Avoiding Malpractice in Medical Billing

Avoiding Malpractice in Medical Billing

One of the leading medical billing companies in U.S., Outsource Strategies International helps practices to streamline everything from scheduling, to insurance verifications, authorizations, coding, and medical billing and collections.

In today’s podcast, Loralee Kapp, one of our Solutions Managers discusses how to avoid malpractice in medical billing.

Podcast Highlights 

01:03 What is Malpractice in Medical Billing?

01:53 Misrepresentation of clinical information

02:28 Examples of abuse

02:49 Worrying malpractice trends

04:03 How to prevent or minimize the risk of medical billing/coding errors

05:42 How MOS can help?

Read Transcript

Hey all, this is Loralee Kapp, Solutions Manager with Managed Outsource Solutions. Today I want to go over how you can avoid malpractice in medical billing.

Medical malpractice occurs when a hospital, physician or other health care professional fails to maintain a proper standard of care and causes injury to a patient due to negligence. Negligence can result from errors in diagnosis, treatment, aftercare, or health management. In medical billing, malpractice refers to unethical and fraudulent billing practices. Errors can occur in every phase of the medical billing process, which can end up being labelled as unethical medical billing practices. An experienced medical billing company such as Managed Outsource Solutions will take care to avoid mistakes in the claim submission. As professional coders and billing staff, we are well aware that even small mistakes can result in financial losses for the patient and provider, and put the healthcare organizations at risk of legal action.

01:03 So, What is Malpractice in Medical Billing?

Although physicians are committed to providing quality care and billing correctly for their services. Unfortunately, errors are common in both areas. Errors in medical billing fall under the category of fraud, but most facilities are not making these mistakes consciously. Whether they are the result of human error or fraudulent practices, flawed medical bills cost patients, insurers, and even healthcare providers, as they often lead to claim denials that delay the payment and affect cash flow. Errors also can expose providers to criminal and civil liability. Malpractices in medical billing are listed under two categories: fraud and abuse.

01:53 Misrepresentation of clinical information

Medicare and commercial insurance companies consider the following as misrepresentation of clinical information or fraud:

  • Knowingly billing for a service at a level of complexity higher than the services actually provided or documented in the medical record
  • Knowingly billing for services not furnished, supplies not provided, or both, including falsifying records to show delivery of such items and
  • Knowingly ordering medically unnecessary items or services for patients as well as
  • Billing for appointments that patients fail to keep

02:28 Examples of abuse

The following are examples of abuse:

  • Billing for unnecessary medical services
  • Charging excessively for services or supplies
  • Misusing codes on a claim, such as upcoding or unbundling codes

Upcoding is when a provider assigns an inaccurate billing code to the medical procedure or treatment to increase reimbursement.

02:49 Worrying trends for malpractice in medical billing

The worrying Trends for Malpractice in Medical Billing –

The following statistics indicate the extent of the problem:

  • The Department of Justice recovered over $2.2 billion from False Claims Act Cases in the fiscal year 2020
  • Medical Billing Advocates of America reported that three out of four claims they review have errors

A report from the AMA Journal of Ethics notes that:

  • Upcoding and fraud costs more than $100 billion annually and can result in unnecessary procedures and prescriptions.
  • In 2016, CMS spent $1.1 trillion on health coverage for 145 million Americans, and of this, $95 billion constituted improper payments connected to abuse or fraud.
  • The FBI estimates that fraudulent billing constitutes 3% to 10% of the total health spending, contributing to inefficiency, high health care costs, and waste.
  • Almost 50% of all Medicare claims contain errors.

04:03 How can we prevent or minimize the risk of medical billing/coding errors?

In order to prevent malpractice in billing, healthcare providers should be vigilant to avoid the following:

  • First, inadvertently upcoding and undercoding – upcoding is billing using codes for services that were not received by the patient, while undercoding is not capturing all the work performed
  • Second, not using the discounted negotiated rate when billing a patient
  • Billing and providing services that are not covered by the patient’s insurance
  • Next is, incorrectly reporting a diagnosis and billing medically unnecessary services
  • Duplicate billing or billing for services more than once including unbundling – billing multiple CPT codes for the individual parts of the procedure
  • And last, billing services performed by an improperly supervised or under-qualified employee.

