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Category Archives: Medical coder certification updates

OBGYN coder seeking REMOTE job

I am seeking my first REMOTE coding opportunity. I am currently coding OBGYN, and have for 9 years, in a large private practice and have mastered all aspects of billing to include coding, claims, denials, payment posting, revenue cycle management, AR and collections. As project manager or team member, I have been identified by physicians, management, and peers as having leadership abilities. I am extremely responsible, have a tremendous work ethic and thrive on multitasking to complete a high volume workload with 97% accuracy rate.

If you are aware of any opportunities, please reach out.

Sincerely,

Jenna Seidlitz, CPC
jmhenslin@hotmail.com

Medical Billing and Coding Forum – Resume Postings

Internal auditing strategies for ongoing ICD-10 success

Internal auditing strategies for ongoing ICD-10 success

Editor’s note: This article was modified from HCPro’s latest long-term care title, ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care, written by Maureen McCarthy, BS, RN, RAC-MT, and Kristin Breese, BSN, BSed, RN, RAC-MT. The complete book helps facilitate ongoing ICD-10 success by arming SNF readers with information and strategies that target the preparation, implementation, and maintenance phases of the fast-approaching coding transition. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com.

 

With the October 1 implementation date of ICD-10 now on a fast track to fruition?and no further delays in sight?even the most committed holdouts in the provider community have kicked off initiatives to ensure staff, outside business partners, and workflows can withstand the major coding transition.

To ensure that preparations made over the past months (or years) ultimately pay off, SNFs should start laying the groundwork for regular facility-wide audits of ICD-10 systems in the aftermath of implementation?a proactive approach that can help providers verify the strength of ongoing transition efforts and catch any snags before they disrupt essential facility processes.

Thus, although the word "audit" can provoke fear and anxiety in providers?often connoting scrutiny and penalties when administered by Medicare contractors?facilities can head off these unsavory external audits, or at the very least reduce negative outcomes, by conducting their own internal varieties.

In a broader sense, frequent self-audits can promote overall business vitality by facilitating the development and maintenance of sustainable processes across the facility, particularly in the face of the impending overhaul to coding methodology and practice.

 

The scope of self-audits

The Office of Inspector General (OIG) considers ongoing monitoring and evaluation important elements of a healthcare organization’s compliance program and identifies two overarching types of reviews:

1.Standards and procedures reviews, which measure whether internal standards are current and complete, or are in need of an update to reflect regulatory changes

2.Claims submission audits, which gauge whether coding, billing, and documentation are in compliance with payer and government contractors, as well as whether services performed are reasonable and support medical necessity

The OIG states that self-audits, which generally fall into the second category of reviews, can accomplish an array of verification processes. More specifically, the agency explains that these audits can be used to determine whether:

  • Bills are accurately coded and reflect services provided
  • Documentation is complete and correct
  • Services or items provided are reasonable and necessary
  • Any incentives for unnecessary services exist

The baseline audit

SNFs should launch a baseline audit after the first three months of ICD-10 implementation. This initial evaluation will help providers identify areas that need improvement or education. To shape baseline (and subsequent) audits, facilities should consider the following list, which identifies key aspects of major operational areas the ICD-10 transition is likely to affect:

1.Documentation

2.Coding/billing in the electronic health record system

3.Guidelines

4.Education

5.Strategic considerations

 

Subsequent audits

Once SNFs have completed their baseline audits, they should analyze the outcomes to develop an auditing compliance plan, which can function as staffs’ blueprint for future documentation, coding, and billing.

The ICD-10 task force, or transition team, should appoint a post-ICD-10 committee to review initial implementation results, evaluate success against established criteria, and identify what works and doesn’t work, especially in the revenue cycle, health information management, and IT realms.

Prior to the October 1 kickoff, this committee should determine which measures will be tracked and collect related preliminary data.

Following the go-live date, this committee?and the facility at large?must be on the lookout for significant post-implementation issues, including claims denials and rejections or coding backlogs. The committee must quickly identify such issues, create feedback loops, and follow the established solution path to remediation?a task that’s best facilitated by routine auditing of both claims and supportive documentation in a patient’s medical record.

Facilities should track all ICD-10 submissions and receipts for 3?6 months after the transition. Quality assurance monitoring should focus on ensuring proper receipt of ICD-10 codes by vendors and payers. Providers should also be sure to address all communications from these sources, as well as trading partners and CMS.

