Ask an Expert
| Q: | I am confused about HIV coding. When do I use Z21 and B20? |
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Good question and one where we find a few errors! The ICD-10-CM code Z21, Asymptomatic human immunodeficiency virus, is used when there is no documentation of symptoms, or if the patient is described as HIV positive, having known HIV, or … Read Full Post |
| Q: | Our patient has SSS & a pacemaker. How do I code the pt’s condition correctly? |
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Sick Sinus Syndrome (SSS) is a condition in which the patient’s heart rhythm is disrupted; depending on the patient’s symptoms, he or she may receive a permanent pacemaker (PPM) to regulate the heart’s rhythm. In the past, SSS (I49.5) was … Read Full Post |
| Q: | How do I correctly code HTN, DM2 & CKD4 on a visit? |
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Coding guidelines have long reflected a causal relationship between HTN and CKD, and coders are accustomed (and permitted) to linking these conditions and coding I12.- and the appropriate stage of CKD (in this case, N18.4). But when the PCP links … Read Full Post |
| Q: | My patient has PVD, atherosclerosis of the lower extremities, and an AAA, which are all in HCC 108. I was told we need to document all three conditions even though there is only one payment for each HCC. Do I really need to waste my time reporting all three conditions? |
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Yes, you do. The medical record is a legal document that must reflect all the conditions the patient has and their management. If the patient has all three conditions, and they are properly assessed and documented, they must all be … Read Full Post |
| Q: | When an MRA patient has several diabetic manifestations, do I need to report all the diabetic codes even though there is a hierarchy? |
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Yes, and the creation of combo codes in ICD-10-CM makes coding multiple diabetic manifestations much easier. (Check out our blog on Combination Codes) There are a few reasons why you should code them all, assuming they were all assessed at … Read Full Post |
| Q: | My physician documents diabetes as follows: DMII/CKD III/Peripheral neuropathy. What is the correct way to code this? |
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Assuming your provider is the last hold-out from an EMR conversion, and based on the way you wrote your question, the correct ICD-10-CM codes are: E11.22 N18.3 E11.40 Remember that you cannot infer a causal relationship between the diabetes and … Read Full Post |
| Q: | How does risk adjusted payment work with regard to hierarchies? I’ve heard that some ICD-10-CM codes ‘trump’ others. |
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Risk adjusted diagnoses are classified into hierarchical condition categories (HCCs). Some HCCs are in a hierarchy. Imagine the HCCs on a ladder, if you will. As you climb up the HCC ladder, the HCCs on the lower rungs are ‘replaced’ … Read Full Post Tagged:
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| Q: | We attended an MRA training workshop and we were told that once a patient with an AAA has had surgery, we cannot code the aneurysm. We’re very confused! Is this correct? |
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It depends. (Don’t you just hate those answers?!) When an AAA is resected, the bulging section of the vessel is removed. After surgery, if the patient were to undergo an abdominal ultrasound, there will be no evidence of the aneurysm. … Read Full Post |
| Q: | The doctor documented that a patient has DM with glaucoma. How do I code this for MRA purposes? |
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Glaucoma can be a manifestation of a patient’s diabetes and the situation you describe would be coded as E11.39 and H42. (Remember that absent a specified diabetes type, the default is Type 2.) Although a lot of diabetics also have … Read Full Post |
| Q: | One of our patients was treated for breast cancer in 2007, and the PCP is reporting ICD-10-CM code C50.912. Is this correct? |
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In all likelihood, no. The coding guidelines for cancer state that “When the primary malignancy has been excised, no further treatment is directed to the site & there is no evidence of an existing malignancy,” the clinician must document ‘history … Read Full Post Tagged:
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| Q: | My PCP documented and coded breast cancer (ICD-10-CM code C50.-) for a patient who had a mastectomy three years ago and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
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Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-10-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | The PCP documented “aortic atherosclerosis.” How do I code this for MRA purposes? |
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Atherosclerosis of the aorta is a common condition in the elderly and the ICD-10-CM code is I70.0. However, it’s important to distinguish between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-10-CM code I35.8, which … Read Full Post |
