ICD-10 Coding for Pemphigus, an Autoimmune Disease

ICD-10 Coding for Pemphigus, an Autoimmune Disease

Pemphigus is a rare group of autoimmune diseases that causes blisters and sores on the skin and inside the mouth, nose, throat, eyes, and genitals. These lesions that form quickly may last for years, with new blisters appearing in the same area of the skin after one blister goes away. Certain risk factors for this disease include age, geographic location, genes and medications. Dermatologists diagnosing and treating this skin condition can rely on professional dermatology medical billing services provided by experienced medical coding companies.

Pemphigus mainly affects the outer of the skin (epidermis) and causes lesions and blisters that are easily ruptured. It tends to be a long-lasting or chronic condition, and some types can be life-threatening without treatment. However, the condition isn’t contagious and the symptoms can be managed with medications to help the skin heal.

Pemphigus Types

There are different types of pemphigus. It is categorized, based on the layer of skin where the blisters form and where the blisters are found on the body.

  • Pemphigus Vulgaris (PV) – This is the most common condition, where blisters may form at the mouth first and then spread to the skin and in other mucous membranes, even the genitals. Blisters can be painful, making it difficult to chew and swallow.
  • Pemphigus Foliaceus (PF) – This type of pemphigus forms blisters only on the skin and often develops on the face, scalp, and upper body, not in the mouth.
  • Pemphigus Vegetans – This type can cause blisters on the groin, under the arms, and on the feet.
  • IgA Pemphigus – Caused by the IgA antibody, this type resembles pemphigus foliaceus or may appear as small pustules. The two distinct subtypes are – subcorneal pustular dermatosis (SPD) and intraepidermal neutrophilic dermatosis (IND).
  • Paraneoplastic Pemphigus (PNP) – This type is characterized by painful blisters in the mouth, lips, oesophagus or skin, and often represents the presence of the underlying cancer.
  • Drug-induced Pemphigus- Pemphigus can occur after taking certain medicines such as some antibiotics and blood pressure medications. For instance, penicillamine is the most common cause of drug-induced pemphigus.

Symptoms can vary based on the type of pemphigus the patient has but could include blisters or sores that leak clear fluid or may bleed lightly, fluid-filled bubble or blister on the skin, sores with a crusty appearance, itchy skin, and more. Pemphigus vulgaris can lead to other problems, such as blisters and sore patches that can cause life-threatening problems such as sepsis, weight loss and malnutrition, tooth decay and gum disease. Some of the severe symptoms of this condition are fever, fatigue, muscle weakness, vision problems and light sensitivity.

Pemphigus – ICD-10 Codes

  • L10 Pemphigus
  • L10.0 Pemphigus vulgaris
  • L10.1 Pemphigus vegetans
  • L10.2 Pemphigus foliaceous
  • L10.3 Brazilian pemphigus [fogo selvagem]
  • L10.4 Pemphigus erythematosus
  • L10.5 Drug-induced pemphigus
  • L10.8 Other pemphigus
    • L10.81 Paraneoplastic pemphigus
    • L10.89 Other pemphigus
  • L10.9 Pemphigus, unspecified

Diagnostic procedures for pemphigus may include a physical examination of skin blisters as well as special testing and clinical presentation such as lesion biopsy, direct immunofluorescence, indirect immunofluorescence or an antibody titer test.

CPT Codes to Report Lesion Biopsy

  • 11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion
  • 11104 Punch biopsy of skin (including simple closure, when performed) single lesion
  • 11106 Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed) single lesion

Though there is no cure for pemphigus or pemphigoid, the signs and symptoms can be controlled mainly using corticosteroids (prednisone, an anti-inflammatory medication to suppress the normal function of the immune system), steroids (topical or systemic steroids), Rituximab (FDA-approved first-line therapy), plasmapheresis or intravenous immunoglobulin therapy (IVIG). Other medications that may be prescribed to suppress the immune system include azathioprine, mycophenolate mofetil, methotrexate, and cyclophosphamide.

