"Diagnosis Coding" & "Collections" Articles

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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.

June 10th, 2020

MEGA - NCCI Edit Changes - WHO Knew?

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 10th, 2020

There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197 Deleted Medically Unlikely ...

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: ...

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?

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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

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 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?

August 13th, 2019

Healthcare Common Procedure Coding System (HCPCS)

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 13th, 2019

There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...

July 9th, 2019

The Importance of Medical Necessity

By Marge McQuade, CMSCS, CHCI, CPOM | Published July 9th, 2019

ICD-10-CM codes represent the first line of defense when it comes to medical necessity. Correctly chosen diagnosis codes support the reason for the visit as well as the level of the E/M services provided. The issue of medical necessity is one of definitions and communication. What is obvious to the ...

May 13th, 2019

Prioritize Your Patient's Financial Experience

By Wyn Staheli, Director of Research | Published May 13th, 2019

For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ...

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 ...

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 ...

February 7th, 2019

Charging Missed Appointment Fees for Medicare Patients

By Wyn Staheli, Director of Research | Published February 7th, 2019 - Last Review/Update February 8th, 2019

Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is ...

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 ...

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 ...

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 30th, 2018

Routine Waiver of Patient Out of Pocket Expenses

By Linda Walker | Published May 30th, 2018 - Last Review/Update June 4th, 2018

Medical billers often encounter the dilemma of a physician who wants to be the hero to his or her patients and waive their out-of-pocket expenses. Out-of-pocket expenses include a patient's co-payment, coinsurance, deductibles, charges above U&C (Usual and Customary), and even services a plan may not cover in some situations....

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

Adjusting Your Collection Strategies to HDHPs

By Ashley Choate | Published January 31st, 2018 - Last Review/Update March 29th, 2018

High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations.....

January 24th, 2018

Better Office Communication Leads to Stronger RCM

By Ashley Choate | Published January 24th, 2018 - Last Review/Update March 29th, 2018

According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ...

January 23rd, 2018

NEW on Find-A-Code...National Coverage Determinations (NCDs)

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2018 - Last Review/Update January 25th, 2018

Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...

January 9th, 2018

Billing Electrotherapy with AcuKnee

By Christine Woolstenhulme | Published January 9th, 2018

This code is commonly used to bill for AcuKnee products. Per AcuKnee, “NMES and electrotherapy may be covered by most insurance providers, provided the following criteria are met;” Documentation of chronic pain or muscle atrophy 3 months or longer Must document improvement Must have physician document medical necessity/Prescription Appropriate authorization from your insurance provider Suggested codes when billing 64550 initial electrotherapy education and placement E0720 Electrotherapy unit itself E0731 Garment ...

January 4th, 2018

Diagnosis Coding with Diagnostic Testing

By Marge McQuade, CMSCS, CHCI, CPOM | Published January 4th, 2018

Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns. If a physician confirms a diagnosis based on the results of a diagnostic ...

December 29th, 2017

Patient With Complex Needs

By Kelly Ogle, BSDH, MIOP, CMPM, CHOP | Published December 29th, 2017 - Last Review/Update January 31st, 2018

In each practice, there are patients who present with a multitude of problems. These problems can range from the smallest of symptoms to the more complex illnesses.....

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?

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 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.

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?

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?

February 16th, 2017

Diagnostic Criteria for Behavioral Health

By Wyn Staheli, Director of Research | Published February 16th, 2017

In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include: History: This can include the patient's personal history as well as that of the patient's family. Physical exam: The healthcare provider will try to rule out physical problems ...

February 10th, 2017

Q/A: What is the Proper Code for "Lumbar Decompression?

By ChiroCode | Published February 10th, 2017 - Last Review/Update February 8th, 2019

Q: What is the proper code for "Lumbar Decompression?

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.

August 3rd, 2016

Medicare Part B deductible, premiums to be unchanged for 2014; tips on deductible collection

By Codapedia | Published August 3rd, 2016

The Medicare deductible for Part B services will not change in 2014, remaining at $147 for the second straight year. The premium for beneficiaries will also remain unchanged at a base rate of $104.90, continuing the slowest five-year period of premium growth in Medicare Part B history, according to CMS.The...

