"Claims Processing" & "ICD10CM Coding" Articles
Click on the title to see the article summary and a link to the full article.
April 20th, 2021
ICD-11 — What’s Happening?
By Wyn Staheli, Director of Research | 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.
March 18th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 18th, 2021
21. Factors influencing health status and contact with health services (Z00-Z99)
Code: Description:Z03.821 Encounter for observation for suspected ingested foreign body ruled outZ03.822 Encounter for observation for suspected aspirated (inhaled) foreign body ruled outZ03.823 Encounter for ...
March 17th, 2021
Q/A: Why is My Claim Being Denied When I Report a Secondary Diagnosis Code?
By Wyn Staheli, Director of Research | Published March 17th, 2021
Question: Recently my claims to Medicare are being denied when I submit a secondary diagnosis code. I’ve heard that this is happening in several states including Washington, California, and New York. Has there been a recent change in what secondary diagnosis codes are allowed?
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
4. Endocrine, nutritional and metabolic diseases (E00-E89)
Code: Description:E70.81 Aromatic L-amino acid decarboxylase deficiencyE70.89 Other disorders of aromatic amino-acid metabolismE74.810 Glucose transporter protein type 1 deficiencyE74.818 Other disorders of glucose transportE74.819 ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
5. Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
Code: Description:F10.130 Alcohol abuse with withdrawal, uncomplicatedF10.131 Alcohol abuse with withdrawal deliriumF10.132 Alcohol abuse with withdrawal with perceptual disturbanceF10.139 Alcohol abuse with withdrawal, unspecifiedF10.930 Alcohol use, unspecified with withdrawal, ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
6. Diseases of the nervous system (G00-G99)
Code: Description: G11.10 Early-onset cerebellar ataxia, unspecifiedG11.11 Friedreich ataxiaG11.19 Other early-onset cerebellar ataxiaG40.42 Cyclin-Dependent Kinase-Like 5 Deficiency DisorderG40.833 Dravet syndrome, intractable, ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
7. Diseases of the eye and adnexa (H00-H59)
Code: Description: H18.501 Unspecified hereditary corneal dystrophies, right eyeH18.502 Unspecified hereditary corneal dystrophies, left eyeH18.503 Unspecified hereditary corneal dystrophies, bilateralH18.509 Unspecified hereditary corneal dystrophies, unspecified eyeH18.511 Endothelial ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
10. Diseases of the respiratory system (J00-J99)
Code: Description:J82.81 Chronic eosinophilic pneumoniaJ82.82 Acute eosinophilic pneumoniaJ82.83 Eosinophilic asthmaJ82.89 Other pulmonary eosinophilia, not elsewhere classifiedJ84.170 Interstitial lung disease with ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
11. Diseases of the digestive system (K00-K95)
Code: Description:K20.80 Other esophagitis without bleedingK20.81 Other esophagitis with bleedingK20.90 Esophagitis, unspecified without bleedingK20.91 Esophagitis, unspecified with bleedingK21.00 Gastro-esophageal reflux disease with esophagitis, ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
13. Diseases of the musculoskeletal system and connective tissue (M00-M99)
Code: Description:M05.7A Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvementM05.8A Other rheumatoid arthritis with rheumatoid factor of other specified siteM06.0A ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
14. Diseases of the genitourinary system (N00-N99)
Code: Description:N00.A Acute nephritic syndrome with C3 glomerulonephritisN01.A Rapidly progressive nephritic syndrome with C3 glomerulonephritisN02.A Recurrent and persistent hematuria with C3 glomerulonephritisN03.A ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
16. Certain conditions originating in the perinatal period (P00-P96)
Code: Description:P91.821 Neonatal cerebral infarction, right side of brainP91.822 Neonatal cerebral infarction, left side of brainP91.823 Neonatal cerebral infarction, bilateralP91.829 Neonatal cerebral infarction, unspecified side
...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Code: Description:R51.0 Headache with orthostatic component, not elsewhere classifiedR51.9 Headache, unspecifiedR74.01 Elevation of levels of liver transaminase levelsR74.02 ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
19. Injury, poisoning and certain other consequences of external causes (S00-T88)
Code: Description:S20.213A Contusion of bilateral front wall of thorax, initial encounterS20.213D Contusion of bilateral front wall of thorax, subsequent encounterS20.213S Contusion of bilateral front wall of thorax, sequelaS20.214A Contusion of ...
March 16th, 2021
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
20. External causes of morbidity (V00-Y99)
Code: Description:V00.031A Pedestrian on foot injured in collision with rider of standing electric scooter, initial encounterV00.031D Pedestrian on foot injured in collision with rider of standing electric scooter, subsequent encounterV00.031S Pedestrian on foot injured ...
March 10th, 2021
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 10th, 2021
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
January 11th, 2021
ICD-10 Code Updates for January 1st
By Wyn Staheli, Director of Research | Published January 11th, 2021
Be aware that new ICD-10-CM and ICD-10-PCS codes took effect on January 1, 2021. Rarely have ICD-10-CM codes been released in January, but as you may have guessed, these changes are in relation to COVID-19. The information in this article will help your organization understand these changes.
December 23rd, 2020
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 23rd, 2020
1. Certain infectious and parasitic diseases (A00-B99)
Code: Description:A84.81 Powassan virus diseaseA84.89 Other tick-borne viral encephalitisB60.00 Babesiosis, unspecifiedB60.01 Babesiosis due to Babesia microtiB60.02 Babesiosis due to Babesia duncaniB60.03 ...
December 22nd, 2020
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020
15. Pregnancy, childbirth and the puerperium (O00-O9A)
Code: Description:O34.218 Maternal care for other type scar from previous cesarean deliveryO34.22 Maternal care for cesarean scar defect (isthmocele) O99.891 Other specified diseases and conditions complicating pregnancyO99.892 Other ...
December 22nd, 2020
ICD-10-CM 2021 Codes for your Specialty
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020
3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
Code: Description:D57.03 Hb-SS disease with cerebral vascular involvementD57.09 Hb-SS disease with crisis with other specified complicationD57.213 Sickle-cell/Hb-C disease with ...
December 8th, 2020
Locating Periodontal Disease in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020
When coding a diagnosis for periodontal disease, keep in mind there are more options than just chronic or acute. To get started, look at chapter 11, Diseases of the digestive system (K00-K95). Looking at this section a little further, you can see this is where the oral cavity is coded ...
November 18th, 2020
How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
By Raquel Shumway | Published November 18th, 2020
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
November 18th, 2020
Cross-A-Code Instructions in Find-A-Code
By Raquel Shumway | Published November 18th, 2020
Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
October 1st, 2020
New Codes for Cytokine Release Syndrome (CRS)
By Wyn Staheli, Director of Research | Published October 1st, 2020 - Last Review/Update October 6th, 2020
New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.
September 29th, 2020
ICD-10-CM 2021 Coding Updates for Chiropractic
By Wyn Staheli, Director of Research | Published September 29th, 2020
October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. This year there are some interesting changes such as a new headache type, new codes related to TMJ, several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard), and some other changes.
September 23rd, 2020
Locating a Diagnosis Code in ICD-10-CM for Dental Offices
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 23rd, 2020
Diagnosis codes used to report with procedures are called ICD-10-CM - International Statistical Classification of Diseases. These codes are published annually in October. To find a diagnosis code in ICD-10-CM, it is important to understand how the chapters and sections are set up. Each chapter is broken down into sections and ...
August 24th, 2020
2021 Brings Another Risk Adjustment Calculation Change
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published August 24th, 2020
In 2021, a big change in Risk Adjustment score calculations will take place, which will affect payments to Medicare Advantage (MA) plans for the coming year and take us closer to quality and value-based programs instead of fee-for-service (FFS) or risk-adjusted (RA). Currently, CMS pays a per-enrollee capitated...
August 5th, 2020
Coding with PCS When There is No Code
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 5th, 2020
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
July 15th, 2020
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 15th, 2020
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ...
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
May 5th, 2020
ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 5th, 2020
The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).
The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.
ICD-10-CM Official Coding Guidelines - ...
April 16th, 2020
Hypertension ICD-10-CM Coding Table, Guidelines, and Tips
By Wyn Staheli, Director of Research & Aimee Wilcox, Director of Content | Published April 16th, 2020
Coding hypertension properly requires knowing all the guidelines. This article summarizes how hypertension is coded using ICD-10-CM and includes tips, definitions and a very helpful coding table summarizing your options.
April 8th, 2020
ICD-10-CM Official Coding and Reporting Guidelines Updated for COVID-19
By Wyn Staheli, Director of Research | Published April 8th, 2020
The ICD-10-CM Official Coding and Reporting Guidelines have just been updated to include COVID reporting. Additional information beyond the previously released interim guidelines are included. These are the rules that should be followed for claims submission. The notice states that this is for April 1, 2020 through September 30, 2020.
March 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 24th, 2020
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
March 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2020
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
March 20th, 2020
Implementing Telehealth Visits
By Namas | Published March 20th, 2020 - Last Review/Update March 23rd, 2020
The following is a step-by-step guide on how to convert office-based encounters to telehealth encounters during the current COVID-19 pandemic. These rules may change post-pandemic, as many changes relaxing existing rules were made on a temporary basis by CMS and commercial payers to facilitate patient access and minimize risk of infection.
Step ...
March 2nd, 2020
Coronavirus - What in the World is it and How is it Coded? 2020-02-20
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 2nd, 2020
On December 31, 2019, we learned of a deadly outbreak of an unknown virus, with an unknown cause. We have since learned the virus was identified in Wuhan, China as a novel coronavirus (2019-n-CoV). Until we have more information on the 2019-nCoV, persons with an underlying medical condition are considered high ...
February 20th, 2020
New HCPCS Code for Coronavirus Testing Announced
By Wyn Staheli, Director of Research | Published February 20th, 2020 - Last Review/Update February 26th, 2020
Currently, healthcare providers testing patients for Coronavirus must use an unspecified code. To provide better tracking, on February 13, 2020, CMS announced the creation of a new HCPCS code.
February 19th, 2020
Q/A: Did Noridian Stop Covering the M99.0- Codes?
By Wyn Staheli, Director of Research | Published February 19th, 2020
Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?
January 30th, 2020
Medicare Announces Coverage of Acupuncture Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 30th, 2020
On January 21, 2020, a CMS Newsroom press-release read,
This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...
January 9th, 2020
Who Knew? There are Three Types of Add-On Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 9th, 2020
Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...
December 30th, 2019
Medicare Changes Bilateral Reporting Rules for Certain Supplies
By Wyn Staheli, Director of Research | Published December 30th, 2019 - Last Review/Update January 6th, 2020
DME suppliers must bill bilateral supplies with modifiers RT and LT on separate claim lines or they are being rejected.
December 19th, 2019
Reporting the Health Effects of Vaping Now and in April 2020
By Wyn Staheli, Director of Research | Published December 19th, 2019
To report vaping related conditions/disorders, use the official CDC guidelines to ensure proper documentation of vaping related health conditions. There is also a new code that will become effective April 1, 2020.
December 10th, 2019
Coding Auto Accident Injuries
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 10th, 2019
There are several different ICD-10-CM code sections that can be used when coding for auto accident injuries. Injury diagnosis codes in ICD-10-CM are found with leading alpha characters S and T. S codes are injuries related to a single body region. T codes are injuries to multiple or unspecified body regions, poisoning, ...
November 25th, 2019
Hypertension ICD-10-CM Code Reporting Table
By Wyn Staheli, Director of Research | Published November 25th, 2019
In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.
November 19th, 2019
Medical Insurance Coverage for TMJ Disorders (TMD)
By Christine Taxin | Published November 19th, 2019 - Last Review/Update November 20th, 2019
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
November 18th, 2019
Documentation Tips
By Christine Taxin | Published November 18th, 2019
Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...
October 7th, 2019
Hypertension & ICD-10
By Raquel Shumway | Published October 7th, 2019
Hypertensive Diseases and ICD-10. Helps and examples for these codes.
October 1st, 2019
2020 Official ICD-10-CM Coding Guideline Changes Are Here!
By Wyn Staheli, Director of Research | Published October 1st, 2019
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...
October 1st, 2019
Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...
October 1st, 2019
The New ICD-10-CM Code Updates Are Here — Are You Ready?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)
A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases.
Chapter 2: ...
September 30th, 2019
Vaccine Administration - When The Right Vaccine Code is Not Enough
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2019
Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...
September 30th, 2019
Q/A: How Do I Bill a House Call?
By Wyn Staheli, Director of Research | Published September 30th, 2019
Question
If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form? A modifier, or something else?
Answer
Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...
September 9th, 2019
Chiropractic 2020 Codes Changes Are Here
By Wyn Staheli, Director of Research | Published September 9th, 2019
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
July 26th, 2019
Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage
By Namas | Published July 26th, 2019 - Last Review/Update August 8th, 2019
Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky.
In their notice, Anthem states:
"Effective for all commercial ...
July 15th, 2019
Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?
By Wyn Staheli, Director of Research | Published July 15th, 2019
Question:
It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...
June 18th, 2019
How to Properly Report Monitoring Patients Taking Blood-thinning Medications
By Wyn Staheli, Director of Research | Published June 18th, 2019 - Last Review/Update June 19th, 2019
Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.
June 14th, 2019
A United Approach
By Namas | Published June 14th, 2019 - Last Review/Update June 18th, 2019
A United Approach
As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...
June 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 13th, 2019
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
May 31st, 2019
Auditing Hospitalist Services
By Namas | Published May 31st, 2019 - Last Review/Update June 4th, 2019
Auditing Hospitalist Services
The inpatient side of coding and auditing can be enormously complex, with many more moving parts than are typically found in the outpatient setting. In this audit tip, we will discuss a few of the challenges that come with auditing one of the most important players in the ...