Accurate and efficient medical billing and coding is essential for any dermatology practice to receive maximum reimbursement for the services provided. By outsourcing the tasks to a reputable dermatology medical coding company that provides the services of AAPC-certified coding specialists, dermatology practices can ensure correct and timely medical billing and claims submission.

What is the Claim Preparation Process in Medical Billing?

What is the Claim Preparation Process in Medical Billing?

The per capita expenditure on healthcare in the United States increased significantly since 1960 and amounted to $125000 in 2020, according to Statista. A significant portion of this sum is spent on health insurance. Physicians need to submit claims or bills to commercial and federal health insurers to get paid for the services rendered to insured patients. Claim submission in medical billing involves several complex steps and getting it right is the key to optimal reimbursement. Medical billing outsourcing to an expert is the best way to achieve this goal.

What is a Medical Claim?

A claim begins at patient registration. A medical claim is a bill sent by the physician to the patient’s health plan for services rendered. The claims preparation process in medical billing involves translating patient encounters into accurate, timely bills, submitting them to payers, and monitoring adjudication to ensure they get fully paid. There are many steps involved in claim preparation and submission and understanding them is essential to manage the process efficiently.

Medical claims are submitted using medical billing software that meets electronic filing requirements as established by the HIPAA claim standard. Manual claims are permitted only in certain circumstances. Electronic claims are paperless patient claim forms generated in the practice management system and then transmitted directly to the payer electronically in accordance with the health plan’s submission requirements or through a third party vendor such as a medical billing service. Leading medical billing companies can manage the process using cloud-based software or work on the practice’s billing software.

Steps in Medical Claim Preparation and Submission

  • Medical billing and coding: The claim submission process in medical billing begins with patient registration. At the front-end medical billing stage, basic patient data is collected such as:
    • Patient demographic information, including personal and contact information
    • Patient referral or appointment scheduling
    • Patient health history
    • Insurance eligibility verification

If there are procedures or services that insurance will not cover, patients are informed about their financial responsibility. The staff will also collect any copayments from them at the visit.

Back-end medical billing begins after the patient checks out. The medical report from the patient’s visit is sent to the medical coder. Medical coding involves pulling out billable information from the medical record and clinical documentation. When a patient encounter occurs in a physician’s office, hospital, or other healthcare facility, physicians document the visit in the patient’s medical record and detail the reason for delivering specific services, items, or procedures. Medical coders review the clinical documentation and assign the correct billing codes – ICD-10 codes to indicate diagnoses and CPT and HCPCS codes to report services/procedures performed. Leveraging professional medical coding services can speed up the process and ensure coding accuracy.

  • Medical Billing Insurance Claims Process

Preparing the superbill: The patient’s insurance plan and payer regulations determine whether a procedure is billable. Charge entry involves entering these charges for the services provided into the practice management system, along with payments made by the patient at the time of service. Claims are prepared from superbills which are created from the medical codes and patient information. The superbill will include healthcare provider details, patient information, and information relating to the visit – medical codes, modifiers, place of service codes, time, units, quantity of items used, and insurance authorization information. Physicians can also include accurate and supportive documentation in the superbill to support medical necessity of services.

Claims scrubbing: During the medical billing insurance claims process, billers will check the codes to make sure that the services/procedures coded are billable. They will also scrub the claims to ensure that there are no mistakes. This process involves scanning claims for the following:

  • Accuracy of procedures performed, and related diagnosis and procedure codes
  • Patient and provider data
  • Insurer data
  • Medical necessity
  • Age and gender specific procedures
  • Medicare, Medicaid, and other data

If errors are detected, they are immediately corrected. Claim scrubbing results in more accurate claims and minimizes risk of denial.