| Q: | My PCP has a habit of documenting a lot of conditions as “history of.” I was told that for a condition like CHF, I can code ICD-10-CM I50.9 when she documents “history of CHF.” Is this correct? |
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No. The term ‘history’ is actually used in two manners by clinicians. In one case, it means the patient had this condition in the past. It can also mean the patient has actually had the condition for some time and … Read Full Post |
| Q: | How does the revalidation of Provider Enrollment Information Process work? |
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When you receive your revalidation notice, you must respond either through internet-based PECOS, which is the most efficient way, or by completing the appropriate 855 application form. The first set of revalidation letters were sent Medicare providers who are actively … Read Full Post |
| Q: | A specialist’s consultation report came back three weeks after our patient had a face-to-face visit with the PCP, and revealed some new risk adjusted diagnoses. Can my PCP make an addendum and report them? |
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Probably not. An addendum is used when the patient was assessed for a condition during the visit and the PCP needed some additional information, to be received very timely, in order to make a definite diagnosis. Addenda are not used … Read Full Post |
| Q: | How much capital do I need to start a home health agency or nurse registry in Florida? |
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That’s not a question with a simple answer. First, we suggest that you explore the marketplace to determine the range for the common expenditures of your preferred business model, and then begin working the financial schedules in AHCA’s licensure application … Read Full Post |
| Q: | How can I get around paying overtime? |
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You can’t. Overtime (OT) pay is a requirement for employees who are paid on an hourly basis, termed non-exempt employees. The law requires that any employee who works more than 40 hours per week is paid time and one-half for … Read Full Post |
| Q: | Two years ago, I saw Mrs. Jones as a new patient. I took a detailed history and developed a treatment plan for her HTN, CAD and other health issues. My office has attempted to schedule additional appointments and Mrs. Jones is either a no-show or cancels the appointment at the last minute. Mrs. Jones had a recent hospital stay where CHF and valvular heart disease were diagnosed. I haven’t seen her in two years and she has come to my office to continue outpatient treatment. I basically have to start from scratch due to her long absence and new health problems. Can’t I bill her visit as a new patient? |
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The answer is no. Mrs. Jones may be a noncompliant patient, but she is an established, noncompliant patient. CMS guidelines specifically define a new patient as someone who has not received services from this physician or another physician in the … Read Full Post |
| Q: | Our office has a patient with a compression fracture of the vertebra that was diagnosed in 2009. Our PCP continues to check off the ICD-9-CM code 733.13. Is this correct? How is a vertebral fracture different from an arm fracture? |
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It’s not different. Fractures are coded when they occur and for the time the patient is receiving treatment or medication. The ICD-9-CM code of 733.13 is also used when the PCP documents “chronic fracture” or “pathologic fracture.” These fractures are … Read Full Post |
| Q: | The doctor documented that a patient has DM with glaucoma. How do I code this for MRA purposes? |
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This answer was updated for ICD-10-CM and with new coding information. Read here. Glaucoma can be a manifestation of a patient’s diabetes and the situation you describe would be coded as 250.5x and 365.44. Although a lot of diabetics also … Read Full Post |
| Q: | Can a patient’s varicose veins or venous stasis be caused by their DM and coded as manifestations of ICD-9-CM code 250.7x, diabetes with peripheral circulatory manifestations? |
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No. The ICD-9-CM coding guidelines state that diabetic gangrene (785.4) and diabetic peripheral angiopathy/PVD (443.81/443.9) are the manifestations associated with ICD-9-CM code 250.7x, diabetes with peripheral circulatory manifestations. |
| Q: | What are the data deadlines and payment periods under the CMS-HCC payment system? |
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The Centers for Medicare and Medicaid Services (CMS) observes the following three deadlines each calendar year when calculating and delivering funding payments to Medicare Advantage plans: • Data received by CMS by the first Friday in March affects the July … Read Full Post |