May 24th, 2019
What to Look for When Auditing Smoking Cessation Services
By NAMAS | Published May 24th, 2019 - Last Review/Update June 19th, 2019
What to Look for When Auditing Smoking Cessation Services
April 23rd, 2019
What is Medical Necessity and How Does Documentation Support It?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
April 22nd, 2019
Auditing Chiropractic Services
By By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
April 22nd, 2019
Q/A: What’s Wrong with the Diagnoses on my Claim?
By Wyn Staheli, Director of Content | Published April 22nd, 2019
Question: I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.
April 15th, 2019
Q/A: How Many Diagnosis Codes do I use?
By Wyn Staheli, Director of Research | Published April 15th, 2019
Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that?
Answer: More is not always better. You only need to ...
April 1st, 2019
Spinal Cord Stimulator Used for Chronic Pain
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 1st, 2019
Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes.
ICD-10-CM Diagnosis Codes ...
April 1st, 2019
Corrections and Updates
By Wyn Staheli, Director of Research | Published April 1st, 2019 - Last Review/Update April 2nd, 2019
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics.
Published Articles
We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...
March 29th, 2019
Prolonged Services
By Namas | Published March 29th, 2019 - Last Review/Update April 4th, 2019
Prolonged Services
I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...
March 27th, 2019
Pain Codes in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 27th, 2019
When coding with ICD-10-CM, pain codes can be found in different sections:
The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ...
March 18th, 2019
How to Report Imaging (X-Rays) of the Thumb
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 18th, 2019
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
March 7th, 2019
Date of Service Reporting for Radiology Services
By Wyn Staheli, Director of Research | Published March 7th, 2019
Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.
March 4th, 2019
Billing Guidelines for Repositioning
By Wyn Staheli, Director of Research | Published March 4th, 2019 - Last Review/Update March 6th, 2019
Code 95992 has some very limited payer payment guidelines which need to be understood for proper reimbursement. Many payer policies consider this service bundled with Evaluation and Management Services, therefore, it would not be separately payable if there was an E/M service performed on the same date. Some providers have reported having trouble ...
March 1st, 2019
Understanding NCCI Edits
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 1st, 2019
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
February 12th, 2019
Coding Medicare Initial Preventive Physical Exams (IPPE)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 12th, 2019
The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...
January 22nd, 2019
Home Oxygen Therapy
January 22nd, 2019
Truncated ICD-10-CM Official Guidelines for Coding and Reporting
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 22nd, 2019
Adherence to ICD-10-CM official guideline's are required under HIPAA and adopted for all healthcare settings. We have made it easy to access guidelines and made them available on the code information page, either on the page you are viewing or view more information by selecting the ICD-10-CM Chapter Section/Guidelines and ...
January 10th, 2019
Are You Protecting Your Dental Practice From Fraud?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 10th, 2019
With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ...
January 3rd, 2019
2019 Coding Changes for Chiropractic
By Wyn Staheli, Director of Research | Published January 3rd, 2019
The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...
December 20th, 2018
The Diabetic Patient and Medical Manifestations
November 26th, 2018
Present on Admission POA Indicator
By | Published November 26th, 2018 - Last Review/Update November 29th, 2018
This article will focus on the Present on Admission (POA) indicator which is used as a method of reporting whether a patient’s diagnoses are present at the time they are admitted to a facility. We’ll look at a few scenarios to determine the correct reporting of POA and the impact...
November 8th, 2018
Diagnosis Coding for Cardiology
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 8th, 2018
Diseases of the Circulatory system are found in Chapter 9 and reported with I00 through I99 according to the following sections:
Acute rheumatic fever (I00-I02)Chronic rheumatic heart diseases (I05-I09)Hypertensive diseases (I10-I16)Ischemic heart diseases (I20-I25)Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)Other forms of heart disease (I30-I52)Cerebrovascular diseases (I60-I69)Diseases of arteries, ...
October 19th, 2018
Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder
By Wyn Staheli, Director of Research | Published October 19th, 2018 - Last Review/Update December 19th, 2018
The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...
October 16th, 2018
Pelvic Floor Dysfunction Treatment Coverage
By Wyn Staheli, Director of Research | Published October 16th, 2018
Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings.
Coverage by payers ...
October 16th, 2018
Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?
By Wyn Staheli, Director of Research | Published October 16th, 2018
Question:
We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...
October 2nd, 2018
Tools and Resources for Life Care Planners
By Christine Woolstenhulme, QMC, QCC, CMCS, CPC, CMRS | Published October 2nd, 2018
Life Care Planners play a vital and underappreciated including understanding the progression of a disease and lifetime clinical treatment options, research, delete (I combined this into the paragraph above) compiled into one easy-to-use resource. a unified providing a single destination for procedure coding coding to find information on...
September 26th, 2018
The Potential Impacts of a Flat Rate EM Reimbursement on our Industry
By BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018
The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the...
September 24th, 2018
2019 Code Changes are Just Around the Corner - Are You Ready?
By Wyn Staheli, Director of Research | Published September 24th, 2018 - Last Review/Update January 28th, 2019
The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...
August 30th, 2018
Keys to Successful Claims Filing
By Noridian Medicare | Published August 30th, 2018
There are many factors that can contribute to your success in filing claims and getting reimbursed. The information below is from the CMS website.
Completing Item 12, Patient's or Authorized Person's Signature, on the CMS-1500 form for a non-assigned claim
A signature on file (SOF) indicates the supplier has obtained the beneficiary's one-time authorization on ...
August 15th, 2018
QPro’s First Annual QPro Con
By Chris Woolstenhulme QCC, CMCS, CPC, CMRS | Published August 15th, 2018 - Last Review/Update August 17th, 2018
Date: October 9-10 Time: 9-3 MST
QPro Con is featuring a virtual event with keynote speakers and experts with years of hands-on experience in the healthcare industry. Stay ahead of the changes and keep informed of important information that affects the healthcare community.
Attendees receive 12 FREE CEUs with the purchase ...
July 12th, 2018
Dual Medicare-Medicaid Billing Problems
By Wyn Staheli, Director of Research | Published July 12th, 2018
It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added):
A state plan must provide ...
June 26th, 2018
WHO Said ICD-11 is Coming Soon
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 26th, 2018
Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...
June 4th, 2018
Why Is Medicare Denying My Claims for Mammography and Breast Biopsies?
By BC Advantage | Published June 4th, 2018
When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out. The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63. The Centers for Medicare & Medicaid Services (CMS) will...
May 30th, 2018
Coding for Strains in ICD 10
By BC Advantage | Published May 30th, 2018 - Last Review/Update June 4th, 2018
According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows....
May 9th, 2018
Preventive Medicine: General Procedures
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018
Preventive Medicine Topics Page
General Procedures
Procedure Codes 36415: Collection of venous blood by venipuncture 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List ...
May 9th, 2018
Preventive Medicine: Screening for Anemia
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening for Anemia
Procedure Codes 85004: Blood count; automated differential WBC count 85014: Blood count; hematocrit (Hct) 85013: Blood count; spun microhematocrit 85018: Blood count; hemoglobin (Hgb) 80055: Obstetric panel
ICD-10-CM 85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0 80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, ...
May 9th, 2018
Preventive Medicine: Annual Wellness Visit
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Annual Wellness Visit
Procedure Codes G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 99385: Initial comprehensive preventive medicine evaluation and management of an individual including ...
May 9th, 2018
Preventive Medicine: Bone Mass Measurements
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Bone Mass Measurements
Procedure Codes G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078: Computed tomography, bone mineral density study, 1 or more ...
May 9th, 2018
Preventive Medicine: Breast Cancer Genetic Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Breast Cancer Genetic Screening
Procedure Codes 81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 ...
May 9th, 2018
Preventive Medicine: Cardiovascular Disease Screening Tests
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Cardiovascular Disease Screening Tests
Procedure Codes 80061: Lipid panel. This panel must include the following:
Cholesterol, serum, total
Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
Triglycerides
82465: Cholesterol, serum, total 83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 84478: Triglycerides 83721: Lipoprotein, direct measurement; LDL cholesterol 83719: Lipoprotein, ...
May 9th, 2018
Preventive Medicine: Cervical Dysplasia Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Cervical Dysplasia Screening
Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...
May 9th, 2018
Preventive Medicine: Colorectal Cancer Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Colorectal Cancer Screening
Procedure Codes G0104: Colorectal cancer screening; flexible sigmoidoscopy G0105: Colorectal cancer screening; colonoscopy on individual at high risk G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0122: Colorectal cancer screening; barium ...
May 9th, 2018
Preventive Medicine: Contraceptive Methods
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Contraceptive Methods
Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...
May 9th, 2018
Preventive Medicine: Diabetes Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Diabetes Screening
Procedure Codes 82947: Glucose; quantitative, blood (except reagent strip) 82948: Glucose; blood, reagent strip 82950: Glucose; post glucose dose (includes glucose) 82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to ...
May 9th, 2018
Preventive Medicine: Therapy for Fall Prevention
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Therapy for Fall Prevention
Procedure Codes 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, ...
May 9th, 2018
Preventive Medicine: Glaucoma Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Glaucoma Screening
Procedure Codes G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
ICD-10-CM G0117-G0118: Z13.5
Frequency G0117-G0118: Once a year
Additional information G0117-G0118
Coverage as is indicated with ...
May 9th, 2018
Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and Administration
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Hepatitis B Virus (HBV) Vaccine and Administration
Procedure Codes G0010: Administration of hepatitis b vaccine 90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743: Hepatitis ...
May 9th, 2018
Preventive Medicine: Hepatitis C Virus (HCV) Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Hepatitis C Virus (HCV) Screening
Procedure Codes G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 86804: Hepatitis C antibody; confirmatory test (eg, ...
May 9th, 2018
Preventive Medicine: Human Immunodeficiency Virus (HIV) Screening
By Brandon Herman, QMC, QMCC, QMBHC, QMPM, QMPoC | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Human Immunodeficiency Virus (HIV) Screening
Procedure Codes G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 ...
May 9th, 2018
Preventive Medicine: Human Papilomavirus (HPV) Vaccine and Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Human Papilomavirus (HPV) Vaccine and Screening
Procedure Codes 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, ...
May 9th, 2018
Preventive Medicine: Influenza Virus Vaccine and Administration
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Influenza Virus Vaccine and Administration
Procedure Codes Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Q2036: Influenza virus vaccine, split virus, when administered to individuals ...
May 9th, 2018
Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
Procedure Codes G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, ...
May 9th, 2018
Preventive Medicine: Lung Cancer Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Lung Cancer Screening
Procedure Codes G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) G0297: Low dose ct scan (ldct) for lung cancer screening S8092: Electron beam computed tomography (also ...
May 9th, 2018
Preventive Medicine: Newborn Screenings/Tests
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Newborn Screenings/Tests
Procedure Codes 82775: Galactose-1-phosphate uridyl transferase; quantitative 83498: Hydroxyprogesterone, 17-d 82017: Acylcarnitines; quantitative, each specimen 82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 82261: Biotinidase, each specimen 83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 83021: Hemoglobin ...
May 9th, 2018
Preventive Medicine: Pneumococcal Vaccine and Administration
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Pneumococcal Vaccine and Administration
Procedure Codes G0009: Administration of pneumococcal vaccine 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
ICD-10-CM G0009, ...
May 9th, 2018
Preventive Medicine: Prostate Cancer Screening
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Prostate Cancer Screening
Procedure Codes G0102: Prostate cancer screening; digital rectal examination G0103: Prostate cancer screening; prostate specific antigen test (PSA)
ICD-10-CM G0102-G0103: Z12.5
Frequency G0102-G0103: Once annually
Additional Information G0102-G0103
Only for males aged 50 and older
G0102
Copayment and deductible may apply, consult your payer
Find-A-Code™ - Preventive Services - ...
May 9th, 2018
Preventive Medicine: Screening Mammography
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Mammography
Procedure Codes 77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057: Screening mammography, bilateral ...
May 9th, 2018
Preventive Medicine: Screening Pap Tests
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Pap Tests
Procedure Codes G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation ...
May 9th, 2018
Preventive Medicine: Screening Gynecological Examination
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Gynecological Examination
Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient
ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...
May 9th, 2018
Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
Procedure Codes 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real ...
May 9th, 2018
Preventive Medicine: Screening Children for Visual Acuity
By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018
Preventive Medicine Topics Page
Screening Children for Visual Acuity
Procedure Codes 99173: Screening test of visual acuity, quantitative, bilateral
ICD-10-CM 99173: Z00.121, Z00.129, Z00.100, Z00.101
Frequency 99173: No specific frequency guidelines
Additional Information 99173
Not covered by Medicare for preventative care
Some policies will only cover as preventive for children, consult your payer
Find-A-Code™ - Preventive ...
May 9th, 2018
Preventive Medicine: Dental Caries in Children
By Find-A-Code | Published May 9th, 2018 - Last Review/Update August 2nd, 2018
Preventive Medicine Topics Page
Dental Caries in Children
Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional
ICD-10-CM 99188: No specific diagnoses
Frequency 99188: No specific frequency guidelines
Additional Information 99188
Covered for children from birth until their seventh birthday
Find-A-Code™ - Preventive Services - The information ...
May 7th, 2018
Q/A: What Code do I Use for Supraspinatus and Infraspinatus Tendonitis?
By Wyn Staheli, Director of Research | Published May 7th, 2018 - Last Review/Update January 28th, 2019
Is there a better code for supraspinatus and infraspinatus tendonitis than the one for a rotator cuff tear?
