Coding, billing and documentation tips for effective reimbursement. Beth Milligan, MD, FAAFP, CHCOM, CPE

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Coding, billing and documentation tips for effective reimbursement. Beth Milligan, MD, FAAFP, CHCOM, CPE"

Transcription

1 Coding, billing and documentation tips for effective reimbursement Beth Milligan, MD, FAAFP, CHCOM, CPE

2 Objectives Explain the importance of clinical documentation Understand the principles of documentation Understand the contents of the medical record Discuss how documentation impacts quality of care, health care outcomes and appropriate reimbursement

3 Billing and coding tips Many health care providers miss the opportunities to maximize reimbursement. Under-coding, omitting modifiers and submitting claims without the documentation needed to support them are everyday events.

4 Documentation matters CMS (Medicare) requires that all medical conditions evaluated and treated, as well as a patient s health history, past and present illness, and outcomes are documented in the medical record.

5 Fast track Beware of the tendency to code according to the complexity of the diagnosis rather than the extent of decision making involved. To bill for a Level 4 established patient visit, CPT (current procedural terminology) guidelines require you to fulfill 2 out of 3 following components: a detailed history, a detailed physical examination and medical decision making of moderate complexity.

6 99214 When the history and medical decision-making indicate a higher level of complexity, you can bill for a visit without having to count or document individual body systems or detailed exam elements. A new diagnosis with a prescription, an order for laboratory tests or X-rays, or a request for a specialty consult are all examples of moderate complex decision making.

7 99203/99204 In 2006, CMS data showed that family physicians billed 43.9 percent of new patient visits as Level 3 (99203) and just 28.5 percent as Level 4 (99204). Unlike a level 4 visit for an established patient, a code new patient visit is requires all 3 components-a detailed history, a detailed physical examination, and a moderate complex decision making.

8 99203/99204 A new patient visit for a 57-year-old female with congestion and cough and chest pain may warrant a if her medical history of obesity, hypertension and reflux made it necessary to rule out a cardiovascular disorder. This must be documented.

9 Modifier 25 Proper documentation is critical when using modifier 25 (procedure). In 2002, Medicare approved approximately 29 million claims using modifier 25, then disallowed nearly 35 percent of them for failing to meet the documentation requirements.

10 Modifier 25 If modifier 25 is used with Medicare, two separate progress notes and the work performed for each need to be clearly defined. Lesions needs to have the dimensions, depth and location documented in the targeted evaluation and management.

11 Know when to bill for prevention Patients who present for yearly health maintenance examinations with a new complaint may indicate using a modifier 25. The note must indicate significant and separate services.

12 Know when to bill for prevention Sometimes, the distinction can be harder to establish. If the acute or chronic problem evaluated is stable and closely related to the prevention examination, then it may not be necessary to submit an E/M code. If the problem or complaint is an exacerbation requiring a significant history, physical exam and treatment beyond what is typically performed during a routing preventative visit, then the E/M should be coded.

13 Time Sometimes a higher level E/M code based solely on time, regardless of the complexity of the medical history, physical exam, or decision making If more than half the time spent with the patient is devoted to counseling and coordination of care, time may be considered the key or controlling factor to qualify for a particular level of E/M service, according to CPT guidelines. Describe in detail the nature of the counseling or activities to coordinate care.

14 Dermatology procedures Focus on measurements. Generally the larger lesion has greater reimbursement. A biopsy generally indicates that only a portion of a lesion was removed to obtain a histologic diagnosis as in the case of a punch biopsy. Location also dictates the scale of reimbursement, which is typically lower for procedures involving the trunk, arms or legs than those on the face or anogenital region. Malignant lesions also generate higher charges

15 Welcome to Medicare exam Known when and how to bill a Welcome to Medicare visit This exam is within the first six months of enrollment and has seven elements, all of which are required for full reimbursement. To appropriately conduct and bill for this exam, create a template listing all the elements.

16 Prioritize diagnoses Patients present with multiple diagnosis during a single routine office visit. ICD-9 coding guidelines state that physicians should list first the ICD-9 CM code for the diagnosis, condition, problem or other reason for the encounter in the medical record to be chiefly responsible for the services provided, and then list additional codes that describe coexisting condition.

17 Prioritize diagnoses Listing the codes in order of importance lets the third-party payers known how to prioritize patient care. Define conditions which are acute, chronic and stable.

18 ICD-9 CM is outdated ICD-9 CM is 30 years old and technology is changing. Many of the existing categories are full and not descriptive enough.

