State Specific Medical Coding Resources

articles, webinars, links, files and other resources for state specific coding, reimbursement and compliance


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recent articles

Select the title to see a summary and a link to the full article.

ICD-11 — What’s Happening?

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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.

tags  Specl: All Specialties    Topic: Diagnosis Coding    Topic: ICD10CM Coding    Topic: Practice Management   

Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?

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Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source? Answer: This is a great question and one that has been asked by many coders and auditors.

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Coding    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Procedure Coding   

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam

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Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...

tags  Loc: All Locations    Payer: All Payers    Payer: CMS|Medicare    Specl: Risk Adjustment|HCC Coding    Topic: CPT Coding    Topic: HCPCS Coding    Topic: Preventive Medicine    Topic: TeleMedicine   

Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K

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Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.

tags  Topic: Billing    Topic: Compliance    Topic: Modifier Coding   

58% of Improper Payments due to Medical Necessity for Ventilators

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Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...

tags  Specl: Home Health|Hospice    Topic: DME    Topic: HCPCS Coding    Topic: ICD9 Coding   

Coding Lesions and Soft Tissue Excisions

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There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions. The code selection will be determined upon the following: Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain) Technique Topography (anatomic location) The size Tissue Level Type of closure required Layers ...

tags  Specl: Dermatology|Plastic Surgery    Specl: Primary Care|Family Care    Topic: CPT Coding    Topic: Modifier Coding   

Properly Reporting Imaging Overreads (Including X-Rays)

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hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.

tags  Specl: Radiology    Topic: Billing    Topic: Coding    Topic: CPT Coding    Topic: E+M Documentation and Coding    Topic: Modifier Coding    Topic: Procedure Coding   

Why Will Medicare Administrative Contractors be Holding Claims Up?

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When Congress passed the expansive American Rescue Plan Act last month, most Americans were focused on the direct payment provision of the bill. However healthcare administrators and policymakers had their attention on another aspect: cuts to Medicare payments. Why would Congress be cutting Medicare payments during the COVID-19 Public Health ...

tags  Payer: CMS|Medicare    Specl: All Specialties   

Evaluation & Management (E/M) Webinar Q/A

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Find answers to some questions asked by attendees of our recent webinar regarding the changes released by the AMA in their March 9, 2021 Errata and Technical Corrections document in relation to Evaluation & Management (E/M).

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

How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment

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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.

tags  Topic: CPT Coding   

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