Pulmonary rehabilitation is a multidisciplinary program meant for patients with chronic respiratory conditions, especially for those with chronic obstructive pulmonary disease (COPD). Physicians generally refer patients with moderate to severe COPD to a rehab program...
Coding Post-operative Complications with ICD-10
Postoperative complications can be general or specific to the particular surgery. They are an important cause of morbidity, mortality, extended hospital stay and increased costs. Some examples of postoperative complications are wound infections, coronary artery bypass...
Medical Specialties with Complex Coding Challenges under ICD-10
Now that ICD-10-CM implementation is well on its way, it is evident as to how various specialties have been affected by the changes. Providers can ensure appropriate reimbursement only by documenting diagnoses in sufficient detail or a higher level of specificity to...
Coding ‘Episode of Care’ – The 7th Character in ICD-10-CM
There are several differences between the format of ICD-9 and ICD-10 coding and this has brought about new medical billing and coding challenges. One of these is the need to assign the 7th character denoting episode of care to codes in certain categories of ICD-10....
“Pokemon Go” Injuries – Code it with ICD-10
Can a virtual-reality game played on mobile phone really cause physical injuries? Yes, “Pokemon Go” can. The craze for the game is resulting in more and more accidents. Using Google Maps, it creates a world that mirrors the user’s own reality. Gamers use their mobile...
Medical Coding for Glaucoma Under ICD-10-CM – Key Considerations
A common eye condition that can cause permanent blindness, glaucoma is estimated to affect over 3 million Americans. According to the Center for Disease Control and Prevention/National Center for Health Statistics, the condition accounts for over 10 million visits to...
Clarifications on Reporting Non-urgent Services in the Emergency Department
Emergency department (ED) visits identified by CPT code 99285 require three key components: comprehensive history, comprehensive examination, and medical decision making of moderate complexity. However, a large proportion of all emergency department (ED) visits are...
Medicare’s Dedicated Billing Code for Hospitalists – Context and Implications
Hospitalists are dedicated to providing care to hospitalized patients, but till recently, quality metrics for these specialists had been clubbed with office-based internal medicine or primary care physicians. With the shift from fee-for-service to quality-based...
Challenges of Coding for Immunizations
Billing for vaccine administration is challenging and explains why many providers choose medical billing and coding outsourcing. There are different codes for Medicare and private insurance companies. Moreover, to correctly report immunizations for children and...
RADV Audit Services for Compliance with CMS Contract Requirements
The Centers for Medicare and Medicaid (CMS) conduct Risk Adjustment Data Validation (RADV) audits to recover improper payments under Medicare Part C or Medicare Advantage (MA) plans. In risk adjustment or Hierarchical Condition Categories (HCCs), the focus is on...