 

Key takeaways

Routine review of ICD-10 coding will soon become an essential function of all facilities’ quality monitoring systems and resulting performance improvement plans. Auditing documentation for sufficient data to support specificity in ICD-10 diagnosis coding should begin 2?3 months prior to the transition and continue well after October 1. Conducting ongoing auditing is crucial to update or solidify processes that underlie, facilitate, and support ICD-10 coding and claim submission, thereby ensuring a hassle-free conversion to the new system.

HCPro.com – Billing Alert for Long-Term Care

Calcinosis Cutis Excision

I am coding for a surgical excisional biopsy of a calcinosis cutis of the left heel. The lesion appears to be 5mm in diameter where two semi-elliptical incisions are made to excise the entire lesion 1.6 cm with a width of 6mm.

I am having a hard time finding a CPT code for this. Has anyone seen this done in the past?

Thank you!

Medical Billing and Coding Forum – Podiatry

Documentation requirements for bilateral procedures

Does anyone have a reference for documentation requirements for symmetric procedures? We’ve searched high and low and cannot find a good source. We’re trying to determine if the provider is documenting sufficiently. Any help would be appreciated!

Medical Billing and Coding Forum – ENT/Otolaryngology

Modifier q6

This is my first time using a locum, she is filling in for my audiologist. I am using modifier Q6 attached to CPT 92557 & CPT 92567 and I am getting denial from Medicare reason code 4 – The procedure code is inconsistent with the modifier used or required modifier is missing. Do I need a second modifier? I can not find any current info on the Medicare website & what I do find is not clear. Any help would be greatly appreciated!

Medical Billing and Coding Forum – Modifiers

Confusion with employer verbage

I am currently employed as an LPN with 30 yrs of Office Nurse experience , as well in that time for 10 yrs Nurse Manager and 2 yrs Office Manager I changed positions when the group I worked with dissolved. For the last 2 1/2 yrs working as an office Nurse in that time I was fortunate enough to take an on line class and very recently obtained my CPC-A
My question is that the clinic I work with now recognizes only Level I or Level II coder I honestly don’t understand how to respond to their query as to my status I have explained that I have several yrs of ICD-9 coding experience as well as the certificate for completion from Bryant and Stratton for ICD-10,CPT and HCPSII in addition to the CPC-A recently obtained.
I’m certain this is a pay issue and have asked administration what qualifications are required for either the Level I or II position and am still waiting for a response I understand they have never hired a CPC or CPC-A, I’m just not sure how best to respond to their question regarding the Level I vs II status,I have googled with little help
Any direction here would be appreciated
Thank you Cheri

Medical Billing and Coding Forum – Employment General Discussion

coding for pre-op

Good Morning, My internal med Doc does pre-op exams for the patient’s specialist. Am I able to code "pre-op" exam for two visits, the first visit would be the initial request by specialist and reviewing chart with decision based on what is in the chart. The second visit may be needed as a followup because our Doc had to send the patient out for further testing: labs, echo, xray…and then come back for that second visit to review and then make the medical decision. Is this ok in some instances especially when a patient has not had any of the above tests in a year or so? thank you….Marla

Medical Billing and Coding Forum – Internal Medicine

Austin bunionectomy

HELP! new to podiatry coding can anyone help with this coding

POSTOPERATIVE DIAGNOSES:
1. Left foot hallux abductovalgus deformity.
2. Left fifth digit adductovarus hammertoe deformity.
3. Left first metatarsophalangeal joint gouty tophi.

PROCEDURES:
1. Left foot Austin bunionectomy with screw fixation and
medial capsulorrhaphy.
2. Left fifth digit skin plasty for adductovarus deformity
correction.
3. Left first metatarsophalangeal joint excision of gouty
tophi.

PATHOLOGY: Left first MPJ gouty tophi.

ANESTHESIA: MAC sedation with IV anesthetic of 1% lidocaine
plain, 20 mL.

MATERIALS: Stryker 3.0 headed screw, 2-0 Vicryl, 3-0 Vicryl, and
4-0 nylon.

INJECTABLES: 1 mL of dexamethasone given postoperatively as
well as 10 mL of 0.5% Marcaine plain.

TECHNIQUE: The patient presented to the preoperative holding area having been n.p.o. past midnight. All preoperative studies were reviewed and discussed with the patient as well as the risks and benefits. The patient wished to proceed with the proposed procedure. The left lower extremity was marked with indelible ink. The patient received preoperative IV antibiotic of 2 g Ancef.

