State Specific Medical Coding Resources

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recent articles

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Five Major ICD-10-CM Changes That Can Effect Your Organization

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Have you had a chance to review the new ICD-10-CM codes for FY 2022? Did you know that many payers do not want to see unspecified codes when there is a possibility for better data? How adept are you at assigning and sequencing COVID-19 codes? Take a minute to review 5 of the major changes to the FY2022 ICD-10-CM code updates and claim your chance to watch our most recent webinar where we review the newest code updates.

tags  Loc: All Locations    Payer: All Payers    Specl: All Specialties    Topic: Code Updates    Topic: Coding    Topic: COVID-19    Topic: Diagnosis Coding    Topic: ICD10CM Coding    Topic: Social Determinants of Health (SDOH)   

New Codes for Pediatric COVID Vaccinations

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On October 6, 2021, the AMA released three new codes to track COVID-19 vaccinations in the pediatric population.

tags  Topic: Code Updates    Topic: COVID-19    Topic: CPT Coding    Topic: Preventive Medicine    Topic: Procedure Coding   

Staging and Grading Periodontitis

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We now understand periodontitis may present itself as a manifestation of systemic diseases in fact; according to DeltaDental, research shows that more than 90 percent of all systemic diseases have oral manifestations, including swollen gums, mouth ulcers, dry mouth, and excessive gum problems. Some of these diseases include: Diabetes Leukemia Oral cancer Pancreatic cancer Heart ...

tags  Specl: Dental    Specl: Oral and Maxillofacial Surgery    Topic: Assessment Tools    Topic: CDT (Dental) Codes   

Summary of 2019 Changes to the ADA Dental Form

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In 2019 the ADA revised the ADA Dental claim form to incorporate editorial changes to further its consistency with the 837D. The previous update was in 2012, the changes in 2012 were made to incorporate the capability to report diagnoses codes.   Some of the important changes include Bx# 8 and 15, the description was updated ...

tags  Specl: Dental   

Dental-Provider Specialty Taxonomy Codes

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The National Uniform Billing Guidelines require the use of taxonomy codes for claims submissions on the ADA-Dental claim form and the CMS-1500 Medical Claim form. When reporting the taxonomy code, be sure the provider is contracted with the payer under the taxonomy code being reported. We have listed the general ...

tags  Specl: Dental    Topic: Billing    Topic: Taxonomy Code Sets   

ICD-10-CM Cracks Down on the Use of "Unspecified" in the 2021 Official Guidelines

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We always knew there would come a day when payers would look down on an "unspecified" diagnosis code and possibly even deny it or delay payment until a review of the record could be performed. ICD-10-CM was adopted by the U.S. for data analytics, which cannot be accurate if unspecified codes are reported when the documentation verifies greater specificity. Join us for a look at the many guideline changes to ICD-10-CM, a review of the newest code changes and suggestions on documentation improvement to elevate coding protocols.

tags  Loc: All Locations    Specl: All Specialties    Topic: Code Updates    Topic: Coding    Topic: Compliance    Topic: Diagnosis Coding    Topic: Documentation    Topic: Guidelines ICD-10-CM    Topic: ICD10CM Coding   

Watch out for New ICD-10-CM Codes

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New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective on October 1, 2021.

tags  Specl: Chiropractic    Specl: Pain Management    Specl: Physical Medicine|Physical Therapy    Specl: Primary Care|Family Care    Topic: Coding    Topic: CPT Coding    Topic: Diagnosis Coding    Topic: Documentation    Topic: ICD10CM Coding    Topic: Medicare   

How Well Will Your Organization Score in the 2022 Star Rating Measures?

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How ready is your organization for implementation of the 2022 new Star Rating measures? Creating opportunities for staff to share innovative ideas is essential to creating a successful outcome, so take a minute to review the Part C and D measures today.

tags  Loc: All Locations    Payer: Medicare Advantage Plans    Specl: Risk Adjustment|HCC Coding    Topic: Risk Adjustment    Topic: Security   

Is Coding Based on Addendums or Late Entries Putting You At Risk of Audit Failure?

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Independent Health, another Medicare Advantage Organization, has been named in a qui tam (whistleblower) lawsuit and enjoined by the DOJ for allegations of fraudulently upcoding to increase beneficiary risk adjustment scores to obtain higher reimbursement. It appears they used DxID, LLC, a coding consulting subsidiary of Independent Health to retrospectively identify and have providers addend unsupported diagnoses. How is your organization actively protecting against accusations of upcoding by improper use and reporting of diagnoses from provider addenda?

tags  Loc: All Locations    Payer: Medicare Advantage Plans    Specl: Risk Adjustment|HCC Coding    Topic: Auditing    Topic: Compliance    Topic: Risk Adjustment   

Injection Services

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Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...

tags  Payer: All Payers    Specl: All Specialties    Topic: Claims Processing    Topic: CPT Coding   

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