Coding Intel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

Billing Guide – How Physician Services are Paid

Table of Contents CPT HCPCS Modifiers NCCI Multiple procedures Fee calculation Global surgical payment Diagnosis coding     A physician sees a patient in the office or treats a patient with a fracture in the emergency department and wants to get paid for this service. That shouldn’t be too much to ask, should it? The coding and reimbursement system in the United States is anything but simple and easy. This billing … [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...]

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...]

Billing Guide-Risk Adjusted Diagnosis Coding for Medical Practices

What to Know About Risk Adjusted Diagnosis Coding, and the Risk Adjustment Factor (RAF) Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF). After reading this guide, clinicians will be able to focus on the specificity in diagnosis coding that not only … [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...]

Compliance Issues in HCC | Risk-adjusted diagnosis coding

Lunch and Learn - August 2017 This is the second video in this series which reviews HCC diagnosis coding. The first video was the an overview, so if you didn't see it, be sure to watch that first and download the complete billing guide. In this video Betsy will be talking about compliance issues related to risk-based diagnosis coding. We've included two handouts here with additional detail. Be sure to download them before you begin … [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...]

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...]

Diagnosis Coding: It’s not just for claims anymore

What to Know About HCC Codes, Medicare Risk Adjustment and HCC Coding Guidelines Getting ready for risk-adjusted diagnosis and alternate payment systems requires paying greater attention to diagnosis coding. This video from CodingIntel describes why medical practices need to step up their game in diagnosis coding, as well as the importance of proper HCC codes, Medicare risk adjustment and HCC coding guidelines. … [Read more...]

Our mission is to provide accurate, comprehensive, up-to-date coding answers, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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