Category Archives: Coding & Billing

Coding Cancers: A Common Charting Error

One of the most common provider charting errors occurs in the area of cancer diagnoses. Practitioners routinely document and code cancers when the patient’s disease has been treated and is no longer evident. For risk adjusted practices, this means the … Read Full Post

Tagged cancer diagnoses, capitation, charting errors, coding cancer, documentation, medicare risk adjustment, mra, risk adjusted reimbursement, risk adjustment |

ICD-10-CM Changes for 2019 take effect on 10/1/18

The 2019 ICD-10-CM codes go into effect on October 1, 2018. There are 473 changes (279 new ICD-10 codes, 51 deleted codes, and 143 revised codes) to know, understand and begin using in a short time. This link contains a … Read Full Post

Tagged 2019 ICD-10 code changes, 2019 ICD-10 codes, icd-10-cm, new 2019 ICD-10 codes |

Borderline Diagnoses

When a provider writes that a diagnosis is borderline, many coders will query the physician before coding. However, the ICD-10-CM Official Guidelines for Coding and Reporting states that borderline diagnoses are not considered uncertain and that there is no distinction … Read Full Post

Tagged borderline diabetes, borderline diagnosis, borderline schizophrenia, icd-10, query the physician |

Combination Codes

One interesting and time-saving feature of ICD-10-CM codes is the combination code. Just like Burger King, McDonald’s and other fast food eateries, the world of coding has combos; the food-oriented ones save us money and the coding combos save us … Read Full Post

Tagged angina, ASHD with angina, chronic kidney disease, CKD, combination codes, combination ICD-10 codes, combo codes, diabetes |

What We’re Reading – How to get your behavioral health codes right

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5, in medical parlance) is a handbook, if you will, to assist in making diagnostic judgments in cases of mental disorders. The manual classifies conditions and provides diagnostic criteria in … Read Full Post

Tagged behavioral health, behavioral health codes, coding guidelines, diagnostic and statistical manual of mental disorders, icd 10 vs icd 9, icd10, mental disorders, mental health |

What We’re Reading – Improve Clinical Documentation for ICD-10

Your administrative staff has probably hounded you for years to improve your documentation. With the ICD-10 transition around the corner on October 1, 2014, clinician documentation will be more important than ever. The code sets from have expanded from 14, … Read Full Post

Tagged clinical documentation, coding & billing education, coding and billing, coding guidelines, dcoumentation, icd 10 vs icd 9, icd10, icd10 transition, improving documentation, medical practice, practice management |

How is the ICD-10-CM Code Set Different from ICD-9-CM?

ICD-9 codes have between three and five characters, and with the exception of “V” and “E” codes, are exclusively numeric. The fourth or fifth character is utilized for greater specificity and combinations of diagnoses are coded separately. One example is … Read Full Post

Tagged coding, diagnosis code sets, gems, general equivalence mapping, home health billing, icd-10 codes, icd-10 format, icd-9 translation to icd-10 codes, icd-9 vs icd-10, icd10 code sets, icd9 code sets, icd9 vs icd10, medical practice billing |

What We’re Reading – Medicare E/M claims for new patients

Beginning on October 1, 2013, CMS will use a new claim edit to determine if more than one initial visit code was billed for a Medicare beneficiary within a three year period. This edit will also identify claims where established … Read Full Post

Tagged center for medicare and medicaid services, coding and billing, first coast service options, medicare claim edit, medicare claims, medicare new patient visit, practice management |

2014 Holds Big Changes for the CMS-HCC Model

The purpose of the CMS-HCC model is to improve the accuracy in predicting the costliness of Medicare Advantage (MA) enrollees’ healthcare costs and to properly fund MA plans for those expenses. It isn’t a perfect model but it surpasses the … Read Full Post

Tagged annual wellness visits, center for medicare and medicaid services, chronic kidney disease, cms-hcc model, ffs medicare, government accountability office, health risk appraisals, hierarchical condition categories, medicare advantage enrolles risk scores, medicare advantage plans, medicare payment advisory commission, medicare risk adjustment, mra, national institutes of health, national kidney foundation, risk adjustment in medicare advantage, risk scores, the patient protection and affordable care act |

Is your practice utilizing the Advanced Beneficiary Notice of Noncoverage (ABN) correctly?

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

Tagged abn, advanced beneficiary notice of noncoverage, center for medicare and medicaid services, coding & billing, medicare billing, medicare patients, submitting a claim |