MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC DRG Code 470
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Official Code Descriptor
Crosswalks & Fee Schedule
Coding Alert(s)
- Industry Notes: 3-Year Extension For Joint Replacement Bundling Demo Finalized - (May 07, 2021)
CMS turns down suggestions to mandate gainsharing, suspend post-acute transfer proration penalty. Home health agencies operating in Comprehensive Care for Joint Replacement Model areas can expect the bundling demonstration to influence their referrals and care planning for a longer period [...]
- Industry Notes: HRSA-Funded Health Centers Get Another Boost - (Apr 16, 2021)
In another move to help rural and underserved communities get vaccinated, the feds are inviting all Health Resources & Services Administration (HRSA)-funded health centers to become part of the Health Center COVID-19 Vaccination Program. Reminder: Last month, the Department of [...]
- Industry Note: Medicare Pulls Back On Damaging Bundling Models - (Sep 01, 2017)
CJR already squeezing home health. Many home health agencies breathed a sigh of relief when the Centers for Medicare & Medicaid Services limited or eliminated altogether bundling models that were expected to limit home health utilization and payments. In a [...]
- Know Your Facts: Educate Yourself On Joint Replacement Bundling Demo - (Feb 18, 2016)
Take note: Hospice services are included. Get to know the new hospital payment model that may drastically change your referrals in coming years. In the Nov. 24, 2016 Federal Register, the Centers for Medicare & Medicaid Services published the final [...]
- CJR: To Partner or Not to Partner Prepare for Hospitals to Knock at Your Door - (Dec 28, 2015)
Physician Fee Schedule Final Rule bumps CJR start date to April 1. If you’re involved in rehab for major lower extremity replacements, keep your eye on the new Comprehensive Care for Joint Replacement (CJR) model — because affected hospitals may [...]
- Reader Questions: Look at Separate Lines When Appealing Bilateral Denial - (Jul 16, 2015)
Question: One of our commercial payers has been denying the bilateral portion of 31237 for the past several months. I have appealed using modifier 79 on the first line and modifier 50 on the second, but only two of the claims [...]
- Reader Questions: Focus on Reason for Procedure When Choosing a Diagnosis - (Jun 11, 2015)
Question: Should the ICD-9 placed on the 1500 claim form be related to the procedure itself or the medical reason for requiring MAC? Rhode Island Subscriber Answer: The diagnoses given on the CMS 1500 claim form should always support the necessity of [...]
- Sinus Procedures: Don't Mess Up Maxillary Cyst Removal Coding - (Oct 20, 2014)
Watch when you’d be better off choosing 31256 over 31267. Sometimes a code’s wording can leave just enough gray area to throw a coder off. For instance, take 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from [...]
- Reader Question: Focus on Reason for Procedure When Choosing a Diagnosis - (Jun 16, 2014)
Question: Should the ICD-9 placed on the 1500 claim form be related to the procedure itself or the medical reason for requiring MAC? Rhode Island Subscriber Answer: The diagnoses given on the CMS 1500 claim form should always support the necessity of [...]
- Denial Management: Refresh Documentation Know-How for Total Joint Replacements -- or Risk Claim Denials - (Apr 07, 2014)
Dodge denial code 5J504 (Need for service/item not medically and reasonably necessary). A new wave of audits may threaten claims for total joint replacement (TJR) procedures in 2014, at least for physicians and hospitals who fail to revisit existing guidelines [...]