The often-used observation in malpractice litigation is: “If you didn’t document it, it’s the same as if it didn’t happen.” Physicians should maintain accurate and complete medical records and document all services provided. Claims should be supported by the proper documentation that proves that the services were actually provided, and were billed at the level to which they were provided and are medically necessary. Payers determine that claims have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed.

05:42 How MOS can help?

Practitioners can rely on medical billing outsourcing companies such as Managed Outsource Solutions to manage their revenue cycle. To avoid inadvertent billing errors that can end up being construed as fraud one medical malpractice, you should make sure to partner with an expert. A reliable, HIPAA compliant medical billing company would have a medical billing and coding team that can help you translate the care you deliver into billable services using the correct CPT, ICD-10, and HCPCS codes, while maintaining compliance with the ever-evolving industry trends and insurance regulations. Partnering with a reliable medical billing and coding company will allow you to focus on your patients instead of worrying about practice management tasks like coding, and billing and claims submissions.

Stay Up to Date with Dermatology Billing Trends

Stay Up to Date with Dermatology Billing Trends

Outsource Strategies International (OSI) is an experienced provider of dermatology coding services. We help dermatologists file clean claims and gain maximum reimbursement. Our AAPC-certified coders can handle complex coding challenges.

In today’s podcast, Loralee Kapp, one of our Solutions Managers, discusses the dermatology billing practice trends to watch.

Read Transcript

Hi, this is Loralee Kapp, the Solutions Manager with Managed Outsource Solutions. Today I want to talk to you about the dermatology billing practice trends and what to watch for. For a full list of ICD-10 codes associated with this podcast, please see the attached document. To ensure accurate and timely claim submission, it is important to stay up-to-date with the industry developments and dermatology medical billing trends.

The healthcare industry is in a continual state of flux, driven by shifts in scientific advancements, patient privacy and insurance providers’ policies. This has also impacted medical coding and billing, with rules changing periodically and new codes being introduced every now and then. To stay ahead of the curve, physician practices and providers of medical billing services in the U.S. must stay up to date with the current trends. Adapting to changes with the help of a reliable medical billing and coding service will ensure efficient claims submission for timely and accurate reimbursement.

Though all areas of healthcare face denials and audits, these concerns are more common in dermatology. Dermatology billing and coding requires thorough reporting, detailed information on procedures completed, and must follow multiple procedure rules, which can lead to billing and coding errors. Staying abreast with the latest trends – such as changing codes, billing rules, documentation requirements and payment methods is crucial for success with dermatology medical billing.

01:34 Top 3 dermatology billing trends

Now, let’s check out the 3 top dermatology billing trends that medical practices need to pay attention to:

01:39 COVID-19 Related Skin Conditions: A wide spectrum of skin conditions has been reported in association with coronavirus. At the American Academy of Dermatology annual meeting held virtually in April 2021, the most discussed topics were COVID-19’s effect on the skin and coverage for vitiligo and atopic dermatitis treatments. A poster presented at the AAD VMX 2021 highlighted skin issues due to mask-wearing such as acne, erythema and rhytides. Dermatologists need to ensure that these conditions are reported using the correct ICD-10 codes.

Dermatologists have an important role in the management of infectious diseases outbreaks like COVID-19. In the coming year and beyond, they should stay focused on their important role in such health care crises and consider how they can best diagnose and effectively treat new skin manifestations while ensuring the highest quality for all patients who need dermatologic care.

