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ICD-10 Coding Questions Answered

Q: One of our physicians is getting conflicting information regarding the ICD-10 codes E66.01 and E66.9. We have been coding E66.9 for Body Mass Indexes (BMIs) between 30-34 and E66.01 for BMIs > 35. She has a laminated cheat sheet card that says E66.9 is for BMIs 30-39 and E66.01 is for BMIs >40. Can […]

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Computer Assisted Coding Anticipated To Grow To $2.5 Billion By 2023

Physician Computer Assisted Coding Market for Professionals Report 2017-2023 provide Industry shares, strategies, analysis and forecasted Computer Assisted Coding Market to reach $2.5 billion by 2023. Report also provides Research and Technology, Company Profile and Computer Assisted Coding for Large Physician Practices and Ambulatory Treatment Centers Market Description and Market Dynamics. The market for computer-assisted […]

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Feds Crack Down on Upcoding

By the time the late President Lyndon B. Johnson signed the law establishing Medicare and Medicaid in 1965, the health care community was already figuring out how to maximize its returns from these new programs designed to insure the elderly, poor, and disabled. Those proceeds, however, have been generated over the years in ways that […]

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Humana Refines Diabetes Risk Stratification Tool Using ICD-10

The ICD-10 transition provided Humana with the “perfect opportunity” to develop a more detailed diabetes risk stratification tool. In an effort to improve the delivery of targeted chronic disease management services to diabetes patients, Humana has revamped its Diabetes Complications Severity Index (DCSI) risk stratification tool to use ICD-10 codes, the payer detailed in a […]

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Why Medical Necessity Continues to Be a Top Priority

Medical necessity is an important issue. Just review the definition of medical necessity: “a legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.” So, what does that really mean? A few years ago, I was preparing to speak at a national conference with […]

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Healthcare Hotbed for Fraud Cases

While it might surprise some folks that five Modesto doctors are among those facing fraud charges in a $40 million medical billing and kickback case based in Southern California, it shouldn’t surprise anyone that there was yet another medical fraud case. Wherever there is money, you’ll find people or institutions are that ripe for defrauding, […]

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When Practices are Too Cautious about HIPAA

Many providers have the belief that HIPAA should be treated like well-regarded advice from your mom: It’s better to be safe than sorry. But that mentality is not always the way to go. Sometimes, practices can be too cautious with HIPAA. There’s a difference between ensuring protected health information (PHI) doesn’t fall in the wrong […]

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ICD-10 Diagnosis Codes That Identify Weeks Gestation of Pregnancy

ICD-10 Diagnosis Codes that identify weeks gestation of pregnancy and birth weight requirement when billing a delivery CPT Procedure Code Effective for Dates of Service beginning January 1, 2017, and thereafter, Medicaid required a Weeks Gestation of Pregnancy Diagnosis Code and a birth weight on delivery claims billed on an UB-04 or CMS 1500 Claim […]

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OB Coding: Delivering Accurate Coding Remains a Challenge

To quote Robert F. Kennedy, “There are those that look at things the way they are, and ask ‘why?’ I dream of things that never were, and ask ‘why not?’” Coders are experts at scanning provider documentation and assigning codes. My approach to chart review is to try to piece together what actually happened during […]

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CMS Told To Crack Down On Improper Medicaid Payments

The Centers for Medicare & Medicaid Services needs to step up its involvement in states’ Medicaid integrity programs in order to strengthen oversight and identify overpayments, according to a new federal watchdog report. CMS oversees how states run their Medicaid integrity programs and supports fraud-fighting efforts through reviews, training and hiring contractors to audit providers. […]

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CMS Updates ICD-10 Quality Measures, More from C&M Meeting

The Centers for Medicare and Medicaid Services (CMS) has released an update to the ICD-10 and Quality Measures website. The home page covers ambulatory surgical centers, hospital inpatient and outpatient, Centers for Disease Control (CDC) and National Healthcare Safety Network (NHSN) Surgical Site Infections (SSI) Measures, CMS outcome and payment measures, Agency for Healthcare and […]

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14 Things To Know About Medical Coding

Medical coders play a crucial role in the revenue cycle process, as they help ensure health systems, hospitals and physicians are properly reimbursed for the services they provide. Here are 14 things to know about medical coding. 1. AAPC describes medical coding as “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal […]

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Outpatient CDI: Is it an Offshoot of Traditional CDI Programs?

There has been a wide array of discussion through published articles, forums, webinars, and meetings about the topic of outpatient clinical documentation improvement (CDI) programs. Outpatient CDI is receiving much attention and experiencing traction in the healthcare industry due to providers coming to terms with the fact that documentation truly matters from a financial perspective, […]

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Clearing Up Confusion Over ICD-10-CM Guidelines

The Health Insurance Portability and Accountability Act (HIPAA) requires covered entities to adhere to the most current International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code set as well as ICD-10-CM guidelines. It is important that the Academy be made aware of payers that do not follow ICD-10-CM guidelines as this is a direct […]

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Key ICD-10 Changes That Impact Pathology/Lab Coding in 2017

Have you updated your reporting of malignant carcinoid tumors, viral hepatitis, GIST or ovarian cyst coding? You haven’t had to deal with annual ICD-10-CM updates until Oct. 1, 2016. Now that the changes are effective, ensure your lab is on top of the latest changes. Take a look at how the first annual update in […]

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What Should Hospital Administrators Concentrate More On?

Hospital administrators have to juggle between various tasks like managing finances, projects and the usual daily hospital operations. To top it all, the priorities are constantly changing from one department to another. Consequently, it is very important to know which task takes precedence over the others. Here are a few points that can help you […]

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