Tag: Medical Coders


Reasons for Holdups in the Medical Billing Process

The revenue cycle function in healthcare is a complex process that has led to a disconnect between physicians, coding teams, billers, and administrators. The result is unnecessary time and staffing resources reallocated toward capturing revenue, instead of focusing on patient care. In the end, significant amounts of money are left on the table, patient care […]
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The Impact of Coding on Maternal Outcomes

While most maternal deaths are preventable, the rate has been increasing in the United States since 2000. As a matter of fact, the U.S. has twice as many maternal deaths than other high-income countries. To reverse this trend, The Joint Commission, the Centers for Medicare & Medicaid Services (CMS), and the Agency for Healthcare Research […]
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Top 10 ICD-10-CM Coding Errors

There are many rules and regulations medical coders must follow for diagnosis coding. Avoiding these 10 most common errors will improve your audit rate. 10. Coding straight from the index. Read the notes in the Tabular List to be sure your selection is correct. 9. Sequencing codes inappropriately. Code the underlying disease BEFORE the manifestation; […]
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Accurate CDI is Imperative in Coding Severe Malnutrition

One billion dollars is a big number, but more astounding to me, as it pertains to a recent finding by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), was that hospitals were found to have incorrectly documented and/or coded severe malnutrition 86.5 percent of the time (173/200)! That’s almost […]
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The Future Of Work Now – Medical Coding With AI

The coding of medical diagnosis and treatment has always been a challenging issue. Translating a patient’s complex symptoms, and a clinician’s efforts to address them, into a clear and unambiguous classification code was difficult even in simpler times. Now, however, hospitals and health insurance companies want very detailed information on what was wrong with a […]
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Understanding The Key Elements of Critical Care Coding

For some coders, confusion exists when Critical Care Coding for critical care services. Code 99291 is used for critical care, evaluation, and management of a critically ill or critically injured patient, specifically for the first 30-74 minutes of treatment. It is to be reported only once per day, per physician or group member of the same specialty. […]
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MAC Clarifies Modifier 50 Appropriate Use

Novitas Solutions recently issued a Modifier 50 Fact Sheet, reminding medical coders of the proper use for this CPT payment modifier. The Medicare Administrative Contractor (MAC) for jurisdictions H and L warns that, effective for Part B claims received on and after Aug. 16, 2019, services will be rejected as unprocessable when modifier 50 Bilateral procedure is used […]
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AMA on Evaluation and Management Service Codes Guidelines for 2021

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management service codes (CPT® 99201-99215) provided to Medicare Part B patients beginning in 2021. The Centers for Medicare & Medicaid Services (CMS) indicated in their initiative that, although […]
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Home and Outpatient Services Codes – Let’s Get It Straight

New billable CPT® home and outpatient service codes for monitoring patients who are taking blood-thinning medications. In 2018, CPT® deleted codes 99363 and 99364 and replaced them with codes 93792 and 93793. There are two important things to know about coding for international normalized ratio (INR) monitoring, also known as a “protime check” (PT). First, […]
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