Medical Coding and Billing Articles
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recent articles
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May 25th, 2021
PCS Coding for Ankle Fracture - Look Deeper Into the Codes!
| Published May 25th, 2021
If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...
May 20th, 2021
Intersegmental Traction — What’s Happening with Roller Tables?
| Published May 20th, 2021
Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?
May 20th, 2021
Congress Has Been Busy — 11 Different Bills Pass Covering Mental Health and Substance Use
| Published May 19th, 2021 - Last Review/Update May 20th, 2021
The House of Representatives has certainly been working hard to advance behavioral health services. This article summarizes each of those bills and includes a link to contact your Senator.
May 18th, 2021
OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment
| Published May 18th, 2021
As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.
May 12th, 2021
Since When did Dental Claims Require Diagnosis Codes?
| Published May 12th, 2021
The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...
May 12th, 2021
Compliance in the Dental Office or Small Practice
| Published May 12th, 2021
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...
May 6th, 2021
Identifying Risk-Adjusted Services During the Opioid Crisis
| Published May 6th, 2021
Between June 2019 and June 2020, the United States saw a total of 107,750 deaths from COVID-19. The spread of this virus was so extraordinary that it led President Trump to declare a public health emergency, and we watched as individual states began implementing laws and regulations to limit social interaction ...
May 4th, 2021
Comparison of Add-On Code Guidelines
| Published May 4th, 2021
Add-on codes are codes that are not intended to be reported alone. They are reported with another primary procedure to identify that additional services have been provided in conjunction with that primary procedure. Generally, they include the words “List separately in addition to code.” Interestingly, there are some differences in the instructions/guidelines regarding the use of these codes in the CPT® codebook, the NCCI Policy Manual, and on the CMS website. This article outlines the differences between each of these.
April 29th, 2021
Coding Lesions and Soft Tissue Excisions
| Published April 29th, 2021
There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions.
The code selection will be determined upon the following:
Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain)
Technique
Topography (anatomic location)
The size
Tissue Level
Type of closure required
Layers ...
April 29th, 2021
58% of Improper Payments due to Medical Necessity for Ventilators
| Published April 29th, 2021
Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...
April 27th, 2021
Why Will Medicare Administrative Contractors be Holding Claims Up?
| Published April 27th, 2021
When Congress passed the expansive American Rescue Plan Act last month, most Americans were focused on the direct payment provision of the bill. However healthcare administrators and policymakers had their attention on another aspect: cuts to Medicare payments. Why would Congress be cutting Medicare payments during the COVID-19 Public Health ...
April 20th, 2021
ICD-11 — What’s Happening?
| Published April 20th, 2021
ICD-11 is officially released, but what does that mean for diagnosis coding in the United States? What's really different? This article discusses what has been happening with ICD-11, some interesting things to note about it, as well as links to other important information.
April 19th, 2021
Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?
| Published April 19th, 2021
Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source?
Answer: This is a great question and one that has been asked by many coders and auditors.
April 12th, 2021
Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K
| Published April 12th, 2021
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
April 8th, 2021
Properly Reporting Imaging Overreads (Including X-Rays)
| Published April 8th, 2021
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
April 1st, 2021
Evaluation & Management (E/M) Webinar Q/A
| Published April 1st, 2021
Find answers to some questions asked by attendees of our recent webinar regarding the changes released by the AMA in their March 9, 2021 Errata and Technical Corrections document in relation to Evaluation & Management (E/M).
March 23rd, 2021
Understanding Skin Biopsy Codes
| Published March 23rd, 2021
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
March 18th, 2021
How Reporting E/M Based on Time May Lose Money
| Published March 18th, 2021
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
March 17th, 2021
The OIG Turns their Gaze to Possible Inpatient Service Upcoding
| Published March 17th, 2021
The Office of Inspector General for the United States Department of Health and Human Services (HHS-OIG) is responsible for ensuring the integrity of programs operated by HHS, including the Medicare and Medicaid programs. One of the ways this is accomplished is through the identification of fraudulent activities, one of which ...
March 17th, 2021
Critical Evaluation and Management Changes Recently Announced by AMA
| Published March 16th, 2021 - Last Review/Update March 17th, 2021
On March 9, 2021, the American Medical Association (AMA) announced some pretty significant changes in relation to reporting Evaluation and Management (E/M) services, particularly for Office or Other Outpatient Services (99202-99215). The AMA Editorial Panel had previously met to discuss how to address concerns and made changes surrounding Office or Other Outpatient Services which are retroactive to January 1, 2021. Learn more about those changes in this article.
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