April 12th, 2018
Q/A: I am Having Trouble with a Claim Rejection on my PI Claim. What do I do?
By Wyn Staheli, Director of Research | Published April 12th, 2018 - Last Review/Update February 4th, 2019
Question:
I have a patient that was involved in a PI case. His lawyers are asking that we bill his insurance company first. This particular patient has xxxx insurance and the clearing house is rejecting the claim based on "ERROR 3430-Invalid principal diagnosis code." We lead with diagnosis code V43.52XA, could we change the position of the V43.52XA code? Or should we submit a paper claim for the case instead?
March 27th, 2018
Maximizing Resources for ICD-10 Coding Audits
By BC Advantage | Published March 27th, 2018 - Last Review/Update April 12th, 2018
From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind....
March 26th, 2018
Avoiding D9 Denials
By Nicole, QCC | Published March 26th, 2018
The following is according to WPS.
Please make sure what is bold below is entered verbatim on the second line of the "Remarks" section. This should be the only thing on the second line of remarks:
Patient control nbr - If you are changing or adding a patient control number
Admission hour - If you are changing or adding the admission ...
March 13th, 2018
CPT Code for DOT exams
By Wyn Staheli, Director of Research | Published March 13th, 2018 - Last Review/Update January 31st, 2019
Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?
March 9th, 2018
Why Is Medicare Denying My Claims for Mammography and Breast Biopsies?
By Jacqueline Thelian, CPC, CPC-I, CHCA | Published March 9th, 2018 - Last Review/Update April 12th, 2018
When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out...
March 8th, 2018
Documentation for Skilled Nursing Facilities
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF).
March 6th, 2018
Increase Revenue by Outsourcing Medical Billing
By iSALUS Healthcare's | Published March 6th, 2018 - Last Review/Update April 12th, 2018
Many practices are starting to weigh the benefits outsourcing medical billing compared to keeping it in-house....
February 28th, 2018
Z Codes That May Only be Principal/First-Listed Diagnosis
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 28th, 2018
Z Codes That May Only be Principal/First-Listed Diagnosis
According to 2018 Guidelines section: 1;C.21.c.16, the following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined:
Z00 Encounter for general examination without ...
February 1st, 2018
Pre-Existing or Gestational?
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 1st, 2018
It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions.
Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
Trimester: When did the pregnancy-related condition develop?
Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia)
Code examples:
O99.011 Anemia ...
February 1st, 2018
Patients Undergoing a Bone Marrow Transplant (BMT)
By Find-A-Code | Published February 1st, 2018
Accoring to Wisconsin Physicians Service Insurance Corporation L34699, when using J2820 for patients undergoing a bone marrow transplant (BMT), 2 diagnosis codes are required:1) Z76.82 Awaiting organ transplant status2) Pick a code from one of these categories:
C81- Hodgkin Lymphoma
C82- Follicular Lymphoma
Non-follicular Lymphoma
C83.1- Mantle cell lymphoma
C83.3- Diffuse large B-cell lymphoma
C83.7- Burkitt lymphoma
C83.8- Other (Intravascular large B-cell lymphoma, Primary effusion B-cell lymphoma, or Lymphoid granulomatosis)
Mature T/NK-cell lymphomas
C84.4- Peripheral T-cell ...
February 1st, 2018
Diagnosis Codes Used With : Vertebroplasty, Vertebral Augmentation and Computed Tomography
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 1st, 2018
Per CGS Administrators LCD L34048 the following codes are the ICD-10-CM Cdes that support Medical Necessity: (Be sure to verify with your local payer)
Stand Alone ICD-10 codes
M80.08XA
M80.88XA
M80.88XG
Primary Diagnosis Codes
M48.51XA
M48.52XA
M48.53XA
M48.54XA
M48.55XA
M48.56XA
M48.57XA
M48.58XA
M84.68XA
Secondary Diagnosis Codes
One of the following diagnosis codes must be reported with one of the codes above in group 2.Combination coding of the primary diagnosis(group 2) of pathologic fracture ...
February 1st, 2018
How to Code Screening and Diagnostic Colonoscopy
By Natalie Tornese, CPC | Published February 1st, 2018
The following information is from BC Advantage.
Colonoscopy is a common procedure performed byGastroenterologists. CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis" ...
February 1st, 2018
Q and A: Coding Mixed Cardiogenic and Septic Shock
By BC Advantage | Published February 1st, 2018
Q: If the attending documented, "likely mixed cardiogenic and septic shock," can I assign codes R57.0 and R65.21? A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember,...
February 1st, 2018
Important CDI and Coding Updates
By Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS | Published February 1st, 2018
COPD and Pneumonia The requirement for code J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) to be coded first when a patient has pneumonia and COPD has been eliminated as of October 1. The 2018 version of ICD-10-CM replaced the "use additional code" with "code also." According...
February 1st, 2018
Traumatic Subluxation Coding Controversy
By Wyn Staheli, Director of Research | Published February 1st, 2018
There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...
January 31st, 2018
Influenza, Are You Billing Correctly?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 31st, 2018
With this year's Flu season being the most widespread on record, providers are seeing more patients and giving more immunizations for influenza than normal. Here are a few things to keep in mind during this flu season.
Know the rules with your payers to ensure proper reimbursement and correct billing. For example, did you ...
January 29th, 2018
Coding for Pain in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018
The following codes are the most common Pain codes used in ICD-10
G89.0 Central pain syndrome Chronic Condition
G89.11‑G89.18 G89.1 Acute pain, not elsewhere classified
G89.21‑G89.29 G89.2 Chronic pain, not elsewhere classified
G89.3 Neoplasm related pain (acute) (chronic) Chronic Condition
G89.4 Chronic pain syndrome
There are more specific pain ...
January 29th, 2018
Referring and Ordering Physician - CMS-1500 Box 17
By Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018
Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ...
January 29th, 2018
Aftercare Z Codes
By Find-A-Code | Published January 29th, 2018
Aftercare visit codes cover situations when the initial treatment of a disease has been performed, and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, ...
January 29th, 2018
Observation Z Codes
By Find-A-Code | Published January 29th, 2018
There are three observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out. The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected ...
January 29th, 2018
Non-Coronary Vascular Stents: Mesenteric Vessels
By Find-A-Code | Published January 29th, 2018
The following information is according to Novitas Solutions L35084.
Mesenteric vessels: This includes
Acute mesenteric ischemia
Chronic mesenteric ischemia
Mesenteric thrombosis
Dissection or any other vascular insufficiency resulting in gastrointestinal symptoms
Stenting of the mesenteric vessels is covered only when angioplasty of the vessels would not suffice and after the patient has had a thorough medical evaluation and management of symptoms, and for whom surgical intervention is the likely ...
January 24th, 2018
Revenue Cycle 101: Reduce your Denials with These Tips
By Ranadene Tapio, MBA, CMRS, CMC | Published January 24th, 2018 - Last Review/Update March 29th, 2018
Your practice seems to be doing everything right. You have a team in place, established your RCM process and you’re submitting claim after claim – but your denial rate isn’t going down....
January 16th, 2018
Non-Coronary Vascular Stents: Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infropoliteal arteries)
By Find-A-Code | Published January 16th, 2018
The following information is according to Novitas Solutions L35084.
Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infrapopliteal arteries): This includes:
Lifestyle-limiting claudication
Focal hemodynamically significant lesion
Ischemic rest pain
Non-healing tissue ulceration
Focal gangrene
Stent placement in infrapopliteal vessels is not expected to be often indicated and in those cases the rationale for stent placement must be explained in the record.
CPT codes:
37221
37223
37226
37227
37230
37231
37234
37235
ICD-10-CM codes:
Type 1 diabetes mellitus
E10.51 - with diabetic peripheral angiopathy without gangrene
E10.59 - with other circulatory ...
January 16th, 2018
Non-Coronary Vascular Stents: Renal artery
By Find-A-Code | Published January 16th, 2018
The following information is according to Novitas Solutions L35084.
Renal artery: Stenting may be indicated for renal artery stenosis causing renovascular hypertension (see below) or renal insufficiency as well as post-transplant renal artery stenosis, arterial aneurysm or dissection. Renal artery angioplasty with or without stenting is covered for renal artery stenosis manifested by at least one of the following conditions:
Recurrent (“flash”) pulmonary edema without cardiac ...
January 16th, 2018
Non-Coronary Vascular Stents: Brachiocephalic arteries
By Find-A-Code | Published January 16th, 2018
According to Novitas Solutions L35084
Brachiocephalic arteries (including subclavian, except carotid bifurcation): Stenting may be indicated for treatment of flow-limiting stenosis resulting in conditions such as:
Subclavian steal syndrome
Upper extremity claudication
Ischemic rest pain of the arm and hand
Non-healing tissue ulceration
Focal gangrene.
CPT codes:
37236
37237
ICD-10-CM codes:
G45.8 - Other transient cerebral ischemic attacks and related syndromes
Unspecified atherosclerosis of native arteries of extremities
I70.201 - right leg
I70.202 - left leg
I70.203 - ...
January 9th, 2018
Antiresorptive Osteonecrosis of the Jaws
By Find-A-Code | Published January 9th, 2018
Osteonecrosis is a serious bone disease caused when the bone is starved of its normal blood supply. Because bone is living tissue, without a good supply of oxygenated blood, it becomes weakened and then dies. Scientists have not been able to identify the exact cause of osteonecrosis of the jaws, but they have ...
January 9th, 2018
Diagnosis billing with J0888
By Find-A-Code | Published January 9th, 2018
The following information is from LCD L36276.
The diagnosis codes listed below require the use of the EC modifier (ESA administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy) when submitting claims for J0888. In addition, these diagnosis codes are marked with an * indicating they require a dual diagnosis. The ...
January 9th, 2018
Non-Coronary Vascular Stents: Inferior vena cava and iliofemoral veins
By Find-A-Code | Published January 9th, 2018
The following information is according to Novitas Solutions, L35084.
Inferior vena cava and iliofemoral veins: This includes vena cava and iliofemoral venous occlusions and stenosis due to the following
Post-radiation venous stenosis
Congenital stenoses or webs
Extrinsic venous compression (May-Thurner syndrome)
Thrombophlebitis and symptomatic post-traumatic venous stenosis.
CPT codes:
37238
37239
ICD-10-CM codes:
Phlebitis and thrombophlebitis
I80.10 - of unspecified femoral vein
I80.11 - of right femoral vein
I80.12 - of left femoral vein
I80.13 - of femoral vein, bilateral
I80.211 - of right iliac vein
I80.212 - of left iliac vein
I80.213 - of iliac vein, bilateral
I80.219 - of unspecified iliac vein
I80.8 - of ...
January 9th, 2018
Preventive Medicine with a New Patient
By Find-A-Code | Published January 9th, 2018
When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required.
New Patient: A patient that has not received any professional services i.e., E&M or any other face to face service from the physician or group within the ...
January 4th, 2018
Filing a CMS-1500 Claim form to Medicare PUB-100 40.1.1.1
By Find-A-Code | Published January 4th, 2018
An independent clinical laboratory may file a paper claim form shall file Form CMS-1500 for a referred laboratory service (as it would any laboratory service). The line item services must be submitted with a modifier 90.
An independent clinical laboratory that submits claims in paper format) may not combine non-referred (i.e., ...
January 3rd, 2018
Abuse, Neglect, or Maltreatment
By Wyn Staheli | Published January 3rd, 2018
According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:
An appropriate code from category T74- (confirmed) or T76- (suspected)
Any accompanying mental ...
January 3rd, 2018
Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 3rd, 2018
There is important information that must be included when documenting injuries and external cause codes in ICD-10-CM. There are expanded sections on poisonings and toxins making it more convenient to code, as ICD-10-CM is very specific.
When using a code from Chapter 19. Injury, Poisoning and Certain other Consequences of External ...
December 28th, 2017
Orthognathic Surgery
By Wyn Staheli | Published December 28th, 2017
Orthognathic surgery is corrective jaw surgery, which payers classify as either medically necessary or aesthetic (not medically necessary). With most payers, surgery performed to correct functional impairments, after conservative measures have failed, would be considered medically necessary.
Conditions considered medically necessary for this surgery may include:
Skeletal deformities of the maxilla or mandible causing ...
December 12th, 2017
Documenting the Location and Correct Coding
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 12th, 2017
The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim.
You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas).
C1 is the first vertebra known as the atlas. The axis-form is ...
December 12th, 2017
Is Your Practice Making Costly Mistakes with The Billing?
By Marge McQuade CMSCS, CHCI, CPOM | Published December 12th, 2017
You may think your billing processes are working perfectly, but even the best billing process can take more time than it should to collect and some collections are lost altogether. It could be the staff's fault or yours as the office manager, but either way it's a major problem. It's...
November 30th, 2017
Coding Carpal Tunnel Syndrome
By Wyn Staheli, Director of Research | Published November 30th, 2017 - Last Review/Update February 5th, 2019
Q: In order to code carpal tunnel syndrome G56.01 or G56.02, does there need to be documentation that nerve conduction (EMG testing) has been performed to confirm the diagnosis?
November 27th, 2017
Erythropoietin Stimulating Agents (ESA)
By Wyn Staheli, Director of Research | Published November 27th, 2017
Coverage
ESA is typically covered for the following condition(s):
Treatment of anemia associated with chronic renal failure (whether or not that patient is on dialysis)
Treatment of significant anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy
Treatment of anemia due to AZT and/or other Nucleoside Reverse Transcriptase Inhibitors (NRTI) used in treatment of HIV/AIDS
Treatment of selected ...