The patient was then transported to the operating room and placed on the operating room table in supine position. Following this, a time-out was then called between myself, anesthesiologist, surgical nurse, and surgical tech about the procedure to be performed as well as the location of the procedure. All were in agreement. Following IV sedation, the left pneumatic ankle tourniquet was then placed to a well padded area above the ankle joint. A Mayo block was then performed over the left first ray as well as reverse Mayo block for the fifth digit. The foot was then scrubbed, prepped and draped in the usual aseptic manner.

Attention was then directed to the left foot hallux abductovalgus deformity. An incision was made medial to the extensor hallucis longus tendon, contouring this to the deformity itself. The incision was then brought through skin into the subcutaneous tissue. Care was taken to retract any neurovascular structures. Upon doing so, a linear capsulotomy was then performed over the left first metatarsophalangeal joint. The head was then fully exposed and noted to have 1 x 1 cm gouty tophi medial to the metatarsophalangeal joint. This was resected in total and separate from the surrounding bone and soft tissue. The specimen was then passed from the operative field and sent to Pathology for further analysis. Attention was then directed back to the incision site within the left first interspace. The adductor conjoined tendon was then released. Attention was then directed
back to the left metatarsal head. The medial eminence was then slightly dissected to create a flat surface. After this, an Austin bunionectomy was then performed with a sagittal saw with a through-and-through cut through the head of the metatarsal with dorsal arm slightly longer. The capital fragment was then shifted laterally and temporarily fixated with a K-wire from the Stryker screw set. Under fluoroscopic guidance it was noted to be in excellent alignment. A Stryker 3.0 screw was then placed through the cannulated wire into the area under Stryker manufacturer guidelines. Noted in excellent compression and alignment well stable. K-wire was then removed. Further medial eminence was then resected as such to create a smooth surface as well as a barrel bur to smooth out any rough edges. The capsulotomy was then sutured closed with 2-0 Vicryl, but upon doing so it was decided to do a medial capsulorrhaphy to help bring the hallux in a more corrected position, thus a wedge capsulorrhaphy was then removed from the medial side of the left first metatarsophalangeal joint and was sutured/tightened closed, noting the hallux in a more corrective alignment. The rest of the capsule was then closed with 2-0 Vicryl. A wet sponge was then placed in the area.

Attention was then directed to the left fifth digit, where an adductovarus hammertoe deformity was noted. Upon mapping out the skin edges, a semi-elliptical incision was made about the proximal interphalangeal joint. By doing so, a wedge of skin was removed, and by holding the 2 skin edges together it was noted to bring the toe itself in a more corrective rectus position. Thus the area was sutured closed with 4-0 nylon.

All areas were then reevaluated under fluoroscopic guidance and noted to be in excellent alignment. Attention was then directed back to the left first metatarsophalangeal joint of the hallux abductovalgus deformity. A running subcuticular stitch with 3-0 Vicryl was then performed. Mastisol was placed about the area. Steri-Strips were then placed around the skin edges to help keep closure. One mL of dexamethasone as well as 10 mL of 0.5% Marcaine plain was then injected about the region. Areas were then dressed with Betadine-soaked Adaptic, 4 x 4’s, gauze and Kling. Tourniquet was then deflated and immediate hyperemia returned to all digits of the left foot. The left foot was then placed in a slipper cast for added protection. The patient was then transferred to the postoperative holding area with vital
signs intact as well as vascular structures intact to the left foot.

Medical Billing and Coding Forum – Podiatry

Application of Cryotherapy Billing

Hello All,

I am in search of a CPT (if one exists) that would be suitable to use for the application of a cryotherapy device for the following reasons:

Improve recovery time after intense activity or exercise
Increase energy and metabolism
Decrease inflammation in the body (arthritis and other chronic pain conditions etc.)
Faster recovery post-surgery – combined with physical therapy
Increase range of motion
Relieve tendonitis

The unit being used is made by cryousasolutions

I’ve searched via google and bing trying to find a CPT…I myself am leaning towards 97010 as the only option but upper management believes that there may be another applicable code so that we may receive reimbursement. We are not a DME vendor (so no HCPCS).

I think the cryotherapy devices for PT services, unfortunately, fall under the cold pack therapy which most insurance carriers will not pay.

Any feedback will be helpful.

Thanks!

Medical Billing and Coding Forum – Chiropractic