19 ICD-10 CM Reimbursement Would enhance accurate payment for services rendered Quality Would facilitate evaluation of medical processes and outcomes

20 ICD-10 CM Fracture of wrist with ICD-9 does not identify left versus right and requires additional documentation. ICD-10 CM describes left versus right, initial encounter and subsequent encounters. It also describes routine healing, delayed healing, nonunion or mal-union

21 ICD-10 CM Incorporates much greater specificity and clinical information which results in: Improved ability to measure health services Increased sensitivity when refining grouping and reimbursement methodologies Enhanced ability to conduct public health surveillance Decreased need to include supporting documentation with claims Pat Brooks, CMS

22 ICD-10 CM 1990 Endorsed by World Health Assembly (diagnosis only) 1994 Release of full ICD-10 by WHO January 1, 1999 U.S. implemented for mortality (death certificates) 2002 ICD-10 published in 42 languages (including six official WHO languages) Implementation in 138 countries for mortality and 99 countries for morbidity

23 Documentation Why is it important? If it was not documented, it was not done Critical for patient care Serves as a legal document Quality reviews Validates the patient care provided Well-documented medical records reduce the re-work of claims processing Compliance with CMS and other payers regulations and guidelines Impacts coding, billing and reimbursement

24 Background CMS anticipated facilities would focus on documentation improvement in order to capture severity of illness and to increase their reimbursement 2011 Documentation and Coding Adjustment (DCA) was introduced by CMS

25 Background Determined that increase in reimbursement was due to better documentation and not due to the treatment of sicker patients Negative adjustments in reimbursement rate 5.8 percent in 2012

26 Bad documentation habits Documentation shortcuts are tempting for busy clinicians, and the innovations of EHRs have allowed for easier movement of information and made it easier to reuse previous documentation with a single click. The practice of reusing previous information can lead to serious consequences for both patient care and reimbursement.

27 Dangers of copy/paste The practice goes by several names copy and paste, cloning, carrying forward but it has the same effect on the integrity of the medical record. Without careful review of the information being copied from a previous encounter, it can cause contradictions in a patients record. It has been repeatedly observed that information may be copied that is not accurate. Past complaints or symptoms in current documentation can lead to a host of errors.

28 Dangers of copy/paste Many times physicians have clearly cut and pasted large blocks of text or even complete notes from other physicians. Copying the information can show repeat claims for services that were only performed once and can lead to over-reimbursement. Once copy and paste gets into the record, its credibility is compromised, and the auditor doesn t know what is accurate and how much work was actually done during the visit (versus a past visit).

29 Scribing Scribing can be harder to recognize in some EHR systems. In some instances, authenticating notes made by another person can be fraudulent if not acknowledged.

30 Scribing E.g. a medical assistant may complete a history and physical on a patient in totality, and the physician may log in to the record and electronically sign the document in a way that overwrites the presence of the medical assistant. This overwriting misrepresents who provided the service which can alter the amount that is billed. This can be fraud.

31 Documenting by exception Using pre-built text in an EHR or documenting by exception can cause problems. Poorly designed systems and poor practice can speed physicians past steps in performing and documenting care.

32 Team effort and communication Good communication between the medical staff and the coder is essential if invoices are to be completed accurately and efficiently. It includes billers and coders in staff meetings and especially when issues of efficiency and errors are on the agenda.

33 Team effort and communication Increasing the access of one party to the other will reduce errors and lost revenue. Many physicians have moved to outsourcing their billing and coding practices, and while this may save on costs, it limits communication between two parties, increasing the likelihood of mistakes and lost revenue.

34 Payers are taking notice Some payers have already enacted broad policies that condemn carrying forward documentation in any medium, electronic or paper. Clearly defined policies against copy/paste in the electronic record have not been established at some of the major insurance providers in this country. However, specific payer policies will probably increase as more providers use EHRs

35 Stopping bad habits Stopping bad documentation habits can be tough. Some EHR manufacturers have altered their systems to make practices like copy/paste impossible. Understand that the EHR is a tool for documentation but not an answer to documentation problems.

36 Be prepared Hospitals and clinics need to prepare for changes in future payment methodologies. Complete and concise documentation leads to correct coding, and correct coding leads to appropriate reimbursement.

37 Improving documentation Conduct an assessment of your current department by evaluating staffing needs and reviewing current medical record processes Identify areas that need improvement Benchmark performance Review coding and compliance policies and procedures Start a documentation improvement program or make improvements to your current one

38 Resources The Clinical Documentation Improvement Specialist s Handbook, Marion Kruse/Heather Taillon, 2011 Documentation Strategies to Support Severity of Illness, Robert Gold, MD 2005 Eliminating Waste and Fraud in Medicare and Medicaid, Deborah Taylor, 04/22/09,

39 Questions?

Elements of Successful Coding in Your Practice

Elements of Successful Coding in Your Practice Kim Huey, MJ, CPC, CCS-P, PCS, CPCO President, KGG Coding and Reimbursement Consulting April 16, 2015 Elements of Successful Coding in Your Practice Kim Huey, MJ, CPC, CCS P, PCS, CPCO for Medical Association

More information

ICD-10 FAQs for Doctors

ICD-10 FAQs for Doctors ICD-10 FAQs for Doctors What is ICD-10? ICD-10 is the 10 th revision of the International Classification of Diseases (ICD), used by health care systems to report diagnoses and procedures for purposes of

More information

Coding for the Internist: The Basics

Coding for the Internist: The Basics Coding for the Internist: The Basics Evaluation and management is the most important part of the practice for an internist and coding for these visits can have an important effect for the bottom line of

More information

Introduction to ICD-10: A Guide for Providers. Centers for Medicare & Medicaid Services

