"Diagnosis Coding" & "Guidelines and Manuals" Articles

Click on the title to see the article summary and a link to the full article.

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?

October 12th, 2020

What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?

By Aimee Wilcox | Published October 12th, 2020

When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ...

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?

older articles ↓

November 19th, 2019

Changes to Portable X-Ray Requirements

By Wyn Staheli, Director of Research | Published November 19th, 2019

On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law.

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 ...

April 23rd, 2019

Let's Talk High Risk E/M Services

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019

Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services. Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...

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 ...

March 21st, 2019

The Impact of Medical Necessity on High Level E/M Services

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2019

I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?" The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

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 14th, 2019

Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

By Aimee Wilcox | Published February 14th, 2019

Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...

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 ...

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 ...

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 ...

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....

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 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 ...

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.

September 1st, 2017

How to Use Guidelines When the Auditor Challenges You

By Dr Ronald J. Farabaugh | Published September 1st, 2017 - Last Review/Update February 5th, 2019

General Rules/Facts Related to the Proper Use versus Misuse of Guidelines

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.

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.

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