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Clinical Documentation Improvement
News & Important Information:According to the OIG- Insufficient documentation accounted for 87.8 percent of improper payments for surgical dressings, see MLN: PROVIDER COMPLIANCE TIPS FOR SURGICAL DRESSINGS Payment Adjustment Rules for Multiple Procedures and CCI Edits - Find-A-Code Spotlight Articles Clinical documentation improvement (CDI) is the process of producing detailed medical documentation accurately representing a patient's clinical status into coded data. CDI is used to provide information to all members of a patient's care team, facilitate improved patient care, disease tacking, outcomes and medical research , maximize claims reimbursement, and improve data collection and analysis. Check Out Find-A-Code's Tools & ResourcesDiagnosis Related Group (DRG) CodesFind-A-Code's DRG Information Page Provider Documentation Guides™ (PDGs)Help providers understand what needs to be documented AHA Coding Clinic®Search the AHA Coding Clinic® Articles by Keywords NCDs/LCDs/ArticlesSearch NCDs, LCDs, and Articles for Documentation Requirements, Limitations of Coverage, and/or Medical Necessity. MS-DRG GrouperQuickly calculate the correct DRG based on submitted ICD-10-CM and ICD-10-PCS codes HCC Code ListingReview CMS, ESRD, HHS and Rx HCCs HCC Risk CalculatorEasily calculate HCC risk scores based on diagnoses and other key factors Berenson-Eggers Type of Service (BETOS) CodesReview the BETOS code listing Check-A-ListDME Documentation Scrub-A-ClaimEliminate Claim Errors Code-A-NoteCode Suggestion Tool NCCI Editors - Validate CCI Edits (Prevent Denials)See Errors and Warnings, prior to claim submission E/M Code CalculatorThese E/M calculators will help ensure providers are selecting the proper E/M codes. Additional Links and ResourcesCDE'sCMS- Clinical Data Elements Select the title to see a summary and a link to the full article. June 1st, 2021 Managed Care Organizations Use CMS Tools to Identify OutliersBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 1st, 2021 - Last Review/Update June 2nd, 2021 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. May 18th, 2021 OIG Plans for Onslaught of Risk Adjustment Audits Claiming 9.5% Error Rate in Code AssignmentBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 18th, 2021 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. March 18th, 2021 How Reporting E/M Based on Time May Lose MoneyBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 18th, 2021 Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ... March 10th, 2021 How Social Determinants of Health (SDOH) Data Enhances Risk AdjustmentBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 10th, 2021 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. November 18th, 2020 Cross-A-Code Instructions in Find-A-CodeBy Raquel Shumway | Published November 18th, 2020 Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim. October 12th, 2020 Medicare Improper Payment Report for Chiropractic (2019)By Jared Staheli | Published October 12th, 2020
CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report by specialty, chiropractic has the highest Part B improper payment ... October 12th, 2020 Medicare Improper Payment Report for Behavioral Health Services (2019)By Jared Staheli | Published October 12th, 2020
CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report, behavioral health services have some of the highest Part ... October 12th, 2020 Medicare Improper Payment Report (2019)By Jared Staheli | Published October 12th, 2020
The Medicare Improper Payment Report for 2019 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July ... July 28th, 2020 OIG Report Highlights Need to Understand GuidelinesBy Wyn Staheli, Director of Research | Published July 28th, 2020 A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers. May 5th, 2020 ICD-10-CM - Supplement information for E-Cigarette/Vaping ReportingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 5th, 2020 The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).
The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.
ICD-10-CM Official Coding Guidelines - ... April 21st, 2020 Special COVID Laboratory Specimen Coding InformationBy Wyn Staheli, Director of Research | Published April 21st, 2020 With all the new laboratory test codes that have been added due to the current public health emergency (PHE), there are a few additional guidelines CMS has released about collecting samples to perform the testing. Please keep in mind that these guidelines are by CMS and may or may not apply to other commercial payer policies. April 20th, 2020 Dismal OIG Report on TelemedicineBy Wyn Staheli, Director of Research | Published April 20th, 2020 Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back. January 30th, 2020 Medicare Announces Coverage of Acupuncture ServicesBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 30th, 2020 On January 21, 2020, a CMS Newsroom press-release read,
This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ... 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: ... August 2nd, 2019 The Slippery Slope For CDI SpecialistsBy Namas | Published August 2nd, 2019 - Last Review/Update August 8th, 2019 Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail.
Many of you in this industry are ... July 22nd, 2019 Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?By Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA | Published July 22nd, 2019 Question:
What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms.
Answer:
There is no question that these adjustments would be considered ... July 9th, 2019 The Importance of Medical NecessityBy 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 ... June 27th, 2019 2018 Medicare Improper Payment Report Shows Slight Improvement but There's Still Work to be DoneBy Wyn Staheli, Director of Research | Published June 27th, 2019 - Last Review/Update July 8th, 2019 The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ... June 13th, 2019 What Medical Necessity Tools Does Find-A-Code Offer?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 13th, 2019 Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ... June 6th, 2019 How to Code Ophthalmologic Services AccuratelyBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 6th, 2019 - Last Review/Update June 11th, 2019 Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.
According to Article A19881 which was published in 2004 and ... May 29th, 2019 Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 29th, 2019 - Last Review/Update June 4th, 2019 Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today? May 13th, 2019 Electrical Stimulation and Electromagnetic Therapy DevicesBy Raquel Shumway | Published May 13th, 2019 - Last Review/Update May 20th, 2019 Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint. May 6th, 2019 Q/A: If Orthopedic Tests are Negative, do You List Them in Your Treatment Notes?By Wyn Staheli, Director of Research | Published May 6th, 2019 Question: If orthopedic tests are negative, do you need to still list them in your treatment notes?
Answer: Yes. Any tests which are performed by a healthcare provider, regardless of the result, should be documented in the patient record. This record is the only way that a reviewer or another provider ... April 23rd, 2019 Let's Talk High Risk E/M ServicesBy 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 ... April 22nd, 2019 Auditing Chiropractic ServicesBy By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019 Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode. March 21st, 2019 The Impact of Medical Necessity on High Level E/M ServicesBy 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 EditsBy 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 12th, 2019 Coding Medicare Initial Preventive Physical Exams (IPPE)By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 12th, 2019 The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ... January 25th, 2019 Medical Necessity vs. Documentation for Inpatient ServicesBy NAMAS | Published January 25th, 2019 - Last Review/Update January 29th, 2019 Auditing the documentation of inpatient and observation E/M services can often be challenging. Many of the notes we are provided for review include so much information that the note feels like a short novel instead of documentation for one date of service. This over-documentation can make it difficult to see ... January 23rd, 2019 How to Report Co-Surgeons Using Modifier 62By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2019 Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session.
An easy way to explain this is to visualize a patient requiring cervical fusion where ... January 22nd, 2019 Home Oxygen TherapyDecember 7th, 2018 Keeping Up to DateBy NAMAS | Published December 7th, 2018 - Last Review/Update December 20th, 2018 Keeping up to date on coding and documentation changes, is critical for medical coders, billers, auditors, and compliance personnel. Every year American Medical Association (AMA) creates, revises, and deletes CPT codes on January 1st. Same thing occurs with the ICD-10 codes in October. For CPT codes, the intention of the... November 30th, 2018 Auditing looking between the linesBy BC Advantage | Published November 30th, 2018 - Last Review/Update January 9th, 2019 When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not... November 7th, 2018 Medi-Cal Coverage Criteria for Hospital Beds and AccessoriesBy Raquel Shumway | Published November 7th, 2018 Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required. October 30th, 2018 Documentation Requirements for Allergy Testing 10/29/2018By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 30th, 2018 Per CMS, First Coast Service Options LCD 33261:
Medical record documentation (e.g., history & physical, office/progress notes, procedure report, test results) must include the following information, and be available upon request:
A complete medical and immunologic history and appropriate physical exam obtained by face-to-face contact with the patient.
The medical necessity for performing ... October 19th, 2018 We've Always Done It This Way and Other Challenges in EducationBy BC Advantage | Published October 19th, 2018 - Last Review/Update November 1st, 2018 As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into... August 16th, 2018 Medicare Timed Codes GuidelinesBy Wyn Staheli, Director of Research | Published August 16th, 2018 Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time.
It should be noted that while ... August 3rd, 2018 When Medical Necessity and Medical Decision Making Don't MatchBy BC Advantage | Published August 3rd, 2018 - Last Review/Update September 24th, 2018 As coders and auditors, we are taught the documentation guidelines on how to determine medical decision making. However, Medicare is clear that medical necessity is what determines the overall payment. In order to know what to do when medical necessity and medical decision making do not line up, you must... July 18th, 2018 Patients Over Paperwork?! We have Great News!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 18th, 2018 Spend more time with patients and less time documenting? Great Concept!
