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Latest News

Check out the latest news on coding, billing, denial management, release of health information, privacy and security regulations and guidance here

HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical Center Payment System Final Rule

November 2022

Policy - Hospitals - Rural health 

This final rule will allow Critical Access Hospitals (CAHs) and small rural hospitals to convert to a Rural Emergency Hospital (REH), which may be a more sustainable option for rural hospitals facing closure and supports access to care in rural and underserved communities.

An REH is a new Medicare provider type that furnishes outpatient services, emergency services, and observation care. In this rule, Medicare will also pay hospital outpatient departments to provide remote behavioral health services to people at home, which will improve access to care in rural communities and promote health equity.

Learn more HERE

OCR Releases New Recognized Security Practices Video

November 2022

In recognition of National Cybersecurity Awareness Month, OCR has produced a new video this October for organizations covered under the HIPAA Rules on Recognized Security Practices. This presentation is intended to educate the health care industry on the categories of recognized security practices and how entities regulated under the HIPAA Rules may demonstrate implementation.

Watch video HERE

Inpatient & Long-Term Care Hospitals: Learn What’s New for Fiscal Year 2023

October 2022

CMS issued the Fiscal Year 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule to update IPPS hospital and LTCH Medicare payment policies. See a summary of key provisions effective October 1, 2022:

  • IPPS payment rate update of 4.3%; LTCH PPS payments increase by approximately 2.4%
  • Hospital Inpatient Quality Reporting Program: adopted 3 health equity-focused measures and summarized feedback received on our approach to measuring health care quality disparities
  • Feedback received on reporting social determinants of health
  • New hospital designation and additional quality measure reporting to drive improvements in maternal health outcomes and health equity
  • Permanent 5% cap on annual wage index decreases
  • Graduate medical education: changed policies, including increased flexibility for rural hospitals that participate in a rural track program

Inpatient Psychiatric Facilities: Learn What’s New for Fiscal Year 2023

CMS issued the Fiscal Year 2023 Inpatient Psychiatric Facilities (IPF) Prospective Payment System final rule to update IPF payments, wage index, and policies. See a summary of key provisions effective October 1, 2022:

  • Updated payment rates by 3.8% with estimated payments to increase by 2.5% after productivity adjustment
  • Applied a permanent 5% cap on wage index decreases

Inpatient Rehabilitation Facilities: Learn What’s New for Fiscal Year 2023

CMS issued the Fiscal Year 2023 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule to update Medicare payment policies and rates. See a summary of key provisions effective October 1, 2022:

  • Updated IRF PPS payment rates by 3.9% with estimated overall payments to increase by 3.2% after productivity and outlier adjustments
  • Applied a permanent 5% cap on annual wage index decreases

Expanded quality data reporting on all IRF patients, regardless of payer

Learn more HERE

Calendar Year (CY) 2023 Physician Fee Schedule (PFS)

October 2022

Provider Types Affected

This MLN Matters Article is for physicians, Ambulatory Surgical Centers (ASCs), and suppliers

billing Medicare Administrative Contractors (MACs) for ASC services they provide to Medicare

patients.

Provider Action Needed

Make sure your billing staff knows about:

     • Updates to the ASC payment system in October

     • New Outpatient Prospective Payment System (OPPS) device pass-through code

     • Newly established HCPCS codes for drugs and biologicals

     • New skin substitute products low-cost group or high-cost group assignment

Learn more HERE

Ambulatory Surgical Center Payment System: October 2022 Update

October 2022

Provider Types Affected

This MLN Matters Article is for physicians, Ambulatory Surgical Centers (ASCs), and suppliers

billing Medicare Administrative Contractors (MACs) for ASC services they provide to Medicare

patients.

Provider Action Needed

Make sure your billing staff knows about:

     • Updates to the ASC payment system in October

     • New Outpatient Prospective Payment System (OPPS) device pass-through code

     • Newly established HCPCS codes for drugs and biologicals

     • New skin substitute products low-cost group or high-cost group assignment

Learn more HERE

How to Use the Medicare National Correct Coding Initiative (NCCI) Tools

October 2022

This booklet provides information about using the Medicare National Correct Coding Initiative (NCCI) Tools.

Table of Contents

1. What is the Medicare NCCI?

2. Using the NCCI Tools

3. Using the NCCI Policy Manual for Medicare

4. Resources

Select a Chapter from the list at the top of the tool to learn how to use the Medicare NCCI tools. In this document, “you” means billing providers, facilities, and suppliers.