Introduction to ICD-10: A Guide for Providers. Centers for Medicare & Medicaid Services Introduction to ICD-10: A Guide for Providers Centers for Medicare & Medicaid Services 1 Table of Contents Compliance Date: October 1, 2014» What is ICD-10?» Why ICD-10 matters» Why transition to ICD-10»

More information

Documentation Bad Habits

Documentation Bad Habits Documentation Bad Habits Shortcuts in Electronic Records Pose Risk by Chris Dimick Electronic documentation habits such as copy and paste save valuable time, but they can ruin the record. As the patient

More information

ICD-10 FROM A NURSE PERSPECTIVE. Learning Objectives 4/22/2015. Adoption of ICD-10 Classification of Diseases CD-10-CM Diagnostic Codes

ICD-10 FROM A NURSE PERSPECTIVE. Learning Objectives 4/22/2015. Adoption of ICD-10 Classification of Diseases CD-10-CM Diagnostic Codes ICD-10 FROM A NURSE PERSPECTIVE Learning Objectives 1. New ICD-10-CM diagnostic system for Dermatology. 2. Impact of new codes on nursing and clinical support staff. 3. Education and resources available.

More information

Part 1 General Issues in Evaluation and Management (E&M) in Headache

Part 1 General Issues in Evaluation and Management (E&M) in Headache AHS s Headache Coding Corner A user-friendly guide to CPT and ICD coding Stuart Black, MD Part 1 General Issues in Evaluation and Management (E&M) in Headache By better understanding the Evaluation and

More information

6/8/2012. Cloning and Other Compliance Risks in Electronic Medical Records

6/8/2012. Cloning and Other Compliance Risks in Electronic Medical Records Cloning and Other Compliance Risks in Electronic Medical Records Lori Laubach, Partner, Moss Adams LLP Catherine Wakefield, Vice President, Corporate Compliance and Internal Audit, MultiCare 1 AGENDA Basic

More information

5/16/2014. Revenue Cycle Impact Documentation risks in an EMR AGENDA. EMR Challenges Related to Billing and Revenue Cycle

5/16/2014. Revenue Cycle Impact Documentation risks in an EMR AGENDA. EMR Challenges Related to Billing and Revenue Cycle EMR Challenges Related to Billing and Revenue Cycle Lori Laubach, Principal Health Care Consulting California Primary Care Association Billing Managers Peer Conference May 20 21, 2014 1 The material appearing

More information

9/15/2015. Learning objectives. Coding and compliance. Coding Compliance for the IDS Environment. Could Your Coding be Costing You Money?

9/15/2015. Learning objectives. Coding and compliance. Coding Compliance for the IDS Environment. Could Your Coding be Costing You Money? Coding Compliance for the IDS Environment Could Your Coding be Costing You Money? Nancy Enos, FACMPE, CPC-I, CPMA, CEMC MGMA 2015 Annual Conference Learning objectives 1. Discover how administrators of

More information

Few non-clinical issues have created as

Few non-clinical issues have created as How to Get All the 99214s You Deserve It s easier than you might think to get what s coming to you. Emily Hill, PA-C Few non-clinical issues have created as much controversy as the CPT codes for evaluation

More information

HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE

HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing & Reimbursement Revenue Cycle Management HOW TO PREVENT AND MANAGE MEDICAL CLAIM DENIALS TO INCREASE REVENUE Billing and Reimbursement for Physician Offices, Ambulatory Surgery Centers and Hospitals

More information

The Transition to Version 5010 and ICD-10

The Transition to Version 5010 and ICD-10 The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services

More information

Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc.

Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. Reasonable efforts have been made to provide the most accurate and current information on CPT 2015 code changes. However codes,

More information

ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard

ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard ICD-10 Lisa Kozakoff Principal Consultant Siemens Healthcare Lisa Kozakoff Principal Consultant Agenda Introduction

More information

Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011

Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 1 Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 The "Affordable Care Act" is coming on-line and has significant implications for the provision of Reproductive

More information

Patient Progress Note & Dictation Standard

Patient Progress Note & Dictation Standard Objective: The patient progress note serves as a basis for planning patient care, documenting communication between the health care provider and any other health professional contributing to the patient's

More information

EHR s-new Opportunities for the Confident Coder

EHR s-new Opportunities for the Confident Coder EHR s-new Opportunities for the Confident Coder Angela Jordan, CPC Chair AAPCCA Board of Directors Manager Coding and Compliance EvolveMD amjordan.cpc@gmail.com Objective EHR basics Basic knowledge of

More information

FAQs on Billing for Health and Behavior Services

FAQs on Billing for Health and Behavior Services FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare

More information

10/23/2010. Objectives. Coding Process. What is ICD-9-CM coding? HCPCS. What is CPT-4? Provide a basic understanding of the coding process

10/23/2010. Objectives. Coding Process. What is ICD-9-CM coding? HCPCS. What is CPT-4? Provide a basic understanding of the coding process Objectives Medical Coding and Billing HCMT 200 Provide a basic understanding of the coding process Understand the importance of complete, accurate documentation to the coding process Learn the benefits

More information

ICD-10 Readiness for Private Practice and Hospitals Presenter Lisa Asbell, RN ICD 10 Specialist

ICD-10 Readiness for Private Practice and Hospitals Presenter Lisa Asbell, RN ICD 10 Specialist ICD-10 Readiness for Private Practice and Hospitals Presenter Lisa Asbell, RN ICD 10 Specialist 1 Purpose of Today s Seminar #1. To motivate you to fully engage your organization in the ICD-10 transition.