| Q: | When an MRA patient has several diabetic manifestations, do I need to report all the diabetic codes even though there is a hierarchy? |
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Yes. The correct way to code the manifestation is with its associated diabetic ‘category.’ So, if the patient has CKD III, retinopathy and PVD, all secondary to diabetes, the correct ICD-9-CM codes to report are: 250.4x, 585.3, 250.5x, 362.01, 250.7x, … Read Full Post |
| Q: | How does risk adjusted payment work with regard to hierarchies? I’ve heard that some ICD-9-CM codes ‘trump’ others. |
| A: |
Risk adjusted diagnoses are classified into hierarchical condition categories (HCCs). Some HCCs are in a hierarchy. Imagine the HCCs on a ladder, if you will. As you climb up the HCC ladder, the HCCs on the lower rungs are ‘replaced’ … Read Full Post |
| Q: | I attended a workshop where I was told that we need more than one lab value to diagnose a condition. Is this correct? |
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It depends on the value and as always, the physician’s clinical judgment and documentation as well as the condition guidelines. Most of the time, laboratory tests are repeated after a few months to ensure the value was not an aberration … Read Full Post |
| Q: | How should I prepare for ICD-10-CM? |
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From time to time, we hear about consultants scaring the daylights out of providers with horror stories about the transition to ICD-10. We disagree with that approach, although it’s important to have a healthy respect for any system that – … Read Full Post Tagged: ICD-10, prepare for ICD-10
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| Q: | My PCP has a habit of documenting a lot of conditions as “history of.” I was told that for a condition like CHF, I can code ICD-9-CM 428.0 when she documents “history of CHF.” Is this correct? |
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No. The term ‘history’ is actually used in two manners by clinicians. In one case, it means the patient had this condition in the past. It can also mean the patient has actually had the condition for some time and … Read Full Post |
| Q: | What can I do to identify areas in my company that need improvement? |
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HR Audits can be an excellent tool to protect your organization, establish best practices and identify areas that need improvement. The evaluation process includes using numerical data (e.g. How long it takes to fill an open position and employee satisfaction … Read Full Post |
| Q: | I have heard that I can save on payroll taxes by converting my employees to independent contractors (I/C). Is this true? |
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Not exactly. The IRS has very specific and strict criteria for the classification of an I/C; in a nutshell, “The more control a company exercises over how, when, where, and by whom work is performed, the more likely the workers … Read Full Post |
| Q: | Our practice is converting to an electronic health record (EHR) and I’ve heard that CMS can give us money. How big a hassle is it to get? |
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Not that big. Consider that if you’ve made the decision to purchase an EHR, your intention is to use it to its maximum capacity. To assist providers in making this transition, CMS has created significant and attractive financial incentives: a … Read Full Post |
| Q: | Our practice just hired a new physician, but she doesn’t have her Medicare provider number yet. Our biller has applied for it and told me that in the meantime, we can bill my new physician’s office visits under my provider number. Is this legit? |
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The answer is no. This behavior is termed ‘knowing misuse of a provider identification number’ and could be considered a false claim, subject to fines and sanctions. Provider claims must identify the actual practitioner who performed the service. In fact, … Read Full Post |
| Q: | How much staff do I need to start a home health agency or nurse registry? |
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For a non-skilled home health agency, Florida requires an administrator, alternate administrator and registered nurse that meet specific requirements. Because one individual can occupy two positions, this requires a minimum of two individuals. For skilled agencies, the registered nurse assumes … Read Full Post Tagged:
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| Q: | What is an ABN? |
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The Advanced Beneficiary Notice of Noncoverage, or ABN for short, is a waiver of liability that is provided to all Medicare patients if the provider believes an item/service may not be covered by Medicare or considered medically necessary. Now that … Read Full Post |
| Q: | What exactly is ICD-10? |
