Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top left corner of this page

Practice Exam

2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Tag Archives: Changes

Updated 2017 ICD-10-CM guidelines come ‘with’ controversial changes

Updated 2017 ICD-10-CM guidelines come ‘with’ controversial changes

by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS


Just like the lyrics to the popular Gap Band song say, "You dropped a bomb on me… I won’t forget it," there are definitely some changes in the 2017 ICD-10-CM Official Guidelines for Coding and Reporting that some of us may wish the Cooperating Parties will forget were ever mentioned.

Generally, changes to the guidelines are minor and rarely cause the chaos and confusion that will certainly ensue with the most recent release, effective October 1. This release includes some contradictory guidance and downright concerning statements that appear as if no one really thought through the repercussions. These revisions will certainly have an impact not only on code assignment, but also specifically on reimbursement.


The guidelines state:

The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related.


I consider this paragraph the most controversial addition to the guidelines. We’ll look at the impact the guideline has on previous examples relating to conditions such as diabetes mellitus, hypertensive heart disease, and some other conditions.

The guidance most commonly discussed is that for "diabetes with," which was stated in the AHA’s Coding Clinic for ICD-10-CM/PCS, First Quarter 2016, and reconfirmed in the following quarter. To summarize, the AHA guidance stated:

The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system and ANY condition listed under the term "with" in the Alphabetic Index is intended to be interpreted as a related condition/manifestation.


It appears that someone has never looked in the actual ICD-10-CM index file, because all conditions related to diabetes mellitus are indented under the word "with," not just isolated ones as in the ICD-9-CM manual.

Here is the comparison (from the ICD-9-CM index):

Diabetes, diabetic (brittle) (congenital) (familial) (mellitus) (severe) (slight) (without complication) 250.0

Compare to this excerpt from the ICD-10-CM Alphabetic Index:

The most surprising aspect to me in the repeated guidance is the contradiction to not assume a relationship between osteomyelitis and diabetes mellitus, which Coding Clinic originally stated in Fourth Quarter 2013 and reiterated in First Quarter 2016, writing:

ICD-10-CM does not presume a linkage between diabetes and osteomyelitis. The provider will need to document a linkage or relationship between the two conditions before it can be coded as such.


Coders understood back in 2013 to not assume relationships between diabetes and other conditions that coexist in a diabetic patient. But this recent guidance creates more questions than answers. This very specific guidance about osteomyelitis leads me to imagine the scenario of a patient who has a relationship created between osteomyelitis and diabetes mellitus by a provider documenting "osteomyelitis due to diabetes mellitus." What codes would be reported?

The correct answer would be to assign the code for other specified complication (e.g., E11.69) since there is no entry specifically for osteomyelitis under diabetes mellitus. It would be classified to the "other" category per the ICD-10-CM conventions. If we examine this a bit closer, E11.69 is listed under the word "with" in the Alphabetic Index.

So, is it assumed or not? The guidance and guidelines directly contradict each other.

Some have argued that the ICD-9-CM index included a specific entry for diabetes with osteomyelitis, and I agree that the word "osteomyelitis" is there in black and white, but take a look at the code title: 250.8 (other specified manifestation of diabetes mellitus). There wasn’t a specific code in ICD-9-CM that said "diabetes with osteomyelitis," just like there isn’t in ICD-10-CM.

Diabetes, diabetic (brittle) (congenital) (familial) (mellitus) (severe) (slight) (without complication) 250.0

I suggest if the Cooperating Parties truly plan on keeping osteomyelitis separate, there should be a separate entry in the Alphabetic Index where it is not at the second indentation level under the word "with," but is under diabetes as a main term with a singular indentation.

The "with" guidance extends much further than I think the Cooperating Parties have considered. For risk-adjusted plans, the assumption of linking diabetes and other related conditions (acute and/or chronic) without necessitating providers document it will have a direct impact on a patient’s overall risk score.

The risk score uses many factors, but chronic conditions like diabetes mellitus are a key component in determining how much CMS should pay an insurance plan for care for Medicare beneficiaries covered under plans like Medicare Advantage (i.e., Part C). Being able to assume a relationship is a major change and will ultimately have a big impact on spending for any risk-adjusted plan, considering diabetes is such a common condition.

The reason this hasn’t really been considered an issue yet is that Medicare Advantage data is compiled based on the previous year’s diagnosis codes to prospectively estimate spending in the upcoming year.

Therefore, CMS is currently using ICD-9-CM data for encounters through September 30, 2015. Hopefully, this new guidance valid for encounters as of January 1, 2016, will be considered a factor, because patients with diabetic complications are certain to increase.

If the word "with" couldn’t get any more controversial, it ventured out of the endocrine system to the very "heart" of every coder’s cardinal rule. We learned, as fledgling coders, to never assume heart disease (like heart failure) is directly related to hypertension unless the provider documents the two conditions as related, like hypertensive heart failure or heart failure due to hypertension.