Open Booklet HERE 

Learn more about the Medicare National Correct Coding Initiative (NCCI) Edits HERE

Legal Implications of a Cyber-Attack

By: HHS 405(d) Task Group Members 

September 2022

The average cost of a cyber-attack continues to rise, hitting an all-time high last year (according to one leading report) of $4.24M, a 10% rise from 2019’s average cost. 

Healthcare remained the industry with the highest average cyber-attack costs for the eleventh year in a row. And the FBI reported that the health sector was hardest-hit by ransomware cyber-attacks in 2021. Some of the costs are harder to measure, such as reputational impact. 

Beyond the measurable cost associated with technical containment and remediation, a portion of this cost is attributable to fulfilling legal obligations.

Read More HERE 

Updated COVID-19 Vaccines Providing Protection Against Omicron Variant Available at No Cost

September 2022

The Department of Health & Human Services (HHS), through CMS announced that people with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines.


The FDA has authorized the Moderna and Pfizer-BioNTech updated vaccines that target the original COVID-19 viral strain and two Omicron variants (BA.4/BA.5) that are currently the most prevalent in the U.S. Individuals are eligible for their updated vaccine shot at least two months after completing at least their primary vaccination series (two doses of Pfizer-BioNTech, Moderna, or Novavax, or one dose of Johnson & Johnson)—regardless of how many monovalent COVID-19 boosters they have received to date.


CMS issued 4 new CPT codes effective August 31, 2022:


Code 91312 for Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product:

  • Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use
  • Short descriptor: SARSCOV2 VAC BVL 30MCG/0.3ML

Code 91313 for Moderna COVID-19 Vaccine, Bivalent Product:

  • Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
  • Short descriptor: SARSCOV2 VAC BVL 50MCG/0.5ML

Code 0124A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent - Administration – Booster Dose:

  • Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose
  • Short descriptor: ADM SARSCV2 BVL 30MCG/.3ML B

Code 0134A for Moderna COVID-19 Vaccine, Bivalent - Administration – Booster Dose:

  • Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose
  • Short descriptor: ADM SARSCV2 BVL 50MCG/.5ML B

Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates

CMS issues hospital IPPS final rule for FY 2023

August 2022

The Centers for Medicare & Medicaid Services today issued a final rule that updates the inpatient prospective payment system rates by 2.6% in FY 2023 compared to FY 2022. The increase reflects a 4.1% market basket update, less 0.3 percentage point for productivity, plus 0.5 percentage point required by statute. The update also includes a 1.7 percentage point cut for outlier payments. In addition, CMS finalized decreases in disproportionate share hospital payments ($300 million), new medical technology payments ($750 million), and enhanced Low-Volume Hospital and Medicare Dependent Hospital payments ($600 million) due to the statutory expiration of these programs.


Among other provisions, the final rule:

  • Returns to using the most recent data available for rate setting, but with several modifications to account for the COVID-19 pandemic.
  • Permanently applies a budget-neutral 5% cap on any decrease to a hospital’s wage index from the prior fiscal year.
  • Uses more than one year of Worksheet S-10 cost report data to determine uncompensated care costs, specifically FY 2018 and FY 2019 data to distribute FY 2023 payments and a three-year average for FY 2024 and beyond.
  • Uses a modified policy for direct graduate medical education full-time equivalent cap calculations.

In addition, CMS finalized revisions to the objectives and measures for the Medicare Promoting Interoperability Program, including making prescription drug monitoring program queries mandatory, and adding a new antimicrobial use and resistance surveillance measure.


View the CMS FY 2023 IPPS Final Rule Home Page here


For files related to the Long-Term Care Hospital PPS, please visit here 



HHS 405(d) Aligning Healthcare Industry Security Approaches Program

July 2022

On July 13th the HHS 405(d) program released a new cybersecurity resource based on organization sizes. The "How to Implement Patching" guide for small, medium, and large Healthcare and Public Health Organizations explains the importance of regularly updating your systems by applying security updates provided by the software or device manufacturer.

Find your size below!

Myth Versus Fact

The 405(d) program resources address the importance of users being extra careful and encrypting content when sending and receiving emails that contain sensitive and private data, especially protected health information (PHI).

  • Check out this month's Myth Versus Fact video HERE.
  • Do you send PHI without encrypting? That Seems Risky. Learn why protecting private data is important HERE

CPT® Orthopoxvirus and monkeypox coding & guidance

Effective for Immediate Use

July 2022

New Current Procedural Terminology (CPT®) codes have been created that streamline the reporting of orthopoxvirus and monkeypox testing and immunizations currently available on the United States market.