November 8th, 2017
Q/A: Physical Exam for Military (Specifically Feet)
By Codepedia | Published November 8th, 2017 - Last Review/Update November 21st, 2017
Q: We had a patient come to our podiatry clinic to get a physical for her feet to qualify for ROTC activities. They came back clear of any deformities, defects, etc. Our scribes listed this visit diagnosis as Z00.00 (Encounter for general adult medical examination without abnormal findings) which seems correct ...
October 5th, 2017
Brace Yourself for New ICD-10 and CPT Codes for 2018!
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 5th, 2017 - Last Review/Update February 5th, 2019
What is new for Chiropractors for 2018? See for yourself the new ICD-10 and CPT Codes.
September 29th, 2017
Big Data & Facility Audit Complex Reviews
By Shannon Cameron, MBA, MHIIM, CPC | Published September 29th, 2017 - Last Review/Update January 31st, 2018
Big data and its use in the healthcare spectrum has proven to be an incredible source of the knowledge and has rapidly abetted progress in seemingly all areas of healthcare......
September 20th, 2017
Bladder/Urothelial Tumor Markers (Jurisdiction F)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 20th, 2017
CMS recently released a new LCD for Jurisdiction F, Bladder/Urothelial Tumor Markers (L36680).
Documentation Requirements
The medical record must clearly identify the number and frequency of bladder marker testing. Medical record documentation must be legible, must be maintained in the patient’s medical record (hard copy or electronic copy), and must meet the ...
September 12th, 2017
ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath
By BC Advantage | Published September 12th, 2017 - Last Review/Update January 25th, 2018
This document is intended to be used as a guide to help coding professionals when coding healthcare encounters of those individuals affected by a hurricane.
September 11th, 2017
Dental Providers- So what are ICD 10 codes?
By Christine Taxin | Published September 11th, 2017
What has been your definition so far when asked about how they are different? What does an ICD-10 code look like? How does an ICD-10 code work?
Have you seen commercials about medical coding schools and wonder if the profession is right for you? With the field expected to grow faster ...
September 1st, 2017
Abuse, Neglect, Maltreatment Coding Table
By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017
NOTICE: This table was created for use by those who have purchased a Find-A-Code specialty specific Reimbursement Guide. Please do not share with others.
Codes in bold are complete codes of the highest specificity.
Codes with ** are listed in the DSM-5 which contains diagnostic criteria.
The underscore ( _ ) means that an ...
September 1st, 2017
Preventive Services: Bone Mass Measurements
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Bone Mass Measurements
September 1st, 2017
Preventive Services: Cardiovascular Disease Screening Tests
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Cardiovascular Disease Screening Tests:
80061 -
Lipid panel, this panel must include the following:
82465 - Cholesterol, serum, total
83718 - Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
84478 - Triglycerides
Z13.6
All Medicare beneficiaries without apparent signs or symptoms ...
September 1st, 2017
Preventive Services: Colorectal Cancer Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Colorectal Cancer Screening.....
September 1st, 2017
Preventive Services: Counseling to Prevent Tobacco Use
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Counseling to Prevent Tobacco Use....
September 1st, 2017
Preventive Services: Diabetes Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Diabetes Screening.....
September 1st, 2017
Preventive Services: Glaucoma Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018
The following information from the Medicare Learning Network provides guidance on Glaucoma Screening....
September 1st, 2017
Preventive Services: Hepatitis B Virus (HBV) Vaccine and Administration
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018
The following information from the Medicare Learning Network provides guidance on Hepatitis B Virus (HBV) Vaccine and Administration....
September 1st, 2017
Preventive Services: Hepatitis C Virus (HCV) Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance on Hepatitis C Virus (HCV) Screening....
September 1st, 2017
Preventive Services: Human Immunodeficiency Virus (HIV) Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018
The following information from the Medicare Learning Network provides guidance on Human Immunodeficiency Virus (HIV) Screening....
September 1st, 2017
Preventive Services: Influenza Virus Vaccine and Administration
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018
The following information from the Medicare Learning Network provides guidance on Influenza Virus Vaccine and Administration....
September 1st, 2017
Preventive Services: Intensive Behavioral Therapy (IBT) for Obesity
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Intensive Behavioral Therapy (IBT) for Obesity....
September 1st, 2017
Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCT
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT)....
September 1st, 2017
Preventive Services: Pneumococcal Vaccine and Administration
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Pneumococcal Vaccine and Administration....
September 1st, 2017
Preventive Services: Prostate Cancer Screening
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Prostate Cancer Screening....
September 1st, 2017
Preventive Services: Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests....
September 1st, 2017
Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs.....
September 1st, 2017
Preventive Services: Screening Mammography
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on a Screening Mammography....
September 1st, 2017
Preventive Services: Screening Pap Tests
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening Pap Tests....
September 1st, 2017
Preventive Services: Screening Pelvic Examinations
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening Pelvic Examinations (includes a clinical breast examination)....
August 11th, 2017
Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 11th, 2017
There is important information that must be included when documenting injuries and external cause codes in ICD-10-CM. There are expanded sections on poisonings and toxins making it more convenient to code, as ICD-10-CM is very specific.
When using a code from Chapter 19 (Injury, Poisoning and Certain other Consequences of External ...
August 4th, 2017
Searching With the Comprehensive Search Tool
By Find-A-Code | Published August 4th, 2017
Occasionally, when a customer searches for a code with key words with the comprehensive search, we get feedback that they are not getting the correct results. Some of the main reasons are the correct code set is not selected in the search box.
Other times customers are not searching the keywords and notes. ...
August 4th, 2017
List of Common Unclassified Injectable drugs (this list in not all-inclusive)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 4th, 2017
This is a list of some of the most common Injectable unclassified drugs used with J3490
Antilirium – 1 mg/ml
Ascorbic Acid – 500 mg/ml
Ascorbic Acid – 250 mg/ml
Bacitracin, Intramuscular – 50,000 unit vials
Bacitracin, Intramuscular – 10,000 unit vials
Brevital Sodium – 500 mg/5 ml
Caffeine and Sodium Benzoate – 250 mg/ml
Capastat Sulfate – 1 ...
July 28th, 2017
36522 Photopheresis Extracorporeal; Not Payable Without Certain ICD-10-CM Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 28th, 2017
When Outpatient hospitals bill CPT code 36522: (Photopheresis, extracorporeal), it must be billed with the following diagnosis codes:
C84.00 - C84.09 Mycosis fungoides;
C84.10 – C84.19 Sezary’s disease;
T86.20 – T86.298 Complications of heart transplant;
T86.30 – T86.39 Complications of heart-lung transplant;
T86.00 - T86.09 Complications of transplanted bone marrow.
Review your local LCD for billing and coding help.
...
July 27th, 2017
The Importance of the 7th Character in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 27th, 2017
There is still confusion on the use of the seventh character. Let's clarify a few common areas.
The 7th character represents the physicians encounter, but not the number of visits.
Reporting the phase of treatment the patient is seeing the provider for, but not the number of injuries or number of visits.
The most common ...
July 13th, 2017
Our Claims are Being Rejected
By ChiroCode | Published July 13th, 2017 - Last Review/Update February 8th, 2019
Question: Our claims are being rejected. We think it is related to our diagnosis codes. What is the reason for this?
June 30th, 2017
Diagnosing, Documenting, and Coding for Radiculopathy
By Evan Gwilliam, DC, MBA, BS, CPC, CCPC, CPC-I, CPMA, NCICS, MCS-P, QCC, CMHP | Published June 30th, 2017
Radiculopathy can be an unpleasant condition, but diagnosing, documenting and coding for it does not have to be. It just takes a little research. The brain communicates with the body via the spinal cord which is protected by the bones of the spinal column, called vertebrae. Nerve roots exit in ...
June 29th, 2017
2018 ICD-10-CM Codes Announced
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 29th, 2017
The new proposed 2018 ICD-10-CM codes have been announced and are to be used for discharges occurring from October 1st, 2017 through September 30th, 2018 and for patient encounters occurring from October 1st, 2017 through September 30th, 2018.
The 2018 General Equivalence Mappings (GEMs) will be available in August 2017. The ...
June 28th, 2017
Code Position Matters, Using the X Place Holder
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 28th, 2017 - Last Review/Update July 26th, 2017
Using the X Place holder is not optional. Be sure you understand how to use it. If the code you are using requires a the Character such as the A - initial encounter, D - subsequent encounter or S- sequela, you understand the "X" Place holder. Not all Codes requiring a 7th ...
May 25th, 2017
Risk Adjustment Calculator (CMS-HCC Model)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 25th, 2017
Risk Adjustments are used to access an illness or severity and comparing classifications of diseases using diagnosis codes.
Find-A-Code gives you the ability to search for risk codes used for calculations on an individual code or calculator for a group of codes to quickly calculate a risk score.
Keep in mind prior ...
May 22nd, 2017
Q/A: What is the ICD-10 Code for Acetabular Labral Tear?
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 22nd, 2017 - Last Review/Update February 8th, 2019
What is the ICD-10 code for acetabular labral tear?
May 5th, 2017
Rules for Choosing the First Listed Diagnosis
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 5th, 2017 - Last Review/Update July 26th, 2017
The ICD-10-CM Guidelines will direct you when coding as to which diagnosis should be first listed and what should not be listed first. Pay careful attention to ensure correct coding and avoid claim denial. There are a few basic rules you should be familiar with as well as common issues when ...
April 20th, 2017
Billing Dermal Filler Injections
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 20th, 2017 - Last Review/Update July 28th, 2017
When billing dermal filler injections, separate payment may be made under the OPPS and ASC payment systems for HCPCS G0429- Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy).
Use in addition: Q2026- Injection, radiesse, 0.1 ml, and Q2028 - Injection, sculptra, 0.5 mg
With a diagnosis of B20 - ...
March 24th, 2017
Are There any Alternatives for Code 97112 Neuromuscular Re-education?
By ChiroCode | Published March 24th, 2017 - Last Review/Update January 31st, 2019
Q: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the insurance benefits.
March 13th, 2017
Taxonomy Code Information - Dental
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 13th, 2017 - Last Review/Update July 28th, 2017
Taxonomy Codes are used to define a Healthcare Provider type as well as the classification and area of specialization. These codes are reported on the ADA form and on the CMS-1500 Medical claim form. For a complete list of all classifications, visit FindACode.com
122300000X - DentistStatus: ActiveDefinition: A dentist is a person qualified by a ...
March 7th, 2017
Menstrual Migraine Coding
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2017 - Last Review/Update July 28th, 2017
When coding chronic migraines related to menstrual cramps, you must document that the patient has menstrual migraines. With ICD-10 there are a variety of migraines, including those that are neurologic, abdominal, and ophthalmologic based. You must also document whether the menstrual migraine (G43.82- and G43.83-) is intractable or not intractable, including ...
March 3rd, 2017
Alcohol and Tobacco Use During Pregnancy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 3rd, 2017 - Last Review/Update July 28th, 2017
If a mother uses alcohol or tobacco during pregnancy, be sure to assign O99.31 "Alcohol use complicating pregnancy, childbirth, and the puerperium."
Document the time of the encounter (such as the trimester), during childbirth, or during the puerperium.
NOTE: You also need to assign a secondary code from category F10- to identify manifestation of the alcohol use.
The following ...
March 3rd, 2017
Diabetes Mellitus in Pregnancy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 3rd, 2017 - Last Review/Update August 1st, 2017
Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should first be assigned a code from category O24 (diabetes mellitus in pregnancy, childbirth, and the puerperium) followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4.
Diabetes mellitus due to underlying condition:
with proliferative diabetic retinopathy without macular edemaE08.3591 right eye
E08.3592 left eye
E08.3593 bilateral
E08.3599 unspecified eye
E08.36 with diabetic cataract
with diabetic macular edemaE08.37X1 right eye
E08.37X2 left eye
E08.37X3 bilateral
E08.37X9 unspecified eye
E08.39 with other diabetic opthalmic complication
with ...
March 2nd, 2017
Z Codes That May Only be Principal/First-Listed Diagnosis
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017
The following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined:
Z00 Encounter for general examination without complaint, suspected or reported diagnosis Except: Z00.6 Z01 Encounter for other special examination without complaint, suspected ...
January 31st, 2017
Clinical Scenario for Coding with ICD-10-CM: Abdominal Pain
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 31st, 2017 - Last Review/Update August 2nd, 2017
Chief Complaint
• “My stomach hurts and I feel full of gas.”
History
• 47 year old male with mid-abdominal epigastric pain, associated with severe nausea & vomiting; unable to keep down any food or liquid. Pain has become “severe” and constant.
• Has had an estimated 13 pound weight loss over the past ...
January 23rd, 2017
Why Should I Document a Differential Diagnosis?
By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP | Published January 23rd, 2017 - Last Review/Update February 8th, 2019
Generating a differential diagnosis — that is, developing a list of the possible conditions that might produce a patient's symptoms and signs — is an important part of clinical reasoning. It allows a provider to perform appropriate testing to rule out possibilities and confirm a final diagnosis.
Courts view the formulation and documentation of a differential diagnosis as evidence of a physician's competence, prudence, and thoughtfulness.
January 20th, 2017
Pre-Existing or Gestational?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 20th, 2017 - Last Review/Update August 2nd, 2017
It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions.
Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
Trimester: When did the pregnancy-related condition develop?
Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia).
Code examples:
O99.011 Anemia ...
November 28th, 2016
Product Wastage Documentation Requirements and Reporting: Using JW Modifier
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 28th, 2016 - Last Review/Update August 1st, 2017
When using the JW modifier for Part B drug claims for discarded drugs and biologicals, any amount of wasted material should be clearly documented in the medical record with the following information:
Date, time, and location of treatment
Approximate amount of product unit used
Approximate amount of product unit discarded
Reason for the wastage
Manufacturer’s serial/lot/batch ...