More information

Gone are the days when healthy

Gone are the days when healthy Five Common Coding Mistakes That Are Costing You Fix these problems to increase your bottom line. GREG CLARKE Emily Hill, PA-C Gone are the days when healthy third-party reimbursements meant practices

More information

Palliative Care Billing, Coding and Reimbursement

Palliative Care Billing, Coding and Reimbursement Palliative Care Billing, Coding and Reimbursement Anne Monroe, MHA Physician Practice Manager Hospice of the Bluegrass and Palliative Care Center of the Bluegrass Kentucky 1 Objectives Review coding and

More information

The Transition to ICD-10. Topics to Be Covered. Compliance Date 9/13/2013

The Transition to ICD-10. Topics to Be Covered. Compliance Date 9/13/2013 The Transition to ICD-10 AAPC 2013 Dallas Regional Conference September 26, 2013 1 Topics to Be Covered ICD-10 compliance date ICD-10 overview Why the transition to ICD-10 Making the switch to ICD-10 CMS

More information

Mitigating Coding Risks. Concerns with electronic records and overcoding. Balancing Medical Necessity and Meaningful Use 2/20/2014

Mitigating Coding Risks. Concerns with electronic records and overcoding. Balancing Medical Necessity and Meaningful Use 2/20/2014 in the EHR Sandy Giangreco, RHIT, CCS, RCC, CPC, CPC H, CPC I, COBGC, PCS Senior Consultant The Haugen Consulting Group Kim Huey, MJ, CPC, CCS P, PCS, CPCO KGG Coding and Reimbursement Consulting, LLC

More information

Lesson 1. Introduction to Coding

Lesson 1. Introduction to Coding Introduction to Coding Medical coders review the documents in the patient s medical record and abstract (collect clinical data) or retrieve information from specific documents. They then assign numeric

More information

ICD-10 Transition ROLES AND RESPONSIBILITIES

ICD-10 Transition ROLES AND RESPONSIBILITIES Welcome to ICD-10 Transition ROLES AND RESPONSIBILITIES Training Spotlight for Physicians and Other Providers Topics for Discussion ICD-10 Transition: Roles and Responsibilities ICD-10 Overview A few facts

More information

Billing an NP's Service Under a Physician's Provider Number

Billing an NP's Service Under a Physician's Provider Number 660 N Central Expressway, Ste 240 Plano, TX 75074 469-246-4500 (Local) 800-880-7900 (Toll-free) FAX: 972-233-1215 info@odellsearch.com Selection from: Billing For Nurse Practitioner Services -- Update

More information

Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding

Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding Clinical Coding Diagnosis Codes Clinicians select ICD-CM codes to describe a patient s diagnoses, symptoms, and clinical findings.

More information

Modifiers 25 and 59. Modifier 25

Modifiers 25 and 59. Modifier 25 Modifiers 25 and 59 This article discusses the appropriate use of modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure

More information

EPEC. Education for Physicians on End-of-life Care. Trainer s Guide

EPEC. Education for Physicians on End-of-life Care. Trainer s Guide EPEC Education for Physicians on End-of-life Care Trainer s Guide Procedure/Diagnosis Coding and Reimbursement Mechanisms for Physician Services in Palliative Care EPEC Project, The Robert Wood Johnson

More information

FAQ for Coding Encounters in ICD 10 CM

FAQ for Coding Encounters in ICD 10 CM FAQ for Coding Encounters in ICD 10 CM Topics: Encounter for Routine Health Exams Encounter for Vaccines Follow Up Encounters Coding for Injuries Encounter for Suture Removal External Cause Codes Tobacco

More information

Step 2 Use the Medical Decision-Making Table

Step 2 Use the Medical Decision-Making Table Step 2 Use the Medical Decision-Making Table In Step 1, we determined the patient location and patient type. For most patient encounters, this determines the first 4 digits of the 5-digit CPT code. Three

More information

AHS s Headache Coding Corner A user-friendly guide to CPT and ICD coding

AHS s Headache Coding Corner A user-friendly guide to CPT and ICD coding AHS s Headache Coding Corner A user-friendly guide to CPT and ICD coding Stuart Black, MD Part 3 - Medical Decision Making (MDM) coding in Headache As stated in the CPT codebook, the classification of

More information

Forms designed to collect this information will help staff collect all pertinent information.