Well, no more, my friends?this is the dawn of a new age of coding. We can assume away, not only for hypertension and (chronic) kidney involvement, but also for hypertension and heart involvement because they are both indented under the word "with" in the Alphabetic Index.

The revised guideline states (bolding is mine)’:

The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term "with" in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.


Please notice that the past statement does identify that if the provider specifically states another cause, the conditions should be coded as unrelated.

The larger issue I have with assuming anything under "with" is seen in the ICD-10-CM Alphabetic Index and is yet another direct contradiction to the guidelines. If the guidance regarding "with" is truly universal within the Alphabetic Index, then it implies a relationship for diseases extending beyond just diabetes mellitus and hypertensive heart disease. For example, it seems that coders could begin to assume, based on the guidelines, that patients who have sepsis with a coexistence of organ dysfunction have severe sepsis, even though the guidelines specifically state "an acute organ dysfunction must be associated with the sepsis in order to assign the severe sepsis code."

Who knew that a little word like "with" could cause so many issues?


Excludes1 notes

The guidelines also include an update on reporting Excludes1 conditions. The updated guidelines state:

An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider.


The Excludes1 conventions clarify what was addressed in the interim guidance provided in October 2015 and in the AHA Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2015, to address situations where Excludes1 notes should be considered Excludes2 or had other exceptions. Category I63 (cerebral infarction) excludes subcategory I69.3- (sequela of cerebral infarction). This guidance directly contradicted the guidelines for Chapter 9, which state: "Codes from category I69 may be assigned on a health care record with codes from I60-I67, if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease."

For 2017, subcategory I69.3- has been revised to be included in an Excludes2 note. Exceptions have been added to the guidelines when the exclusion was for a category that may include a number of different conditions, like the "other" category. Some of those inclusive conditions should never be coded with the diagnosis the Excludes1 note appears under, others may be completely unrelated.

This opens the door for a third-party auditor to debate the application of the Excludes1 note if coding the two conditions separately creates a financial impact.


Edito’?s note

McCall is the director of HIM and coding for HCPro, a division of BLR, in Middleton, Massachusetts. She oversees all of the Certified Coder Boot Camp programs. McCall works with hospitals, medical practices, and other healthcare providers on a wide range of coding-related custom education sessions. For more information, see – Briefings on APCs

2018 ICD-10-PCS Code Changes

The U.S. Department of Health & Human Services (HHS) has released the code changes for ICD-10-PCS coding system. ICD-10-PCS codes were adopted under HIPAA for hospital inpatient healthcare settings to use for reporting procedures. Their guidelines help healthcare providers and coders to accurately identify procedures to be reported on healthcare claims.

The 2018 updates will reflect services from Oct. 1, 2017 through Sept. 30, 2018, so be sure to update your medical records to account for the changes.

There were 75,789 codes in 2017. In 2018, the number jumps to 78,705…


Continue reading this article


The post 2018 ICD-10-PCS Code Changes appeared first on Outsource Management Group, LLC..

ICD-10 – Outsource Management Group, LLC.

Medical coding & billing: Know the ICD-9 2011 changes

Every year, in October you come face with new ICD-9 codes that you need to add to your diagnosis arsenal. This time too it’s no exception what with the new estasia, congenital malformation, and body mass index (BMI) codes you’ll need to know. Here are some of the proposed changes that’ll impact your cardiology practice so that you are all geared up when the fall rolls around.

Your ectasia hunt will end at 447.7x

ICD 9 2011 adds four specific codes to aortic ectasia, which could be among the most significant changes for cardiology coders. By Estasia we mean dilation or enlargement and aortic ectasia often refers to an enlargement that is milder than an aneurysm. However, ICD-9 2010 doesn’t distinguish ectasia from aneurysm, linking aortic ectasia to 441.9 and 441.5. The proposed 2011 codes are specific to aortic ectasia.

New corrected congenital malformations code

Some of the just-in codes deal with congenital malformations of the heart and circulatory system. Code V13.65 will be very helpful to our practice.

The ICD-9 proposal has expanded the body mass index (BMI) codes to show higher BMIs with five just-in codes. From October 1, you will stop using V85.4 and start using more specific V codes in its place.

The advantage: BMI has become a key health tool and those codes will also provide more data.

With just a few days to go for October 1, you will benefit a lot if you sign up for an audio conference, more so as this CMS will not allow a grace period for using the 2011 diagnosis codes.

Such a conference will provide you with all possible medical coding & billing updates pertaining to ICD 9 2011 changes not just for cardiology, but for every specialty – be it the new codes, the revised ones or the deleted ones. Some audio conferences also offer you CEUs if you sign up for one.