02:42 Telehealth Dermatology Appointments are gaining popularity: Before the pandemic, telemedicine use in dermatology was minimal. In June 2020, the National Psoriasis Foundation’s COVID-19 Task Force provided a new list of recommendations for patients and practitioners on telehealth usage. According to the study, candidates for telehealth are clinically stable patients on treatment, those requiring follow-up care or prescription refills and those with COVID-19 who are experiencing flares. It was also recommended that new patient telehealth consultations should be restricted to only those facing significant barriers to in-person care. In-person visits should also be provided for patients experiencing disease progression.

Patients are also upbeat about remote office visits. An Updox survey found that 65 percent of the patients who used telehealth services liked the convenience and 63 percent appreciated not being exposed to other sick patients, while 44 percent favored the ease of scheduling appointments and38 percent noted the simplicity of scheduling follow-up appointments.

These statistics provide evidence of telehealth technology’s versatility and accessibility. According to a study presented at the annual AAD conference, nearly 67% of people plan to utilize teledermatology appointment options post-pandemic – even after clinics are allowed in-person visits. Going forward, videos, photos, and patient-reported data are likely to be the basis of telehealth in dermatology settings. Dermatologists also need to know the rules for coding and billing telehealth visits.

04:23 Dermatology medical billing outsourcing

Outsourcing your dermatology medical billing services to a reliable partner can help your practice in many ways. Dermatology practices are under added pressure to cut overhead costs in these challenging times. They also have to deal with coding and billing changes that happen from time to time and maintain compliance with standards. Outsourcing is a great option to gain time to focus on the changing demands in dermatology care. Partnering with a reliable provider of dermatology medical billing services can help practices streamline operations, cut costs, and ensure proper coding and billing to secure optimal payment for services rendered.

Though dermatologists provide many types of medical, surgical and cosmetic surgeries and services, getting reimbursed appropriately can be a challenge. In Medscape’s 2019dermatologist compensation survey, respondents cited getting fair reimbursement and following multiple rules and regulations as the most challenging part of their job. Compared with 38% of all physicians, 46% of dermatologists reported spending 10-19 hours a week on paperwork and administrative tasks. These findings suggest that partnering with a professional dermatology medical billing and coding company is the best option for practices to translate patient services into error-free claims, get appropriate reimbursement, and improve their bottom line.

ICD-10 Codes for Reporting Dyspnea – A Chronic Breath Condition

ICD-10 Codes for Reporting Dyspnea – A Chronic Breath Condition

Based in the United States, Outsource Strategies International (OSI) is a reputable and professional medical billing outsourcing company that provides quality medical billing and coding services for various specialties.

In today’s podcast, Meghann Drella, one of our Senior Solutions Managers, discusses in detail about Dyspnea – a common breath issue and its associated ICD-10 codes.

Read Transcript

Hello and welcome to our podcast series. My name is Meghann Drella and I am a Senior Solutions Manager here at Outsource Strategies International. Today I will be discussing Dyspnea and the ICD-10 codes associated with it.

0:14 – Dyspnea – Introduction

Dyspnea or shortness of breath can be the cause of many health issues. Dyspnea refers to shortness of breath. It is a common symptom for many health issues reported in general practice and in hospital emergency rooms and can be a sign of a life-threatening condition. According to NCBI research, 7% of patients in hospital emergency rooms and 60% of those in ambulatory pulmonological practices complain of dyspnea.

0:42 – Types of Dyspnea

While acute dyspnea could be due to conditions such as asthma, anxiety, pneumonia, any block in breathing passageways, allergy, anemia, heart failure, hypotension or low blood pressure, pulmonary embolism, collapsed lung, hiatal hernia or terminal illness, chronic dyspnea can be caused by asthma, COPD, heart problems, obesity, fibrosis or certain lung conditions such as croup, traumatic lung injury, lung cancer, tuberculosis, pulmonary edema, pulmonary hypertension or sarcoidosis. In 2014, the American Thoracic Society (ATS) has proved that individuals with dyspnea or shortness of breath have an increased long-term mortality risk compared with individuals without dyspnea.

