Sounding the Alarm About False Positives

There are false negatives; there are false positives; there are untested individuals with disease. I am in the process of developing a 90-minute COVID-19 webinar for ICDUniversity in December to…

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New York ER doctors sue UnitedHealth over out-of-network claims

Five New York emergency room physician groups on Monday filed a federal lawsuit alleging that UnitedHealth Group and Multiplan conspired to underpay out-of-network providers. The group of staffing firms, all…

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Demand for medical coders, billers accelerates despite pandemic

Some jobs have weathered the pandemic far better than others. Medical coders and billers were booming even before the coronavirus hit, and demand for those skills has only accelerated. The…

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Physician asset protection: 5 practical lessons

An examination of asset protection issues from current news headlines highlights the defensive measures doctors and healthcare executives must consider. Physicians face many risks beyond medical malpractice. A shocking case…

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Evaluation and Management – Looking Beyond COVID-19

Now that the initial wave of Covid-19 has passed and providers have mastered the telehealth billing requirements, it is time to turn attention to the 2021 Evaluation and Management (E&M)…

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The Definition of Medical Necessity in the Era of COVID

Sometimes, in an audit, it comes down to the definition of “medical necessity.” While the coronavirus pandemic is horrible already, it seems to be getting worse. But COVID has forced…

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Treating COVID-19

The ICD-10-PCS codes can be found in the XW0 Table for the drug infusions. There were new ICD-10-PCS codes implemented on Aug. 1, involving substances associated with the treatment of…

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Coding scenario: Type 2 diabetes

In our Coding Case Studies, we will explore the correct coding for a specific condition based on a hypothetical clinical scenario. This scenario involves a patient presenting with symptoms of…

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New ICD-10-CM code changes for CLI may ‘empower’ patients, physicians

Critical limb ischemia, also known as chronic limb-threatening ischemia, is an undertreated disease that often leads to amputation and/or mortality. One reason for undertreatment and underdiagnosis was coding. Until recently,…

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ICD-10 coding guideline changes for 2021

For 2021, there are 490 new, 47 revised and 58 deleted ICD-10-CM codes. We will cover the ICD-10-CM guidelines in this article and the ICD-10-CM code changes next month. There…

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Updates on COVID-19 Billing and CS Modifier Audits

The pandemic continues to impact Medicare reimbursement. COVID-19 continues to make news on the regulatory front with two new directives from the Centers for Medicare & Medicaid Services (CMS), centering…

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8 Things to Know about Vaccine Planning

In the United States, there is currently no authorized or approved vaccine to prevent coronavirus disease 2019 (COVID-19). Operation Warp Speed has been working since the pandemic started to make a…

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Lessons Learned About Antibodies

The term “antibody” has entered our main-stream vocabulary due to the advent of SARS-CoV-2 with manifestation of disease as COVID-19. Antibodies are also called immunoglobulins. They are protein/carbohydrate structures of…

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Coding Denials: Back to Basics

Coding must be supported by documentation, but also by the Official Coding Guidelines. While preparing for a clinical validation presentation on acute kidney injury denials, I took inventory of the…

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