The American Medical Association (AMA) has announced an update to Current Procedural Terminology (CPT®), the nation’s leading medical terminology code set for describing health care procedures and services, that includes a new laboratory test code for the orthopoxvirus and two codes for the vaccines being utilized to prevent monkeypox infection.


These new CPT codes are effective for immediate use and are designed to clinically distinguish the diagnostic test and vaccinations for monkeypox to support data-driven tracking, reporting and analysis necessary for resource planning and allocation during the public health response to the outbreak.


Laboratory test code

  • 87593 Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each

Product code

  • 90622 Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
  • 90611 Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use

View the AMA website here

CPT® Evaluation and Management (E/M) Code and Guideline Changes

effective January 1, 2023

July 2022

E/M revisions to code descriptors & guidelines 2021-2023


On Nov. 1, 2019, the Centers for Medicare and Medicaid Services (CMS) finalized a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule. This provision includes revisions to the Evaluation and Management (E/M) office visit CPT® codes (99201-99215) code descriptors and documentation standards that directly address the continuing problem of administrative burden for physicians in nearly every specialty, from across the country.


After these revisions were implemented, the CPT Editorial Panel approved, for 2023, additional revisions (PDF) to the rest of the E/M code section. These revisions seek to provide continuity across all the E/M sections allowing for the revisions implemented in the E/M office visit section in 2021 to extend to all other E/M sections.


2023 summary of revisions to the E/M code descriptors and guidelines:

  • E/M Introductory Guidelines related to Hospital Inpatient and Observation
  • Care Services codes 99221-99223, 99231-99239, Consultations codes 99242-99245, 99252-99255, Emergency Department Services codes 99281-99285,
  • Nursing Facility Services codes 99304-99310, 99315, 99316, Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350
  • Deletion of Hospital Observation Services E/M codes 99217-99220
  • Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
  • Deletion of Consultations E/M codes 99241 and 99251
  • Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
  • Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
  • Deletion of Nursing Facility Services E/M code 99318
  • Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
  • Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340 
  • Deletion of Home or Residence Services E/M code 99343
  • Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
  • Deletion of Prolonged Services E/M codes 99354-99357
  • Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
  • Revision of Prolonged Services E/M code 99417 and guidelines
  • Establishment of Prolonged Services E/M code 993X0 and guidelines

View the January 2023 CPT® Evaluation and Management (E/M) Code and Guideline Changes here

OCR fines 11 healthcare orgs for HIPAA right-of-access cases 

July 18, 2022

The HHS Office for Civil Rights on Friday said it has settled nearly a dozen investigations of allegations of HIPAA Right of Access Initiative violations.


WHY IT MATTERS

OCR's enforcement actions include some substantial monetary penalties for the following healthcare providers and compelled them to furnish patients with timely copies of their health records.


THE LARGER TREND

The 11 new cases bring the total number of settlements to 38 since OCR began enforcing the HIPAA Right of Access Rule in 2019. Despite the more rigorous enforcement, however, some patients are still forced to sue to gain access to their own healthcare information.


ON THE RECORD

"It should not take a federal investigation before a HIPAA-covered entity provides patients, or their personal representatives, with access to their medical records," OCR Director Lisa J. Pino said in a statement. "Health care organizations should take note that there are now 38 enforcement actions in our Right of Access Initiative and understand that OCR is serious about upholding the law and peoples' fundamental right to timely access to their medical records."


View HHS Office for Civil Rights Right of Access Initiative here

COVID-19: Novavax Vaccine, Adjuvanted — New Codes 

CMS issued 3 new CPT codes effective July 13, 2022

The FDA authorized emergency use of the Novavax COVID-19 vaccine, Adjuvanted for the prevention of COVID-19 disease in patients 18 years and older:

Code 91304 for vaccine product:

  • Long descriptor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage, for intramuscular use
  • Short descriptor: SARSCOV2 VAC 5MCG/0.5ML IM

Code 0041A for vaccine administration, first dose:

  • Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; first dose
  • Short descriptor: ADM SARSCOV2 5MCG/0.5ML 1ST

Code 0042A for vaccine administration, second dose:

  • Long descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; second dose
  • Short descriptor: ADM SARSCOV2 5MCG/0.5ML 2ND

Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited this webpage.