Forms designed to collect this information will help staff collect all pertinent information. 1 CPT AUDIT TOOL INSTRUCTIONS The Nursing Consultants from the Public Health Nursing and Professional Development Unit based on multiple Evaluation & Management audits across the state have developed these

More information

ASDIN 8th Annual Scientific Meeting

ASDIN 8th Annual Scientific Meeting WHO World Health Organization Developed in 1994 AN INITIAL UNDERSTANDING OF Sarah Reed, CPC Coding and Compliance Coordinator Meritas Health Corporation Implementation 138 countries mortality 99 countries

More information

E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM

E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM E/M coding workshop. The risk of not getting it right. PAMELA PULLY CPC, CPMA BILLING/CLAIMS SUPERVISOR GENESEE HEALTH SYSTEM Disclaimer This information is accurate as of December 1, 2014 and is designed

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

(For use with 1995 and 1997 CMS Documentation Guidelines for Evaluation & Management Coding )

(For use with 1995 and 1997 CMS Documentation Guidelines for Evaluation & Management Coding ) Appendix I: E/M Codebuilder (For use with 1995 and 1997 CMS Documentation Guidelines for Evaluation & Management Coding ) Introduction The evaluation and management (E/M) code reported to a third-party

More information

Speaker s Disclaimer

Speaker s Disclaimer Surviving the Conversion to ICD 10: A Glimpse of What s to Come Richard E. Moses, D.O., J.D. 2015 Annual Scientific Meeting Pennsylvania Society of Gastroenterology Lancaster Marriott at Penn Square Lancaster,

More information

A GUIDE TO EVALUATION & MANAGEMENT CODING AND DOCUMENTATION

A GUIDE TO EVALUATION & MANAGEMENT CODING AND DOCUMENTATION A GUIDE TO EVALUATION & MANAGEMENT CODING AND DOCUMENTATION Produced by ConnectiCare, Inc. in conjunction with its affiliate Group Health Incorporated TABLE OF CONTENTS Summary and Overview...Page 3 Part

More information

TUTORIAL: How to Code an Emergency Department (ED) Record

TUTORIAL: How to Code an Emergency Department (ED) Record TUTORIAL: How to Code an Emergency Department (ED) Record Welcome! Assigning ICD-10-CM codes to diagnoses and CPT/HCPCS Level II codes to procedures/services for emergency department office records can

More information

CPT Coding Update And Other Issues

CPT Coding Update And Other Issues CPT Coding Update And Other Issues Robert E. Smith, M.D. Alison Lynch, M.D. November 13, 2013 1 Disclaimer This information is for educational and informational purposes only, and represents the understanding

More information

Overview of ICD10 Transition Impact on Physician Practices Presented by Theresa Mendoza Director of Quality, BI and Data Services

Overview of ICD10 Transition Impact on Physician Practices Presented by Theresa Mendoza Director of Quality, BI and Data Services Overview of ICD10 Transition Impact on Physician Practices Presented by Theresa Mendoza Director of Quality, BI and Data Services What is ICD10? ICD10 is a diagnostic/procedural coding system implemented

More information

ICD-10-CM Transition

ICD-10-CM Transition KY HFMA Spring 2014 Annual Meeting ICD-10-CM Transition Heather Greene, MBA, RHIA, CPC, CPMA Vice President, Compliance Services AHIMA Approved ICD-10 CM/PCS Trainer Myth # 1 Implementation planning should

More information

ICD-9 Basics Study Guide

ICD-9 Basics Study Guide Board of Medical Specialty Coding ICD-9 Basics Study Guide for the Home Health ICD-9 Basic Competencies Examination Two Washingtonian Center 9737 Washingtonian Blvd., Ste. 100 Gaithersburg, MD 20878-7364

More information

Maximizing Third Party Reimbursement Through Enhanced Medical Documentation and Coding. Installment One of the Webinar Series

Maximizing Third Party Reimbursement Through Enhanced Medical Documentation and Coding. Installment One of the Webinar Series Maximizing Third Party Reimbursement Through Enhanced Medical Documentation and Coding Installment One of the Webinar Series Provides education and capacity building services to a variety of individuals

More information

BILLING FOR THE T.O.V.A.

BILLING FOR THE T.O.V.A. BILLING FOR THE T.O.V.A. Effective January 1st, 2006, CPT codes used for billing of psychological and neuropsychological tests were changed. Claims must now be filed using codes depending upon who performed

More information

GUIDE TO HOME HEALTH DIAGNOSIS CODES

GUIDE TO HOME HEALTH DIAGNOSIS CODES GUIDE TO HOME HEALTH DIAGNOSIS CODES Proper selection of diagnoses codes for the Medicare OASIS Assessment The process of selecting correct diagnosis codes for the OASIS Start of Care, Re-Certification

More information

Evaluation & Management. Guidelines. Presented by: Kristi A. Gutierrez CCS-P, CPC, CEMC

Evaluation & Management. Guidelines. Presented by: Kristi A. Gutierrez CCS-P, CPC, CEMC Evaluation & Management Documentation and Coding Guidelines Presented by: Kristi A. Gutierrez CCS-P, CPC, CEMC Objectives Participants will gain a working knowledge of Medicare s 1995 Evaluation & Management

More information

AHLA. HH. Introduction to Medical Coding for Payment Lawyers

AHLA. HH. Introduction to Medical Coding for Payment Lawyers AHLA HH. Introduction to Medical Coding for Payment Lawyers Robert A. Pelaia Senior University Counsel University of Florida Jacksonville Jacksonville, FL Institute on Medicare and Medicaid Payment Issues