  • Claim submission: Claims are submitted on payer-specific forms. Medicare and private insurance companies use different types of claim forms. Medicare claims are submitted on the CMS-1500 form (for physician practices) and the CMS-1450 or UB-04 (for hospitals). Private payers, Medicaid, and other third-party payers may use different claim forms based on their specific requirements or have unique claim forms based on the CMS format. Submitting a clean claim in medical billing also involves meeting standards of billing compliance such as HIPAA. Once the claims are complete, they will be submitted to the insurance company via a third party vendor like a clearing house or a medical billing company.Adjudication: The medical billing process also includes monitoring adjudication. Once they receive a claim, the insurance company will evaluate it to determine its validity and if accepted, how much it will pay the provider. The insurance company can deny or reject a claim. It will send Electronic Remittance Advice (ERA) forms back to the provider detailing what services are reimbursed or if any more information is required. The report will also include explanations as to why certain procedures will not be covered. If a claim is rejected or denied, the report will provide the reason for this. The provider can then correct and resubmit the claims for reimbursement.

    Patient statement preparation: After a claim is reimbursed, the medical billing team will prepare the patient statement. The patient will be billed for procedures not covered by the insurance company. If the patient received care from an out-of-network provider, the No Surprises Act, which went into effect on January 1, 2022, requires the provider to submit a claim to the health plan for out-of-network services to see if the payer will provide coverage. The patient cannot be billed for the unexpected balance bill from the out-of-network facility or provider.

    A/R Follow-up: The final phase in the medical billing cycle is patient collections. Medical billers will initiate processes to collect patient payments. Accounts receivable (AR) is the balance of money due to the provider from patients and payers. Specific and consistent activeaccounts receivablefollow upis an essential part of successful revenue cycle management.

The claim submission process in medical billing is complex and error-prone. Inefficient processes can lead to several problems such as reduced reimbursement, denials, penalties for regulatory noncompliance, and even fraud and litigation costs. Partnering with an experienced provider of medical billing and coding services is a practical strategy for providers to ensure a smooth process that ensures that they get paid for services delivered.

World Sickle Cell Disease Day Observed on June 19

World Sickle Cell Disease Day Observed on June 19

June 19 is observed as World Sickle Cell Disease (SCD) Day across the world. Sponsored by the United Nations, the international campaign aims to increase public knowledge and provide a better understanding about sickle cell disease and the challenges faced by patients, their families and caregivers. Also known as sickle cell anemia, SCD is an inherited blood disorder – wherein there is not enough healthy red blood cells to carry adequate oxygen throughout the body.

Reports from the World Health Organization (WHO) suggest that sickle-cell-disease affects nearly 100 million people worldwide and over 3, 00,000 children are born every year with the condition. This is a genetic condition that affects about 100,000 people in the United States. It is most common in African, Mediterranean, and Arabian Peninsula areas. SCD is considered one of the main causes of premature death among children under the age of five in various African countries. Physicians who treat this inherited blood disorder need to correctly document the same in the patients’ medical records. Opting for medical billing and coding services from an established provider can help simplify the documentation process.

The 2022 annual international campaign aims to raise awareness of SCD and help reduce the stigma and discrimination experienced by families with children and adults living with SCD. It aims to provide the right form of support to the affected population. People with the disease are born with two sickle cell genes, one from each parent. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene.

Symptoms of SCD varies from person to person and may include – painful swelling of the hands and feet, anemia, frequent infections, problems with vision, delayed growth and periodic episodes of pain (called crises). If left untreated, this genetic disorder can lead to severe complications like – stroke, acute chest syndrome, organ damage, pulmonary hypertension, gall stones, leg ulcers and blindness.

Diagnosis of SCD involves a blood test to check for hemoglobin S. Generally, this blood test is performed as part of the routine newborn screening done at the hospital. However, older children and adults can also undergo the test. However, if a parent or child has sickle cell anemia, the physician may request additional tests to check for any further complications related to the disease. People who are planning to have children can undergo the test to determine what chances there are for their children to have SCD. Physicians can diagnose SCD before a child’s birth by using a sample of amniotic fluid or tissue taken from the placenta. There is no specific cure for sickle cell anemia.