Audioeducator offers medical coding audio conference and provides advanced Learning Opportunities about medical coding update through all types of audio conferences and exceptional series of training CD’s, DVD’s & Tapes.

2016 CPT Code Changes

2016 Newly Added Lab Codes List

80081 Obstetric panel (includes HIV testing)

This new code is identical to the 80055 code (Obstetric panel) except the HIV testing was added. In order to bill this code all components of the panel must be performed. The added service for this new panel includes HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result (87389).


The following are the new codes for 2016 for gene-specific and genomic procedures. Molecular pathology codes include all analytical services performed in the test. This includes cell lysis, nucleic acid stabilization, extraction, digestion, amplification, and detection. Any procedures required prior to cell lysis such as microdissection (88380, 88381) are reported separately. AMA instructs coders to use 87149-87153, 87470-87801, and 87900-87904 for any molecular testing done for microbial identification. This means molecular testing for infectious agents, such as HPV are NOT reported in the molecular pathology section of the code book. You should look to the Microbiology section for those codes.

For in situ hybridization, use the 88271-88275 (when interpreted by scientist instead of pathologist) and 88365-88368 when interpreted by a pathologist.

81170 ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain

81162 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis. Do not report 81162 in conjunction with 81211, 81213, 81214, 81216)

81218 CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence

81219 CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon 9

81272 KIT (v-kit Hardy-Zukerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons 8, 11, 13, 17, 18)

81273 KIT (v-kit Hardy-Zukerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), gene analysis, D816 variants(s)

81276 KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma gene analysis; additional variants(s) (eg, codon 61, codon 146)

81311 NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)

81314 PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18)


This new section of genomic sequencing procedures (GSPs) are DNA or RNA sequence analysis methods that simultaneously assay multiple genes or genetic regions relevant 

to a clinical situation. Most commonly referred to a “Next Gen Sequencing” (NGS) or “Massively Parallel Sequencing” (MPS) in the laboratory, are tests intended to 

evaluate the genetic material in totality or near totality.

The codes in this section should be used when the components of the descriptor(s) are met regardless of the technique used, unless specifically noted in the code descriptor. 

If all the components are NOT performed, then you must assign code(s) in the Tier 1 or Tier 2 section or if they aren’t listed in the Tier codes, use the unlisted code 

81479. AMA provides two parenthetical statements after this introduction section:

• For cytogenomic microarray analyses, see 81228, 81229, 81405, 81406.
• For long QT syndrome gene analyses, see 81280, 81282 

81412 Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GA, HEXA, IKBKAP, MCOLN1, and SMPD1

81432 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 14 genes, include ATM, BRCA1, BRIP1, CHD1, MLH1, MSH2, MSH6, NBN, PALB2, PTEN, RAD51C, STK11, and TP53

81433 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11

81434 Hereditary retinal disorders (eg, retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR, and USH2A

81437 Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma; genomic sequence analysis panel, must include sequencing of at least 6 genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL

81438 Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma; duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL

81442 Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence
analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1

The CPT codes listed above in this section are panels associated with various disorders where the testing is performed by genomic sequence analysis. In each of the CPT panel codes the code descriptors define specifically what genes must be tested in that panel as well as the minimum number of genes that must be tested in order to assign that given CPT code.


Multianalyte Assays with Algorithmic Analyses (MAAAs) are procedures that utilize multiple results derived from assays of various types, including molecular pathology assays, fluorescent in situ hybridization assays and nonnucleic acid based assays (eg, proteins, polypeptides, lipids, carbohydrates). Algorithmic analysis using the results of these assays as well as other patient information, if used, is then performed and reported typically as a numeric score(s) or as a probability.

MAAAs are typically unique to a single clinical laboratory or manufacturer. The results of individual component procedure(s) that are inputs to the MAAAs may be provided on the associated laboratory report; however, these assays are not reported separately using additional codes. For more information on these codes, please see the MAAA section of the 2016 CPT code book and Appendix O in your 2016 Code book

81490 Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score. Do not report 81490 in conjunction with 86140

81493 Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score

81525 Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score

81528 Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result. Do not report 81528 in conjunction with 81275, 82274

81535 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination

+81536 Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure) Do not report 81536 in conjunction with 81535

81538 Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival

81540 Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype

81545 Oncology (thyroid), gene expression analysis of 142 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious)

81595 Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score

0009M Fetal aneuploidy (trisomy 21, and 18) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy

0010M Oncology (High-Grade Prostate Cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA and human kallikrein 2 [hK2]) plus patient age, digital rectal examination status, and no history of positive prostate biopsy, utilizing plasma, prognostic algorithm reported as a probability score


Immunofluorescence Stains

AMA has added one code for 2016, an add-on code for immunofluorescence stains. This code represents any additional stains that are performed above the initial first stain which is assigned CPT 88346. The “unit of service” is defined as each additional “single antibody stain procedure” from that designated specimen. It is not solely each additional stain performed, it has to be a separate stain procedure for that given stain, hence the descriptor “single antibody stain procedure.”

