Diagnostic Coding

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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.

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.

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.

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?

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.

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.

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?

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.

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...

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 ...

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?

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.

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.

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 ...

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.

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.

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 - -...

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?

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...

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.
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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

Dealing with the Little Coding Conundrums 

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

Diagnosis Coding and Documentation - Tips and Tricks 

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

What Are ICD-10 Codes and What Has Changed Since Implementation? 

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

Some of the most often searched questions on the internet include, what are ICD 10 codes, how many ICD 10 codes are there, what does ICD 10 CM stand for, when did ICD 10 start, and everyone’s favorite coding question, “what is the ICD 10 code for… (fill in the blank). It’s been a few years since ICD-10-CM was released and implemented and a lot has changed. In this webinar we will discuss

ICD-10-CM Changes Effective October 1, 2019 

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

Are you aware of the ICD-10-CM code changes set take effect as of October 1, 2020? Do any of them apply to your organization? Which of them will be assigned as an HCC? What are the documentation and coding guidelines applicable to them and which guidelines are changing or being ...

Chiropractic Manipulative Treatment (CMT) Coding and Documentation (Part 1) 

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

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.

Anatomy and Diagnosis of the Heart 

by  Find-A-Code™

Join Brandon Leavitt in this webinar all about the heart. He'll review the anatomy of the heart (including functionality) and the guidelines specific to ICD-10-CM code selection for specific diseases, injuries, or other conditions.

Anatomy and Diagnostic Coding for Wound Care 

by  Find-A-Code™

In this webinar, Brandon Leavitt will review the anatomy of wounds from injury, disease, and other conditions and the proper ICD-10-CM coding for them. A review of pressure and non-pressure, and venous stasis ulcers, burns, corrosions, neoplasms, and other diseases affecting the integument will be presented.

Radiology Coding Auditing Dexa Scans for Osteoporosis & Mammograms for the Breast 

by  Find-A-Code™

Learn important coding tips when billing Dexa scans (for osteoporosis) and mammograms (for breast diseases). Coders and clinicians specializing in Radiology, Family Practice, Orthopedics, and OB-GYN will all find useful information for their practice. This is a follow-up from the webinar "Diagnosis of osteoporosis and diseases of the breast".

Diagnosis of Osteoporosis and Diseases of the Breast 

by  Find-A-Code™

Osteoporosis diagnosis and breast diseases will be covered in this webinar, benefiting coders and clinicians specializing in Radiology, Family Practice, Orthopedics, and OB-GYN. This will prepare participators for the following Find-A-Code webinar on radiology coding, which will explain coding/billing for Dexa scans to detect osteoporosis, and mammogram screening for breast evaluation.

ICD-10-CM Updates for the Auditor, a NAMAS webinar 

by  Find-A-Code™

ICD-10-CM Updates for the Auditor, a NAMAS webinar

ICD-10-CM Training - Session 01 

by  Find-A-Code™

ICD-10-CM Training - Session 01

ICD-10-CM Training - Session 02 

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ICD-10-CM Training - Session 02

ICD-10-CM Training - Session 03 

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ICD-10-CM Training - Session 03

ICD-10-CM Training - Session 04 

by  Find-A-Code™

ICD-10-CM Training - Session 04

ICD-10-CM Training - Session 05 

by  Find-A-Code™

ICD-10-CM Training - Session 05

ICD-10-CM Training - Session 06 

by  Find-A-Code™

ICD-10-CM Training - Session 06

ICD-10-CM Training - Session 07 

by  Find-A-Code™

ICD-10-CM Training - Session 07

ICD-10-CM Training - Session 08 

by  Find-A-Code™

ICD-10-CM Training - Session 08

ICD-10-CM Training - Session 09 

by  Find-A-Code™

ICD-10-CM Training - Session 09

ICD-10-CM Training - Session 10 

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ICD-10-CM Training - Session 10

ICD-10-CM Training - Session 11 

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ICD-10-CM Training - Session 11

ICD-10-CM Training - Session 12 

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ICD-10-CM Training - Session 12

ICD-10-CM Training - Session 13 

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ICD-10-CM Training - Session 13

ICD-10-CM Training - Session 14 

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ICD-10-CM Training - Session 14

ICD-10-CM Training - Session 15 

by  Find-A-Code™

ICD-10-CM Training - Session 15

ICD-10-CM Training - Session 16 

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ICD-10-CM Training - Session 16

ICD-10-CM Training - Session 17 

by  Find-A-Code™

ICD-10-CM Training - Session 17

ICD-10-CM Training - Session 18 

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ICD-10-CM Training - Session 18

ICD-10-CM Training - Session 19 

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ICD-10-CM Training - Session 19

ICD-10-CM Training - Session 20 

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ICD-10-CM Training - Session 20

ICD-10-CM Training - Session 21 

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ICD-10-CM Training - Session 21

ICD-10-CM Training - Session 22 

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ICD-10-CM Training - Session 22

ICD-10-CM Training - Session 23 

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ICD-10-CM Training - Session 23

ICD-10-CM Training - Session 24 

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ICD-10-CM Training - Session 24

ICD-10-CM Training - Session 25 

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ICD-10-CM Training - Session 25

ICD-10-CM Training - Session 26 

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ICD-10-CM Training - Session 26

ICD-10-CM Training - Session 27 

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ICD-10-CM Training - Session 27

ICD-10-CM Training - Session 28 

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ICD-10-CM Training - Session 28

ICD-10-CM Training - Session 29 

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ICD-10-CM Training - Session 29

ICD-10-CM Training - Session 30 

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ICD-10-CM Training - Session 30

ICD-10-CM Training - Session 31 

by  Find-A-Code™

ICD-10-CM Training - Session 31

ICD-10-CM Training - Session 32 

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ICD-10-CM Training - Session 32

ICD-10-CM Training - Session 33 

by  Find-A-Code™

ICD-10-CM Training - Session 33

ICD-10-CM Training - Session 34 

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ICD-10-CM Training - Session 34

ICD-10-CM Training - Session 35 

by  Find-A-Code™

ICD-10-CM Training - Session 35

ICD-10-CM Training - Session 36 

by  Find-A-Code™

ICD-10-CM Training - Session 36

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