1:32 – Causes of Dyspnea

Heart problems that can cause shortness of breath include cardiomyopathy, heart rhythm issues or pericarditis (inflammation of tissue that surrounds the heart). Obstructive lung diseases such as emphysema and chronic bronchitis may also cause breath issues. If the symptom continues for some time, it can also be an indication of some life-threatening conditions. In a healthy person, breath issues can be the result of very strenuous exercise, extreme temperatures or higher altitude.

2:00 – Signs and Symptoms of Dyspnea

The major symptom is labored breathing that may last for a few minutes after strenuous activity. Other signs include tightness in the chest, shortness of breath after exertion, rapid/shallow breathing, heart palpitations, wheezing, and coughing. Emergency medical treatment is necessary, if the symptoms include sudden onset of severe dyspnea, chest pain, nausea or loss of ability to function.

2:25 – Diagnosis and Treatment

Rapid evaluation and diagnosis are crucial to reduce the burden of disease. Diagnosis may include a complete physical examination using X-rays and computed tomography (CT) images to evaluate the health of the person’s heart, lungs, and related systems, electrocardiogram (ECG) to find any signs of a heart attack, spirometry tests to measure airflow and the patient’s lung capacity or other tests to check the oxygen level in a patient’s blood. Treatment for dyspnea depends on the cause of the problem.

I hope this helps but always remember that documentation as well as a thorough knowledge of the payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.

How to Report Cervical Cerclage Procedure

How to Report Cervical Cerclage Procedure

Outsource Strategies International (OSI) provides medical billing services for a wide range of medical specialties. We serve individual physicians, medical practices, clinics and hospitals.

In today’s podcast, Meghann Drella, one of our Senior Solutions Managers discusses how to report cervical cerclage procedures.

Read Transcript

Hello and welcome to our podcast series. My name is Meghann Drella and I’m a Senior Solutions Manager here at Outsource Strategies International (OSI). Today, I’ll be discussing how to report cervical cerclage procedures.

Regarded as a common medical procedure performed for cervical insufficiency or incompetence, cervical cerclage holds the cervix closed during pregnancy. Typically, the cervix is a narrow canal that connects the lower part of the uterus to the vagina of the woman and allows the baby to exit during birth. It is a funnel-shaped tissue from where the baby comes out of the uterus and through the vagina during childbirth. The procedure is recommended for women in order to prevent late miscarriage or pre-term or premature birth during pregnancy when the cervix starts to shorten or open too early. For a woman who has a history of one or more late miscarriages, it is advisable to undergo the treatment in the first or second trimester of pregnancy. The procedure is performed at the surgical center or at a hospital; the patient can go home on the same day after the procedure.

During pregnancy, a closed cervix helps keep the baby inside the uterus until delivery. However, as the pregnancy progresses, the extra pressure on the cervix may cause it to open before the baby is ready to be born. A cervical cerclage can help a pregnancy reach full term, at least 37 weeks, by keeping the cervix closed.

01:25 For Whom the Procedure is Done

Generally, cervical stitch is performed between 12 and 14 weeks of pregnancy and will remain in place up to the 24th week of your pregnancy until the risk of pregnancy loss or premature birth has passed. Physicians may remove the suture as the full-term due date approaches or if other indications arise. Cerclage may be done for women who are pregnant and have –

  • Short cervical length
  • Changes in the cervix during pregnancy
  • A history of early pregnancy losses
  • A history of inflammation or infection
  • A history of surgery or trauma to the cervix and
  • Structural abnormalities of the uterus

02:04 Risks Associated with the Procedure

Potential complications or risks associated with the procedure are very rare. But, all procedures have some amount of risk. Physicians will review potential problems like –

  • Preterm premature rupture of membranes (PPROM)
  • Premature labor or birth
  • Infection of the cervix or amniotic sac that protects the baby
  • Trauma to the cervix or nearby structures
  • Inability of the cervix to dilate during normal labor
  • Another cerclage for future pregnancies and
  • Adverse reaction to anesthesia

02:35 Types of Cervical Cerclage

There are three different types of cervical cerclage – Transvaginal Cerclage, Transabdominal Cerclage and a McDonald Operation.

