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Jan 24th, 2023

GERD: Improving the Coding, Documentation, Billing, and Reimbursement Flow

by Jessica Hocker, CPC, CPB, CRC

GERD is a common condition where stomach acid flows back into the esophagus, causing symptoms like heartburn. It is treated with lifestyle changes, medication and surgery. Proper documentation is important for accurate coding and treatment. Providers should stay up-to-date with coding and billing policies.

Dec 27th, 2022

Leveraging Hierarchical Condition Category (HCC) Coding to Improve Overall Healthcare

by Kem Tolliver, CMPE, CPC, CMOM

Diagnosis code usage is a major component of optimizing HCCs to improve overall healthcare. Readers will gain insight into how accurate diagnosis code usage and selection impacts reimbursement and overall healthcare.

Dec 20th, 2022

Accurately Reporting Diabetic Medication Use in 2023

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Along with the ICD-10-CM coding updates, effective as of October 1st, the guidelines were also updated to provide additional information on reporting diabetic medications in both the general diabetic population and pregnant diabetics. Accurate reporting is vital to ensure not only maximum funding for risk adjusted health plans, but also to ensure medical necessity for the services provided to this patient population.

Dec 13th, 2022

Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The benefits of computer-assisted-coding (CAC) are great and understanding how to engage with the engine to ensure maximum coding efficiency is vital to the program's success for your organization. But how do you know when to accept an autosuggested code and when to ignore it, especially when it has to do with historical patient data?

Dec 6th, 2022

3 Reasons Coders Should Review the ICD-10-CM Codes and Coding Guidelines Annually

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each year coding updates are published and more often than not, there can be anywhere from a few hundred to over a thousand new, revised, or deleted codes changes. Coders who take the time to review all of the changes instead of just those pertinent to their organization will accumulate knowledge and experience that helps them stand out in the coding industry as experts.

Nov 22nd, 2022

Fatten Up Your BMI Coding Skills

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Accurately reporting body mass index (BMI) codes has become important with many of the payers reimbursing provider organizations up to ten dollars per chart for reporting 3008F with a documented BMI code. However, as is almost always the case, it isn't a simple scenario of collecting, documenting, and reporting the patient's BMI but rather hitting the mark on all of the criteria that goes along with it and understanding how to identify morbid obesity based on coding guidelines in the ICD-10-CM code set and specific payer policies.

Oct 24th, 2022

End-Stage Renal Disease Risk Model Updates for 2023

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?

Oct 24th, 2022

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

Oct 11th, 2022

Z Codes: Understanding Palliative Care and Related Z Codes

by Gloryanne Bryant, RHIA CDIP CCS CCDS AHIMA-Approved ICD-10-CM/PCS Trainer

Palliative care is often considered to be hospice and comfort care. Palliative care is sometimes used interchangeably with “comfort care” and then again sometimes with “hospice care.” But these terms do have slightly different meanings and sometimes the meaning varies depending on who is stating it. The National...

Oct 6th, 2022

2023 ICD-10-CM Code Changes

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...

Sep 18th, 2022

What is the ICD-10 Code for May-Thurner Syndrome?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

May-Thurner syndrome is not identified in the Alphabetic Index of the ICD-10-CM codebook, so what is the ICD10 code for reporting this condition? Eponymous diseases are conditions, illnesses, syndromes, disorders, or disease named after the person who either discovered it (usually a physician) or in some cases the patient who was diagnosed with the disease (think Lou Gherig's disease). When trying to identify these diseases in the Alphabetic Index you may have to do a little additional research to identify the actual name of the condition rather than the eponymous name. So what exactly is the ICD-10-CM code for May-Thurner syndrome and what other names does it go by?

Sep 8th, 2022

Are You Prepared to Avoid Repayments

by Raquel Shumway

Watchful care is needed when submitting claims. The Office of the Inspector General (OIG), after completing an audit on a Medicare Advantage Plan in August 2022, is now demanding repayment of claims to the tune of $3,518,465. Although the payer is contesting that amount, it is possible that they may begin demanding repayments from the providers to cover their costs of repayment.

Aug 30th, 2022

CMS Publishes Over 1,000 New ICD-10-CM Codes Effective on October 1, 2022

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each October 1st, the newest updates to ICD-10-CM take effect. This year with more than a thousand new codes added there is a lot of information to dig into and prepare our providers for. Many of the deleted and changed code descriptions, including the endeavor to capture social determinants of health, were made to enable expansion of specific coding categories so additional details could be reported, when captured in the documentation.

Aug 8th, 2022

Before Requesting a Review on Modifiers, Read This!