Document meaningful information? Sound good?
CMS is proposing just that! CMS released a new proposal July 12, 2018, focused on streamlining clinician billing and expanding access to high-quality care. The goal is to improve and restore the doctor-patient relationship, modernize Medicare ... July 9th, 2018 Documentation: Face to Face for Home Health CertificationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018 As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ... June 26th, 2018 WHO Said ICD-11 is Coming SoonBy 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 ... June 14th, 2018 Home Oxygen Therapy -- CMN for OxygenBy Raquel Shumway | Published June 14th, 2018 The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN. May 16th, 2018 Key Performance Indicators RevisitedBy Glenn Krauss | Published May 16th, 2018 - Last Review/Update May 24th, 2018 DI's present-day Key Performance Indicators centered upon reimbursement do not truly reflect a meaningful account of performance in impacting the quality, completeness and effectiveness of medical record documentation. Common KPIs include number of physician queries left, number of queries responded to by the physician, number of queries responded to... April 23rd, 2018 Brooklyn Chiropractor OIG Report - Lessons LearnedBy Wyn Staheli, ChiroCode Director of Research & Dr. Evan Gwilliam, Clinical Director PayDC Software | Published April 23rd, 2018 - Last Review/Update February 28th, 2019 In August of 2017, a Brooklyn chiropractor was ordered to repay $672,805 to Medicare because the reviewer found that 100% of the claims reviewed (from 2011-2012) did not meet medical necessity requirements. The chiropractor enlisted help from two reputable experts who disputed the findings of Medicare’s Professional Reviewer (MPR). However, the OIG maintained that the findings of the original auditor were valid.
Since none of us have ½ million in cash just laying around, it is essential to learn, understand, and make changes where appropriate to help audit-proof patient documentation.
Read here to learn more. April 23rd, 2018 Critical Care DocumentationBy Scott Kraft, CPC, CPMA | Published April 23rd, 2018 - Last Review/Update May 2nd, 2018 Critical care documentation should show critical need for the patient AND immediate action by the provider.... April 19th, 2018 Proper Record Keeping and DocumentationBy | Published April 19th, 2018 Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ... March 27th, 2018 Home Oxygen Therapy -- A Face-to-Face EncounterBy Raquel Shumway | Published March 27th, 2018 - Last Review/Update June 14th, 2018 What is required for a Home Oxygen Therapy, Face-to-Face Encounter. March 26th, 2018 Documentation for Evaluation and Management (E/M) ServicesBy | Published March 26th, 2018 According to WPS, when billing or coding for E/M services you should follow a few guidelines.
Documentation must support the level of service billed and the medical necessity for the level billed. Below are additional tips for services which commonly incur CERT error findings for insufficient documentation.
Critical Care Visits
Clear indication of patient ... March 21st, 2018 Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?By Wyn Staheli, Director of Research | Published March 21st, 2018 - Last Review/Update January 30th, 2019 In order to understand and answer the question, "Why code 99080 is being denied when billed with an E/M Service, it is important to first review the requriements of selecting the appropriate level of Evaluation and Management service and how that relates to reporting a 99080 special report service. Continue reading for better understanding. March 13th, 2018 When is 97112 Neuromuscular Re-education Billable?By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019 Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received. March 9th, 2018 The Comprehensive Error Rate Testing ProgramBy Frank Cohen, MBA, MPA | Published March 9th, 2018 - Last Review/Update April 12th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? March 9th, 2018 Documentation for Ordering Oxygen Supplies and EquipmentBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 26th, 2018 The Medicare Learning Network provides guidance on required documentation for Ordering Oxygen Supplies and Equipment. March 9th, 2018 Documentation for Negative Pressure Wound TherapyBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for negative pressure wound therapy. March 9th, 2018 Documentation for Surgical DressingsBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for surgical dressings.
March 9th, 2018 Documentation for Enteral NutritionBy Medicare Learning Network | Published March 9th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for enteral nutrition. ... March 8th, 2018 Documentation for Home Blood Glucose Monitors (BGM)By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 14th, 2018 The Medicare Learning Network provides guidance on how to Prevent Denials for Home Blood Glucose Monitors (BGM)... March 8th, 2018 Documentation for Therapeutic CGMs and Related SuppliesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 14th, 2018 The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related Supplies March 8th, 2018 Documentation for Manual WheelchairsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases.... March 8th, 2018 Documentation for Lower Limb ProsthesisBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on denials for lower leg prostheses and how to prevent them:
For the 2017 report period, most of the improper payments for lower leg prostheses were due to insufficient documentation.
For Medicare to cover a lower limb prosthesis claim, the medical record must support the beneficiary’s ... March 8th, 2018 Documentation for Bacterial Culture Lab TestsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on how to prevent denials of Bacterial Culture Laboratory Tests March 8th, 2018 Documentation for Bacterial Culture Lab OrdersBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on delivering orders for bacterial culture laboratory tests... March 8th, 2018 Documentation for Power Tilt/Recline Seating Systems for WheelchairsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems... March 8th, 2018 Documentation for Ostomy SuppliesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018 The Medicare Learning Network provides guidance on essential documentation elements required to prevent denials for ostomy supplies.... March 8th, 2018 Documentation for Home Health Services (Part A non DRG)By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medical Learning Network provides coverage guidance, which should be documented, for home health services. March 8th, 2018 Documentation and Orders for Respiratory Assistive DeviceBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines. March 8th, 2018 Documentation and Orders for Laboratory TestsBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for ordering laboratory tests. March 8th, 2018 Documentation for Skilled Nursing FacilitiesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF). March 8th, 2018 Documentation for Inpatient Rehabilitation FacilitiesBy Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018 The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF). February 28th, 2018 Telemedicine Billing and ReimbursementBy Jared Staheli | Published February 28th, 2018 The opportunities for providers who want to provide telemedicine continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding ... February 12th, 2018 The Coder as the Last, Best Hope for the Right DRGBy Dr. Erica Remer | Published February 12th, 2018 - Last Review/Update April 12th, 2018 f the story doesn't make sense, there is probably something missing. There are a variety of reasons why the DRG might not tell the story of the patient encounter.... February 1st, 2018 Pre-Existing or Gestational?By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 1st, 2018 It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions.
Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
Trimester: When did the pregnancy-related condition develop?
Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia)
Code examples:
O99.011 Anemia ... February 1st, 2018 Traumatic Subluxation Coding ControversyBy 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 29th, 2018 Anesthesia Documentation Modifiers - Jurisdictions: J8A, J5A, J8B, J5BBy Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018 Documentation Modifiers direct prompt and correct payment of the anesthesia claims submitted. Documentation modifiers (AA, QK, AD, QY, QX and QZ) must be billed in the first modifier field.
If a QS modifier applies, it must be in the second modifier field. Processing delays and denials may occur for claims submitted ... January 26th, 2018 Creating a Culture of Compliance in 2018By Sean M. Weiss, CHC, CEMA, CMCO, CP MA, CPC-P, CMPE, CPC | Published January 26th, 2018 - Last Review/Update February 7th, 2018 This year (2018), health care organizations (Hospitals, Health Systems and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency.... January 24th, 2018 Better Office Communication Leads to Stronger RCMBy 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 Antiresorptive Osteonecrosis of the JawsBy Find-A-Code | Published January 9th, 2018 Osteonecrosis is a serious bone disease caused when the bone is starved of its normal blood supply. Because bone is living tissue, without a good supply of oxygenated blood, it becomes weakened and then dies. Scientists have not been able to identify the exact cause of osteonecrosis of the jaws, but they have ... January 9th, 2018 GeneSight Psychotropic Testing and DocumentationBy Find-A-Code | Published January 9th, 2018 According to Wisconsin Physicians Service Insurance Corporation, there is limited coverage for the GeneSight® Psychotropic (AssureRx Health, Inc, Mason, OH) gene panel. GeneSight® testing may only be ordered by licensed psychiatrists or neuropsychiatrists contemplating an alteration in neuropsychiatric medication for patients diagnosed with major depressive disorder (MDD) (in accordance with DSM IV/V criteria) who are suffering with refractory moderate to ... January 9th, 2018 Coverage and/or Medical Necessity for the Use of Hyaluronan or DerivitiveBy Find-A-Code | Published January 9th, 2018
According to Palmetto GBA, Medicare will cover the cost of the injection and the injected hyaluronate polymer for patients who meet the following clinical criteria:
Knee pain associated with radiographic evidence of osteophytes in the knee joint, sclerosis in bone adjacent to the knee, or joint space narrowing.
