CMS pays Medicare Advantage plans differentially based on Hierarchical Condition Category (HCCs). This coding model uses demographics and diagnoses to predict future health care costs for Medicare beneficiaries enrolled in a Medicare Advantage plan. Each year, Medicare announces what the rates will be and indicates any coding changes in the HCC model. Between 2017 in 2018, there were no coding changes to the HCC model. However, changes … [Read more...]
Diagnosis Coding | Not just for claims anymore
Physician claims: paid based on CPT often denied based on diagnosis codes Physicians use CPT or HCPCS codes to tell the payer WHAT was done (colonoscopy, office visit) and modifiers to describe special circumstances (assistant at surgery, bilateral procedure.) We use diagnosis codes to tell the payer: The reason the service was performed. The medical necessity of the service. … [Read more...]
ICD-10 coding for suspected cancer
Diagnosis coding for possible malignance How would you feel if your primary care physician and your general surgeon told you—and your insurance company—that you had breast cancer when you didn’t have breast cancer? You actually had atypical ductal hyperplasia, not breast cancer. Not only have they told you, the claim has gone to your insurance company and the insurance company thinks you have breast cancer. And, it is listed in your … [Read more...]
Improving the accuracy of your diagnosis risk scores | Webinar
Recorded June 6, 2018 Presented by Betsy Nicoletti with guest speaker Edwin Knights, MD Edwin Knights, M.D. was the physician leader in his practice in implementing risk diagnosis coding and brings experience and strategic knowledge to this important topic. Overview: Many practices have a basic understanding of HCC risk adjusted diagnosis coding, but still struggle with improving the accuracy of the diagnosis codes submitted on claim … [Read more...]
Diabetes coding in Hierarchical Condition Coding (HCC)
In fee-for-service medicine: Diagnosis coding establishes medical necessity, and may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In risk based contracts or Accountable Care Organizations (ACOs): Payers assess the acuity of a panel of patients, and use that acuity along with age/gender … [Read more...]
Depression coding in Hierarchical Condition Coding (HCC)
In fee-for-service medicine: Diagnosis coding establishes medical necessity, and may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In risk based contracts or Accountable Care Organizations (ACOs): Payers assess the acuity of a panel of patients, and use that acuity along with age/gender … [Read more...]
Dear Resident, Do you Understand Relative Value Units (RVUs)?
Measuring physician productivity with work RVUs: News flash! Physicians are more interested in medicine than coding. No doctor undertook the rigors of medical school in order to be an expert coder. But, when residency ends, some physicians will find themselves looking at employment contracts in which their compensation will be determined in part by productivity. Often, the first two years will be strictly salary-based but will transition in … [Read more...]
Can you screen for an existing condition? | Diagnosis Coding for Lab Services
Can you screen for an existing condition, “In the absence of any signs, symptoms or associated diagnosis” Sometimes, the hardest thing about coding for preventive services isn’t the visit at all. It’s the labs. Patients come in for an annual physical and many times they believe that all of the lab work done that day or in preparation for that day will be covered as part of their preventive service. And we know what that means to patients. … [Read more...]
Compliance issues in ICD-10 coding for risk based contracts and HCCs
Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Well, here’s an excerpt. “Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment. (Do not code conditions, which no longer exist).” Most of the articles I’ve written have focused on the first sentence in this guideline. This article will focus on the second. “Do not code conditions which no … [Read more...]
HCC diagnosis coding: what medical practices need to know about risk adjusted diagnosis coding
Webinar - Recorded December 14, 2017 Risk coding is all the rage! Are you up-to-date? In fee-for-service medicine, physician services are paid based on the fee associated with that CPT code, HCPCS code and modifiers. The diagnosis coding establishes the medical necessity for this service. With new payment models, diagnosis coding for physician services takes on added importance and affects future payments. In this presentation from … [Read more...]
HCC diagnosis coding: Can you add a code from the past medical history?
Recently a fellow coder wrote to me about risk adjusted diagnosis coding. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. I stated that in order to include the condition on the claim form, there should be documentation in the history of the present illness or the assessment and the plan that the condition was addressed at the … [Read more...]
ICD-10-CM Coding Changes for October, 2017
Procedure codes and diagnosis codes change every year, challenging coders and clinicians alike. This October is no different. There are 360 new diagnosis codes, 142 codes were deleted and there were 226 revisions to the ICD-10-CM database, bringing us to a total of 71,714 diagnosis codes. There are always some wording changes that don’t change the meaning of the code. This year, some code descriptions went from “extremities” to “extremity” … [Read more...]
What’s the difference between B20 and Z21? Which is right for positive HIV status?
ICD-10-CM diagnosis coding for positive HIV status Question: For an HIV positive patient without symptoms, is the correct diagnosis code Z21 or B20? What difference does it make to reimbursement? Answer: … [Read more...]
Overview of HCCs | Risk-adjusted diagnosis coding
Lunch and Learn - July 2017 How do we get paid for physician services in medical practices? Watch this 10 minute video and download the handouts below for an overview of HCC diagnosis coding. Also see the complete billing guide and other diagnosis coding resources here. In the past, payment has been based on what we do, the CPT code, or HCPCS code billed on the claim form. In a fee-for-service world, payors use diagnosis codes to establish … [Read more...]
Screening pelvic/breast exam and pap smear denials | G0101 and Q0091
Lunch and Learn - June 2017 Updated for 2018 We received this question from one of our members: "We have a medicare patient for whom we provided a pelvic and a breast exam and a pap smear. We submitted it to Medicare and it got denied. Can you tell me why?" Medicare doesn't pay for "routine services", but they do pay for certain screening test. This short video reviews the Medicare requirements and coding for screening pelvic and breast … [Read more...]
Diagnosis Coding for Tick Bites
Question: Why is it so hard to code for a tick bite? And, how is it coded? Answer: The provider searches for the word “tick” and in many systems, up pops W57.xxxA. Someone helpful has changed the ICD-10 definition to include the word tick, although the ICD-10 definition is “Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter.” A tick is an arthropod. But, the problem with that is, W57.xxxA is an … [Read more...]
HCC Coding
What to Know About HCC Coding, Risk Adjustment and Diagnosis Codes Payers are moving to new payment models that take into consideration how sick your patient population is. What is risk adjustment? What are HCC's? What is HCC coding? What are the proper diagnosis codes? And what does it all mean for your practice? Watch this 15 minute video from CodingIntel to learn more. Additional information can be found in our Billing Guide for Risk … [Read more...]
How to get paid for services in medical practices: three quick videos for new clinicians and staff
An Overview of CPT Codes, HCPCS, Diagnosis Codes & ICD-10-CM This three-part series from CodingIntel is a must see for new staff and physicians, and is a helpful review for everyone. Includes modules on How Physician Services are Paid, and the basics of CPT codes, HCPCS, diagnosis codes and ICD-10-CM. Part 1 - How Physician Services are Paid Have a new staff member or physician who needs a primer on “how physician services are paid?” This … [Read more...]
ICD-10-CM Coding for Depression and Anxiety
ICD-10 chapter 5 includes diagnosis codes for depression and anxiety. These codes require specificity. This video addresses how to select diagnosis codes for patients with depression or anxiety. … [Read more...]
A to Z in ICD-10 – Cheat Sheet
This quick reference sheet highlights each letter of ICD-10, A-Z. Includes key points and important tips. … [Read more...]