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Generally, there is uniformity in the use of modifiers between payers. However, this is not always the case; you may see a difference in payer policies and how modifiers are handled. One way to know if a modifier can be used according to CMS rules can be found when using ...

Jul 14th, 2022

HHS Leaders Urge States to Maximize Efforts to Support Children’s Mental Health

by SAMSHA Newsroom

Today, agencies across the U.S. Department of Health and Human Services (HHS) issued a joint letter to states, tribes, and jurisdictions encouraging them to prioritize and maximize their efforts to strengthen children’s mental health and well-being. The letter, signed by leaders of the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL), outlines HHS’ plans to support and facilitate state-level coordination across federal funding streams to advance and expand mental health services for children.

Jul 5th, 2022

Sometimes it's the Little Coding Conundrums That Keep Us Concerned

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We all experience coding situations that make us stop and rethink our coding path. Do we have the most current information on this situation? Does the payer contract change the way we must report the service? Are we missing something? Each of us experience simple to complex coding issues in our work and sometimes it is just nice to collaborate and discuss them openly to see how they may be resolved. Have you ever questioned the proper use of major depressive disorder codes versus the newly added (2021) depression, unspecified code? Take a look at what the OIG said about these codes and how the payer responded.

Jun 16th, 2022

2022-05-26-MLNC - Biosimilars: Interchangeable Products May Increase Patient Access

by CMS - MLNConnects

News - COVID-19: New Administration Code for Pfizer Pediatric Vaccine Booster Dose - - Biosimilars: Interchangeable Products May Increase Patient Access - - Critical Care Evaluation & Management Services: Comparative Billing Report in May - -...

Jun 7th, 2022

Do You Know What Code is Used to Report Long-Haul COVID-19 Conditions?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

A new code was added to the ICD-10-CM official code set with an effective date of October 1, 2022 for reporting post-COVID-19 sequela. We have all heard about people having odd conditions following COVID-19, well now there is a code available for reporting all of these anomalies, but are you familiar with the code and the rules for reporting it?

Apr 27th, 2022

How to Reduce the Risk of Copy and Paste

by Erica E. Remer, MD CCDS

Providers should never C&P (copy and paste) material they have not read nor vetted for accuracy. A young Jeopardy! champion died from bilateral pulmonary emboli following a colectomy in January 2021. Following his surgery, it was reported that the surgeon referred to “DVT/VTE Prophylaxis/Anticoagulation” and another note read, “already ordered.” “DVT...

Apr 13th, 2022

Hepatic Fibrosis Coding — Are Your Bases Covered?

by Raquel Shumway

Patients are generally diagnosed when they reach End Stage Liver Disease (ESLD) by undergoing a liver biopsy. This creates higher healthcare costs and higher risks of complications and mortality. However, newer non-invasive tests now exist that can help in the assessment and early detection of hepatic fibrosis before it reaches the level of cirrhosis.

Feb 10th, 2022

SDoH Improves Reimbursement and Risk Scores

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The new guidelines for evaluation and management (E/M) services 99202-99215 refer to social determinants of health (SDoH) on the new or revised Table of Risk. Healthcare professionals have long hoped for the ability to score these problematic patient conditions in a meaningful way, not only for reimbursement, but also for quality of care and treatment options. SDoH codes recently added to the ICD-10-CM codeset continue to impress upon us the importance of identifying and reporting these patient issues and when combined with the new table of risk for scoring the E/M service, can impact reimbursement and care.

Feb 9th, 2022

How Soon Will the United States Adopt ICD-11?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The ICD-11 diagnostic codeset went into effect worldwide on January 1, 2022 and has been adopted by some countries while others are still considering implementation, including the United States. The changes from ICD-9 to ICD-10 were significant but the change to ICD-11 will include the addition of new chapters, concepts, and symbols like the ampersand (&). Take a minute to familiarize yourself with this diagnostic coding set. The goal is to adopt a single version that has the flexibility to accommodate future code revisions and additions.

Jan 27th, 2022

Medicare End-Stage Renal Disease (ESRD) Beneficiaries Rush to Join Medicare Advantage

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

SUMMARY: Medicare Advantage plans saw a surge in enrollments as ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans for the first time in 2021. Will your organization be ready for ESRD audits?

Oct 14th, 2021

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

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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

Oct 6th, 2021

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

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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

Oct 4th, 2021

Watch out for New ICD-10-CM Codes

by Wyn Staheli, Director of Content - innoviHealth

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

Jul 19th, 2021

Chronic Pain Coding Today & in the Future

by Wyn Staheli, Director of Content - innoviHealth

Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

Jul 14th, 2021

How to Properly Assign ICD-10-CM Codes for Pain

by Wyn Staheli, Director of Content - innoviHealth

Pain is a common diagnosis among all specialties so it should not be surprising to find there are 162 ICD-10-CM codes for reporting it and over 80 mentions in the ICD-10-CM Official Guidelines for Coding and Reporting which describe when certain types of pain should be reported and how the codes should be sequenced.

