Tag: Diagnosis Codes

Billing Debridement Separately from Surgery

Facts to Avoid Confusion During Debridement Billing

Debridement is a process that involves the removal of foreign material, as well as tissue that is either devitalized or contaminated, until healthy tissue is revealed. Its primary purpose is to clean the affected area and is often performed concurrently with other orthopedic surgical interventions. In my role as an auditor specializing in orthopedics, I […]
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Adapting Risk Adjustment Coding

How Adapting Risk Adjustment Coding Can Change Healthcare Landscape?

Risk adjustment coding plays a vital role in the healthcare sector by capturing and documenting the severity of patient conditions. Its primary purpose is to guarantee precise reimbursement and risk adjustment scores. Given the ever-changing healthcare landscape, it is imperative for healthcare providers and coding professionals to remain adaptable and well-informed about the evolving requirements. […]
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10 Tips to Clean Medicare Part-B Claims

10 tips to Squeaky Clean Your Medicare Part-B Claims

Don’t allow preventable error to disrupt your revenue cycle. In order for a claim to be considered clean, it must contain all necessary information for the payer to fully process it without requiring further investigation or development. This includes being submitted within the designated timeframe, passing all necessary reviews, having any required medical evidence or […]
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Important Changes to ICD-10-CM Codes and Guidelines

New codes and updates become effective April 1. The updates to ICD-10-CM and ICD-10-PCS that become effective April 1 were released in mid-January. The updates include 42 new diagnosis codes. The significant changes to the ICD-10-CM guidelines are the following: A.19 – Code Assignment and Clinical Criteria This section has added a new sentence: “If […]
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Billing for Tetanus Vaccine? Check the Diagnosis

Did you know that tetanus vaccines are covered under Medicare Part B only when administered for treatment purposes? Preventive tetanus vaccinations do not fall under coverage. The Centers for Medicare & Medicaid Services Internet-Only Manuals Pub. 100-02, Chapter 15, Section clarifies, “Vaccinations or inoculations are excluded as immunizations unless they are directly related to […]
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2023 Update to Diagnosis Codes Is Substantial

Exactly 1,468 new diagnosis codes will be added to the ICD-10-CM code set for fiscal year (FY) 2023. Moreover, 251 codes will be deleted, 35 code descriptors will be revised, and 36 codes will be converted to parent codes. The changes go into effect Oct. 1. Review the Latest Files The diagnosis code files and […]
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Social determinants of health and medical coding: What to know

Recognition of the impact that social determinants of health (SDOH) have on patients’ outcomes is growing, as is the desire to incorporate SDOH factors into patient-care plans. But awareness of an existing data infrastructure that could help physician practices do so is limited. “The clinical care we provide only accounts for about 50% of the […]
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ICD-10-PCS Codes for 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 COVID-19. As we know, these codes are not to be assigned unless the substances were used to treat coronavirus. Here is some information regarding these […]
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Sequence ICD-10-CM Codes for Proper Payment

Five terms lead the way to determining primary diagnosis codes. When we select diagnosis codes for billing, we are telling the story of a patient’s healthcare encounter. Patients often present with multiple conditions — some related, some not. Medical coders are tasked with selecting the most specific codes and putting them in the right order. […]
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