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Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Outpatient Evaluation and Management Services

This tip sheet is intended to assist providers and coding staff with the documentation, Current Procedural Terminology (CPT) Codes and ICD-10-CM selection on services submitted to Healthfirst—specifically for Outpatient Evaluation and Management Services.

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Clinical Documentation Improvement
  
Coding - Video - 2024
Video - Documentation and Coding of Breast Cancer

This 5-minute video offers guidance on proper clinical documentation and coding of breast cancer.

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Clinical Documentation Improvement
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Aspiration Pneumonia, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for types of Aspiration Pneumonia.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Compression of Brain, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for Compression of Brain (non-Traumatic).

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Policy, Billing, or Coverage Update - 2020
The ICD-10 Transition: Focus on Non-Covered Entities

The ICD-9 code set used to report medical diagnoses and inpatient procedures is being replaced by the ICD-10 code set. To accommodate the ICD-10 code structure, the standards used for electronic health care transactions, Version 4010/4010A, were upgraded to Version 5010 on January 1, 2012.

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General ICD-10/ICD-11 Information
  
Coding - Practice Guidelines and Tips - 2024
Documentation and Coding: Sepsis, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for sepsis.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Coding - Policy, Billing, or Coverage Update - 2024
Medicare Physician and Practitioner Providers - Medical Record Request for Calendar Year 2022 (CY22) Part C Improper Payment Measure (Part C IPM)

This request is based on diagnosis data submitted to the Centers for Medicare & Medicaid Services (CMS) as a result of services you provided to MA beneficiaries during calendar year 2021 (CY21). The purpose of this request is to validate diagnoses that were sent to CMS to determine health status-adjusted payments under risk adjustment.

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Risk Adjustment Data Validation Audit
  
Coding - Policy, Billing, or Coverage Update - 2024
Medicare Hospitals - Medical Record Request for Calendar Year 2022 (CY22) Part C Improper Payment Measure (Part C IPM)

This request is based on diagnosis data submitted to the Centers for Medicare & Medicaid Services (CMS) as a result of services you provided to MA beneficiaries during calendar year 2021 (CY21). The purpose of this request is to validate diagnoses that were sent to CMS to determine health status-adjusted payments under risk adjustment.

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Risk Adjustment Data Validation Audit
  
Coding - Practice Guidelines and Tips - 2023
Documentation and Coding: Hepatitis C, CMS-HCC_V28 Model Updates

This tip sheet is intended to assist providers and coding staff with the documentation and ICD-10-CM selection, along with the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Version 28 Model Updates, on services submitted to Healthfirst—specifically for chronic Hepatitis C.

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Clinical Documentation Improvement
CMS-HCC_V28 Model Updates
  
Provider Alerts - Coding - Claims & Billing - Policy, Billing, or Coverage Update - 2022
Coding Instructions for Co-Surgeons and Team Surgeons

Healthfirst follows the Centers for Medicare & Medicaid Services (CMS) guidance for the use of co-surgeon (-62) and team surgeon (-66) modifiers with claim submissions.

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Billing
  
Provider Alerts - Coding - Policy, Billing, or Coverage Update - 2023
Acceptable Procedure Code/Modifier Combinations

Effective Sept. 1, 2023, Healthfirst is updating internal systems to deny procedure code/modifier combinations that are specifically flagged as invalid or inactive. These changes are based on New York State Medicaid (NYSM), American Medical Association (AMA), and Centers for Medicare & Medicaid Services (CMS) guidelines.

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Coding
  
Coding - Coronavirus (COVID-19) - Practice Guidelines and Tips - 2021
Coding Novel Coronavirus: Type COVID-19

This document provides guidance on proper coding practices for a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19). Please note that Healthfirst guidelines related to waiving the cost share for evaluating a member for suspected COVID-19 are not reflected within this coding guidance. Please refer to the Coronavirus (COVID-19) section at hfproviders.org to find information on claims/encounters that will result in the waiver of cost sharing for members.

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COVID-19
  
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