Topics & Specialty Resources

articles, webinars, tips, links and other resources for medical coding, reimbursement and compliance

Facilities & Organizations - ACOs, Hospitals, etc.Payers - Medicare, Medicaid, BC/BS, Aetna, etc.Specialties - Cardiology, ENT, Family Practice, etc.States - State specific informationSubjects - Audits, E&M, HIPAA, Practice Management, etc.

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recent articles

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Important Changes to Shared/Split Services


Reporting of split (or shared) services has always been wrought with the potential for incorrect reporting when the fundamental principles of the service are not understood. A recent CMS publication about these services further complicates the matter.

tags  Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Procedure Coding   

Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021


Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.

tags  Specl: All Specialties    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: HCPCS Coding   

Managed Care Organizations Use CMS Tools to Identify Outliers


Managed Care Organizations (MCOs) include risk-adjusted plans whose funding is based on the health status of their beneficiaries. Government-funded MCOs use CMS information to search for suspected cases of fraud and abuse.

tags  Loc: All Locations    Payer: All Payers    Payer: Medicare Advantage Plans    Specl: Risk Adjustment|HCC Coding    Topic: Auditing    Topic: Coding    Topic: Diagnosis Coding    Topic: Documentation    Topic: Fraud    Topic: ICD10CM Coding    Topic: Risk Adjustment   

Chronic Care Management Services


This article discusses some of the different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death.

tags  Specl: Behavioral Health|Psychiatry|Psychology    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Preventive Medicine    Topic: Procedure Coding   

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!


If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...

tags  Specl: Orthopedics    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: Facilities    Topic: Hospital    Topic: ICD10PCS Coding    Topic: Procedure Coding   

Intersegmental Traction — What’s Happening with Roller Tables?


Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?

tags  Specl: Chiropractic    Specl: Physical Medicine|Physical Therapy    Topic: Coding    Topic: Compliance    Topic: CPT Coding    Topic: Procedure Coding   

Congress Has Been Busy — 11 Different Bills Pass Covering Mental Health and Substance Use


The House of Representatives has certainly been working hard to advance behavioral health services. This article summarizes each of those bills and includes a link to contact your Senator.

tags  Specl: Behavioral Health|Psychiatry|Psychology    Specl: Emergency Medicine    Topic: Coding    Topic: Health Care Reform    Topic: Practice Management    Topic: Substance Use Disorder   

OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code Assignment


As the OIG has published their intent to further investigate the 9.5% of improper payments based on incorrect ICD-10-CM code assignation, they implore Managed Care Organizations (MCOs) to begin employing some of the CMS tools and data analytic programs used to help identify outliers.

tags  Loc: All Locations    Payer: All Payers    Specl: Risk Adjustment|HCC Coding    Topic: Diagnosis Coding    Topic: Documentation    Topic: Fraud    Topic: Guidelines ICD-10-CM    Topic: ICD10CM Coding    Topic: OIG    Topic: Risk Adjustment   

Since When did Dental Claims Require Diagnosis Codes?


The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...

tags  Specl: Dental    Topic: ACO - Accountable Care Organization    Topic: CDT (Dental) Codes    Topic: Claims Processing    Topic: ICD10CM Coding   

Compliance in the Dental Office or Small Practice


If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...

tags  Specl: All Specialties    Specl: Dental    Topic: Claims Processing    Topic: Compliance   

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