Morning stiffness of less than 30 minutes in duration or crepitus on motion of the ... January 4th, 2018 Reimbursement for Therapy StudentsBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, qualified professionals may serve as clinical instructors for therapy students within their scope of practice. Physical therapist assistants and occupational therapy assistants may only serve as clinical instructors for physical therapist assistant students and occupational therapy assistant students, respectively, when performed under the direction and supervision ... January 4th, 2018 Proper Usage of Electrical StimulationBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment.
97032 is a constant attendance electrical stimulation modality ... January 4th, 2018 Skilled Therapy, When it's Appropriate and BillableBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators,
"A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ... January 4th, 2018 Initial Evaluation Codes for PT's and OT'sBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation.
These evaluation codes are untimed, billable as one unit.
Do ... January 4th, 2018 PT and OT Reevaluation CodingBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ... January 4th, 2018 General Physical Therapy Modality GuidelinesBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention.
CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ... January 4th, 2018 Diathermy eg Microwave Use and DocumentationBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ... January 4th, 2018 Ultrasound TherapyBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to
3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ... January 4th, 2018 Hydrotherapy GuidelinesBy Find-A-Code | Published January 4th, 2018 According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ... January 4th, 2018 Modifiers 54-55, split surgical and postoperative careBy Find-A-Code | Published January 4th, 2018 54 -Surgical care only; Surgeon is performing only the preoperative and intra-operative care
55 - Postoperative management only; Physician, other than surgeon, assumes all or part of postoperative care
Modifiers should be placed on the surgical code
Used on 10 day and 90 day surgical procedures
Both the surgeon and the physician providing the postoperative ... December 12th, 2017 Documenting the Location and Correct CodingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 12th, 2017 The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim.
You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas).
C1 is the first vertebra known as the atlas. The axis-form is ... December 1st, 2017 Auditing the Use of a ScribeBy Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT | Published December 1st, 2017 - Last Review/Update January 31st, 2018 A scribe is someone that can act as a walking transcriptionist on behalf of a medical provider...... November 30th, 2017 Coding Carpal Tunnel SyndromeBy 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? November 24th, 2017 Inpatient critical care: When is it ok to question the medical necessity?By Stephanie Allard, CPC, CEMA, RHIT | Published November 24th, 2017 - Last Review/Update January 31st, 2018 While critical care may be easily identifiable within documentation it is not always clear if it is medically necessary..... October 27th, 2017 Speech-Language Pathology Services Policy from UniCareBy Find-A-Code | Published October 27th, 2017 Medically Necessary:
Rehabilitative speech-language pathology (SLP) services are considered medically necessary when ALL of the following criteria are met:
The services are used in the treatment of communication impairment or swallowing disorders resulting from illness*, injury, surgery, or congenital abnormality; and
Based on a plan of care, the therapy sessions achieve a specific ... October 20th, 2017 A P.A.R.T. TemplateBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 20th, 2017 - Last Review/Update February 5th, 2019 Here at ChiroCode we are often asked for examples of perfect forms to use in the office. As such we have developed some.
October 20th, 2017 PFSH Documentation: Q and ABy Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT | Published October 20th, 2017 - Last Review/Update January 31st, 2018 When coding an E/M visit in the emergency department, would you count all PFSH listed even if they don't pertain to the indication as to why the patient arrived? October 13th, 2017 So, How Do You Decide if a Service was Provided?By David Glaser, JD | Published October 13th, 2017 - Last Review/Update January 31st, 2018 An earlier coding tip explained that the oft-repeated "if it isn't written, it wasn't done" is good risk management advice, but not a legal truism..... October 6th, 2017 Acronyms and Abbreviations: When You Fall into the Grey AreaBy Omega Renne, CPC, CPMA, CPCO, CEMC, CIMC | Published October 6th, 2017 - Last Review/Update February 1st, 2018 We've all been there... you are coding or auditing, and then a note comes up that is not like the ones you've reviewed before. The language is unclear, the acronym(s) could mean so many different things, and it's hard to get a straight answer about whether or not it's supported higher or lower.... October 6th, 2017 Clarification to "The Big Myth: If it Isn’t Written, it Wasn’t Done"By David Glaser | Published October 6th, 2017 Several months ago we ran an article titled, The Big Myth: “If it Isn’t Written, it Wasn’t Done” Documentation is NOT a Requirement for Most Medicare Claims, written by David M. Glaser, which resulted in a request for clarification from some of our readers.
One question posed, was “Who exactly is Mr. ... September 29th, 2017 Does Every Visit Need to Document Quality and Quantity of Pain & Update the Treatment Plan?By ChiroCode | Published September 29th, 2017 - Last Review/Update February 5th, 2019 Does every single visit need to document quality and quantity of pain and an update to the treatment plan? September 25th, 2017 Q/A: What is the Proper Usage of Code 97150?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published September 25th, 2017 - Last Review/Update February 5th, 2019 What is the proper usage of CPT 97150 and what are the documentation requirements for that? September 20th, 2017 Bladder/Urothelial Tumor Markers (Jurisdiction F)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 20th, 2017 CMS recently released a new LCD for Jurisdiction F, Bladder/Urothelial Tumor Markers (L36680).
Documentation Requirements
The medical record must clearly identify the number and frequency of bladder marker testing. Medical record documentation must be legible, must be maintained in the patient’s medical record (hard copy or electronic copy), and must meet the ... September 15th, 2017 Copy and Paste: The Real Rules PrevailBy Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CEMA | Published September 15th, 2017 - Last Review/Update January 31st, 2018 Have you looked for published guidance on cloning/copying and pasting from the Centers for Medicare & Medicaid Services (CMS)? There is one published resource that provides rudimentary guidance..... September 14th, 2017 Double Dipping in the History of the Evaluation and Management NoteBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published September 14th, 2017 There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history.
The subcomponents of history include:
Chief Complaint ... September 1st, 2017 Medicare Improper Payment Report for Chiropractic (2016)By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017 The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ... September 1st, 2017 Medicare Improper Payment Report for Behavioral Health Services (2016)By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017
The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ... September 1st, 2017 Medicare Improper Payment Report (2016)By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017 The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ... September 1st, 2017 Quick Tip from ChiroCode -- DocumentationBy ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019 Documentation Solutions, a quick tip video by Dr Gwilliam. September 1st, 2017 How to Use Guidelines When the Auditor Challenges YouBy 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 August 18th, 2017 The Incredible Disappearing ConsultationBy J. Paul Spencer, CPC, COC | Published August 18th, 2017 - Last Review/Update January 25th, 2018 In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255 for inpatient). June 29th, 2017 Focus on Clinical Documentation to Improve Coding and Audit ResultsBy Betty Stump, MHS, RHIT, CPC, CCS-P, CPMA, CDIP | Published June 29th, 2017 Auditors spend their day surrounded by the end product of the health care process. Those CPT, HCPCS and ICD-10-CM codes generated as a result of services provided to the patient. Our work is focused on determining if those codes have been correctly assigned based on the content of the medical ... June 13th, 2017 Documentation for Physical TherapistBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 13th, 2017 - Last Review/Update July 26th, 2017 Medical review decisions are based on the information submitted in the medical record. Therefore, it is critical that the medical record information submitted is accurate and complete to allow medical review to make a fair payment decision. The medical record information submitted should:
Paint a picture of the patient’s impairments and ... May 30th, 2017 Q/A: How do I Bill Class 4 Deep Tissue Hot Laser Treatment?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published May 30th, 2017 - Last Review/Update February 8th, 2019 Is there a way to bill out for Class 4 deep tissue hot laser treatments? May 22nd, 2017 Maintenance Visit DocumentationBy Dr Evan Gwilliam | Published May 22nd, 2017 - Last Review/Update January 31st, 2019 What is required for documenting a maintenance visit for a Medicare beneficiary?
Watch this video by Dr. Evan Gwilliam for his thoughts.
ChiroCodeQ&A_maintenance visit from Innoventrum on Vimeo.
ChiroCode Q&A "Maintenance Visit Documentation" With Dr. Evan Gwilliam. https://vimeo.com/208521720
... April 28th, 2017 Can I be Forbidden from Billing 99204 or 99214?By ChiroCode | Published April 28th, 2017 - Last Review/Update January 31st, 2019 Q: An insurer told me that chiropractors cannot bill 99204 or 99214 because those exams "require a level of decision making that would typically only occur in an emergency room." Is this true? Do I have any recourse? April 20th, 2017 Therapy Plan of CareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 20th, 2017 - Last Review/Update July 28th, 2017 The Local Coverage Determination (LCD) for Outpatient Physical and Occupational Therapy Services describes the coverage limits of outpatient physical and occupational therapy services under Medicare Part B. It's billed to either the Medicare Fiscal Intermediary (FI) or Part A or Medicare Carrier or Part B MAC when services are provided ... March 2nd, 2017 Insufficient DocumentationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017 When the medical documentation submitted is inadequate to support payment for the services billed, it may be determined that the claim contained insufficient documentation. If the claims reviewer is unable to conclude the services, some or all, were actually provided, they may determine the claim is unprocessable or incomplete. There are ... February 27th, 2017 Documentation: Face to Face for Home Health CertificationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 27th, 2017 - Last Review/Update August 16th, 2017 As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. ... 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. January 20th, 2017 Pre-Existing or Gestational?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 20th, 2017 - Last Review/Update August 2nd, 2017 It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions.
Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)?
Trimester: When did the pregnancy-related condition develop?
Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia).
Code examples:
O99.011 Anemia ... January 13th, 2017 Whiplash DamagesBy ChiroCode | Published January 13th, 2017 - Last Review/Update January 31st, 2019 Whiplash Damages in Rear-end Collisions - The Patient’s Dilemma:
The rear-end collision is a major cause of cervical spine injuries which often require treatment by chiropractors and other health care practitioners. Claims adjusters trivialize soft tissue injuries [it’s “only” a sprain or strain] but whiplash is real and so are the damages that come with it. December 7th, 2016 Insurance Denying Everything as MaintenanceBy ChiroCode | Published December 7th, 2016 - Last Review/Update March 4th, 2019 Are you having a difficult time getting reimbursed? Are claims being denied because the insurance classifies everything as maintenance? November 30th, 2016 When can I Bill for a Consult E/M Code?By | Published November 30th, 2016 - Last Review/Update March 5th, 2019 Physician referrals -- When can we bill a consult code? If we do not have the referral on our referral pad can we bill the consult code? November 19th, 2016 Lack of Medical NecessityBy ChiroCode | Published November 19th, 2016 - Last Review/Update March 5th, 2019 (from page 210 in chapter 3.5 of the 2017 DeskBook) One of the biggest problems providers face when audited is that many services are deemed not medically necessary and are routinely denied. Much of the proof falls back on the medical record.
Here are some specific situations as they may ... September 24th, 2016 Medicare Improper Payment Report for Behavioral Health Services (2015)By Wyn Staheli, Director of Research | Published September 24th, 2016 Medicare claims review sheds light on problem areas for behavioral health providers. July 29th, 2016 Past medical, family and social historyBy | Published July 29th, 2016 When an Evaluation and Management service requires past medical, family and social history, (or one or two of those) here is what needs to be documented, and the rules around using one that is previously documented. Past medical history includes the patient's chronic illnesses, previous illnesses, injuries and surgeries, medications... July 29th, 2016 How soon after a visit must the documentation be complete?By | Published July 29th, 2016 Most physicians, Nurse Practitioners and Physician Assistants document the service they have performed on the same calendar date. Occasionally, at the end of the day, the service might not be documented before the clinician leaves the office, particularly if called away urgently. In that case, the service is documented... July 29th, 2016 Can we bill a low level E/M with every procedure?By | Published July 29th, 2016 Can’t we bill a low level E/M with every procedure? No! Medicare says this: Per CCI (chapter 11, Letter R.): “The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E/M service. However, a... July 28th, 2016 Cloned documentation on OIG radar screen in 2014By | Published July 28th, 2016 One of the areas where the OIG has its sights set in 2014 is on physician documentation. The OIG plans to review documentation of E/M services looking for what it describes as “documentation vulnerabilities.” Put more specifically, the OIG reports that Medicare Administrative Contractors (MACs) have seen an increase in... July 19th, 2016 Documentation GuidelinesBy | Published July 19th, 2016 What is the difference between the two sets of Guidelines? There are two major differences. The first is in the history of the present illness (HPI). In the 1995 Guidelines, in order to document a history of the present illness at a detailed level, the clinician must document four elements... June 9th, 2016 Understanding and Using Taxonomy Codes to Maximize ReimbursementBy | Published June 9th, 2016 Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ... January 6th, 2016 Family meetings without the patient presentBy | Published January 6th, 2016 Medicare does not permit a physician practice to bill for family meetings without the patient present. The physician may not bill Medicare, nor may they bill the family member. It is fairly common for the spouse or child of a patient to ask to see the... December 11th, 2015 The Benefit of Checking BenefitsBy | Published December 11th, 2015 Many of your physicians perform surgeries and diagnostic procedures on patients. It is easy to call and determine if precertification is required, but how many of you actually look at what is required of a patient prior to performing the procedure? In many cases outpatient procedures... December 2nd, 2015 Chief Complaint - Rules related to the Chief Complaint in the D.G.By | Published December 2nd, 2015 The guidelines go on to read, "The medical record should clearly reflect the chief complaint." This leaves physicians to ask the question, does the chief complaint need to be listed separately from the history of the present illness or the rest of the rest of the... December 2nd, 2015 Past medical, family and social history - Documenting and auditing the history section of an E/M serviceBy | Published December 2nd, 2015 When an Evaluation and Management service requires past medical, family and social history, (or one or two of those) here is what needs to be documented, and the rules around using one that is previously documented. Past medical history includes the patient's chronic illnesses, previous... December 2nd, 2015 History of the present illness - HPI Rules from the Documentation GuidelinesBy | Published December 2nd, 2015 Here are the elements of the HPI: Location: Where do the patient's symptoms occur? In order to use location, it should be a place on the body that you could point to or touch and that the physician describes as the place where the patient's symptoms occur. Head, shoulders, knees... December 2nd, 2015 CMS clarifies the ways physician practices can respond to additional documentation requestsBy | Published December 2nd, 2015 It’s one of the inevitabilities of running a physician practices that never happens at a good time and seems to rarely go very smoothly. You see an additional documentation request – known as an ADR – from either your Medicare Administrative Contractor (MAC) or one of... December 1st, 2015 The Joy of Medicine - AMA wants to Restore the Joy of MedicineBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 1st, 2015 The AMA is investing in making happier doctors and believes it will help them delver better care. Physicians have been put under tremendous stress with government oversights and insurance companies, medical decisions are bound to be compromised. Frustration becomes even more apparent with trying to get approval for treatment and ... November 24th, 2015 You do not need to change or rewrite your original ordersBy Find-A-Code | Published November 24th, 2015 CMS wants to remind you not to change or rewrite your original orders for any service or product due to the change of code sets from ICD-9-CM to ICD-10-CM.
For any type of product or service prior to October 1, 2015, do not change the order, even if it will be ... November 24th, 2015 What counts as social history?By | Published November 24th, 2015 The Documentation Guidelines say social history is: an age appropriate review of past and current activities. As auditors, we interpret this to include: smoking, alcohol and drug use living arrangements employment history school history support system, if relevant In order to credit social history in a... November 20th, 2015 Documentation of Pressure UlcersBy Find-A-Code | Published November 20th, 2015 Documentation of Pressure Ulcers, read entire article by Wound Consultants Inc.
... November 19th, 2015 Documentation Guidelines - E/M auditingBy | Published November 19th, 2015 What is the difference between the two sets of Guidelines?
There are two major differences. The first is in the history of the present illness (HPI). In the 1995 Guidelines, in order to document a history of the present illness at a detailed level, the clinician must document ... November 19th, 2015 Medical Necessity is not Medical Decision MakingBy | Published November 19th, 2015 I can count on two consistent issues in coding audits. Doctors report that their patients are, in general, sicker than patients in other practices. Coders report that their physicians are, in general, worse documenters than physicians in other practices and select codes that are too high based on ... November 19th, 2015 Not Documented, Not Done: Medicare Myth or Rule?By | Published November 19th, 2015 After years of unchallenged recitation, the coding community has virtually canonized the phrase “not documented—not done” into coding scripture. But there are good reasons to question whether the now-famous epigram reflects an actual rule or whether it has simply taken on a life of its own like ... November 19th, 2015 Review of Systems - ROS Rules for AuditingBy | Published November 19th, 2015 Sometimes one symptom can be used in more than one system. For example, dizziness. Although we typically think of this as a neurological symptom, sometimes cardiologists ask about dizziness and relate it to the cardiovascular system.
In the citations section of this entry, there are references for symptoms ... November 19th, 2015 Can consults be billed based on time?By | Published November 19th, 2015 Yes, both inpatient and outpatient consults may be coded based on time, when the conditions for using time are met.
CPT® tells us that a physician or NPP may use time to select a code when counseling "dominates" the visit. CMS confirms these rules in their Documentation Guidelines. ... November 12th, 2015 Family history--what countsBy | Published November 12th, 2015 By: Codapedia Editor (Oct/15/2015)
The Documentation Guidelines describe family history as:
a review of medical events in the patient's family, including diseases which may be hereditary or place the patient at risk
This family history is a review of the illness's, health status, and cause of death of close members of the patient's ... September 21st, 2015 Documentation and Reimbursement for TestingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 21st, 2015 - Last Review/Update August 7th, 2017 The medical record must contain documentation that the testing is expected to influence treatment of the condition toward which the testing is directed. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition that warrants the test(s).
