Healthcare providers are often confused about what a commercial or managed care payer would want in order to approve the claim. Much of this confusion comes from the timing of requirements to ensure reimbursement.
Q: If a patient comes into an outpatient facility for a surgical procedure and the physician evaluates the patient before performing the procedure, can you append modifier -25 to the E/M service?
Coders are on the front lines of claim submission and in a good position to foster compliance. Learn strategies to prevent fraud and abuse and encourage accurate documentation and billing within your outpatient facility. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pelvic congestion syndrome is a chronic medical condition affecting millions of women between the ages of 20 and 45. Lori-Lynne Webb CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS , reviews symptoms of the condition and reporting using CPT and ICD-10-CM codes.
A recent report from the Office of Inspector General focuses on improper payments for specimen validity tests billed in combination with urine drug tests. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I, reviews Medicare instructions and coding guidance for presumptive and definitive drug testing.
Allen Frady, RN-BSN, CCDS, CCS, CRC, reviews various guidance related to clinical validation to help coders and CDI teams better navigate the complex topic.
A common question that coders often ask is when to report a secondary diagnosis. In part one of this two-part series, Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , looks at the general coding guidelines related to secondary diagnosis coding found in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting.