Treatment may include a combination of medications and blood transfusion. In addition, bone marrow transplant (also known as stem cell transplant) is a treatment modality for SCD – reserved for children and teenagers below 16 years. Physicians who diagnose, screen and treat people with SCD must carefully document these tests and procedures using the correct medical codes. Medical billing and coding services provided by reputable companies can help physicians use the correct codes for their medical billing process.

ICD-10 Codes for Sickle Cell Disease (SCD)

  • D57 – Sickle-cell disorders
    • D57.0 – Hb-SS disease with crisis
    • D57.1 – Sickle-cell disease without crisis
    • D57.2 – Sickle-cell/Hb-C disease
    • D57.3 – Sickle-cell trait
    • D57.4 – Sickle-cell thalassemia
    • D57.8 – Other sickle-cell disorders

The General Assembly of the United Nations on December 22, 2008 created a resolution that recognized sickle cell disease (SCD) as a global public health concern. The resolution urged the member countries and the United Nations Organization to spread awareness about sickle-cell disease at both the national and international levels every year. Therefore, June 19 of each year was officially designated as “World Sickle-Cell Day”. The first World Sickle Cell Day was observed on June 19, 2009.

As part of the campaign, a wide range of activities are organized across the world. People can participate in the campaign by attending “Shine the Light on Sickle Cell” gathering in their community on June 19. “Shine the Light on Sickle Cell” initiative aims to raise awareness about sickle cell disease and sickle cell trait and the unique health challenges people living with SCD face.

People across the globe host/participate in several events like – becoming a blood or bone marrow donor, participating in sponsored run, walk, or cycling events, holding quiz nights, making donations to the Sickle Cell Society, and sharing real-life patient stories on social media platforms – in an effort to overcome stigmas and clear up misconceptions about SCD. People can use the hash tags #WorldSickleCellDay2022 and #ShinetheLightonSickleCell2022 to help raise awareness on social media about sickle cell disease and sickle cell trait.

Participate in Sickle Cell Disease (SCD) awareness Day campaign on June 19. Understand the stigma associated with sickle cell disease and focus on the different ways to provide the right support to the affected population.

Medical Coding for Acne – A Common Skin Condition

Medical Coding for Acne – A Common Skin Condition

Acne is one of the most common skin conditions in the United States, affecting about 50 million Americans annually. Breakouts appear in the form of pimples, whiteheads, blackheads, or painful nodules and cysts mostly on the face, forehead, chest, shoulders and upper back. If left untreated, the condition can lead to severe complications like scars (pitted skin), dark spots on the skin and other skin changes (such as hyperpigmentation or hypopigmentation).

Treatment for acne involves a combination of medications and other therapies. However, the choice of treatment modalities depends on the type of acne and its severity. Acne documentation is important for dermatologists both from the viewpoint of patient care and physician reimbursement. Dermatology medical billing and coding can be challenging. Dermatologists treating different skin conditions need to use the right ICD-10 codes to report the correct diagnoses. Relying on the services of a reputable medical billing and coding company can help in accurate and timely claim submission and appropriate reimbursement.

What Causes Acne – Types and Symptoms

Even though acne affects people of all age groups, it is most commonly seen among teenagers. It is estimated that about 80 percent of people aged 11-30 years will have at least a mild form of acne. When the condition appears during the teenage years, it is more common in males. It can continue into adulthood and when it does, it is more common in women.

Several factors can cause acne. Excess or high production of oil (sebum) in the pore is one of the main factors. Other related causes include buildup of dead skin cells in the pore, growth of bacteria in the pore, inflammation, hormonal factor or changes, use of greasy cosmetics, usage of certain medications (that contain androgen and lithium), consumption of certain foods ( including carbohydrate-rich foods) and emotional stress. Acne causes several types of lesions or pimples, which vary in size, color and level of pain.