Also please note in the parenthetical that the AMA specifically states to not report 88346 and 88350 when the stain performed is a multiplex immunofluorescence stain(s)… it directs to the coder to assign the miscellaneous code 88399.

NOTE that 88350 has a + sign denoting an add-on code and can only be billed when 88346 is also billed. 

+88350 Immunofluoroscence, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) Report 88350 in conjunction with 88346. Do not report 88346 and 88350 for fluorescent in situ hybridization studies, see 88364, 88365, 88366, 88367, 88368, 88369, 88373, 88374, and 

88377. Do not report 88346 and 88350 for multiplex immunofluorescence analysis, use 88399

CMS newly added codes

G0475 Hiv antigen/antibody, combination assay, screening

G0476 Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test.

Coding Ahead

[Announcement] SNFs: Final FY 2017 Payment and Policy Changes

On July 29, CMS issued a final rule (CMS-1645-F) outlining FY 2017 Medicare payment policies and rates for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), the SNF Quality Reporting Program (QRP), and the SNF Value-Based Purchasing (VBP) Program. CMS projects that aggregate payments to SNFs will increase in FY 2017 by $ 920 million, or 2.4 percent, from payments in FY 2016. This estimated increase is attributable to a 2.7 percent market basket increase reduced by 0.3 percentage points, in accordance with the multifactor productivity adjustment required by law.

Changes to the SNF QRP:

• Adopts three measures to meet the resource use and other measure domains and one measure to satisfy the domain of medication reconciliation
• SNFs that fail to submit the required quality data to CMS will be subject to a 2 percentage point reduction to the annual market basket percentage update factor for fiscal years beginning with FY 2018
• Policies and procedures associated with public reporting are being finalized, including the reporting timelines, preview period, review and correction of assessment-based and claims-based quality measure data, and the provision of confidential feedback reports to SNFs

SNF VBP Program:

• Specifies the SNF 30-Day Potentially Preventable Readmission Measure, (SNFPPR), as the all-cause, all-condition risk-adjusted potentially preventable hospital readmission measure as required by law

• Finalized additional policies, including establishing performance standards, establishing baseline and performance periods, adopting a performance scoring methodology, and providing confidential feedback reports to SNFs

For More Information:

• Final Rule will become effective on October 1, 2016
• SNF PPS website
• SNF QRP webpage
• SNF VBP webpage


See the full text of this excerpted CMS fact sheet (issued July 29).

The Medical Management Institute – MMI – Medical Coding News & MMI Updates

[Announcement] Hospital IPPS and LTCH PPS Final Rule Policy and Payment Changes for FY 2017

Hospital Discharges

Originally Published in MLN Connects

On August 2, CMS issued a final rule to update FY 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.

The final increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful Electronic Health Record (EHR) users is approximately 0.95 percent. This reflects the projected hospital market basket update of 2.7 percent adjusted by -0.3 percentage point for multi-factor productivity and an additional adjustment of -0.75 percentage point in accordance with the Affordable Care Act. This also reflects a 1.5 percentage point reduction for documentation and coding required by the American Taxpayer Relief Act of 2012 and an increase of approximately 0.8 percentage points to remove the adjustment to offset the estimated costs of the Two Midnight policy and address its effects in FYs 2014, 2015, and 2016.

• In sum, CMS projects that total Medicare spending on inpatient hospital services, including capital, will increase by about $ 746 million in FY 2017
• This projected increase in spending includes an estimated $ 350,000 increase in FY 2017 payments to hospitals located in Puerto Rico under the final policy to make IPPS payments for capital-related costs based solely on the national capital Federal rate

The final rule also includes:

• IPPS rate adjustments for documentation and coding and Two-Midnight Policy Medicare uncompensated care payments
• CMS-1632-F & IFC: Finalization of the extension of the Medicare-Dependent Hospital Program and low-volume hospital adjustment provided by MACRA
• Notification procedures for outpatients receiving observation services
• Hospital-Acquired Condition Reduction Program
• Hospital Readmissions Reduction Program
• Medicare and Medicaid EHR Incentive Programs 
• Hospital IQR Program
• Hospital Value-Based Purchasing Program
• PPS-Exempt Cancer Hospital Quality Reporting Program
• Inpatient Psychiatric Facility Quality Reporting Quality Reporting Program
• LTCH PPS changes
• LTCH Quality Reporting Program

See the full text of this excerpted CMS fact sheet (issued August 2).

The Medical Management Institute – MMI – Medical Coding News & MMI Updates