Before the procedure, the physician may perform a detailed physical examination which includes a manual pelvic exam to assess the cervix for abnormalities, such as flattening or opening. Other tests like blood tests and Transvaginal Ultrasound may also be performed to analyze the baby’s vital signs and rule out any major birth defects. In certain cases, the healthcare provider may take a swab of cervical secretions or do amniocentesis – a procedure in which a sample of amniotic fluid is removed from the uterus to check for infection.

Typically, cervical cerclage is performed as an outpatient procedure at a hospital or surgical center under regional or general anesthesia.

After cervical cerclage, an ultrasound is performed to check the baby’s well-being. Patients may experience some spotting, cramps and painful urination for a few days. Tylenol is recommended for managing pain or discomfort. If the physician used stitches to reposition vaginal tissue affected by incisions within the cervix, patients may notice passage of the material in two to three weeks as the stitches dissolve.

03:47 Billing and Coding for Cervical Cerclage

Billing and coding for cervical cerclage can be challenging, as it involves several rules related to reporting the procedure accurately. Physicians administering the cervical stitching must use the relevant CPT codes to bill for the procedure correctly. CPT codes include 57700 and 59325. Most women undergoing cervical cerclage can return home the same day after the procedure.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.

Billing and Coding for Electroencephalogram (EEG)

Billing and Coding for Electroencephalogram (EEG)

A reputable medical billing outsourcing company with extensive experience, Outsource Strategies International (OSI) provides efficient medical billing services for individual physicians, medical practices, clinics, and hospitals.

In today’s podcast, Natalie Tornese, Senior Group Manager for OSI, discusses how to report billing and coding for EEGs.

Read Transcript

Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I’m the Senior Group Manager for Outsource Strategies International (OSI). I wanted to take this opportunity to go over reporting billing and coding for EEGs.

0:16 – Introduction to Electroencephalogram (EEG)

An EEG or electroencephalogram is a non-invasive test that detects or records electrical patterns in the brain. An EEG is mainly used to detect potential problems associated with  brain activity through electrodes that are attached at measured positions on the scalp at rest or at sleep. The electrical activity of the brain is shown as wavy lines on a recording and these lines allow physicians to quickly assess whether there are abnormal patterns. The EEG will pick up on the brain waves, which may show irregularities of activity, amplitude, pattern, or speed. Any irregularities seen may be a sign of seizures or other metabolic brain disorders.

0:59 – Why Is an EEG Done?

In order to track and record brain wave patterns during an EEG, a small flat metal discs (called electrodes) are attached to the scalp with wires. These electrodes analyze the electrical impulses in the brain by sending signals to a computer that record the results. Generally associated with certain brain disorders, the electrical brain measurements produced during an EEG are used to confirm or rule various associated conditions like seizure disorders (such as epilepsy), dementia, memory issues, brain tumors, stroke or brain damage from a head injury, sleep disorders, encephalitis and encephalopathy. In addition, the procedure is also performed to determine the level of brain activity when a person is in persistent coma and also can be used to monitor activity during brain surgery.

1:54 – Types of EEG

The type of EEG requested by a neuro-specialist will depend on the severity of the condition and extent of brain damage. The different types include –

2:02 – A Routine EEG is a basic test performed when a person suffers a seizure for the very first time. This is ideally performed within 24 hours (after the occurrence of a seizure). A routine EEG can be done with or without video monitoring to evaluate whether a person has abnormal waves during specific movements of activities.

2:23 – An Ambulatory EEG is a type of test where the patient needs to wear a specific equipment to record the various levels of brain activity on a continuous basis so that patients can go about their normal activities.

2:38 – A Sleep EEG or Sleep-deprived EEG is generally used to test for sleep disorders. The procedure may be used if a routine EEG does not give enough information.

