Tag: Medical billing and coding

How to avoid medical necessity denials

How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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Preventive Medicine Versus E&M Codes

Preventive Medicine Versus E&M Codes

Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms, conditions, diagnoses and/or problems that need to […]
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Don’t Overlook These New PLA Codes

Don’t Overlook These New PLA Codes

A quarterly update for the Clinical Laboratory Fee Schedule (CLFS), issued May 4, includes nine new CPT® codes for proprietary laboratory analyses (PLAs). Medical coding and billing staff that process claims for lab testing should be aware of these codes and pricing. 9 New PLA Codes The following PLA (type of service 5) codes are […]
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How to Build ICD-10-PCS Codes From Op Reports

How to Build ICD-10-PCS Codes From Op Reports

Arrive at the correct procedure code by breaking down the operative report. Even seasoned coding professionals occasionally find it challenging to assign the appropriate ICD-10-PCS codes from the operative report. Mastering the procedural coding system used in the inpatient hospital setting takes practice. Medical coders reporting inpatient services should start by reading the operative report, […]
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