When an office/outpatient visit is coded based on time, think beyond face-to-face time to get full credit. This article reviews time-based coding, how to count time, which activities count toward time, and which ones don’t.
Whether the discussion is about reimbursement, quality metrics, patient outcomes, or CC/MCC capture rates, the whispers of risk adjustment have grown to a roar. Jennifer Brettler, DO, FACP, CHCQM-PHYADV , reveals just how much risk adjustment plays a role in documentation and coding integrity, impacting patient care.
Our experts answer questions about serotonin syndrome, the difference between National Correct Coding Initiative edits and medically unlikely edits, and prolonged service codes.
The majority of U.S. healthcare organizations struggle with denials and underpayments in all care settings, making it difficult to keep up with a meaningful manual appeals process. Learn how coding professionals can leverage technology to accurately capture and validate clinical data, ensuring proper coding and documentation while reducing the likelihood of denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Successfully managing inpatient stay denials should begin long before they occur and depends on having excellent case management, CDI, and coding departments. Although these departments have differing duties, Cathy Farraher Nakhoul, RN, BSN, MBA, CCM, CCDS , shows how they all play a part in ensuring that the final coded data is compliant and accurate.
Review a cross-sectional study published in the Journal of the American Medical Association that revealed people experiencing homelessness were significantly less likely to receive inpatient systemic therapy or procedures despite having a higher prevalence of more aggressive cancers and longer lengths of stay.
With guidance from Linda Martien, CPC, COC, CPMA, CPC-I, CRC, AAPC approved instructor, AAPC fellow , coding professionals can review arthritis codes to avoid the use of generalized codes in order to reflect a patient’s condition more accurately and ensure compliance with insurance requirements.
Q: A patient presents with exacerbation of COPD complicated by positive COVID-19 with COVID-19 pneumonia and superimposed MRSA bacterial pneumonia in the setting of chronic bronchitis due to smoking, severe persistent asthma (not currently in exacerbation), and left lower lobe lung cancer in remission following a lobectomy one year ago. Patient continues to smoke cigarettes. How would this diagnostic note be reported in ICD-10-CM?
Q: Based on the instructions for sacroiliac joint injections, our physicians believe they can bill the injection and report imaging separately if they use ultrasound. Is this true?
The American Medical Association recently announced new codes, deletions, and revisions included in the CPT 2025 code set. Explore these notable updates to the code set.
How do you code the conversion of a previous unicompartment knee arthroplasty to a total knee arthroplasty when there is no conversion code? This article reviews the AMA’s and the American Academy of Orthopaedic Surgeons’ takes on this issue. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Revisions to the E/M guidelines have simplified documentation and eliminated unnecessary documentation. Clinicians may choose levels of E/M services based on time or level of medical decision-making. Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC emeritus , dives deep into both processes and provides best practices for each.
The American Medical Association recently announced new codes, deletions, and revisions included in the 2025 CPT code set. Explore these notable updates to the code set.
Pancytopenia is defined as the simultaneous presence of anemia, leukopenia (neutropenia), and thrombocytopenia. Refresh yourself on how each condition plays a role in diagnosing, treating, and coding pancytopenia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Review a recent OIG audit which found that without strengthening program safeguards, CMS and its contractors may not be able to prevent or detect improper payments for short inpatient stays or recover overpayments for claims that do not comply with Medicare requirements.
Q: Consider patients who are admitted with cellulitis and have type 2 diabetes mellitus with no neuropathy or elevated glucose levels. Should coders query the provider to clarify if the cellulitis is caused by the diabetes, or should such a query only be sent if a patient has other complications of diabetes such as hypoglycemia or neuropathy?
With advice from three certified medical professionals, CDI specialists and healthcare providers can develop relationships that foster a culture of collaboration and continuous improvement in documentation and coding practices.
Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS, provides an overview of toxic encephalopathy including signs and symptoms, diagnosis and treatment, and relevance for coding professionals and CDI teams.
Critical access hospitals ensure that people living in remote, rural, or underserved communities still have access to medical care. Learn about the ins and outs of their reimbursement models and other billing and coding considerations.
The connection between medical necessity and diagnosis coding should be included with your training on the 2025 update to the ICD-10-CM code set. This article serves as a refresher on medical necessity, possible ICD-10-CM conflicts, and other best practices.
