Recent content by rmooney1114

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    IDC-10 payment information

    Hello, I was hoping someone could lead me in the right direction. I am looking for a way to find out if certain diagnosis codes are covered/reimbursed by certain payers in our area. I am a coder/auditor/risk adjustment coder, but a lot of providers always ask me if certain dx codes are actually...
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    96127 vs 96160

    Thank you! That is the information I found as well, I was just hoping someone could elaborate on that and if in fact the 96127 is used to bill for the PHQ9
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    96127 vs 96160

    Hello, I need some clarification on 96127 vs 96160. My previous employer always billed the 96160 for depression screen questionnaire PHQ-9, and I just want to make sure that is correct, because when you research online it states the PHQ-9 should be 96127. Can anyone give me some insight on the...
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    Risk Adjustment - Medication List

    Hello, I have a question in regards to using a medication list in order to validate diagnoses reported within the record. If a patient has for example COPD in the PMH/PL list and it is not validated anywhere else in the note, but in the current med list, the medication Ventolin is documented...
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    Medication List / Risk Adjustment

    Hello, I have a question in regards to using a medication list in order to validate diagnoses reported within the record. If a patient has for example COPD in the PMH/PL list and it is not validated anywhere else in the note, but in the current med list, the medication Ventolin is documented...
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    CMS 2019 proposed changes

    Hello, is there a link where I can subscribe or frequently check for updates to the 2019 proposed changes by CMS. I read that they are supposed to make a decision on the their proposed 2019 changes included all the E/M changes and, I want to make sure i get the information as soon as its posted...
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    New Patient OV with a procedure

    Thank you, your response was very helpful. My reason for asking was that we recently had an outside audit by insurance company and the biggest issues were E/M with procedures and the fact that a separate E/M was not warranted. Those have since been corrected, but then we were "advised" that...
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    New Patient OV with a procedure

    Hello, here is my scenario. A provider sees a new patient, the reason for the visit is to remove a wart and there is nothing else wrong with the patient in order to warrant a separate E/M to be billed with the procedure. The new patient E/M (99203 for example) has a higher RVU than the wart...
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    Long Term Use of Aspirin

    Thank you so much, that what I was thinking as well.
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    Long Term Use of Aspirin

    Thank you , yes that was the point I was trying to get across, was that it should be linked to some sort of condition if we are to report as long term use, otherwise we shouldn't be capturing long term use of aspiring for every patient that has this on their med list. Thanks for your response!!
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    Long Term Use of Aspirin

    Thank you, I wasn't just referring to Medicare HCC's, there are other risk adjustment models such as DxCG in which long term use of aspirin does risk adjust, that's why I was asking. Thanks!
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    Long Term Use of Aspirin

    Hello, I have a question in regards to Risk Adjustment coding. When extracting codes from documentation, If Aspirin is in the current medication list, would you automatically code for Long Term Use of Aspirin? Have a debate in regards to this and I wanted other opinions/thoughts on this.. My...
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    Risk Adjustment Coding Information

    Hello, i was wondering if anyone has any specific websites, or newsletters in regards to HCC's and Risk Adjustment Coding information that they subscribe to, that sends out periodic updates etc. If so can you please provide the link or info. I like to stay current with any and all changes and...
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    Coding BMI without associated DX

    I am a risk adjustment coder, and I don't think the question is being understood correctly. I have spoke with several other risk coders and everyone says it depends on the project and assignment. My question is not who can document. I know that anyone can basically document the BMI, but that the...
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    Coding BMI without associated DX

    Hello, I need some clarification, if you will on something. As it pertains to Risk Adjustment Coding, is the coder allowed to extract just the BMI code if documented, without any associated dx also being documented, such as obesity, morbid obesity, overweight? I understand that the BMI codes are...
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