2:49 – Video Telemetry, also called a video EEG, is a special type of EEG where a patient is filmed while an EEG recording is taken to provide more information about brain activity. As part of the procedure, the EEG signals are transmitted wirelessly to a computer and the video is recorded by the computer and kept under regular surveillance by trained staff.

3:13 – Risk Factors

An EEG for most people does not pose any significant risks. The electrodes used for an EEG only pick up electrical charges; they do not emit electricity and they are harmless. In rare cases, an EEG can cause seizures in patients suffering from a seizure disorder. When a person with epilepsy or another seizure disorder undergoes an EEG, the stimuli presented during the test (such as a flashing light) may cause a seizure. However, the neurologist performing the EEG can safely manage any situation that might occur during the procedure.

3:49 – What Happens During an EEG?

During an EEG test, which is typically performed on an outpatient basis in a hospital clinic, usually takes about 20-30 minutes or as many as 24 hours to several days if you are in a hospital, so that the actual brain waves can be measured. In some cases of extended monitoring, patients may be admitted to the hospital for a few days. Patients may feel little or no discomfort as the electrodes may just record the brain waves and do not transmit any sensations.

4:18 – Patients may be asked to lie down on their back in a reclining chair or on a bed. The EEG technician will measure the patient’s head and mark the scalp with a special pencil to indicate the area wherein the electrodes need to be attached. Those spots are scrubbed with a sticky gel adhesive that helps the electrodes get a high-quality reading of the recording.

4:39 – The technician will attach about 16 to 25 electrodes to spots on the scalp. They are connected with wires to an instrument that amplifies the brain waves and converts the electrical impulses into visual patterns that appear on a computer screen. Once the electrodes are in place, the EEG typically takes up to 60 minutes. On the other hand, testing for certain conditions require patients to sleep during the test. In these cases, of course, the test can take a longer time.

5:07 – Patients can relax in a comfortable position with their eyes closed during the test. However, at times during the course of the procedure, the technician may instruct the patient to open and close their eyes, breathe deeply for a few minutes, read a few paragraphs and look at the flashing stimuli. After the test is complete, the technician will remove the electrodes from the scalp.

5:26 – During this test, video is recorded wherein the patient’s body motions are captured while the EEG records the brain waves. This combined recording can help diagnose and treat in a more effective manner.

5:38 – Billing and Coding for EEGs

Billing and coding for EEGs can be challenging, as it involves numerous rules related to reporting the procedure accurately. Physicians administering the EEG must use the relevant CPT codes to bill for the procedure correctly. I will include a transcript of all associated CPT codes for this procedure along with this recording.

I hope this helps but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Coding Achilles Tendinitis

Coding Achilles Tendinitis

A well-known U.S. based medical billing outsourcing company, Outsource Strategies International (OSI) provides efficient medical billing and coding services for individual physicians, medical practices, clinics, and hospitals.

In today’s podcast, Natalie Tornese, our Senior Group Manager, discusses Achilles Tendinitis, its diagnosis, causes, symptoms, and treatments.

Read Transcript

0:00 – Hello everyone and welcome to our podcast series.  My name is Natalie Tornese and I’m the Senior Group Manager for Outsource Strategies International. I wanted to take this opportunity to go over Achilles Tendinitis.

0:13 – Achilles Tendinitis – Introduction

A common source of injury when engaging in sports and activities is Achilles tendinitis which occurs as a result of repetitive movements caused by over-stretching of the muscles and ligaments, poor training practices, collisions, sudden movements, improper use of equipment and changes in direction. Achilles tendinitis happens when–the band of tissues that directly connects the calf muscles at the back of the lower leg to your heel bone or calcaneus become affected. It most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It also can occur in middle-aged people who engage in sports activities like tennis or basketball. If left untreated, the injury can make the tendons to tear or rupture. In many cases, treatment may involve resting or changing an exercise routine, but more severe cases may require a surgical repair.