 Joint Cyber Advisory TLP White: North Korean State-Sponsored Cyber Actors Use Maui Ransomware to Target the Healthcare and Public Health Sector 

North Korean State-Sponsored Cyber Actors Use Maui Ransomware to Target the Healthcare and Public Health Sector

July 2022

The Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA), and the Department of the Treasury (Treasury) are releasing this joint Cybersecurity Advisory (CSA) to provide information on Maui ransomware, which has been used by North Korean state-sponsored cyber actors since at least May 2021 to target Healthcare and Public Health (HPH) Sector organizations.


This joint CSA provides information—including tactics, techniques, and procedures (TTPs) and indicators of compromise (IOCs)—on Maui ransomware obtained from FBI incident response activities and industry analysis of a Maui sample. The FBI, CISA, and Treasury urge HPH Sector organizations as well as other critical infrastructure organizations to apply the recommendations in the Mitigations section of this CSA to reduce the likelihood of compromise from ransomware operations. Victims of Maui ransomware should report the incident to their local FBI field office or CISA.


The FBI, CISA, and Treasury highly discourage paying ransoms as doing so does not guarantee files and records will be recovered and may pose sanctions risks. Note: in September 2021, Treasury issued an updated advisory highlighting the sanctions risks associated with ransomware payments and the proactive steps companies can take to mitigate such risks. Specifically, the updated advisory encourages U.S. entities to adopt and improve cybersecurity practices and report ransomware attacks to, and fully cooperate with, law enforcement. The updated advisory states that when affected parties take these proactive steps, Treasury’s Office of Foreign Assets Control (OFAC) would be more likely to resolve apparent sanctions violations involving ransomware attacks with a non-public enforcement response.


View the Detailed Advisory Here


​Teaching Physicians, Interns, & Residents Guidelines 

Teaching Physicians, Interns, & Residents Guidelines MLN Booklet

July 2022

What’s Changed?

  • Updated teaching settings to include any telehealth service or procedure through audio/video real-time technology
  • Added content about interpreting diagnostic radiology and tests if a physician other than a resident does the interpretation or review
  • In residency training sites outside a Metropolitan Statistical Area (MSA), teaching physicians, as required, may use audio/video real-time technology when the resident does services
  • Added content about psychiatric services under an approved Graduate Medical Education (GME) Program, including documentation
  • Medicare Part A pays graduate medical training programs separately when total time determines office or outpatient Evaluation and Management (E/M) visit level, which includes the resident’s time providing services with a teaching physician present
  • When total time decides the office or outpatient E/M visit level, only include teaching physician-presence time
  • After providi​ng the service, you must document the medical record with the teaching physician’s physical or virtual presence, i​ncluding telehealth services, only in residency training sites outside an MSA
  • Starting January 1, 2022, teaching physicians may use only Medical Decision Making (MDM) when selecting E/M visit level for time-based office and or outpatient E/M visits under the primary care exception
  • During the PHE, we expanded the residents’ services list
  • After the PHE, we’ll no longer include levels 4–5 office or outpatient E/M visits in the primary care exception
  • For all teaching settings ​during the PHE, teaching physicians may direct care and review services each resident provides during or at once after each visit through audio/video real-time technology

Access Teaching Physicians, Interns, & Residents Guideline Here

Quarterly Update to the National Correct Coding Initiative [NCCI] Procedure-to-Procedure [PTP] Edits, Version 28.2, Effective July 1, 2022 

June 2022

NCCI third quarter edit files are available on these Medicare NCCI webpages:

Access NCCI Coding Edits Here

Office of the Inspector General (OIG) to Review a Medicare Administrative Contractor (MAC) Cost Report Settlements with Audit 

June 2022

Report Number (W-00-22-35886)

The Office of the Inspector General (OIG) to review a single Medicare Administrative Contractor (MAC), and based on the results, they may expand this work to other MAC’s.

OIG’s objective will be to:

(1) quantify the extent to which the MAC amends audit adjustments after cost reports have been audited and settled, and whether the audit adjustments contain obvious errors or are inconsistent with the law, regulations and rulings, or general instructions;

(2) quantify the effect of amended audit adjustments; and

(3) gain an understanding of the types and/or causes of amended audit adjustments.

Access Notice Here

People’s Republic of China State-Sponsored Cyber Actors Exploit Network Providers and Devices 

June 2022

Alert (AA22-158A)

Common vulnerabilities exploited by People’s Republic of China state-sponsored cyber actors PRC state-sponsored cyber actors readily exploit vulnerabilities to compromise unpatched network devices. Network devices, such as Small Office/Home Office (SOHO) routers and Network Attached Storage (NAS) devices, serve as additional access points to route command and control (C2) traffic and act as midpoints to conduct network intrusions on other entities. Over the last few years, a series of high-severity vulnerabilities for network devices provided cyber actors with the ability to regularly exploit and gain access to vulnerable infrastructure devices. In addition, these devices are often overlooked by cyber defenders, who struggle to maintain and keep pace with routine software patching of Internet-facing services and endpoint devices.