TC - Technical component Modifier may be ... September 17th, 2015 ICD-10 -Understanding Format and StructureBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 17th, 2015 The first three characters of an ICD-10 code designate the category of the diagnosis.
The next three characters (characters three through six) correspond to the related etiology (i.e., the cause, set of causes, or manner of causation of a disease or condition), anatomic site, severity, or other vital clinical details.
The seventh character is ... September 17th, 2015 Injuries DocumentationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 17th, 2015 - Last Review/Update August 7th, 2017 ICD-9 used separate “E codes” to record external causes of injury. ICD-10 better incorporates these codes and expands sections on poisonings and toxins.
When documenting injuries, include the following:
1. Episode of Care e.g. Initial, subsequent, sequelae
2. Injury site Be as specific as possible
3. Etiology How was the injury sustained (e.g. sports, ... August 17th, 2015 Clinical Documentation Guidance for ICD-10-CM/PCSBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 17th, 2015 Documentation assessment and gap analysis is important in ICD-10-CM/PCS. Clinical documentation will also affect code assignment and relative weight associated with payment. To read more information on problem areas with documentation issues read AHIMA's article.
... August 10th, 2015 Documentation Requirements for Therapy ServicesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015 Documentation Requirements for Therapy Services, indicates that the amount of time for each specific intervention/modality provided to the patient is not required to be documented in the Treatment Note. However, the total number of timed minutes must be documented. These examples indicate how to count the appropriate number of units ... July 8th, 2015 SOAP notes (subjective, objective, assessment, plan)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 8th, 2015 SOAP notes (subjective, objective, assessment, plan)
Each letter in “SOAP” is a specific heading in the notes:
SOAP is an acronym for “subjective” ( S ) or the patient’s re-response and feeling to treatment, “objective” (O) or the observations of the clinician, “assessment” (A) or diagnosis of the problem, and “procedures accomplished ... July 7th, 2015 Dental Documentation with ICD-10By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 7th, 2015
ICD-10 will require more specificity in your documentation requirements. It is important to train your staff along with Dentists. Take a look at the specific areas that will be required documentation for Dental:
Type of condition
Onset - acute or chronic
Etiology (cause)
Anatomical location and laterality if laterality applies
Severity - mild, moderate or severe
Stages ... March 26th, 2015 DSM-FAQBy Wyn Staheli | Published March 26th, 2015 - Last Review/Update July 27th, 2017 The Diagnostic and Statistical Manual for Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is generally accepted as the authoritative guide for the diagnosis of mental disorders. This FAQ article was created to address some commonly asked questions about DSM coding and clear up some common misconceptions. March 24th, 2015 Instructions for: P.A.R.T. Documentation FormBy | Published March 24th, 2015 - Last Review/Update April 9th, 2018 Patient Portion
The first part of the form is for the patient to complete. The date, name and age are completed, along with a brief description of why they came in for a visit.
Pain
“X’s” are placed on areas causing pain. Qualify the pain with a letter, i.e., “A“ for “Ache.”
The patient ... February 26th, 2015 Chiropractic Billing 101: A Basic GuideBy | Published February 26th, 2015 - Last Review/Update January 27th, 2017 Director of Communications, ChiroCode
In my 20 years of professional bull riding I have had many highs and lows. There were times when the rankest of bulls couldn’t throw me and times when I couldn’t ride a rocking chair. When in a slump, what always worked for me, and for the ... January 26th, 2015 Documentation ResourcesBy ChiroCode | Published January 26th, 2015 - Last Review/Update January 30th, 2017 Documentation is essential to establishing medical necessity and the level of services provided to the patient. Treatment plans and outcome assessments are crucial elements to thorough documentation.
This page is only a general listing of documentation resources for chiropractic. More thorough and detailed explanations are found in Section D-Documentation in the ... December 4th, 2014 Durable Medical Equipment - Documenting Continued UseBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update March 1st, 2016 Treating physicians’ records often omit documentation of a beneficiary’s continuing use of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). By Medicare statute, lack of physician documentation regarding a beneficiary’s continued need and use of an item of DMEPOS will result in claim denials. Many “model charts” from various clinical ... November 21st, 2014 Get Ready! Improve your Clinical Documentation!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 21st, 2014 - Last Review/Update March 1st, 2016 It is time to start improving your clinical documentation to prepare your practice for ICD-10.
Select the codes most often used in your practice. Now, you need to determine if your current documentation is sufficient to support ICD-10. It would be best to assume it is not, since ICD-9 was not ... November 21st, 2014 Coding for Laser TherapyBy | Published November 21st, 2014 - Last Review/Update January 30th, 2017 The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the ... November 19th, 2014 Getting Ready for 2015By | Published November 19th, 2014 - Last Review/Update January 30th, 2017 Each new year brings a bundle of surprises in terms of changes and updates that practices must learn and implement. In effort to aid in the preparation of this year, I have listed some common helpful tips that you might follow in order to best manage your workload ahead.
-Evaluate fees:Â Fee ... November 17th, 2014 Conducting a Gap Analysis for Your Documentation & Billing SystemsBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 17th, 2014 - Last Review/Update January 30th, 2017 What is a Gap Analysis?
A Gap Analysis is a process by which a practice conducts a baseline assessment of the company's coding, billing, operations, and business practices. The objective of a Gap Analysis is to ensure that the practice is in full compliance with applicable legal and ethical requirements. This ... October 20th, 2014 Clarification of Equipment and Approach in CodingBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 20th, 2014 - Last Review/Update January 30th, 2017 When determining the type of approach taken in a surgical procedure, it is important to review not only the title of the report but also the body of the report to locate the method used.
Somewhere in the body of the report, and always preferably in the title, scope, endoscope, endoscopy ... October 16th, 2014 ICD-10 TIP of the MONTH: The Documentation of ProceduresBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017 To assist you in understanding the key definitions related to documenting procedures in ICD-10, see below for a list of terms to be used in your documentation. Brought to you by Crozer Keystone ICD-10 tip of the month.
Examples:
Alteration - Modifying the anatomic structure of a body part without affecting ... October 16th, 2014 Clinical documentation; Supporting good patient care and proper ICD-10 coding - VIDEOBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 16th, 2014 - Last Review/Update January 30th, 2017 Supporting good patient care and proper coding in an ICD-10 environment.
Speaker Joe Nichols MD presenting training video on Clinical Documentation: (ICD-10 Webinar).
... October 3rd, 2014 ICD-10 and Clinical Documentation CME/CEBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 3rd, 2014 - Last Review/Update January 30th, 2017 MedScape is offering a free training activity for healthcare providers who will be involved in clinical documentation with ICD-10.
This activity is to make providers aware of the key elements of good clinical documentation.