November 21st, 2016
Best Diagnosis Codes for E-stim
By ChiroCode | Published November 21st, 2016 - Last Review/Update March 5th, 2019
What are the best diagnosis codes for E-stim?
September 23rd, 2016
Top ICD-10 Code Changes for Chiropractors in 2017
By ChiroCode | Published September 23rd, 2016 - Last Review/Update March 5th, 2019
There are thousands of code changes going into effect on October 1. Here is a list of the the 70 or so that are most relevant to chiropractors.
August 30th, 2016
Documenting injuries
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 30th, 2016
ICD-10 expands sections on poisonings and toxins.
When documenting injuries, include the following:
1. Episode of Care e.g. Initial, subsequent, sequelae 2. Injury site Be as specific as possible3. Etiology How was the injury sustained (e.g. sports, motor vehicle crash, pedestrian, slip and fall, environmental exposure, etc.)?4. Place ...
August 30th, 2016
Documentating Diabetes Mellitus, Hypoglycemia and Hyperglycemia
By Find-A-Code | Published August 30th, 2016
The Increased Specificity in ICD-10-CM means documentation must more specific to accommodate the complications and combinations used. The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.When documenting diabetes, include the following:1. Type e.g. Type 1 ...
August 24th, 2016
Getting Ready for new ICD-10 Codes for Chiropractic
By ChiroCode | Published August 24th, 2016 - Last Review/Update March 5th, 2019
ICD-10-CM changes for 2017 include 1,974 new codes, 311 deleted codes, and 425 revised codes. Chiropractors, fortunately, are only affected by about 70 of these changes. And none of them are ground breaking. However, if you report deleted codes, your claims could be denied. Read more to see some examples of the changes
August 16th, 2016
2017 ICD-10- CM Gynecology Updates
By Bonnie Schreck | Published August 16th, 2016
The final list of the new ICD-10- CM codes that become effective October 1, 2016 has been released. There are approximately 1600 changes to the code set, making up for the four years the ICD-10- CM codes have not had a complete update. For fiscal year (FY) 2017, updates to...
August 16th, 2016
2017 ICD-10-CM and ICD-10-PCS Code Updates
By | Published August 16th, 2016
The 2017 ICD-10-CM and ICD-10-PCS code updates, including a complete list of code titles, are available on the 2017 ICD-10-CM and GEMs and 2017 ICD-10-PCS and GEMs webpages.
August 3rd, 2016
ICD-10 Changes for 2017
By Wyn Staheli, Director of Research | Published August 3rd, 2016
The Centers for Medicare & Medicaid Services (CMS) recently released the Proposed Rule regarding the updates to the ICD-10-CM and ICD-10-PCS code sets for Fiscal Year 2017 which begins October 1, 2016. Comments regarding the proposed ICD changes are due May 6th and CMS has stated that the Final Rule ...
August 3rd, 2016
When can I use “unspecified” codes? What about “other”?
By Dr. Evan Gwilliam | Published August 3rd, 2016
The official guidelines for ICD-10-CM define the conventions used in the code set. In section 1.A.6, we learn the following about some common abbreviations in the Tabular List:
August 3rd, 2016
Billing Units
By Wyn Staheli, Director of Research | Published August 3rd, 2016
Are you billing units correctly? This article outlines important considerations to ensure that claims are submitted properly.
July 29th, 2016
Sports Physicals
By Codapedia | Published July 29th, 2016
Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope. If the patient presents for a well child visit, and also needs their camp physical filled out,...
July 28th, 2016
Where is the ICD-10 code for facet syndrome?
By Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA | Published July 28th, 2016
The facet joints are a pair of joints in the posterior aspect of the spine. Their proper name is zygapophysial joints. These joints can become inflamed due to trauma or overuse and cause back pain. This is called facet syndrome.
Unfortunately there was no ICD-9 code for this condition. However, diagnosis ...
July 22nd, 2016
Testing for Influenza
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 22nd, 2016 - Last Review/Update August 4th, 2017
There are several types of testing that distinguishes between influenza virus types A and B and several changes in codes in 2016.
For direct observation to detect an infectious agent by immunoassay use:
87804- Infectious agent antigen detection by immunoassay with direct optical observation; Influenza.
If the specimen is tested for both Type ...
July 19th, 2016
NAMAS: What You Need to Know About 2017 ICD-10 Updates
By Find-A-Code | Published July 19th, 2016
October 2016 brought us the implementation of ICD-10-CM. The switch from ICD-9-CM to ICD-10-CM brought with it a level of uncertainty and maybe even a little panic. With a great deal of preparation and planning in place, the implementation came and went without too much trouble. Now that we've settled ...
July 8th, 2016
What You Need to Know About 2017 ICD-10 Updates
By Jessica Franzese, CPC, CPMA | Published July 8th, 2016 - Last Review/Update August 17th, 2017
October 2016 brought us the implementation of ICD-10-CM. The switch from ICD-9-CM to ICD-10- CM brought with it a level of uncertainty and maybe even a little panic. With a great deal of preparation and planning in place, the implementation came and went without too much trouble. Now that we've ...
June 28th, 2016
Key Terms in ICD-10
By ChiroCode | Published June 28th, 2016 - Last Review/Update March 5th, 2019
In some places, the ICD-10-CM code set uses words we think we are familiar with. However, a review of the guidelines shows that some of these words have very specific definitions. Here are a few important ones to remember.
June 27th, 2016
Are There Codes to Idenitfy the Left or Right Side of the Spine?
By Brandy Brimhall | Published June 27th, 2016
Q: We cannot find codes to identify the left or right side of the spine, such as with low back pain. Do we add digits 1 or 2 to the code to clarify left or right?
A: No. Codes pertaining to the spine are not specific to laterality. The codes do ...
June 9th, 2016
Understanding and Using Taxonomy Codes to Maximize Reimbursement
By | Published June 9th, 2016
Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ...
May 25th, 2016
May be a Payable Code for Dental Procedures under Medical Policy
By Christine Taxin | Published May 25th, 2016
The following list may be payable Codes for Dental Procedures under a patients Medical Policy. Be sure to verify with the payer for benefit coverage and exclusions.
ICD-10-CM Diagnosis Codes
B00.2 Herpesviral gingivostomatitis and pharyngotonsilitis
K00.0 Andontia
K00.1 Supernumerary Tooth
K00.2 Abnormalites of size and form of tooth
K00.3 Mottled Teeth
K00.4 Disturbances in tooth formation
K00.5 Hereditary ...
May 13th, 2016
Using the Right Diagnosis
By Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC | Published May 13th, 2016 - Last Review/Update August 16th, 2017
One of the hardest parts when reviewing a medical record for coding or auditing is the determination of what conditions were addressed. Any condition that is taking into account or affects patient care, treatment or management should be documented and ultimately coded. However, the documentation still needs to support that ...
May 3rd, 2016
Did you Know?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 3rd, 2016
Find-A-Code has ICD-10-CM Official Guidelines!
The use of Guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA) and have been adopted for all healthcare settings. Guidelines are a set of rules developed to accompany and complement the official conventions and instructions provided within the code.
Find-A-Code understands how ...
April 25th, 2016
ICD-10-CM Coding for Influenza
By Bonnie G. Schreck, BS, CCS, CPC, COC, CCS-P, COBGC | Published April 25th, 2016
Influenza in ICD-10-CM is classified in the following categories:
J09 Influenza due to certain identified influenza viruses – this includes the following types:
o Avian
o Bird
o A/H1N1
o Swine
o Other influenza of animal origin (not bird/not swine)
J10 Influenza due to other identified influenza viruses – this includes any specified type not of animal ...
April 5th, 2016
Dentition Damage Covered by Medical Insurance
By Christine Taxin | Published April 5th, 2016
Generally, restorative dental treatments are not covered by a patient’s medical policy, except in cases of traumatic injury. However, if the patient exhibits oral side effects from a medical condition, an over-the-counter drug, a prescription medication or an illegal drug, then there is a good case to be made for...
March 25th, 2016
Auditing Smoking Cessation Services
By John Burns, CPC, CPC-I, CEMC, CPMA | Published March 25th, 2016 - Last Review/Update August 16th, 2017
Most payers do indeed recognize smoking and tobacco cessation services as a covered health insurance benefit. We have found that some providers perform these services without fully understanding the reimbursement opportunities, while others claim such services without adequately documenting to support them. Medicare, for example, will pay for two (2) ...
March 17th, 2016
ICD-10-CM: Heart Failure
By | Published March 17th, 2016
Congestive heart failure (CHF) is a common heart condition that exists in many patients. In ICD-9-CM coding, this was reported with code 428.0. In ICD-10-CM, if only CHF or congestive heart failure is documented, it would be reported with I50.9 Heart failure, and would not reflect the true extent of...
March 16th, 2016
Coverage Criteria and Medical Necessity with Medicare
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2016 - Last Review/Update August 3rd, 2017
In the absence of a systemic condition, treatment of mycotic nails may be covered. The treatment of mycotic nails for an ambulatory patient is covered only when the physician attending the patient's mycotic condition documents that (1) there is clinical evidence of mycosis of the toenail, and (2) the patient ...
March 7th, 2016
Diagnosis Codes for Cervical Kyphosis
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published March 7th, 2016
Coding for a reduced cervical curve is a little tricky in ICD-10. This article explores the choices and issues around this diagnosis.
February 29th, 2016
ICD-10-CM: Osteomyelitis Documentation
By Bonnie Schreck | Published February 29th, 2016
Bones are typically resistant to bacterial colonization, but events such as trauma, surgery, the presence of foreign bodies, or the placement of prostheses may disrupt bony integrity, or a result of a spread after bacteremia, and lead to the onset of bone infection caused by an infectious organism, or osteomyelitis....
February 25th, 2016
Narrative Support suggestions for Dental
By Christine Taxin | Published February 25th, 2016
Suggestions for narrative support for use in Box 19 CMS-1500 and Box 35 of the ADA Dental Claim Form
February 15th, 2016
Q&A: How do You Code for a Bilateral Condition, Such as Sciatica?
By ChiroCode | Published February 15th, 2016 - Last Review/Update March 5th, 2019
How do you code for a bilateral condition, such as sciatica?
February 12th, 2016
Behavioral Heath Treatment/Services - Documentation Requirements
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 12th, 2016 - Last Review/Update August 4th, 2017
Reason for referral.
Tests administered, scoring/interpretation, and time involved.
Present evaluation.
Diagnosis (or suspected diagnosis that was the basis for the testing if no mental/neurocognitive illness was found).
Recommendations for interventions, if necessary.
Identity of person performing service.
...
February 8th, 2016
How do we Know Which Codes a Payer will Allow?
By ChiroCode | Published February 8th, 2016 - Last Review/Update April 26th, 2019
Question:
How do we know which codes a payer will allow?
February 1st, 2016
Definitive Diagnoses - To Code or Not To Code
By Bonnie Schreck | Published February 1st, 2016
For inpatient coding, there are times when the diagnosis(es) cannot be established at the time of admit or throughout the course of the admission. In these cases, they are documented in the medical record as “probable,” “suspected,” “likely,” “questionable,” “possible,” or “rule out” conditions. This guideline is true for certain...
January 8th, 2016
What are External Cause Codes in ICD-10?
By ChiroCode | Published January 8th, 2016 - Last Review/Update September 3rd, 2019
Chapter 20 External Causes of Morbidity includes codes from V00 to Y99. They were greatly expanded in ICD-10-CM.
January 6th, 2016
CMS-1500 form revised to fit more diagnosis codes, less patient demographic information
By Codapedia | Published January 6th, 2016
CMS-1500 form revised to fit more diagnosis codes, less patient demographic informationIt doesn’t get used nearly as much as it used to, but there is a new CMS-1500 claim form that has been revised slightly to fit more diagnosis codes and to facilitate the transition to...
January 6th, 2016
6 ways to stop filing duplicate Medicare claims - Duplicates could expose your practice to fraud investigation
By | Published January 6th, 2016
Whenever a Medicare Administrative Contractor (MAC) releases a list of the top reasons for claims denials, the list almost never fails to include duplicate claims. When the MAC perceives the claim to be a duplicate, based typically on a match of the patient identifying information, furnishing...
December 21st, 2015
What Does It Mean To Scrub An Insurance Claim?
By Codapedia | Published December 21st, 2015
During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It’s unfortunately a necessary evil, as surgeons who contract with insurance companies rely on that reimbursement as the lifeblood for...
December 11th, 2015
Charge capture: Paper and Electronic Encounter Forms
By Codapedia | Published December 11th, 2015
Physicians and Non-Physician Practitioners (NPPs) may want to distance themselves from coding, but implementing an Electronic Health Record (EHR) moves them in the opposite direction. If using an EHR, after completing the note, the clinician selects the CPT® and ICD-9 codes (the procedure and diagnosis...
November 30th, 2015
Z-Codes What are They?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 30th, 2015 - Last Review/Update August 8th, 2017
Z-codes are used for the reason of the encounter instead of the V codes, they are found in Chapter 21: Factors influencing health status and contact with health services (Z00-Z99). A corresponding procedure must accompany a Z code if a procedure is preformed.
Note: The chapter specific guidelines provide additional information about the ...
November 20th, 2015
Documentation of Pressure Ulcers
By Find-A-Code | Published November 20th, 2015
Documentation of Pressure Ulcers, read entire article by Wound Consultants Inc.
...