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ICD-10-CM (based on the International Classification of Diseases, 10th edition, Clinical Modification) is a standard set of codes used for conveying a patient’s clinical profile, if you will. Defined codes are used primarily to facilitate the gathering of data, its … Read Full Post |
| Q: | What is the difference between a home health agency and a nurse registry? |
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Home health agency (HHA): State licensure is required. In Florida, this will generally suffice to accept patients covered by third-party insurance plans although Florida adds the requirement of accreditation. Home health agencies can provide skilled or non-skilled care. Skilled care … Read Full Post |
| Q: | How do I find patients for my home health agency or nurse registry? |
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Referral sources are the key to a successful long-term care business. Solidifying these avenues before you open the company makes the most sense. In many cases, agency owners have relationships with discharge planners and physicians in their community. Some suggestions … Read Full Post |
| Q: | My patient has PVD, atherosclerosis of the lower extremities, and an AAA, which are all in HCC 105. I was told we need to document all three conditions even though there is only one payment for each HCC. Do I really need to waste of my time reporting all three conditions? |
| A: |
Yes, you do. The medical record is a legal document that must reflect all the conditions the patient has and their management. If the patient has all three conditions, they must all be documented and reported. From a purely payment … Read Full Post |
| Q: | My physician documents diabetes as follows: DMII/CKD III/Peripheral neuropathy. What is the correct way to code this? |
| A: |
Based on the way you wrote your question, the correct ICD-9-CM codes are: 250.00 585.3 356.9 Remember that you cannot infer a causal relationship between the diabetes and the other two conditions unless the clinician specifically documents it by using … Read Full Post |
| Q: | What types of behaviors are considered discriminatory by employers? |
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The provisions of Title VII of the Civil Rights Act of 1964 make it illegal for most employers to engage in the following: 1. Discrimination or segregation in all terms of employment based on race, color, religion, gender or ethnicity. … Read Full Post |
| Q: | One of our patients was treated for breast cancer in 2007, and the PCP has checked ICD-9-CM code 174.9 on the superbill. Is this correct? |
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In all likelihood, no. The coding guidelines for cancer state that “When the primary malignancy has been excised, no further treatment is directed to the site & there is no evidence of an existing malignancy,” the clinician must document ‘history … Read Full Post |
| Q: | My PCP documented and coded breast cancer (ICD-9-CM code 174.9) for a patient who had a mastectomy in 2008 and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
| A: |
Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-9-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | The PCP documented “aortic atherosclerosis.” How do I code this for MRA purposes? |
| A: |
Atherosclerosis of the aorta is a common condition in the elderly and the ICD-9-CM code is 440.0. However, it’s important to distinguish the difference between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-9-CM code … Read Full Post |
| Q: | A specialist’s consultation report came back three weeks after our patient had a face-to-face visit with the PCP, and revealed some new risk adjusted diagnoses. Can my PCP make an addendum and report them? |
| A: |
Probably not. An addendum is used when the patient was assessed for a condition during the visit and the PCP needed some additional information, to be received very timely, in order to make a definite diagnosis. Addenda are not used … Read Full Post |
| Q: | How accurate do my employees’ time sheets need to be? |
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Very accurate. Recordkeeping can be a hot issue for small employers who are notorious for operating rather informally and resisting the use of time cards or time sheets. It would be difficult for an employer to defend against an accusation … Read Full Post |
| Q: | We attended an MRA training workshop and we were told that once a patient with an AAA has had surgery, we cannot code the aneurysm. We’re very confused! Is this correct? |
| A: |
It depends. (Don’t you just hate those answers?!) When an AAA is resected, the bulging section of the vessel is removed. After surgery, if the patient were to undergo an abdominal ultrasound, there will be no evidence of the aneurysm. … Read Full Post |
| Q: | How should I prepare my practice for the ICD-10 transition? |
| A: |
Coleman Consulting Group’s structured ICD-10-CM curriculum will launch in Summer of 2012. Contact us today to schedule an overview, or to inquire about our ICD-10 Coaching services. Here are a few links you read to learn more about this important … Read Full Post |