August 3rd, 2016

Selecting a Third-Party Collection Agency and Choosing the Correct Collection Program

By | Published August 3rd, 2016

Increasing cash flow through the use of a modern, third-party collection agency is a must for practice survival. With states reducing government funding and third-party payers reducing allowables, more and more dollars are being transferred to patient responsibility. Practices now must trim operating expenses and increase patient payments in order...

July 29th, 2016

When patient doesn’t pay health exchange premium, you may be left holding the bag

By Codapedia | Published July 29th, 2016

One of the issues surrounding implementation of the Affordable Care Act (ACA) that impacts physician billing and payment and hasn’t gotten a lot of attention is what happens when a patient buys an insurance plan under the exchange, but then stops paying the premium. The answer may end up leaving...

July 29th, 2016

Win The Losing Battle-Verify

By Codapedia | Published July 29th, 2016

Do you feel like you are fighting a losing battle? Are you watching your account receivables going up and your collections going down? Is your cash flow suffering? What is a practice to do? One of the most effective ways to keep your cash flowing is by checking your patient’s...

July 29th, 2016

Using denial tracking to improve collections

By Codapedia | Published July 29th, 2016

Here are some examples of denials that a practice should track to be sure that they are paid correctly by the insurance company. Set up a denial type for each of these. Fee Schedule Issues: Wrong amount paid per the contracted fee schedule. May be too high or too low...

July 29th, 2016

Real Time Claims Adjudication (RTCA)

By Codapedia | Published July 29th, 2016

Real time claims adjudication (RTCA) is a software interface between a physician's practice management information system and a payers claims processing system that allows the practice to submit a claim at the time of checkout, and receive a response from the insurance company while the patient is waiting. It allows...

July 28th, 2016

Using Leins in Personal Injury Cases

By | Published July 28th, 2016 - Last Review/Update January 25th, 2017

Using Liens in PI Cases When it comes to getting paid on PI cases, few documents and protocols are as important as those relating to a well drafted financial policy, along with a set of unalterable financial protocols (at least not easy to change). With these in place, you are ...

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.

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 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?

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.

December 11th, 2015

Selecting a Third-Party Collection Agency and Choosing the Correct Collection Program

By Codapedia | Published December 11th, 2015

December 3rd, 2015

Days in Accounts Receivable - Measuring your collection efforts

By Codapedia | Published December 3rd, 2015

Practices should monitor their days in accounts receivable monthly and compare their days with the average days of other practices by specialty. Days in Receivables Outstanding: A/R/(last 3 months of gross charges/90) = Days in A/R Example: 3 months of charges= $927,009; A/R = 567,828...

December 3rd, 2015

Aging Report - A critical measure of collections

By Codapedia | Published December 3rd, 2015

Run your aging report every month in summary and in detail by payer class. A good goal is to have less than 20% of your total accounts receivable 120 days or older. Practices with great accounts receivable policies and procedures can have a lower percentage than...

December 3rd, 2015

Accounts Receivable Benchmark Data - Monitoring your collection efforts

By Codapedia | Published December 3rd, 2015

Accounts Receivable benchmarks are measures of how successfully and how quickly the practice collects their revenue for services provided. These measures include the gross collection ratio, the net collection ratio, aging report and day in receivable outstanding. Physician practices should make a special effort to...

December 3rd, 2015

Gross Collection Ratio - An Accounts Receivable Measure

By Codapedia | Published December 3rd, 2015

The gross collection ratio is shockingly low for many practices. Physicians do not understand why they collect only 20, 40, 60 or 80 cents on the dollar. The percentage of collections based on the gross charges varies significantly by practice and specialty. It is influenced...

November 19th, 2015

Net Collection Ratio - An Accounts Receivable Measure

By Codapedia | Published November 19th, 2015

The net collection ratio is calculated this way: Cash collections divided by net charges. Net charges are the difference between gross charges and required government and third party adjustments. Use gross charges, insurance adjustments and cash collections for the same time period. Example: Gross charges = $3,740,318; Cash ...

