ICD-10 Symptoms & Conditions Coding

Symptoms and Conditions Coding ICD-9 has always had codes describing symptoms, conditions or manifestations of a condition using the word “with”. ICD-10 has more options. Combination codes are used to describe symptoms and conditions. An uncomplicated condition is described as uncomplicated or without certain symptoms, like appendicitis with or without acute exacerbation, or a mental condition with or without hallucinations, or gastric ulcers with or without bleeding. It’s a good idea to avoid using unspecified codes or the ones that use the word “uncomplicated”. Those codes don’t really communicate the severity of a disease or condition process and often won’t support the CPT code (provider’s service) which may have been more intense and complicated than unspecified and uncomplicated designations imply, resulting in lower payments. All About Medical...

Medical Coding Career

Medical Coding as a Career For those who are looking for a new career where they can help people, provide valuable support services, and get paid well, the health care industry is a great choice. Over 7 million people (1 out of 8) now work in the healthcare field in the U.S. and over $500 billion dollars is now spent on healthcare. Coding is a very interesting job and is well paid. Because of massive coding protocol changes, the need for coders has significantly increased. What is Medical Coding? Coding was devised to help standardize billing to insurance companies as well as to provide more information about diagnoses, treatments and the epidemiology of disease. The International Classification of Diseases (ICD) currently the 10th revision, reports various diagnoses, coding what is wrong with a patient and the CPT codes (Current Procedural Terminology) tell what the provider did to analyze and establish a treatment protocol. Medical coders work wherever health care is rendered. Experienced coders have the ability to work at home as a business enterprise or as a contract worker.   Coding is detail-oriented work requiring a good knowledge of medical terminology. The coder must carefully review patients’ charts to determine the correct code for the diagnosis and then itemize the service codes as well as keep up to date on annual coding changes. Where to learn to code: Med-Certification.com provides a unique Complete Coding Program which includes medical terminology, coding theory and a 600 patient chart practicum where all of standard codes used are taught, ICD (diagnoses), CPT (service/procedure) and HCPC (governmental additions).  This easy to follow and learn training...

Medical Billing Code Denials & Audits

The number 1 reason CMS (Medicare) denies claims is for use of the Evaluation and Management codes (E/M). These are the codes used to describe the evaluation and treatment of various disorders that are not procedures. With the E/M codes, medical necessity is the primary factor and the documentation has to be in place to support the service. Audits are always on the lookout for claims with norms that are higher than average. Misuse of CPT code modifiers is pegged for Inspector General (OIG) checking this year. To make it more complicated, new sub-modifiers are to be used to improve specificity rather than using the typical -59 modifier. Code Modifiers Modifier 51 describes multiple procedures and is used to inform payers that two or more procedures are being reported on the same day. A claim form (CMS 1500) that has modifier 51 appended to a CPT code(s) tells the payer to apply the multiple procedure payment formula to the CPT code(s) linked to the modifier 51, assuming the payer accepts this modifier. Modifier 59, is employed to show a distinct procedural service modifier and is reported with a CPT code combination when a coding rule has to be met, when another, more specific modifier (multiple-51 or bilateral-50) will not explain the situation to the payer, or when the code combination is correct, but the payer has a reimbursement edit in place. According to CPT, modifier -59 is used to support a different session, a different procedure or surgery, a different site or organ system, a separate incision or excision, a separate lesion, or a separate injury (or area of...

ICD-10 Video

Med-Certification.com invites you to watch two informational and short videos provided by The Centers for Medicare & Medicaid Services (CMS) which explain ICD-10 concepts and provide examples of how to code using ICD-10. Concepts Have a look: About ICD-10 Coding diabetes example Coding...

ICD-10 Coding Delayed

Unbelievable – one more big government snafu to complicate health care and its hard-pressed providers. Congress passed a fix bill in early April focused on postponing Medicare cuts in reimbursement under the “Sustainable Growth Rate formula,” part of the big “cost containment” effort to further complicate the provision of health care. So, the AMA stepped in and lobbied to throw in the ICD-10 implementation set to take place on October 1, 2014, as a consolation. And, the bill passed!! So 2015 is the new date (put off something like 10 years now while the rest of the world uses the ICD-10). The cynical view is that with all the new rules about compliance (including the “meaningful use” mandated for this year), fully implementing the EHR (Electronic Health Record), then adding the ICD-10 process, it boils down to just another way of payers not paying providers. Adding 64,000 codes makes the process so complex, that providers believe the probability is it will be more difficult to get paid. Many wonder if they will have the time to see patients at all. Meanwhile, hospitals and clinics are furious about the cost of the delay. Most have invested heavily in the IT required to make it all happen and most are ready or would have been by October 1, 2014. The American Health Information Management Association estimated that a one-year delay will cost the healthcare industry up to $6.6 billion. Other estimates state that postponement will cost hospitals (depending on size) from $500,000 to $3 million each. Training costs are a serious matter as well. Providers have invested in staff training as...

Medical Billing and Coding Introduction

Hospitals and medical practices benefit greatly from medical billing and coding.  For a medical practice to receive prompt payment from insurance companies it is important to streamline the claim process.  This is where medical billing and coding come in handy. Some facilities have in-house medical billing and coding employees, while other operations outsource them.  Regardless, medical billing and coding workers input data related to the following: patient records registration encounters appointments and scheduling followups electronic insurance claims claim denial followup insurance authorization account reconciliation coding and code verification reporting and much more. When a medical facility incorporates well trained personnel or contract services to provide medical billing and coding, it frees up physicians so they can spend more time caring for their patients.  When doctors and physicians do not have to deal with administrative tasks it keeps patients flowing, patient care more one-on-one, more patients may be seen, with an improved revenue picture. Not only do expert medical billers and coders increase profit margins, they also minimize loss.  Well trained staff employ better coding which prevents denied or challenged claims. As technology continues to advance, reduced paperwork is a big advantage.  Bill Gates himself said that he envisioned that offices may one day be “paperless.” Timeliness.  By electronically submitting streamlined and clean claims it expedites the processing and payment from insurance companies.  Quicker payments mean quicker profits for medical providers, losing much less over harder to recover receivables. Well trained staff are important whether employees, subcontractors, or outsource services. A newly emerging pro is the Medical...