CME/CE Released: 09/15/2014; Valid for credit through 09/15/2015
Link
... August 26th, 2014 Un-Timely Filing - ZERO ReimbursementBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 26th, 2014 - Last Review/Update January 25th, 2017 Be sure you have office procedures in place to keep an eye on the time frame of your claims: Claims denied by Medicare for “untimely submission” are not eligible for appeal. In fact most carriers do not afford you an appeal if timely filing is an issue; there are only ... August 7th, 2014 Durable Medical Equipment, Prosthetics, Orthotics and SuppliesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017 Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.  We have given you some basic information to get you started including modifiers and how CMS views DMEPOS, please ... July 16th, 2014 G0402: Medicare Preventive VisitBy | Published July 16th, 2014 - Last Review/Update January 25th, 2017 Medicare covers a one-time Initial Preventive Physical Examination (IPPE), also referred to as the “Welcome to Medicare†visit.  IPPE is a unique benefit available only to patients newly enrolled in the Medicare Program and must be received within the first 12 months of the effective date of their Medicare Part ... February 13th, 2014 Muscle Testing TableBy | Published February 13th, 2014 - Last Review/Update August 3rd, 2018 Muscle and Range of Motion Testing guidelines have recently been clarified in the AMA CPT Assistant. Muslce Testing Table included August 30th, 2012 Inappropriate Medicare Payments for Chiropractic ServicesBy | Published August 30th, 2012 - Last Review/Update January 27th, 2017 OIG released two reports critical of the way chiropractic handled documentation and coding. Their findings are included in this article. Read further to see what documentation is needed for proper payment. As required by the Social Security Act, Medicare pays only for reasonable and necessary chiropractic services, which are limited to active/corrective manual manipulations of the spine to correct subluxations. A chiropractic service must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function. December 31st, 2001 Commonly Asked Chiropractic Coding QuestionsBy ChiroCode | Published December 31st, 2001 - Last Review/Update August 19th, 2015 Commonly Asked Questions:
1. Retention of Records
2. 97140 Denials
3. Exercise Equipment
4. Coding for BioFreeze
5. 97014 or G0283
6. Billing for additional insurance forms
7. Report of Findings
8. Laser therapy
9. Spinal Decompression
10. Diagnosis Coding – 4th and 5th digit
11. Re-Reading X-rays
12. Outcomes Assessment Questionnaires
13. Accounts Receivable
14. 15-Minute Units
15. E/M and CMT There are more articles. View all articles... View articles for the current subject by subtopic:
Select the webinar title to view a summary and link to the webinar video. January 28th, 2021 New Dental Codes for 2021 and Find-A-Code Dental Tools/ResourcesOutline of Presentation:
- Why Dental coding is changing
- New 2021 Dental Codes
- Why Cross Coding is Not a Choice
- New Dental Tools & Resources in Find-A-Code
Be ready for 2021 with complete understanding of the new dental codes. Understand what codes are not covered under dental, and how to bill with medical codes. January 21st, 2021 Dental Medical Billing & Coding Certification on QPro.com - Your Dental Certification DestinationQPro.com is the industry leader for dental coding and billing certifications. The credentialing exams are hosted and administered by QPro.com. To earn dental-to-medical billing credentials, candidates must pass at least three exams including the requisite Qualified Medical Coder/Biller Exam. From there, candidates can earn designations in nine specializations, such as dental implant coding, oral surgery, sleep apnea, sedation dentistry, and coding and reimbursement for CBCT scans. January 7th, 2020 Rock Solid Care PlansDon't ever let anyone challenge your care plans ever again. If you can know what the regulators are looking for while still being free to deliver the care you deem to be best for your patient, then you win. And your patient wins. Join Dr. Gwilliam, certified professional medical auditor, and all around nice guy, as he guides you to the steps to create rock solid care plans that will stand up to third party scrutiny. November 5th, 2019 Proving Medical Necessity and Functional ImprovementMedicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement. May 14th, 2019 Confusing Codes for Chiropractors - 97110 versus 97112 versus 97530In this webinar, you'll get a deep dive into three therapeutic procedure codes. Dr. Gwilliam, a chiropractor and certified professional coder, will take you thorough the ins and outs of therapeutic exercises, activities, and neuromuscular reeducation. They will be compared and contrasted with examples to make sure everyone leaves with the confidence to document and bill them correctly. December 18th, 2018 Chiropractic Manipulative Treatment (CMT) Coding and Documentation (Part 1)The most used codes in chiropractic are 98940, 98941, 98942, and 98943. In this webinar, Dr. Gwilliam will go over the fundamentals of these codes and make sure you are proficient with them. They probably play a bigger part of your practice than any other code, so it is worth it to make sure you are reporting them correctly. By the end of this presentation you will be able to diagnose, document, and code properly for CMT, as well as avoid common mistakes.
December 4th, 2018 Documenting Diagnoses Like a Peer Reviewer (Part 2)Chiropractors only use a fraction of the codes available in the ICD-10 code set. But each group of diagnoses have things to teach us based on coding guidelines, objective findings, standards of care, and more. In this presentation Dr. Gwilliam will review the most commonly used diagnoses (by chiros) and make sure you know everything that should be documented in order for a peer reviewer to walk away satisfied.
November 20th, 2018 Documenting Treatment Plan and Goals That Actually WORK - November 20th, 2018Dr. Friedman will discuss the need to document Treatment Plan and Goals and what we MUST document and what we SHOULD document. He'll also demonstrate how we can do this in the least amount of time and with the least amount of effort. November 6th, 2018 Medicare ReviewsMedicare continues to increase their efforts to review doctors and recover “overpayments”. This increases the likelihood that your notes will be reviewed and that you will be required to pay money back to Medicare. In this webinar Dr. Short will show you:
Why you should appeal every adverse decision.
How to appeal adverse decisions.
What information you need in your documentation for an effective appeal.
How to structure your appeals to be most effective. October 16th, 2018 Documenting Diagnoses Like Peer Reviewer (Part 1)When an outsider looks at your records, you want them to easily find exactly what they are looking for. Let ICD-10 codes guide you as you choose the words to use in the Diagnostic Statement in your initial encounter. Don't assume a reviewer can interpret your clinical findings. Spell it out for them. Dr. Gwilliam, ICD-10 guru and all around good guy, will show you how to do that is this webinar. October 2nd, 2018 X-Ray and the Evidenced Based Practice: How DC’s Can Demonstrate the Need for X-RaysLearn:
Improve Patient Outcomes and Satisfaction with X-Rays
Increase Practice Profits Using Research Studies
Incorporate Biomechanical Measurements in Your Patient Communications September 25th, 2018 Neuromuscular Reeducation, Massage Therapy - Proper Use, Documentation and CodingIn this webinar, Dr. Howard Levinson (Forensic Consultant) will address the erroneous use and billing of Neuromuscular Reeducation, Massage Therapy and Hydrotherapy in chiropractic clinics. He will offer strategies regarding how these services may be used appropriately in the chiropractic setting and provide documentation and coding information.
September 18th, 2018 Pain in the Ass*essmentIn this webinar, Dr. Friedman will discuss how the Assessment may be the most misunderstood aspect of our documentation and how we can document it properly and quickly so it shows how the patient is progressing with care. September 4th, 2018 Mandatory Chart Reviews - What You Need to KnowIn this webinar, we are going to discuss what a Chart Review is, why it's mandatory, YOUR benefits to conducting our outsourcing a Chart Review along with the general steps for preparing, performing and properly documenting a Chart Review and its findings. Also, learn what to do post Chart Review - what your next steps should be and how to prioritize. July 31st, 2018 Lift the Cloud: Part 1 of 2In this presentation, Dr. Gwilliam, a widely renowned auditor and coder, will reveal to you the references he and other auditors use when reviewing your claims and documentation. These include coding books, Medicare guidelines, and private payor policies. Buckle up for a wild ride. July 17th, 2018 The KEY to EXCEPTIONAL Documentation in the LEAST Amount of TimeDr. Friedman has been practicing for 31 years and has been teaching documentation, performing record reviews and IMEs and helping doctors with board issues and malpractice complaints for years. With all of this experience in the documentation world, Dr. Friedman has discovered the one common denominator that can help us document exceptionally well in much less time. This one common denominator, if documented properly, will work for every kind of patient, including Medicare and personal injury. This ONE thing might just be the key to unlocking the treasure. July 6th, 2018 Coding and Auditing Wound CareIn this webinar, Aimee will review wound care coding and auditing information for wound care services, including proper modifier use, NCCI edits, Medicare coverage guidelines, and documentation requirements. June 26th, 2018 ICD-10 Guidelines for the ChiropractorTime for a little refresher. You might think you know ICD-10 now that it has been around for a while. The guidelines teach which codes go first, how certain key words are defined, and ensure that you submit the right information on your claim forms. This webinar will be taught by Dr. Evan Gwilliam who helped write ChiroCode's ICD-10 book and is a certified ICD-10 instructor. June 5th, 2018 Improve your Over-the-Counter Collections NOWIn this webinar, we're going to go back to the fundamentals and allow you to evaluate your own over-the-counter collections systems and immediately implement one or more steps for improvement, making a difference in your cash flow, starting now. May 29th, 2018 The Most Expensive Documentation Mistakes Chiropractors MakeNotes need to give payers the information they need in order to adjudicate your claims. Do your notes include what they need to see? Can you standardize and simplify your note taking process to decrease your administrative burden? In this webinar, Dr. Gwilliam, Certified Coder, Certified Professional Medical Auditor, and Clinical Director for PayDC Chiropractic EHR Software, will show you how to make it easy. He will review examples and boost your confidence that you are doing things correctly. May 22nd, 2018 Coding and Documenting Physical Therapy Treatment ModalitiesPresented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA May 22nd, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Ever wonder how to get paid for that e-stim or ultrasound? Do payers give you a hard time and ... May 8th, 2018 How to Handle High Deductibles, Cash Plans and Pre-PaysIn this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to handle high deductibles, pre-pays, discounts, hardships and in-network vs. out-of- network care plans. Learn what the OIG is looking for when it comes to discounts and offering free services. May 1st, 2018 Proving Medical Necessity and Functional ImprovementMedicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement. You will learn:
-What is Medicare’s definition of medical necessity.
-What does Medicare’s determination of Medical Necessity mean to your care plan.
-How to prove medical necessity.
-How to report this information to Medicare.
