy of the experts at Healthcare Information Services. Here are this month’s coding updates:

New Cigna Coverage Policy

Effective May 16th, 2016 Cigna enacted a new policy for strapping. This policy will now cover strapping tape as a medical necessity, citing its importance in the initial management of an immobilized joint and restriction of movement. Strapping tape will be covered for the following:

  • Hand or Finger: CPT code 29280 for finger fracture or dislocation.
  • Ankle or Foot: CPT code 29540 for acute sprains and strains of the ankle.
  • Toes: CPT code 29550 for toe dislocation or fractures

It is important to note that strapping will not be covered for many cases considered experimental or unproven. This includes elastic therapeutic tape, and taping of the shoulder, chest, thorax, hip, elbow, wrist, knee, or back.

Changes in ICD-10 Effective 2017

This month, we will hear the final rule on the ICD-10-CM changes for 2017. We will know much more once the final rule has been published, but here is what we know so far:

  • There will be 152 additions to the musculoskeletal system and 885 to injuries.
  • Musculoskeletal changes include codes for periprosthetic fractures around implants.
  • Salter Harris fractures and femur fractures will also see coding additions.

Medical Necessity for E/M Services

Criteria for payment and individual requirements of a CPT code are dependent on the medical necessity of E/M visits. For example, it is not appropriate to bill for a higher level of evaluation and management service when a lower service is warranted. Documentation volume should be the primary factor in determining which level of service should be billed.

This again illustrates the importance of documentation of services in order to maintain accurate records.

Healthcare Information Services (HIS) is proud to provide you with the latest coding updates. If you have any questions about any of these monthly updates, contact HIS for expert advice.