November 13th, 2015
Using ICD-10-CM Z-codes
By Evan M. Gwilliam DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA, Christine Woolstenhulme, CMRS | Published November 13th, 2015
Chapter 21 of ICD-10-CM is titled "Factors Influencing Health Status and Contact with Health Services". They cover codes in the categories from Z00 to Z99. This chapter is used for encounters with health care providers where the patients have no current illnesses or injury. For example, a patient may present at ...
October 20th, 2015
Finding Strain and Sprains in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 20th, 2015
There has been some confusion on Sprain vs. Strain and how to find them in ICD-10-CM. They are now split in two separate code ranges and Injury is now related to the anatomic location specific to the injury.
It will help to remember the following information when searching for Strains vs. ...
October 5th, 2015
Reporting Laterality Still Requires Modifiers
By Wyn Staheli, Director of Research | Published October 5th, 2015
One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).
Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology ...
October 5th, 2015
ICD-10 Coding Resources and Suggestions
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 5th, 2015
ICD-10 is finally here, it is no longer a myth. Here are a few suggestions to help you with ICD-10 and resources available for you.
Check out Find-A-Code, if you are not familiar with this on-line tool, you will quickly find this to be your most valuable resource during your transition ...
September 30th, 2015
Welcome ICD-10! Locating the Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2015
It is finally here, Now what? For all of our customers we want to offer some Mapping Instructions, and show you how to locate the correct code ICD-10 Codes with Find-A-Code and InstaCode Institute’s resources. Be sure you understand the structure of ICD-10 and what a complete code looks like. ...
September 25th, 2015
No More V-codes Now What? Take a look at V20.2
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 25th, 2015
V-codes will be a part of the past, you will be using encounter codes with ICD-10-CM.
Lets take a look at how you will code V20.2 Routine infant or child health with ICD-10-CM.
ICD-10-Cm will now use Z-codes which represent the reason for the encounter. If a procedure is performed, you must use ...
September 17th, 2015
Specifying anatomical location and laterality
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 17th, 2015
Specifying anatomical location and laterality required by ICD-10 is easier than you think. This detail reflects how physicians and clinicians communicate and to what they pay attention - it is a matter of ensuring the information is captured in your documentation. In ICD-10-CM, there are three main categories of changes:
...
September 17th, 2015
Injuries Documentation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 17th, 2015 - Last Review/Update August 7th, 2017
ICD-9 used separate “E codes” to record external causes of injury. ICD-10 better incorporates these codes and expands sections on poisonings and toxins.
When documenting injuries, include the following:
1. Episode of Care e.g. Initial, subsequent, sequelae
2. Injury site Be as specific as possible
3. Etiology How was the injury sustained (e.g. sports, ...
August 28th, 2015
ICD-10 Preparation for Pediatricians
By Daniel Schwartz | Published August 28th, 2015 - Last Review/Update February 3rd, 2017
Pediatricians are great at making boo-boos less painful for their patients, but without proper planning, they may not be able to alleviate the potential pains associated with the upcoming ICD-10 transition. What is ICD-10 Exactly and Why is This Transition Happening Now? Starting October 1st, providers will no longer be...
August 19th, 2015
Cervical diagnosis Using ICD-10 - July 2013
By | Published August 19th, 2015 - Last Review/Update January 27th, 2017
By Dr. Evan Gwilliam
Using a Medicare Local Coverage Determination (LCD), and the General Equivalence Mappings (GEMs) as a starting point, I will attempt in this article to predict which ICD-10-CM codes will be approved for the secondary cervical diagnoses which Medicare uses now. (By the way, I just use the ...
August 19th, 2015
Attention Dentists: How does the switch to new diagnostic codes this year affect you?
By By Greg Alterton, CDA Dental Benefit Plan Specialist | Published August 19th, 2015
Increasingly, dental plans are deferring to medical benefit carriers on certain dental procedures that can be claimed as medical procedures with patients’ medical plans. More and more, these medical plans are paying for not only surgical dental procedures, but some preventive dental services as well.
In submitting claims to medical plans, ...
August 19th, 2015
How do I know which seventh character to use with sprain and strain codes in ICD-10?
By Evan M. Gwilliam | Published August 19th, 2015
The sprain and strain codes offer three choices for the final character:
A - initial encounter
D - subsequent encounter
S - sequela
August 17th, 2015
Clinical Documentation Guidance for ICD-10-CM/PCS
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 17th, 2015
Documentation assessment and gap analysis is important in ICD-10-CM/PCS. Clinical documentation will also affect code assignment and relative weight associated with payment. To read more information on problem areas with documentation issues read AHIMA's article.
...
August 13th, 2015
ICD-10 Peer Support Group
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 13th, 2015
UHIN offers an ICD-10 Peer Support Group.
Did you know that your peers can be one of your best education resources? To encourage collaboration within the community, we have set up a recurring conference call where everyone can trade tips and tricks for ICD-10 preparation. These are open calls- just ...
August 10th, 2015
Lumbar Diagnosis Using ICD-10
By Melinna Giannini | Published August 10th, 2015 - Last Review/Update January 27th, 2017
This article is coming out before the payers have told us which ICD-10 codes will be used for claim submission. However, we have access to the same code set that they do, therefore this is an educated guess at which codes might used by DCs for the lumbar spine. The ...
August 10th, 2015
Can Chiropractors Finally Code a "Subluxation" in ICD-10?
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
There is a word that has long been held as sacred to the Chiropractic profession. It is the so-called vertebral “subluxation.” Throughout ICD-9, which is the diagnostic code set used on claims for the last thirty years, the term “subluxation” is used to describe a partial dislocation,” which is not how it is defined by many Chiropractors. Medicare ...
August 10th, 2015
ICD-10 External Cause Codes Tell the Whole Story
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Beginning October 1, 2015 all claims for health care services in the United States must use ICD‑10 diagnosis codes. ICD‑9 has been the standard since 1979, but has outlived its usefulness. Because of its structure, ICD‑10 provides better data for research and statistical analysis than ICD‑9. Although there is no national mandate to report ...
July 20th, 2015
Formats for Submitting Claims to Medicare - Electronic Submission Requirements
By Find-A-Code | Published July 20th, 2015
(Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014)
The Administrative Simplification Compliance Act (ASCA) requires that claims be submitted to Medicare electronically unless certain exceptions are met. In addition, the Health Insurance ...
July 20th, 2015
Payment Jurisdiction for Services Subject to the Anti-Markup Payment Limitation
By Find-A-Code | Published July 20th, 2015
(Rev. 3089, Issued: 10-21-14, Effective Date: January 1, 2015 - For Analysis, Design, and Programming April 1, 2015 - For Testing and Implementation; ImplementationJanuary 5, 2015, April 6, 2015 – For MAC testing of PECOS changes only)
Diagnostic tests and their interpretations are paid on the MPFS. Therefore, they are subject ...
July 10th, 2015
Carrier Claims Processing - Reporting of Pricing Localities for Clinical Laboratory Services (Rev. 85, 02-06-04)
By Jared Staheli | Published July 10th, 2015
Carriers shall report to the common working file (CWF) new State pricing localities (positions 58 and 59 on the carrier record) indicated on the Clinical Diagnostic Laboratory fee schedule for any reference laboratory service billed with a HCPCS 90 modifier. If the laboratory test billed is not a reference laboratory ...
July 10th, 2015
Carrier Claims Processing - Jurisdiction of Laboratory Claims (Rev. 3071, 12-22-14)
By Jared Staheli | Published July 10th, 2015
Jurisdiction of payment requests for laboratory services furnished by an independent laboratory, except where indicated in §50.5.1 and §50.5.2, lies with the B MAC serving the area in which the laboratory test is performed. Jurisdiction is not affected by whether or not the independent laboratory uses a central billing office ...
July 10th, 2015
Carrier Claims Processing - Examples of Reference Laboratory Jurisdiction Rules (Rev. 85, 02-06-04)
By Jared Staheli | Published July 10th, 2015
EXAMPLE 1:
Scenario 1:
An independent laboratory located in Oregon performs laboratory services for physicians whose offices are located in several neighboring States. A physician from Nevada sends specimens to the Oregon laboratory.
Jurisdiction:
The carrier in Oregon has jurisdiction.
EXAMPLE 2:
Scenario 2:
American Laboratories, Inc., is an independent laboratory company with branch ...
July 10th, 2015
Claims Processing Requirements for Panel and Profile Tests (Rev. 372, 04-04-05)
By Jared Staheli | Published July 10th, 2015
All test codes should be processed and stored in history as they are submitted. That is, if tests are submitted as individual CPT codes together and paid as a panel (see §90), the claim history data will reflect the individual codes and the panel used in pricing. All tests must ...
July 9th, 2015
Claims Processing Instructions for the Designated Carrier (Rev. 866, 07-03-06) - Competitive Acquisition Program
By Jared Staheli | Published July 9th, 2015
The designated carrier shall follow normal procedures to enroll the Drug Vendors as provider specialty type, 95, Competitive Acquisition Program (CAP) for Part B Drug Vendors.
A separate 4 position, alpha-numeric vendor identification number (VIN) shall be assigned to be used in the prescription number and a master list of which ...
July 9th, 2015
Claims Processing for Separately Billable Tests for ESRD Beneficiaries (Rev. 1655, 02-02-09)
By Jared Staheli | Published July 9th, 2015
Clinical laboratory tests can be performed individually or in predetermined groups on automated profile equipment. If a test profile is performed see §40.6.1. If a clinical laboratory test is performed individually, see §40.6.2.1. However the tests are performed in the laboratory setting, the services must be billed individually, and must ...
July 9th, 2015
Carrier Claims Processing - Referring Laboratories (Rev. 85, 02-06-04)
By Jared Staheli | Published July 9th, 2015
Medicare recognizes that specimens drawn or collected by one laboratory are sometimes referred to another laboratory for testing. Payment for a Medicare-covered, referred laboratory service may be made under the rules established in Chapter 15 §40.1.
The rules specified Chapter 15 §40.1 do not apply to services performed in a physician ...
July 9th, 2015
Carrier Claims Processing - Physicians (Rev. 1, 10-01-03)
By Jared Staheli | Published July 9th, 2015
If a physician or medical group furnishes laboratory tests in an office setting and it is appropriate for them to be performed in the physician’s office, no further development of the source of the laboratory tests is required.
If a claim or physician’s bill raises a question as to the source ...
July 9th, 2015
Carrier Claims Processing - Assignment Required (Rev. 1, 10-01-03)
By Jared Staheli | Published July 9th, 2015
Carriers must:
• Pay for clinical laboratory services provided in the physician’s office only on an assignment basis.
• Treat as assigned any claims for clinical laboratory services provided in the physician’s office even if the claimant submits the claim on a non-assigned basis or if the assignment option is not designated.
• ...
July 9th, 2015
Carrier Claims Processing - Hospital-Leased Laboratories (Rev. 1, 10-01-03)
By Jared Staheli | Published July 9th, 2015
Carriers process claims from hospital laboratories that are leased by physicians and independent laboratories.
Before processing claims for services furnished by a hospital laboratory department operated on a lease or concession basis by a pathologist or by a nonphysician specialist such as a biochemist (with a visiting pathologist or outside independent ...
July 9th, 2015
Carrier Claims Processing - Hospital Laboratory Services Furnished to Nonhospital Patients (Rev. 3014, Effective: Upon Implementation of ICD-10)
By Jared Staheli | Published July 9th, 2015
When a hospital laboratory performs a laboratory service for a non-hospital patient, (i.e., for neither an inpatient nor an outpatient), the hospital bills its A/B MAC (A) on the ASC X12 837 institutional claim format or on the hard copy Form CMS-1450. If an A/B MAC (B) receives such claims, ...
July 9th, 2015
Claims Processing Rules for ESAs Administered to Cancer Patients for Anti-Anemia Therapy (Rev. 3085, Effective: Upon Implementation of ICD-10)
By Jared Staheli | Published July 9th, 2015
The national coverage determination (NCD) titled, “The Use of ESAs in Cancer and Other Neoplastic Conditions” lists coverage criteria for the use of ESAs in patients who have cancer and experience anemia as a result of chemotherapy or as a result of the cancer itself. The full NCD can be ...
July 9th, 2015
Claims Processing Rules for Hospital Outpatient Billing and Payment - Drugs, Biologicals, and Radiopharmaceuticals (Rev. 2903, 04-07-14)
By Jared Staheli | Published July 9th, 2015
A. General Billing and Coding for Hospital Outpatient Drugs, Biologicals, and Radiopharmaceuticals
Hospitals should report charges for all drugs, biologicals, and radiopharmaceuticals, regardless of whether the items are paid separately or packaged, using the correct HCPCS codes for the items used. It is also of great importance that hospitals billing ...
July 8th, 2015
Claims Processing Requirements - General (Rev. 3085, Implementation: Upon Implementation of ICD- 10)
By Jared Staheli | Published July 8th, 2015
A/B MACs (B) are billed with the ASC X12 837 professional claim format or, if approved, with the paper form CMS-1500. A/B MACs (A) are billed with the ASC X12 837 institutional claim format or, if approved, with the paper Form CMS-1450.
See Chapters 24, 25 and 26 for detailed claims ...
July 8th, 2015
Oral Anti-Emetic Drugs Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen (Rev. 2931, 07-07-14)
By Jared Staheli | Published July 8th, 2015
See the Medicare Benefit Policy Manual, Chapter 15, and the National Coverage Determination (NCD) Manual, Section 110.18, for detailed coverage requirements.
Effective for dates of service on or after January 1, 1998, Medicare Part B (including (institutional claims processed by Part A Medicare Administrative Contractors (MACs) and physician/supplier claims processed by ...