Depending on the type and severity of the condition, the symptoms vary and these include – whiteheads (closed plugged pores), small red, tender bumps (papules), pimples (pustules), painful, pus-filled lumps under the skin (cystic lesions), large, solid, painful lumps under the skin (nodules), and blackheads (open plugged pores).

Diagnosis and Treatment of Acne – Know the ICD-10 Codes

Treatment modality for this condition may depend on the age of the patient and the type and severity of acne. Mild acne can be treated with over-the-counter (OTC) medications like gels, soaps, pads, creams, and lotions that are applied to the skin. On the other hand, moderate acne may be treated with – oral antibiotics or contraceptives, topical antimicrobials, corticosteroid injections and hormone therapy (primary used in women). For people with severe acne that does not respond to topical or oral medications, additional treatment like laser and light therapy, superficial chemical peels, and surgical procedures may be recommended to help treat and repair scarring.

Medical coding for inflammatory skin conditions like acne can be complex. Healthcare providers need to be familiar with the highly specific ICD-10 codes to report different types of acne. By outsourcing these tasks to a reputable dermatology medical coding company with AAPC-certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission.

ICD-10 diagnosis codes for acne include –

  • L70 Acne
    • L70.0 Acne vulgaris
    • L70.1 Acne conglobata
    • L70.2 Acne varioliformis
    • L70.3 Acne tropical
    • L70.4 Infantile acne
    • L70.5 Acné excoriée
    • L70.8 Other acne
    • L70.9 Acne, unspecified

Apart from the above treatment modalities, incorporating certain lifestyle modifications or habits like – washing one’s face with warm water and mild soap, avoiding oil-based makeup products, removing make-up before sleeping and wearing loose clothing (if acne is back on the shoulders or chest) — can help manage or reduce the severity of the condition in the long run. When it comes to reporting diagnoses of inflammatory skin conditions like acne, dermatologists and other physicians can rely on the services of an experienced medical billing company.

Medical Billing Codes to Bill for Umbilical Hernia Repair

Medical Billing Codes to Bill for Umbilical Hernia Repair

Umbilical hernias are common and occur in 10 to 20 percent of all children in the US. It is a medical condition that occurs at the umbilicus when a loop of the intestine pushes through the umbilical ring.

Healthcare providers diagnose umbilical hernia during the physical examination of the abdomen. They are harmless, but if left untreated they can grow and become painful over time. Umbilical hernia can be treated and repaired through surgery. Accurate documentation using ICD-10 and CPT codes is essential for effective revenue cycle management. A medical coding company can ensure that the treatment rendered is appropriately coded so that your medical claims are reimbursed in a time-bound manner.

ICD 10 Codes to Report Umbilical Hernia

  • K42: Umbilical hernia
    • K42.0: Umbilical hernia with obstruction, without gangrene
    • K42.1: Umbilical hernia with gangrene
    • K42.9: Umbilical hernia without obstruction or gangrene

CPT Codes to Report Umbilical Hernia

Open hernia repair

  • 49491: Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible
  • 49492: Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or strangulated.
  • 49495: Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible
  • 49496: Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy, incarcerated or strangulated
  • 49500: Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible
  • 49501: Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy, incarcerated or strangulated
  • 49505: Repair initial inguinal hernia, age 5 years or older; reducible
  • 49507: Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated
  • 49520: Repair recurrent inguinal hernia, any age; reducible

Laparoscopic hernia repair

  • 49650: Laparoscopy, surgical; repair initial inguinal hernia
  • 49651: Laparoscopy, surgical; repair recurrent inguinal hernia
  • 49652: Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible
  • 49653: Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when important); incarcerated or strangulated

Additional codes related to hernia repair

  • 15734: Muscle, myocutaneous, or fasciocutaneous flap; trunk
  • 20680: Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)
  • +49568: Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)
  • 49659: Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy
  • 49999: Unlisted procedure, abdomen, peritoneum and omentum

Medical coding outsourcing can ease the complex task of coding umbilical hernia repair. This can enable healthcare providers to focus on delivering exceptional patient care.