-How to determine Maximum Medical Improvement. April 17th, 2018 Documenting Diagnoses Like a Peer Reviewer, Take 2In his last ChiroCode Webinar, Dr. Gwilliam went over the details of three conditions that are covered by the Diagnosis and Documentation cards available in the ChiroCode store. By popular demand, Dr. Gwilliam has agreed to come back and cover three more. The goal is to show you how to ensure that the code you select matches the documentation created at the encounter. You don’t need to research all of the guidelines for each code in the ICD-10 Tabular List. It has already been done for you. You’ll find out which objective tests to perform and even which CPT codes make the most sense to link to the diagnoses you pick. If you can’t wait for the presentation, pick up your copy of the cards from ChiroCode.com/store today! March 29th, 2018 Coding and Auditing TeleHealth ServicesDo you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies. March 20th, 2018 Documenting a Great Patient History in Much Less TimeWe've all been taught how critical a great history is for our new patients, but many chiropractors are skipping important steps in an effort to save time. Dr. Friedman will explain what we need to document and how to get all the information in the least amount of time without missing anything. He will also discuss how by documenting the history properly on the first visit, all subsequent visits can be documented easier and faster. February 22nd, 2018 Coding Auditing Inpatient Evaluation and Management — A Hands-On ExperienceDo your providers perform and report Evaluation and Management (E/M) services in the inpatient setting? Does the documentation match with the services being billed, or does it fall short? Join Aimee for a hands-on audit of an inpatient E/M service and get an idea of the information and documentation needed to correctly code inpatient E/M services. February 20th, 2018 Documenting Diagnoses Like a Peer ReviewerThe right ICD-10 code is the one that matches the documentation. Does your record clearly distinguish between sciatica and radiculopathy? Do you know which codes are excluded from being billed alongside myositis? You will leave this presentation with a clear understanding of what to document for the diagnoses you use most, and match it to the CPT code that makes the most sense. Dr. Gwilliam, a certified auditor and ICD-10 Instructor will show you the way. February 6th, 2018 The ABN 2018The Advanced Beneficiary Notice of Non-coverage is one of the most important Medicare forms that you can use in your office because it protects your right to be paid. Dr. Ron Short will show you how, when and why to use the ABN and how to properly complete the form. January 30th, 2018 Trauma and the Presence of Effusion or EdemaHow do you document them? What PI codes do you use to report them? What PI codes do you use to validate them? Can they both be present at the same time? How do you treat them? As a Med-Legal Consultant & Strategist, Chiropractor, PI Practice Coach, Speaker, Author, Inventor, Educator and entrepreneur, Dr. Grant’s mission is to help professionals gain greater confidence, skill, & strength to successfully deliver the best recovery care and provide powerful claim strategies for traumatically injured patients. January 25th, 2018 Surgical Coding and AuditingEver wonder what an auditor is looking for when they review your surgical coding? Join Aimee and review the basic rules and documentation requirements. We’ll tear apart a couple of operative reports, code them, review NCCI edits, modifiers, and more. Get an idea of how you are doing and things you may want to incorporate into your practice to be better prepared when an audit comes your way. Also, we’ll review our cool Code-A-Note tool and how it can help you locate CPT and ICD-10-CM codes quickly. This tool is great for new coders, coders new to a specialty, difficult coding situations, or anyone who just wants a second opinion on their code options. January 9th, 2018 Essential Elements of a Care PlanCreating effective care plans and using them properly is the solution to most clinic's documentation issues. Once you make it clear to auditors and reviewers what the game plan is, and you show that you follow it throughout care, communication issues will be eliminated and you will be able to manage the case better. In this presentation, Dr. Gwilliam, Clinical Director for PayDC Software, and former Vice President of ChiroCode, will review fundamental concepts of care plans, as outlined in Chapter 4.4 of the DeskBook, and show how it is done in one chiropractic EHR. You will leave the webinar with a clear path to improve your care plans so that you can be confident that third parties understand your records. November 28th, 2017 Documentation Mistakes that Can De-value your Personal Injury CaseDon't make mistakes that will cost you money. In this presentation Dr. Gwilliam will show you how to avoid documentation errors that attorneys and IMEs can use to decrease the value of your personal injury case. Learn how to show medical necessity through the codes you assign and support it properly in the documentation. Create goals that tell the story and establish the need for care. Avoid cloned records. All this and more in this fun-filled presentation. November 21st, 2017 Proving Medical Necessity and Functional ImprovementMedicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement. You will learn:
What is Medicare’s definition of medical necessity.
How to prove medical necessity.
How to report this information to Medicare.
How to determine Maximum Medical Improvement. October 17th, 2017 Treatment PlansEarlier this year the Medicare Administrative Contractors revised their Local Coverage
Determinations. There are some changes that will affect how you document your Medicare
visits. Medicare requires that you have a treatment plan with measurable goals. The treatment plan also serves the purpose of providing you and your patient with a roadmap of care. In this
webinar Dr. Short will show you:
What specific elements Medicare requires in each treatment plan.
How to use common clinical tools to develop effective treatment plans.
Why the treatment plan is critical to proving medical necessity and overall patient care.
This webinar will give you practical information that you can apply in your office the next day.
You can obtain the notes for this webinar by subscribing to my e-mail updates at http://www.chiromedicare.net/mailing-list- signup/ or by following the link provided in my e-
mail update. They will be available by the Monday prior to the webinar presentation. September 26th, 2017 2018 Coding and Documentation IssuesIn this webinar, Dr. Gwilliam will go over code updates for 2018. He will show you some new ways to look at Episodes of Care, which is critical for Medicare. You'll learn how to use self audit checklists to make sure you survive the inevitable third party audit. Confession: This webinar is really just a pitch for all of the cool new things we are adding to the 2018 DeskBook, which will be released in October. We will give you the low down on what you need to be successful next year. September 12th, 2017 The New Local Coverage Determinations and What They Mean to YouEarlier this year the Medicare Administrative Contractors revised their Local Coverage Determinations. There are some changes that will affect how you document your Medicare
visits.
In this webinar, Dr. Ron Short will explain the changes to the Local Coverage Determinations and how to utilize them in your practice.
You will learn:
What has changed and how it will affect you
What has stayed the same
How to document Medicare Visits August 8th, 2017 How to Document Subsequent Visits for Medicare and Everyone Else REALLY REALLY FAST Without Driving Yourself Crazy in the ProcessEveryone seems to want to know how to document WELL, but FAST. Dr. Friedman will explain and demonstrate how this is not only POSSIBLE to do for Medicare, but for everyone else, too. We just need to find that ONE format of documentation that will work for EVERYONE, so there's ONE LESS THING for us to think about. Believe it or not, Medicare has actually made it EASY for us to document well and fast. Dr. Friedman will take you through the steps, from his perspective of practicing for more than 30 years and from reviewing records, performing IMEs and teaching documentation seminars nationally for years August 1st, 2017 The Perfect SOAP NoteThe so-called perfect SOAP note is a little like Sasquatch, or the Chupacabra. Does it really exist? In this groundbreaking presentation, Dr. Gwilliam will finally show the world a perfect SOAP note template that will always work for all payors at all times. And it will be easy to create in almost no time. Okay, actually, he will just get as close as he can by combining years of ChiroCode wisdom, Medicare guidance, and private payor preferences. Bring your opinion to this webinar because, odds are, it will differ in some way, and perhaps, as a group, we will be able to come to a consensus. July 18th, 2017 Evidence-based Care Plans for ChiropracticIn this special webinar for the Kentucky Association of Chiropractors, we will review the latest evidence available about effective care plans for chiropractors. More information is found in Chapter 4.5 of the 2017 ChiroCode DeskBook, which is all about creating care plans that are evidence-based and focused on measurable goals. Proper care plans still allow the doctor to take care of patients based on their clinical skill, but also show medical necessity to outsiders. This presentation is based on an updated article published last year, and available free here: http://www.jmptonline.org/article/S0161-4754(15)00184-0/fulltext July 11th, 2017 Contusion Confusion - PI's Great Overlooked and Misused FindingEach injury has a set of confirmatory symptoms that can be used to convey severity. Contusions are one of the easiest to report, but not always the easiest to find. Most contusions are not being recognized. The truth is that they are very prevalent and they are not being documented properly by DC's.
This webinar will help you expand your diagnostic skills for contusion discovery and give you insight on how to document, validate, treat and code for contusions. June 20th, 2017 Medicare Subsequent (daily) Visit DocumentationMedicare has increased their review of chiropractors recently. What are they looking for? Medicare regulations are specific in what they want in your documentation. In the second of this two part series Dr. Ron Short will review the regulations regarding the subsequent (daily) visit documentation and translate them into practical actions that you can take in your office. In this webinar you will learn:
What Medicare needs to see documented during the daily visit
How to best capture the required information
What element to have on each visit
When to re-examine the patient.