July 8th, 2015
Claims Processing Jurisdiction for Oral Anti-Emetic Drugs (Rev. 2931, 07-07-14)
By Jared Staheli | Published July 8th, 2015
The following chart shows which drugs are billed to the A/B MAC, or carrier and which drugs are billed to the DME MAC.
Per the Balanced Budget Act of 1997, effective for claims with dates of service on or after January 1, 1998, the claims processing jurisdiction rules in Chart 1 ...
July 7th, 2015
Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15)
By Jared Staheli | Published July 7th, 2015
For services furnished on or after November 29, 2011, Medicare will cover Intensive Behavioral Therapy for Obesity. Medicare beneficiaries with obesity (BMI ≥30 kg/m2 ) who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other ...
July 7th, 2015
Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages for Screening for Hepatitis C Virus (HCV) (Rev. 3215, 01-05-15)
By Jared Staheli | Published July 7th, 2015
Contractors shall use the appropriate claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare summary notice (MSN) messages when denying payment for HCV screening, HCPCS G0472:
• Denying services submitted on a TOB other than 13X, 71X, 77X, or 85X:
CARC 170 - Payment is denied when ...
July 6th, 2015
Claims Adjustment Reason Codes for the IPPE (Rev. 1615, 01-05-09)
By Jared Staheli | Published July 6th, 2015
Contractors shall use the appropriate Claim Adjustment Reason code, such as 149 (Lifetime benefit maximum has been reached for this service/benefit category) when denying additional claims for an IPPE and/or a screening EKG.
...
July 6th, 2015
Correct Place of Service (POS) Codes for IBT for CVD on Professional Claims (Rev. 2432, 11-08-11)
By Jared Staheli | Published July 6th, 2015
Contractors shall pay for IBT CVD, G0446 only when services are provided at the following POS:
11- Physician’s Office
22-Outpatient Hospital
49- Independent Clinic
72-Rural Health Clinic
Claims not submitted with one of the POS codes above will be denied.
The following messages shall be used when Medicare contractors deny professional claims for incorrect POS:
Claim Adjustment ...
July 6th, 2015
Diagnosis Code Reporting for Screening for STIs and HIBC to Prevent STIs (Rev. 2476, 02-27-12)
By Jared Staheli | Published July 6th, 2015
A claim that is submitted for screening chlamydia, gonorrhea, syphilis, and/or hepatitis B shall be submitted with one or more of the following diagnosis codes in the header and pointed to the line item:
a. For claims for screening for chlamydia, gonorrhea, and syphilis in women at increased risk who are ...
July 5th, 2015
Edits for Glaucoma Screening Services (Rev. 1, 10-01-03)
By Jared Staheli | Published July 5th, 2015
A. Common Working File Edits
Effective January 1, 2002, CWF edits glaucoma screening claims for frequency and valid HCPCS codes for dates of service January 1, 2002, and later.
B. Claims Edits
Nationwide claims processing edits for pre or post payment review of claim(s) for glaucoma screening are not required at this ...
June 29th, 2015
HIPAA Standards for Claims
By Find-A-Code | Published June 29th, 2015
(Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014) The standards adopted under HIPAA include both a transaction standard and an implementation guide. The following are the claims transactions and the implementation ...
June 25th, 2015
FI – Telehealth Originating Site Facility Fee – Medicare Part B – Claims Processing for Indian Health Services (Rev. 1776, 01-04-10)
By Jared Staheli | Published June 25th, 2015
The Telehealth Originating Site Facility Fee is reported on TOB 12X, 13X or 85X along with the revenue code 0780 and HCPCS code Q3014 as described in Chapter 12, Section 190 of Pub. 100-04, Medicare Claims Processing Manual.
No clinic visit shall be billed if this is the only service received. ...
June 25th, 2015
Claims Submitted to Carriers/AB MACs (Rev. 1586, 10-06-08)
By Jared Staheli | Published June 25th, 2015
Medicare does not require that the influenza virus vaccine be administered under a physician’s order or supervision. Effective for claims with dates of service on or after July 1, 2000, Medicare does not require that pneumococcal vaccinations be administered under a physician’s order or supervision. Medicare still requires that the ...
June 25th, 2015
Simplified Roster Claims for Mass Immunizers (Rev. 1586, 10-06-08)
By Jared Staheli | Published June 25th, 2015
The simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by PHCs and other individuals and entities that give the vaccine to a group of beneficiaries, e.g. at PHCs, shopping malls, grocery stores, senior citizen homes, and health ...
June 25th, 2015
Roster Claims Submitted to AB MACs for Mass Immunization (Rev. 3159, 02-02-15)
By Jared Staheli | Published June 25th, 2015
If the PHC or other individual or entity qualifies to submit roster claims, it may use a preprinted Form CMS-1500 that contains standardized information about the entity and the benefit. Key information from the beneficiary roster list and the abbreviated Form CMS-1500 is used to process pneumococcal and influenza virus ...
June 25th, 2015
Claims Submitted to FIs/AB MACs for Mass Immunizations of Influenza Virus and Pneumococcal Vaccinations (Rev. 1586, 10-06-08)
By Jared Staheli | Published June 25th, 2015
Some potential "mass immunizers," such as hospital outpatient departments and HHAs, have expressed concern about the complexity of billing for the influenza virus vaccine and its administration. Consequently, to increase the number of beneficiaries who obtain needed preventive immunizations, simplified (roster) billing procedures are available to mass immunizers. The simplified ...
June 25th, 2015
Electronic Roster Claims (Rev. 1586, 10-06-08)
By Jared Staheli | Published June 25th, 2015
As for all other Medicare-covered services, FIs/AB MACs pay electronic claims more quickly than paper claims. For payment floor purposes, roster bills are paper bills and may not be paid as quickly as EMC. (See chapter 1.) If available, FIs/AB MACs must offer free, or at-cost, electronic billing software and ...
June 25th, 2015
CWF Edits on Carrier/AB MAC Claims (Rev. 2824, 04-07-14)
By Jared Staheli | Published June 25th, 2015
In order to prevent duplicate payment by the same carrier/AB MAC, CWF will edit by line item on the carrier/AB MAC number, the HIC number, the date of service, the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688; the ...
June 25th, 2015
CWF A/B Crossover Edits for FI/AB MAC and Carrier/AB MAC Claims (Rev. 2824, 04-07-14)
By Jared Staheli | Published June 25th, 2015
When CWF receives a claim from the carrier/AB MAC, it will review Part B outpatient claims history to verify that a duplicate claim has not already been posted.
CWF will edit on the beneficiary HIC number; the date of service; the influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, ...
June 25th, 2015
Carrier - Claims Processing Requirements for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
1. Claims will be submitted by IHS physicians and practitioners using either the American National Standards Institute Accredited Standards Committee (ANSI ASC) 837P or Form CMS-1500.
2. The designated carrier shall supply IHS physicians and practitioners with any billing software that would normally be given to physician and non-physician practitioners.
3. The ...
June 25th, 2015
Carrier – Ambulance Services - Claims Processing (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
Medically necessary ambulances provided by an IHS ambulance supplier are paid based upon Chapter 15 of Pub. 100-04, Medicare Claims Processing Manual. Suppliers must report an origin and destination code for each ambulance service billed.
Modifier Reporting –
Origin and destination modifiers used for ambulance services are created by combining two alpha ...
June 25th, 2015
Carrier - Clinical Laboratory Services - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
Some clinical laboratory procedures or tests require FDA approval before coverage is provided. Laboratory services furnished by a freestanding facility are covered under Medicare Part B if the laboratory is an approved independent clinical laboratory. However, as is the case of all diagnostic services, in order to be covered these ...
June 25th, 2015
Carrier – MNT - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
If the RD providing the services is an employee of an independent or free standing clinic and the services are provided in the clinic, the services are billed to the designated carrier.
See Chapter 4, §§300 through 300.6 of Pub. 100-04, Medicare Claims Processing Manual, for more information on the Healthcare ...
June 25th, 2015
Carrier Claims Processing and Payment Policy for ASC Claims for Indian Health Services (Rev. 1325; 01-07-08)
By Jared Staheli | Published June 25th, 2015
Effective for services on or after January 1, 2008, the designated IHS carrier shall accept and pay for claims submitted by IHS and tribal hospitals that elect to enroll as ASC facilities. See Pub. 100-04, Medicare Claims Processing Manual, Chapter 14, for information on ASC claims processing. See Pub. 100-02, ...
June 25th, 2015
General Claims Processing Rules for DMEPOS for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
The DME MACs may only be billed for surgical dressings, splints, casts and for prosthetics and orthotics by IHS suppliers, not by IHS providers. The Region D DME MAC shall accept all DMEPOS claims submitted by IHS suppliers and shall forward electronic media claims to the appropriate DME MAC for ...
June 25th, 2015
A/B MAC (A) Payment Policy and Claims Processing for Indian Health Services (Rev. 3049, 09-23-14)
By Jared Staheli | Published June 25th, 2015
Bills are submitted to the A/B MAC (A) by IHS providers (including CAHs) using the ASC-X12 837 institutional claim format. In exceptional circumstances, a hardcopy Form CMS-1450 may be accepted by the designated A/B MAC (A).
The IHS providers are identified by Provider Type 08 in the Provider Specific File in ...
June 25th, 2015
A/B MAC (A) - Inpatient Acute Care - Medicare Part A - Claims Processing for Indian Health Services (Rev. 3049, 09-23-14)
By Jared Staheli | Published June 25th, 2015
All charges are combined and reported under revenue code 0100 (all-inclusive room and board plus ancillary) on type of bill (TOB) 11X (hospital inpatient). Inpatient services are billed from admission through discharge. Interim billing is not allowed.
See Chapter 1, §50.2 of Pub. 100-04, Medicare Claims Processing Manual, for more information ...
June 25th, 2015
FI - Inpatient Ancillary Services - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1776, 01-04-10)
By Jared Staheli | Published June 25th, 2015
All charges, except therapies, telehealth originating site facility fee, PPV, influenza virus and hepatitis B vaccines are combined and reported under revenue code 024X (allinclusive ancillary) on TOB 12X (hospital inpatient Part B). Medicare Part B deductible and coinsurance amounts are applied to inpatient Medicare Part B ancillary services, but ...
June 25th, 2015
Swing-bed – Medicare Part A - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
Revenue code 0022 (special charges) and the Health Insurance Prospective Payment System (HIPPS) codes are reported on the bill along with the accommodation revenue codes. Services are itemized and billed with the appropriate revenue code that describes the service on TOB 18X (hospital swing bed). Medicare swing-bed bill processing instructions ...
June 25th, 2015
FI - Outpatient - Medicare Part B - Claims Processing for Indian Health Services (Rev. 2075, 01-28-11)
By Jared Staheli | Published June 25th, 2015
All charges, except for therapies, telehealth originating site facility fee, PPV, influenza virus vaccine, hepatitis B vaccine and hospital-based ambulance services are combined and reported under revenue code 0510 (clinic visit) on TOB 13X (hospital outpatient).
Regardless of the number of times a patient is seen in a given day at ...
June 25th, 2015
FI - ASC - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1325; 01-07-08)
By Jared Staheli | Published June 25th, 2015
Charges are reported under revenue code 0360 (operating room services) or 0490 (ambulatory surgical care) on TOB 83X (ambulatory surgical center). ASC surgeries are identified with CPT codes 10000-69979 only. One bill is required for all services provided on the day a surgical procedure is performed.
*Exception: Revenue code 0276 (intraocular ...
June 25th, 2015
FI - CAH Inpatient - Medicare Part A - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
All charges are combined and reported under revenue code 0100 (all-inclusive room and board plus ancillary) on TOB 11X (hospital inpatient). Inpatient services are billed from admission through discharge.
The MSN is suppressed.
...
June 25th, 2015
FI - CAH Ancillary Services - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1776, 01-04-10)
By Jared Staheli | Published June 25th, 2015
All charges, except therapies, telehealth originating site facility fee, PPV, influenza virus and hepatitis B vaccines are combined and reported under revenue code 024X (allinclusive ancillary) on TOB 12X (hospital inpatient Part B). The MSN is suppressed.
See §§100.10 and 100.11 of this chapter, for more information on the payment of ...
June 25th, 2015
FI - CAH Swing-bed - Medicare Part A - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
Services are itemized and billed with the appropriate revenue code that describes the service on TOB 18X (hospital swing-bed). Technical criteria for swing-bed admissions apply (i.e., 3 day qualifying hospital stay, 30 day transfer requirements, etc.) but CAH swing-bed providers are not required to report revenue code 0022 or HIPPS ...
June 25th, 2015
FI - CAH Swing-bed - Inpatient Ancillary Claims - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
The IHS CAH swing-bed Medicare Part B inpatient ancillary bills revert to inpatient Medicare Part B ancillary bills and are submitted under the regular hospital (or CAH) provider number (not the swing-bed provider number) with revenue code 0240 (all inclusive ancillary) on TOB 12X (inpatient Part B). The MSN is ...
June 25th, 2015
FI - CAH Outpatient - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1776, 01-04-10)
By Jared Staheli | Published June 25th, 2015
All charges, except therapies, telehealth originating site facility fee, PPV, influenza virus vaccine, hepatitis B vaccine, and hospital-based ambulance services are combined and reported under revenue code 0510 (clinic visit) on TOB 85X (CAH).
Non-patient lab specimens are billed on TOB 14X (hospital other).
The MSN is suppressed.
See Chapter18, §10 of Pub. ...