More information

caresy caresync Chronic Care Management

caresy caresync Chronic Care Management caresy Chronic Care Management THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in

More information

South Dakota Medicaid ICD-10 Provider Education Series

South Dakota Medicaid ICD-10 Provider Education Series South Dakota Medicaid ICD-10 Provider Education Series Lori Lawson, Deputy Medicaid Director, DSS Jane Beth Turner, RHIA, AHIMA ICD-10 Approved Trainer, Cognosante 1 Agenda Brief overview of transition

More information

ICD 10 ESSENTIALS. Debbie Sarason Manager, Practice Enhancement and Quality Reporting

ICD 10 ESSENTIALS. Debbie Sarason Manager, Practice Enhancement and Quality Reporting ICD 10 ESSENTIALS Debbie Sarason Manager, Practice Enhancement and Quality Reporting October 29, 2015 CHANGING FROM 1CD 9 TO ICD 10 IN 2015 Rest of world has been using ICD 10 for decades World Health

More information

Medical Necessity: What Is It? Medical Necessity. What CMS and Payors Need

Medical Necessity: What Is It? Medical Necessity. What CMS and Payors Need Medical Necessity: What Is It? Documenting to Support Medical Necessity: What CMS and Payors Need Kim Huey, MJ, CPC, CCS P P, CHCC, PCS, CHAP for AAPC Regional Chicago October 2012 Medical Necessity Definition

More information

Glossary of Frequently Used Billing and Coding Terms

Glossary of Frequently Used Billing and Coding Terms Glossary of Frequently Used Billing and Coding Terms Accountable Care Organization (ACO) Accounts Receivable Reports All Inclusive Fees Allowances and Adjustments Capitation Payments Care Coordination

More information

* Dignity Health. Success

* Dignity Health. Success * Dignity Health. Tools for Success Table of Contents ICD 10 Overview Physician Practice Checklist Financial Planning for ICD 10 ICD 10 Education for Physicians ICD 10 Education for Staff ICD 10 Impacts

More information

Question and Answer Submissions

Question and Answer Submissions AACE Endocrine Coding Webinar Welcome to the Brave New World: Billing for Endocrine E & M Services in 2010 Question and Answer Submissions Q: If a patient returns after a year or so and takes excessive

More information

Introduction to Medical Coding For Lawyers

Introduction to Medical Coding For Lawyers American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues March 20-22, 2013 Introduction to Medical Coding for Payment Lawyers Robert A. Pelaia Senior University Counsel for

More information

Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas

Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas Billing and Coding in Neurology and Headache Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas CPT Codes vs. ICD Codes Category

More information

Non-Physician Practitioner Services Coding & Reporting. Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013

Non-Physician Practitioner Services Coding & Reporting. Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013 Non-Physician Practitioner Services Coding & Reporting Karla R. Peter, RHIT, CCS, CCS-P, CPC Avera Health September 6, 2013 Medical Necessity Overarching Criterion Medicare Claims Processing Manual, Chapter

More information

The Official Guidelines for coding and reporting using ICD-9-CM

The Official Guidelines for coding and reporting using ICD-9-CM Reporting Accurate Codes In the Era of Recovery Audit Contractor Reviews Sue Roehl, RHIT, CCS The Official Guidelines for coding and reporting using ICD-9-CM A set of rules that have been developed to

More information

Defining the Core Clinical Documentation Set

Defining the Core Clinical Documentation Set Defining the Core Clinical Documentation Set for Coding Compliance Quality Healthcare Through Quality Information It is time to examine coding compliance policy and test it against the upcoming challenges

More information

Documentation Guidelines for Physicians Interventional Pain Services

Documentation Guidelines for Physicians Interventional Pain Services Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record

More information

Initial Preventive Physical Examination

Initial Preventive Physical Examination Initial Preventive Physical Examination Overview The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expanded Medicare's coverage of preventive services. Central to the Centers

More information

Billing Information - CPT and other Sources: Women s Health Screening

Billing Information - CPT and other Sources: Women s Health Screening Billing Information - CPT and other Sources: Women s Health Screening Getting Paid for Prevention Getting paid for preventive services depends on correct coding. Here's how to code four common types of

More information

Slide 1 DEPLOYMENT HEALTH CODING AND DOCUMENTATION Col (s) Roger Gibson Military Public Health OSD (HA) Clinical Programs and Policies

Slide 1 DEPLOYMENT HEALTH CODING AND DOCUMENTATION Col (s) Roger Gibson Military Public Health OSD (HA) Clinical Programs and Policies Slide 1 DEPLOYMENT HEALTH CODING AND DOCUMENTATION Col (s) Roger Gibson Military Public Health OSD (HA) Clinical Programs and Policies We are here today to discuss Coding and Documentation as it relates

More information

Health Information Technology Courses

Health Information Technology Courses Health Information Technology Courses Course ID Course Title Credits HIT-100 Introduction to Healthcare 3 HIT-110 Medical Terminology I 3 HIT-120 Medical Terminology II 3 HIT-130 Medical Transcription/Editing

More information

Program and list of learning outcomes from syllabi, with highlighted essential learning outcomes that will be assessed in future for program outcomes

