In Coding
Aug 1st, 2017
Proper coding tells the patient’s complete story, helps prove medical necessity, and portrays accurate data trends. By Kellie S. Hall, CPC, CPCO, CCS-P To understand the value of diagnosis coding, look beyond what it takes to get a claim paid today and consider the importance of the data diagnosis codes represent. Tell the Patient’s Story ...
Avoid fighting stacks of denials by adhering to documentation requirements in LCDs. The importance of diagnostic test orders to proper compliance and reimbursement is well illustrated by a personal story. Years ago, I received a frantic phone call from an imaging center going through a Medicare contractor prepayment review. Approximately three months before, the program ...
In CMS
Jan 23rd, 2017
A doctor’s Hippocratic oath isn’t good enough for the Centers for Medicare & Medicaid Services (CMS): they need proof that every service a beneficiary receives is medically necessary. This proof comes in the form of diagnostic codes reported on claims, backed by observations documented by the doctor. Coding and documentation that don’t align can cost ...
In Coding
Oct 10th, 2016
Don’t forget the role of medical necessity when reporting a low-level evaluation and management (E/M) service, such as 99211 Office or other outpatient visit for the evaluation and management of an established patient…usually, the presenting problem(s) are minimal. For example, a patient has an established diagnosis of hypertension. The provider documents that the patient should ...
What is the primary driver of an E/M level? Find out what lands the knockout punch. By Brian Meredith, CPC Per the CPT® codebook, medical decision-making (MDM) “refers to the complexity of establishing a diagnosis and/or selecting a management option as measured by” three criteria categories. MDM can be quantified according to this criteria, and ...