June 25th, 2015
FI - Vaccines and Vaccine Administration - Claims Processing for Indian Health Services (Rev. 1325; 01-07-08)
By Jared Staheli | Published June 25th, 2015
These vaccines are reported on TOB 12X, 13X, 83X, or 85X along with the appropriate revenue codes and HCPCS codes as found in billing instructions in Chapter 18, §10.2 of Pub. 100-04, Medicare Claims Processing Manual.
No clinic visit shall be billed if vaccine and its administration are the only service ...
June 25th, 2015
FI - Physical Therapy, Occupational Therapy, SpeechLanguage Pathology and Diagnostic Audiology Services - Claims Processing for Indian Health Services (Rev. 1325; 01-07-08)
By Jared Staheli | Published June 25th, 2015
Therapy services and diagnostic audiology services are reported on TOB 12X, 13X, 83X or 85X using the appropriate revenue code and HCPCS codes.
No clinic visit shall be billed if a therapy service or a diagnostic audiology service is the only service received. These services may be billed with or without ...
June 25th, 2015
FI - CAH Ambulance Services - Medicare Part B -Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
Medically necessary ambulance services originating out of an IHS CAH with a hospitalbased ambulance service are submitted with revenue code 054X (ambulance) with charges for ambulance, as well as the appropriate ambulance HCPCS codes on TOB 85X. IHS CAHs that meet the 35 mile rule for cost based payment shall ...
June 25th, 2015
FI - Other Screening and Preventive Services - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
The screening and preventive services listed in §100.13 of this chapter are reported on TOB 12X, 13X, or 85X with revenue code 0510 (clinic visit).
Services for screening pap smears are only payable by the FI when billed with a pelvic exam. Prostate cancer screening, cardiovascular screening blood tests and screening ...
June 25th, 2015
FI - MNT - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
By Jared Staheli | Published June 25th, 2015
The MNT services provided under the auspices of the hospital are reported to the designated FI under revenue code 0510 (clinic visit). The current MNT HCPCS codes are required for the both the assessment and reassessment. The MSN is suppressed.
See Chapter 4, §§300 through 300.6 of Pub. 100-04, Medicare Claims ...
June 18th, 2015
DME MACs Only - Appeals of Duplicate Claims (Rev. 2993, Upon Implementation of ICD-10)
By Jared Staheli | Published June 18th, 2015
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) must afford appeal rights for the initial determination of an item or service only, unless the supplier is appealing whether or not the denied item is actually a duplicate. If a claim is denied as a duplicate, the DME MACs must ...
June 17th, 2015
ICD-10 training: Coding for diabetes
By Find-A-Code | Published June 17th, 2015
In order to understand diabetes coding in ICD-10, it’s worth making a comparison of the structural differences between ICD-9-CM and ICD-10-CM.
Diabetes mellitus (DM) codes in ICD-10-CM are combination codes that include the type of DM, the body system affected, and the complication affecting that body system as part of the code description. Subcategory levels first ...
June 17th, 2015
DMEPOS Clinical Trials and Demonstrations (Rev. 2993, Upon Implementation of ICD- 10)
By Jared Staheli | Published June 17th, 2015
The definition of the QR modifier is “item or service has been provided in a Medicare specified study.” When this modifier is attached to a HCPCS code, it generally means the service is part of a CMS related clinical trial, demonstration or study.
The DME MACs shall recognize the “QR” modifier ...
June 15th, 2015
Carrier Jurisdiction of Requests for Payment (Rev. 2487)
By Find-A-Code | Published June 15th, 2015
Carriers have jurisdiction for all claims from the following:
• Physicians;
• Other individual practitioners;
• Groups of physicians or practitioners;
• Labs not part of a hospital;
• Ambulance claims submitted by ambulance companies under their own Medicare number (hospitals may operate ambulances as part of the hospital and bill the intermediary (FI));
• Ambulatory ...
May 30th, 2015
Multiple External Cause Coding Guidelines
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 30th, 2015 - Last Review/Update August 8th, 2017
More than one external cause code is required to fully describe the external cause of an illness or injury. The assignment of external cause codes should be sequenced in the following priority: If two or more events cause separate injuries, an external cause code should be assigned for each cause.
The ...
May 29th, 2015
ICD-10 Training for Chiropractors
By ChiroCode | Published May 29th, 2015
Part 1
Part 2
Part 3
Part 4
Case Study 15
Case Study 21
Case Study 22 and 23
Case Study 24
Case Study 25
...
May 11th, 2015
Anatomy of ICD-10 and New Features: Finding S52.131A
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 11th, 2015 - Last Review/Update February 3rd, 2017
We are used to the simple ICD-9-CM Diagnoses Codes where there are only are 3–5 digits. Lets take a look at how an ICD-10 code is broken down.
ICD-10-CM, these Diagnosis Codes can be as short as 3 digits or as long as 7 digits; furthermore, ICD-10 consists of Alphabetical and ...
May 6th, 2015
ICD-10-CM 7th Character and its use
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 6th, 2015 - Last Review/Update August 8th, 2017
The 7th character is used in certain chapters (e.g., Obstetrics, Injury, Musculoskeletal, and External Cause chapters). However, it is not used in every chapter and may have a different meaning depending on the section where it is being used. One thing that is consistent, is that it must be used in the 7th character ...
May 6th, 2015
ICD-10-CM Abbreviations: NEC, NOS
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 6th, 2015 - Last Review/Update August 8th, 2017
The difference between NEC and NOS is very specific and not to be confused as they are two very different abbreviations.
NEC - When a specific code is not available for a condition, the Index directs the coder to the “other specified” code in the Tabular List. NEC is used to indicate the ...
March 26th, 2015
DSM-FAQ
By Wyn Staheli | Published March 26th, 2015 - Last Review/Update July 27th, 2017
The Diagnostic and Statistical Manual for Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is generally accepted as the authoritative guide for the diagnosis of mental disorders. This FAQ article was created to address some commonly asked questions about DSM coding and clear up some common misconceptions.
March 16th, 2015
Plantar Fasciitis: Medical Necessity and Cross Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2015 - Last Review/Update August 9th, 2017
Prior to treatment you must determine Medical Necessity.
Be sure conservative therapy/treatment was previously done and documented for at least 6 months and proven to be unsuccessful.
NSAIDS - at least 4 weeks ineffective or contraindicated
Physical Therapy such as taping and stretching
Activity modification
Splints used at night for more that 4 weeks
Corticosteroid injection
Arch Supports, ...
March 9th, 2015
Billing Imminuzation for Pneumococcal, Influenza, and Hepatitis B with Medicare
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 9th, 2015 - Last Review/Update August 9th, 2017
The current diagnosis pointer for, Influenza, Pneumococcal or Hepatitis B vaccines is ICD-10-CM code Z23. Listed are tips for coding, and also the diagnosis pointers used for claims previous to 10/01/15:
Influenza: G0008
Procedure codes:
90630
90653-90662
90672-90674
90685-90688
Medicare codes:
Q2034-Q2039
Expired diagnosis code:
V04.81
Pneumococcal: G0009
Procedure codes:
90670
90732
Expired diagnosis code:
V03.82
Hepatitis B: G0010
Procedure codes
90739-90747
Expired diagnosis code
V05.3
Both Influenza and Pneumococcal Vaccines received in same visit: G0008 with G0009
Procedure codes:
(See previous)
Expired diagnosis code:
V06.6 (effective 10/01/06 - 09/30/15)
Extra Tips:
Be sure ...
February 23rd, 2015
What is the difference between ICD-9-CM and ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 23rd, 2015
ICD-10-CM uses 3–7 alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM (for example, ICD-10-CM has the same hierarchical structure as ICD-9-CM).
The 7th character in ICD-10-CM is used in several chapters (for example, the Obstetrics, Injury, Musculoskeletal, and External Cause chapters). ...
February 15th, 2015
Underdosing - a New Clinical Concept in ICD-10 codes T36 – T50
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2015 - Last Review/Update March 1st, 2016
T36-T50 Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50)
Underdosing is a clinical concept new to ICD-10. Underdosing identifies situations referring to the practice of a patient taking less medication as prescribed by a physician, or a physician prescribing less than what is prescribed by ...
December 4th, 2014
OASIS Data to be Submitted via Assessment Submission and Processing (ASAP) System Effective Jan 1, 2015
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016
Effective January 1, 2015, OASIS assessment data will be submitted to CMS via the national OASIS Assessment Submission and Processing (ASAP) system. With the implementation of the OASIS ASAP system, Home Health Agencies will no longer submit OASIS assessment data to CMS via their state databases. To access the ...
October 29th, 2014
Getting Ready for 2015
By | Published October 29th, 2014 - Last Review/Update January 30th, 2017
Each new year brings a bundle of surprises in terms of changes and updates that practices must learn and implement. In effort to aid in the preparation of this year, here are some common helpful tips that you might follow in order to best manage your workload ahead.
-Evaluate fees: Fee schedules ...
October 17th, 2014
Acupuncture ICD-10 Common Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 17th, 2014 - Last Review/Update January 30th, 2017
The following is a short list of some other handy ICD-10 codes:
M76.50 Patellar tendinitis, unspecified kneeM76.51 Patellar tendinitis, right kneeM76.52 Patellar tendinitis, left kneeM05.33 Rheumatoid arthritisM15.9Polyosteoarthritis, unspecified (generalized osteoarthritis NOS)M16.10 Unilateral primary osteoarthritis, unspecified hipM54.40 Lumbago with sciatica, unspecified sideM54.41 Lumbago with sciatica, right sideM54.42 Lumbago with sciatica, left sideM54.6 Pain in the thoracic spineM54.9Dorsalgia, unspecified (backache NOS, back ...
October 16th, 2014
Using 6 characters for a 7 Character Code
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Don't do that!
The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is 6 characters, a placeholder X must be used to fill in the empty characters.
Remember:
You may be using the placeholder "X" to complete a code. Be sure ...
October 9th, 2014
Acupuncture and the Treatment of Headaches
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 9th, 2014 - Last Review/Update January 30th, 2017
Acupuncture services are often reimbursed for the treatment of headaches. For examples on headache codes and coding for headaches with ICD-10, visit HealthCMi
...
October 8th, 2014
#2 DRIP Line ICD-10 -CM Did you know... ICD-10-CM/PCS Examples: Structural Differences
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 8th, 2014 - Last Review/Update August 9th, 2017
The examples below show the structural differences between ICD-9-CM and ICD-10-CM/PCS.
ICD-9-CM Diagnoses Codes:
3–5 digits
First digit is alpha (E or V) or numeric
Digits 2–5 are numeric; and Decimal is after third digit
Examples:
496 – Chronic airway obstruction, Not Elsewhere Classified (NEC)
511.9 – Unspecified pleural effusion
V02.61 – Hepatitis B carrier
ICD-10-CM Diagnoses Codes:
3–7 digits
Digit 1 is ...
July 31st, 2014
Fill In Doctor: Locum Tenens
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ...
May 2nd, 2014
CMS Makes ICD-10 Announcement
By | Published May 2nd, 2014 - Last Review/Update January 25th, 2017
On the evening of April 30th, the release of the 2015 Inpatient Prospective Payment System Proposed Rule included three separate references to the implementation of ICD-10:
1. "The ICD-10-CM/PCS transition is scheduled to take place on October 1, 2015. After that date, we will collect non-electronic health record-based quality measure data coded only in ICD-10-CM/PCS." - page 648
2. "ICD-10 will officially be implemented on October 1, 2015." - page 1065
3. "ICD-10-CM/PCS will officially be implemented on October 1, 2015." - page 1074
Today, May 2, 2014, CMS released the following statement:
January 28th, 2014
ICD-10 Guidelines that Chiropractic Physicians Should Remember
By | Published January 28th, 2014 - Last Review/Update January 27th, 2017
Depending on the publisher, there are about 30 pages of guidelines in the ICD-10-CM code set. The bulk of these guidelines, from section 1.C, are chapter-specific.
Chiropractic physicians typically use codes from just four or five of the 21 chapters available in ICD-10-CM. These include, but are not necessarily limited to, ...
November 26th, 2013
How do I know which ICD-10 codes payers are going to like?
By | Published November 26th, 2013 - Last Review/Update January 27th, 2017
One of the biggest questions doctors have is “Which codes will I actually use when ICD-10 kicks in on October 1, 2014?” This is the great mystery. Fortunately we have access to the same code set that payers will be using as they determine which codes they like to see. ...
September 11th, 2013
ICD-10 Coding Possibilities for Chiropractic Physicians
By Evan M Wsilliam, DC, CPC, CCPC, NCICS, CCCPC, CPC-I, MCS-P, CPMA | Published September 11th, 2013 - Last Review/Update January 27th, 2017
Right now, it’s hard to say which ICD-10 codes third-party payers will select as medically necessary, but we can make an educated guess based on information from a few sources. More detail is expected from Medicare before the end of 2013. For doctors of chiropractic (DCs), the natural place to start is with the relatively short list of frequently used ICD-9-CM codes for submitting claims. We’ll investigate a handful of diagnosis codes that Medicare recognizes as medically necessary and explore ICD-10-CM code possibilities.
June 14th, 2013
Maybe ICD-10 Will Just Go Away...
By | Published June 14th, 2013 - Last Review/Update January 27th, 2017
Maybe ICD-10 will just go away...
Or maybe not. In case you have not heard, the ICD-9 codes that you have been using on claim forms since the late 1970s will cease to exist as of October 1st, 2014. You may have also heard that the entire country was supposed to switch ...
article requests
If you would like a specific article written on a medical coding and billing topic, please contact us.
contact
innoviHealth Systems, Inc.62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
article topics
article
Thank you for choosing Find-A-Code, please Sign In to remove ads.
Quick, Current, Complete - www.findacode.com