Program and list of learning outcomes from syllabi, with highlighted essential learning outcomes that will be assessed in future for program outcomes Key Core Courses for Health Care Office Management Program and list of learning outcomes from syllabi, with highlighted essential learning outcomes that will be assessed in future for program outcomes

More information

Importance of Auditing

Importance of Auditing Medicare 201: Practitioner Importance of Auditing EY Fraud Investigation and Dispute Services Jennifer Shimek, Senior Manager Gretchen Segado, Manager Agenda Importance of Auditing National and Local Coding

More information

Getting Ready for ICD-10. Part 1: The Basics

Getting Ready for ICD-10. Part 1: The Basics Getting Ready for ICD-10 Part 1: The Basics Introduction In the United States, on October 1, 2015 the ICD 9 code set used to report medical diagnoses and inpatient procedures will be replaced by the International

More information

Basics of Medical versus Vision Coding

Basics of Medical versus Vision Coding Basics of Medical versus Vision Coding Marcus Gonzales, OD TOA Convention 2011 DISCLAIMER This lecture and the concepts within apply to CPT and Medicare/Medicaid guidelines that are currently applicable,

More information

ICD-10 Overview. The 411 on ICD-10. Camillia Harris, ICD-10 Communications Lead Eric Hendrick, ICD-10 Functional Deputy Project Lead

ICD-10 Overview. The 411 on ICD-10. Camillia Harris, ICD-10 Communications Lead Eric Hendrick, ICD-10 Functional Deputy Project Lead ICD-10 Overview The 411 on ICD-10 Presented by: Camillia Harris, ICD-10 Communications Lead Eric Hendrick, ICD-10 Functional Deputy Project Lead June 18, 2013 0 Mission We will provide Georgians with access

More information

ICD-10-CM. Objectives

ICD-10-CM. Objectives ICD-10-CM What is it? Why? Now What? Debbie Johnson, RHIT, CHP American Health Care Association Webinar September 12, 2013 Objectives Learn what ICD-10-CM is what the main differences in ICD-9 and ICD-10

More information

ICD-10 Preparation for Dental Providers. July 2014

ICD-10 Preparation for Dental Providers. July 2014 ICD-10 Preparation for Dental Providers July 2014 What is ICD-10? The International Classification of Diseases (ICD) is a set of codes used worldwide to classify medical diagnoses and inpatient procedures.

More information

Preparing for ICD-10 WellStar Medical Group Toolkit

Preparing for ICD-10 WellStar Medical Group Toolkit Preparing for ICD-10 WellStar Medical Group Toolkit Preparing for ICD-10 On Oct. 1, 2015, WellStar will transition from ICD-9 to ICD-10 coding for all medical diagnoses and hospital procedures Systemwide.

More information

ALZHEIMER S DISEASE CAREGIVING ADVISORY GROUP

ALZHEIMER S DISEASE CAREGIVING ADVISORY GROUP - 1 - ALZHEIMER S DISEASE CAREGIVING ADVISORY GROUP Convened by the National Alliance for Caregiving Through generous funding of Wyeth & Élan Alliance April 8, 2009 - 2 - Represented Organizations Alzheimer

More information

Chapter 2 Coding, Billing, and Reimbursement for Procedures

Chapter 2 Coding, Billing, and Reimbursement for Procedures Chapter 2 Coding, Billing, and Reimbursement for Procedures Cathryn B. Heath Introduction Coding, billing, and reimbursement are an integral part of the procedures performed in today s modern medical office.

More information

Revenue Cycle Management: The steps Title X agencies must take to get paid

Revenue Cycle Management: The steps Title X agencies must take to get paid Revenue Cycle Management: The steps Title X agencies must take to get paid Webinar 2: Revenue Cycle Management: After the Client Visit August 7 th, 2013 Intended Audience Title X Grantee and sub-recipient

More information

EMR Pearls and Perils

EMR Pearls and Perils EMR Pearls and Perils Presented by Bruce Rappoport, MD, CPC, CHCC All rights reserved Today s EMR Data Points Selection Implementation Upgrades Documentation Payer communications Coding 1 Documentation

More information

CPT 99213. The Key to E/M Documentation (and Reimbursement)? Rick Horsman DPM Olympia, WA

CPT 99213. The Key to E/M Documentation (and Reimbursement)? Rick Horsman DPM Olympia, WA CPT 99213 The Key to E/M Documentation (and Reimbursement)? Rick Horsman DPM Olympia, WA CodinglinePRINT www.codingline.com/silver.htm www.apmacodingrc.com COGNITIVE VS. PROCEDURAL SERVICES Cognitive Services

More information

Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA

Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA Transitioning from ICD-9-CM to ICD-10-CM Tidewater Physicians Multispecialty Group Williamsburg, VA February 22, 2014 Our Agenda Some guidelines for this morning s presentation Our Transformational Point

More information

Coding and Billing. General Office Billing Guidelines Scroll to page 1. Key Terms.. Scroll to page 2

Coding and Billing. General Office Billing Guidelines Scroll to page 1. Key Terms.. Scroll to page 2 OVER VEIW General Office Billing Guidelines Scroll to page 1 Key Terms.. Scroll to page 2 Coding for Evaluation and Management Services..Scroll to page 2 Frequently Used Common Procedural Codes.. Scroll

More information

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC.