May 18th, 2021

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

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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.

Apr 20th, 2021

ICD-11 — What’s Happening?

by Wyn Staheli, Director of Content - innoviHealth

ICD-11 is officially released, but what does that mean for diagnosis coding in the United States? What's really different? This article discusses what has been happening with ICD-11, some interesting things to note about it, as well as links to other important information.

Oct 1st, 2020

New Codes for Cytokine Release Syndrome (CRS)

by Wyn Staheli, Director of Content - innoviHealth

New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.

Jun 10th, 2020

MEGA - NCCI Edit Changes - WHO Knew?

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197 Deleted Medically Unlikely ...

Mar 24th, 2020

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...

Feb 19th, 2020

Q/A: Did Noridian Stop Covering the M99.0- Codes?

by Wyn Staheli, Director of Content - innoviHealth

Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?

Oct 7th, 2019

Hypertension & ICD-10

by Raquel Shumway

Hypertensive Diseases and ICD-10. Helps and examples for these codes.

Sep 30th, 2019

Vaccine Administration - When The Right Vaccine Code is Not Enough

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...

Sep 9th, 2019

Chiropractic 2020 Codes Changes Are Here

by Wyn Staheli, Director of Content - innoviHealth

There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?

Aug 13th, 2019

Healthcare Common Procedure Coding System (HCPCS)

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...

Jul 9th, 2019

The Importance of Medical Necessity

by Marge McQuade, CMSCS CHCI CPOM

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 ...

Apr 23rd, 2019

What is Medical Necessity and How Does Documentation Support It?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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 ...

Mar 27th, 2019

Pain Codes in ICD-10-CM

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

When coding with ICD-10-CM, pain codes can be found in different sections: The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ...

Nov 8th, 2018

Diagnosis Coding for Cardiology

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Diseases of the Circulatory system are found in Chapter 9 and reported with I00 through I99 according to the following sections: Acute rheumatic fever (I00-I02)Chronic rheumatic heart diseases (I05-I09)Hypertensive diseases (I10-I16)Ischemic heart diseases (I20-I25)Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)Other forms of heart disease (I30-I52)Cerebrovascular diseases (I60-I69)Diseases of arteries, ...

Oct 19th, 2018

Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder

by Wyn Staheli, Director of Content - innoviHealth

The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...

Sep 24th, 2018

2019 Code Changes are Just Around the Corner - Are You Ready?

by Wyn Staheli, Director of Content - innoviHealth

The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...

Feb 1st, 2018

Traumatic Subluxation Coding Controversy

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jan 9th, 2018

Billing Electrotherapy with AcuKnee

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

This code is commonly used to bill for AcuKnee products. Per AcuKnee, “NMES and electrotherapy may be covered by most insurance providers, provided the following criteria are met;” Documentation of chronic pain or muscle atrophy 3 months or longer Must document improvement Must have physician document medical necessity/Prescription Appropriate authorization from your insurance provider Suggested codes when billing 64550 initial electrotherapy education and placement E0720 Electrotherapy unit itself E0731 Garment ...

Jan 4th, 2018

Diagnosis Coding with Diagnostic Testing

by Marge McQuade, CMSCS CHCI CPOM

Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns. If a physician confirms a diagnosis based on the results of a diagnostic ...

Nov 30th, 2017

Coding Carpal Tunnel Syndrome

by Wyn Staheli, Director of Content - innoviHealth

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?

Jul 13th, 2017

Our Claims are Being Rejected

by ChiroCode™

Question: Our claims are being rejected. We think it is related to our diagnosis codes. What is the reason for this?

May 22nd, 2017

Q/A: What is the ICD-10 Code for Acetabular Labral Tear?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

What is the ICD-10 code for acetabular labral tear?

Feb 10th, 2017

Q/A: What is the Proper Code for "Lumbar Decompression?

by ChiroCode™

Q: What is the proper code for "Lumbar Decompression?

Jan 23rd, 2017

Why Should I Document a Differential Diagnosis?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

Feb 8th, 2016

How do we Know Which Codes a Payer will Allow?

by ChiroCode™

Question: How do we know which codes a payer will allow?

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Jul 7th, 2022

Dealing with the Little Coding Conundrums

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

May 11th, 2021

by Find-A-Code™

ICD-10-CM Training - Session 36

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