1:09 – Types of Achilles Tendinitis   

Generally, Achilles tendinitis can develop in different ways. Diagnosing the condition at an early stage can help prevent serious injury. There are two different types of Achilles tendinitis, one called insertional and the other is non-insertional. Insertional tendinitis affects the lower portion of the tendon where it attaches to the heel bone. The condition is not necessarily related to activity. Non-insertional Achilles tendinitis is more common in young, active people. The condition involves fibers in the middle portion of the tendon. These fibers start to break down, thicken, and swell.

 1:46 – Causes of Achilles Tendinitis  

Any repeated or intense activity that strains the Achilles tendon can potentially cause tendonitis. As people age, the structure of the tendon weakens which makes it more susceptible to injury (particularly in people who have increased the intensity of their sports activities). There are other related causes which include – exercising without proper warm-up, straining the calf muscles (during repeated exercise or physical activity), wearing old or poorly fitting shoes, wearing high heels daily or for prolonged durations, a sudden increase in physical activity (without allowing your body to adjust to increased training), running on hard or uneven surfaces, playing sports such as tennis that require quick stops and changes of direction or having bone spurs in the back of your heels.

2:38 – Signs and Symptoms

The symptoms are pain and swelling that begin as a mild ache usually at the backside of the leg or above the heel (after running or any other sports activity). This is one of the main symptoms associated with the condition. Additionally, people may also experience a tenderness or stiffness, especially in the morning, which usually improves with mild activity throughout the day. Other related symptoms include discomfort or swelling in the back of the heel, tight calf muscles, limited range of motion when flexing the foot and the skin on the heel may feel overly warm to the touch.

3:15 – Risk factors

A number of factors can increase the risk of this condition, which include age, medical conditions (like psoriasis or high blood pressure), physical problems (like obesity and tight calf muscles), incorrect training choices, and use of certain medications (like certain types of antibiotics).

3:35 – Diagnosis of Achilles Tendinitis

Diagnosing this condition generally begins with a detailed medical history evaluation by the physician. Patients will be asked about pain and swelling in the heels or calf. A detailed physical exam will also be performed wherein the physician will gently press on the affected area to determine the location of the pain, tenderness or swelling. Orthopedists may also ask patients to stand on the balls of their feet while observing their range of motion, alignment and flexibility of the foot and ankle. They may also perform imaging tests like X-rays, magnetic resonance imaging (MRI) scans, and ultrasound which can help rule out other possible causes of pain and swelling and to assess any damage to the tendon.

4:19 – Treatment of Achilles Tendinitis

Treatment modalities for this condition can range from self-care strategies like rest and anti-inflammatory medications, to more invasive treatments like steroid injections, platelet-rich plasma (PRP) injections, and surgery. In most cases, the RICE method – which is comprised of rest, ice, compression, and elevation – is usually effective in treating it right after the tendon gets injured. Orthopedists may also suggest medications (like over-the-counter medications like ibuprofen (Advil, Motrin IB, others) or naproxen), or physical therapy exercises is helpful like stretching and strengthening), and orthotic devices to relieve strain on the tendon. If any of these conservative treatment modalities don’t yield the desired results or if the tendon has torn, surgery may be recommended to repair the tendon.

I will include a transcript along with this podcast outlining the specific ICD-10 codes associated with this condition.

5:17 – Common Complications of Achilles tendonitis

The common complications associated with Achilles tendonitis is pain, having trouble walking or exercising, and the tendon or heel bone becoming deformed. Tendinitis will usually go away after a few days, following rest and proper home treatment. However, recovery may take longer if the patient continues to put pressure on the tendon or doesn’t change exercise habits to prevent another injury or rupture. Seeking proper treatment for the ruptured tendon is very important. In addition, carefully following the physician’s instructions will give patients a much better chance for a quick recovery. Incorporating certain self-care strategies like stretching the calf muscles, combining high- and low-impact exercises, choosing shoes with proper cushioning and arch support, and reducing the heel size of the shoes can prevent the occurrence of Achilles tendinitis in the long run.

I hope this helps but  always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.