You can obtain the notes for this webinar by subscribing to my e-mail updates at http://www.chiromedicare.net/mailing-list- signup/ or by following the link provided in my e-mail update. They will be available by the Monday prior to the webinar presentation. June 6th, 2017 So What Exactly IS Medical Necessity?In this webinar, Dr. Friedman will discuss the initial new patient exam and how it doesn't do what we THINK it does for our documentation. He'll also discuss what establishes the NEED to begin care and justifies the NEED to continue care. Understanding this concept is CRITICAL for ALL patients, regardless who is paying for the care.
May 16th, 2017 Medicare Initial Visit DocumentationMedicare has increased their review of chiropractors recently. What are they looking for? Medicare regulations are specific in what they want in your documentation. In the first of this two part series Dr. Ron Short will review the regulations regarding the initial visit documentation and translate them into practical actions that you can take in your office. In this webinar you will learn:
-What Medicare needs to see documented during the initial visit
-How to best capture the required information
-What you need to make a good treatment plan
-When to start a new episode of care
April 11th, 2017 Audit Your Evaluation VisitsIn this webinar, get a sneak peak at how ChiroCode audits a typical evaluation encounter. Do you document functional loss? Are you using outcome assessment tools appropriately? Does your treatment plan include measurable goals? Do you document complicating factors? Answer all these questions and more in this action-packed half hour with Dr. Gwilliam. December 1st, 2016 Chapter 4.2 - Part 2 Record KeepingLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.2 on record keeping principles in chiropractic.
... December 1st, 2016 Chapter 4.3 - Evaluations 1: History and ExamLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.3 on documenting for evaluations. This is part 1 of 3.
... December 1st, 2016 Chapter 4.3 - Evaluations 2 SubluxationsLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.3 on documenting for subluxations. This is part 2 of 3.
... December 1st, 2016 Chapter 4.3 - Evaluations 3: Diagnosis and Treatment plansLet Dr. Gwilliam, ChiroCode's Vice President, walk you through the rest of Chapter 4.3 on documenting for evaluations and re-evaluations. This is part 3 of 3.
... December 1st, 2016 Chapter 4.4 - Subsequent Treatment VisitsLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.4 on documenting daily or subsequent visits.
... December 1st, 2016 Chapter 4.5 - Evidence-based Care PlansLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.5 on creating care plans that can't be denied. This is part 2 of 2
... December 1st, 2016 Chapter 4.5 - Treatment Plan GoalsLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.5 on creating care plans that can't be denied. This is part 1 of 2.
... December 1st, 2016 Chapter 5.2 - Chiropractic Manipulative Therapy Coding and DocumentationLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 1 of 7.
... November 1st, 2016 Chapter 4.1 - Part 1 Record KeepingLet Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 4.1 on documentation used in chiropractic.
... August 9th, 2016 How to Satisfy Medical Necessity for a Daily EncounterMeeting Medical Necessity through our daily documentation is a source of confusion and frustration for many DCs. We will help you navigate the ever-evolving world of documentation guidelines and you'll walk away with an understanding of what medical necessity is, regardless of the payer.
During this presentation, we will cover:
· Key Components Needed to Satisfy Medical Necessity
· Tools You Can Utilize to document response to care and justify the need for continued care
· Common Mistakes DCs Make in Establishing Medical Necessity August 2nd, 2016 No Treatment Plan? Prepare to Pay!If you are using canned treatment plans, or no treatment plans at all, be prepared to pay every visit back in it's entirety. Treatment plans, as well as the associated treatment goals are one of the most important parts of an initial chiropractic visit. In this webinar, join Dr. Alan Bergquist, CEO of Chiropractic Compliance Solutions, LLC, as he explains the details required in an effective treatment plan.
July 5th, 2016 Documenting a Thorough New Patient First Visit QuicklyDr. Friedman will discuss the importance of starting the documentation process with the new patient correctly and how to get the most thorough information in the least amount of time. June 14th, 2016 Proving Medical Necessity for ChiropracticDr. Friedman will discuss the 3 parts of the patient examination and why only ONE part is actually for medical necessity. This ONE thing is critical for determining if more chiropractic treatment is justified or not and if treatment has been effective or not. May 24th, 2016 DeskBook 101: Documentation Made SimpleDocumentation can be used against you, or it can be you best defense when someone tries to deny your claims or you get audited. Chapter 4 of the ChiroCode DeskBook covers all the basics, and some of the advanced stuff too. In this training, learn what makes solid documentation for Assessment Visits, and what is necessary for Treat February 23rd, 2016 DeskBook 101: Creating care plansChapter 4.5 of the 2016 DeskBook is all about creating care plans that are evidence based and logical. They allow the doctor to take care of patients based on their clinical skill, but also show medical necessity to outsiders. Bring your DeskBook to follow along as you learn how to use this chapter. January 26th, 2016 DeskBook 101: Common Procedure CodesIn this webinar, Dr. Gwilliam will review chapter 4.2 Common Procedure Codes. More than half the chapter is brand new for 2016 and it is crammed full of coding and documentation tips for the codes you use most. Figure out all the little tricks you need to keep your claims clean and survive an audit. Bring your copy of your DeskBook to follow along. There are more webinars. View all webinars... View webinars for the current subject by subtopic: ACA Clarifies Aetna PolicyAetna Physical Therapy PolicyAmerican College of Radiology Practice Parameter for Communication of Diagnostic Imaging FindingsCan I Perform 2 Untimed Codes at the Same Time?Chiropractic Software-Generated Documentation by NoridianCMS Meaningful Use Registration and Attestation WebsiteCMS-Novitas Solutions: E/M Documentation Auditor's InstructionsCMS-Novitas Solutions: Specialty Exam: CardiovascularCMS-Novitas Solutions: Specialty Exam: DermatologyCMS-Novitas Solutions: Specialty Exam: Ears, Nose and ThroatCMS-Novitas Solutions: Specialty Exam: EyesCMS-Novitas Solutions: Specialty Exam: Genitourinary (Female)CMS-Novitas Solutions: Specialty Exam: Genitourinary (Male)CMS-Novitas Solutions: Specialty Exam: Hematologic/Lymphatic/Immunologic ExaminationCMS-Novitas Solutions: Specialty Exam: MusculoskeletalCMS-Novitas Solutions: Specialty Exam: NeurologyCMS-Novitas Solutions: Specialty Exam: RespiratoryCoding and Billing WorkshopsCoding_Changes_2014Complaince Program Guidance for Third-Party Medical Billing CompaniesCompliance Program Guidance for Ambulance SuppliersCompliance Program Guidance for Clinical LaboratoriesCompliance Program Guidance for Home Health AgenciesCompliance Program Guidance for HospicesCompliance Program Guidance for HospitalsCompliance Program Guidance for Individual and Small Group Physician PracticesCompliance Program Guidance for Medicare+Choice OrganizationsCompliance Program Guidance for Nursing FacilitiesCompliance Program Guidance for Pharmaceutical ManufacturersCompliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supply IndustryCR 5550 Clarification - Signature Requirements by CMSDetails about EHR Incentive ProgramDocumentation Topics PageEHR Topics PageGastro_ArticleGeriatricHealth Behavior Assessment and Intervention Billing and Coding Guide by the APAHHS, Justice Department warn hospitals on EHR-related payment fraudHHS/CMS Letter Regarding Cloning RecordsHIPAA regulations and sign-in sheets - by HHSHome Health Billing FAQsImpairment Rating GuidesInappropriate Medicare Payments for Chiropractic Services Report - by the OIGInjury and Illness Recordkeeping RequirementsMedicare Advantage Plans: Cost Sharing LimitsMedicare Documentation Job Aid for Doctors of Chiropractic — MLNMedlinePlusNew Modifiers to Identify Occupational Therapy (OT) and Physical Therapy (PT) Services Provided by a Therapy AssistantNoridian Documentation ChecklistsNoridian Review of A5500 (Therapeutic Shoes)OIG Compliance Program for Individual and Small Group Physician PracticesOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOIG Issues Renewed Focus on Chiropractic ServicesPressure Ulcer GuidelinesProperly Appealing CCI Edit Denials - by ACAProvider Compliance Tips for Diabetic Test StripsProvider Compliance Tips for Hospital Beds and AccessoriesProvider Compliance Tips for Infusion Pumps and Related DrugsProvider Compliance Tips for Laboratory Tests - Blood CountsQuality Payment ProgramRisk classification based on the comprehensive foot examination by American Diabetes AssociationScreening Pap Tests and Pelvic Examinations by CMSSecurity Risk Assessment WizardSonomaSubjective/Objective Findings Necessitating CareSupplemental Compliance Program Guidance for HospitalsSupplemental Compliance Program Guide for Nursing FacilitiesThe Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1 BThe One-Minute Spinal Outcome Measure (There are no podcasts at this time, please check back later.)
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