March 3rd, 2015

Collect Up Front

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 3rd, 2015 - Last Review/Update January 30th, 2017

According to Medicare regulations, you are able to collect monies owed by the patient at the time of the visit (deductibles, coinsurance and co-pays), this is also true with other commercial insurance contracts. Collecting monies owed by patients at the time of their visit can reduce overhead. Of course, you ...

November 21st, 2014

A Practice's Responsibility in Managing Medical Expenses

By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017

Medical expenses are one of the largest expenses in many United States households.Â Medical bills and insurance remittance are also possibly the most difficult of all bills for patients to interpret and understand.Â Of course, this lack of understanding often has a negative impact on many things, such as: provider/patient relationship, provider ...

November 10th, 2014

Reduce The Need To Turn Patients Over To A Collection Agency

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 10th, 2014 - Last Review/Update January 30th, 2017

If you have worked in billing and reimbursement, you are aware that turning patients over to a collection agency to collect on a debt should always be a last resort. Are your office policies conducive to retaining happy, paying patients or harming the word-of-mouth advertizing so important to medical providers ...

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"Diagnosis Coding" & "Collections" Articles

New Codes for Cytokine Release Syndrome (CRS)

MEGA - NCCI Edit Changes - WHO Knew?

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

Q/A: Did Noridian Stop Covering the M99.0- Codes?

Hypertension & ICD-10

The New ICD-10-CM Code Updates Are Here — Are You Ready?

Vaccine Administration - When The Right Vaccine Code is Not Enough

Chiropractic 2020 Codes Changes Are Here

Healthcare Common Procedure Coding System (HCPCS)

The Importance of Medical Necessity

Prioritize Your Patient's Financial Experience

What is Medical Necessity and How Does Documentation Support It?

Pain Codes in ICD-10-CM

Charging Missed Appointment Fees for Medicare Patients

Diagnosis Coding for Cardiology

Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder

2019 Code Changes are Just Around the Corner - Are You Ready?

Coding for Strains in ICD 10

Routine Waiver of Patient Out of Pocket Expenses

Traumatic Subluxation Coding Controversy

Adjusting Your Collection Strategies to HDHPs

Better Office Communication Leads to Stronger RCM

NEW on Find-A-Code...National Coverage Determinations (NCDs)

Billing Electrotherapy with AcuKnee

Diagnosis Coding with Diagnostic Testing

Patient With Complex Needs

Coding Carpal Tunnel Syndrome

Brace Yourself for New ICD-10 and CPT Codes for 2018!

ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath

Our Claims are Being Rejected

Q/A: What is the ICD-10 Code for Acetabular Labral Tear?

Diagnostic Criteria for Behavioral Health

Q/A: What is the Proper Code for "Lumbar Decompression?

Why Should I Document a Differential Diagnosis?

Medicare Part B deductible, premiums to be unchanged for 2014; tips on deductible collection

Selecting a Third-Party Collection Agency and Choosing the Correct Collection Program

When patient doesn’t pay health exchange premium, you may be left holding the bag

Win The Losing Battle-Verify

Using denial tracking to improve collections

Real Time Claims Adjudication (RTCA)

Using Leins in Personal Injury Cases

Key Terms in ICD-10

Q&A: How do You Code for a Bilateral Condition, Such as Sciatica?

How do we Know Which Codes a Payer will Allow?

What are External Cause Codes in ICD-10?

Selecting a Third-Party Collection Agency and Choosing the Correct Collection Program

Days in Accounts Receivable - Measuring your collection efforts

Aging Report - A critical measure of collections

Accounts Receivable Benchmark Data - Monitoring your collection efforts

Gross Collection Ratio - An Accounts Receivable Measure

Net Collection Ratio - An Accounts Receivable Measure

Collect Up Front

A Practice's Responsibility in Managing Medical Expenses

Reduce The Need To Turn Patients Over To A Collection Agency

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contact

article topics