Top network device CVEs exploited by People’s Republic of China state-sponsored cyber actors: 

  • Cisco
  • Citrix
  • DrayTek
  • D-Link
  • Fortinet
  • MikroTik
  • Netgear
  • Pulse
  • QNAP
  • Zyxel

Click here for PDF Summary

ONC's Cures Act Final Rule Highlighted Regulatory Dates 

June 2022

Empowering Patients with Their Health Record in a Modern Health IT Economy

The patient is at the center of the 21st Century Cures Act. Putting patients in charge of their health records is a key piece of patient control in health care, and patient control is at the center of HHS' work toward a value-based health care system. The ONC Cures Act Final Rule implements interoperability requirements outlined in the Cures Act. Patients need more power in their health care, and access to information is key to making that happen. 

Access full guidelines here

2023 ICD-10-CM Official Guidelines for Coding and Reporting

June 2022

The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS.

Access full guidelines here

2023 ICD-10-CM Files

June 2022

The 2023 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2023. These 2023 ICD-10-CM codes are to be used for discharges occurring from October 1, 2022 through September 30, 2023 and for patient encounters occurring from October 1, 2022 through September 30, 2023.

Access full files here

CPT® Appendix T and Modifier 93: Audio-only medical services

May 2022

Make sure your billing staff knows about these changes:

• New COVID-19 CPT vaccines and administration codes

• CPT proprietary laboratory analyses (PLA) coding changes effective July 1, 2022

• New CPT Category III codes effective July 1, 2022

Access full guidelines here

Effective July 1, 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)

May 2022

Make sure your billing staff knows about these changes:

• New COVID-19 CPT vaccines and administration codes

• CPT proprietary laboratory analyses (PLA) coding changes effective July 1, 2022

• New CPT Category III codes effective July 1, 2022

Access full guidelines here

2023 ICD-10-PCS Official Guidelines for Coding and Reporting

May 2022

The 2023 Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). These guidelines should be used as a

companion document to the official version of the ICD-10-PCS as published on the CMS website. The ICD-10-PCS is a procedure classification published by the United States for classifying procedures performed in hospital inpatient health care settings.

Table of Contents

A. Conventions .......................................................................3

B. Medical and Surgical Section Guidelines ...................................5

2. Body System ..............................................................5

3. Root Operation..........................................................5

4. Body Part ...............................................................13

5. Approach ...............................................................16

6. Device ....................................................................17

C. Obstetrics Section Guidelines...............................................18

D. Radiation Therapy Guidelines.............................................18

E. New Technology Section Guidelines.......................................19

F. Selection of Principal Procedure...........................................20

Access full guidelines here

2023 ICD-10-PCS Files

May 2022

The 2023 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2023. These 2023 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2022 through September 30, 2023.

Access full files here

AHA Resource on ICD-10-CM Coding for Social Determinants of Health

April 2022

Hospitals and health systems are working to address their patients’ social needs and the broader social determinants of health in the communities they serve. This includes societal and environmental conditions such as food, housing, transportation, education, violence, social support, health behaviors and employment.

Any clinician can document a patient’s social needs

Access the full article here

Contact Us

Congress Passes 72-Hour Federal Breach Reporting Law for Critical Infrastructure

March 2022

As part of a larger spending bill signed by President Biden on March 15, 2022, Congress passed the Cyber Incident Reporting for Critical Infrastructure Act (CIRA) to increase funding for the federal Cybersecurity and Critical Infrastructure Agency (CISA). CIRA requires companies considered to be in a “critical infrastructure” sector to notify CISA within 72 hours of a significant cyber incident and, in the case of ransomware, within 24 hours of making a payment. CISA may look to the 16 industries considered “vital” to the United States’ physical and economic security and public health or safety:

  • Chemical
  • Commercial facilities
  • Communications
  • Critical Manufacturing
  • Dams
  • Defense Industrial Base
  • Emergency Services
  • Energy
  • Financial Services
  • Food and Agriculture
  • Government Facilities
  • Healthcare and Public Health
  • Information Technology
  • Nuclear Reactors, Materials, and Waste
  • Transportation Systems
  • Water and Wastewater Systems
Access the full article here

Contact Us