Ms. Jackson is the Manager of Health Finance and Reimbursement, Division of Health Policy and Practice Services, Washington, DC. Electrodiagnostic Testing with Same Day Evaluation Management By: Shane J. Burr, MD; Scott I. Horn, DO; Jenny J. Jackson, MPH, CPC; Joseph P. Purcell, DO Dr. Burr practices general inpatient and outpatient

More information

Oral Health Coding Fact Sheet for Primary Care Physicians

Oral Health Coding Fact Sheet for Primary Care Physicians 2015 Oral Health Coding Fact Sheet for Primary Care Physicians CPT Codes: Current Procedural Terminology (CPT) codes are developed and maintained by the American Medical Association. The codes consist

More information

Introduction to ICD - 10. Andrea Devlin, CPMA, CPC Alta Partners, LLC 2015

Introduction to ICD - 10. Andrea Devlin, CPMA, CPC Alta Partners, LLC 2015 Introduction to ICD - 10 Andrea Devlin, CPMA, CPC Alta Partners, LLC 2015 Agenda Introduction Benefits of ICD-10 Features of ICD-10 ICD-9 vs. ICD-10 ICD-10 Structure Question & Answer Introducing ICD-10

More information

Welcome to How to Make a Successful Transition to ICD 10 CM. IHS Organizers: Housekeeping

Welcome to How to Make a Successful Transition to ICD 10 CM. IHS Organizers: Housekeeping Welcome to How to Make a Successful Transition to ICD 10 CM Presenter: Amy Hayes MBA, CCS, CCS P, CHA, CMBS Owner The Office Assistant, LLC www.oabilling.com IHS Organizers: Suzanne Hill Professional Development

More information

Road Map to ICD-10 CM ( (Alternate Route Required) Disclosures. Topics for Discussion. No relevant relationships were disclosed

Road Map to ICD-10 CM ( (Alternate Route Required) Disclosures. Topics for Discussion. No relevant relationships were disclosed Road Map to ICD-10 CM ( (Alternate Route Required) Presented by Teresa Thompson, CPC TM Consulting, Inc TMConsultingfirm@icloud.com Disclosures No relevant relationships were disclosed Topics for Discussion

More information

Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today

Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today Currently in the United States, ICD-9 is the code set used to report diagnoses and inpatient procedures. ICD-9 stands

More information

Re: Horizon Blue Cross Blue Shield of New Jersey Inappropriate Application of Modifier 25

Re: Horizon Blue Cross Blue Shield of New Jersey Inappropriate Application of Modifier 25 February 5, 2015 Glenn Pomerantz, MD, JD Vice President and Chief Medical Officer Horizon Blue Cross Blue Shield of New Jersey 3 Penn Plaza East Newark, NJ 07105 Re: Horizon Blue Cross Blue Shield of New

More information

Georgia Medicaid ICD-10 Presentation. June 2015

Georgia Medicaid ICD-10 Presentation. June 2015 Georgia Medicaid ICD-10 Presentation June 2015 Agenda Objectives ICD-10 Updates ICD-10 Importance ICD-10 Policy Updates ICD-10 and Patient Care ICD-10 Resources Interactive Voice Response System (IVRS)

More information

ICD-10-CM AND THE EMERGENCY PHYSICIAN

ICD-10-CM AND THE EMERGENCY PHYSICIAN ICD-10-CM AND THE EMERGENCY PHYSICIAN BACKGROUND Technically known as the International Statistical Classification of Diseases and Related Health Problems, the International Classification of Diseases

More information

Modifier -25 Significant, Separately Identifiable E/M Service

Modifier -25 Significant, Separately Identifiable E/M Service Manual: Policy Title: Reimbursement Policy Modifier -25 Significant, Separately Identifiable E/M Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM028 Last Updated:

More information

1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES

1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES 1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES 1.1 ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES Welcome to the ICD-10-CM, Skilled Nursing Facilities, and Lab Services training. Please

More information

CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes

CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes Understanding CCM Chronic Care Management (CCM) is defined as the non-face-to-face services provided to Medicare

More information

Preparing for ICD-10. Preparing for ICD-10. Preparing for ICD-10

Preparing for ICD-10. Preparing for ICD-10. Preparing for ICD-10 Preparing for ICD-10: What You Should Be Doing Now PHCA November 11, 2014 Presented by: Reinsel Kuntz Lesher LLP Senior Living Services Consulting Stephanie Kessler, Partner Karin Sherman, Senior Consultant

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Documentation and Reporting Guidelines for Evaluation and Management Services NY Policy: 0024 Effective: 12/01/2013-03/31/2014 Coverage is subject to the terms, conditions, and limitations of

More information

Frequently Asked Questions about ICD-10-CM/PCS

Frequently Asked Questions about ICD-10-CM/PCS Frequently Asked Questions about ICD-10-CM/PCS Q: What is ICD-10-CM/PCS? A: ICD-10-CM (International Classification of Diseases -10 th Version-Clinical Modification) is designed for classifying and reporting

More information