Posted and filed under YouBeTheCoder.

You Be the Coder: July

Test your knowledge The Advanced Beneficiary Notice of Non-coverage (ABN)  A 67 year old Medicare patient comes into the office for a cosmetic skin procedure. The following day the billing office staff checked and found the reason for service was not medically reasonable as per the Local Coverage Determination. The patient had not been made…

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Posted and filed under Healthcare.

The Realities of Snoring and its Long-Term Effects

Snoring is often laughed about, but it is no joking matter. Chronic loud snoring, waking up choking or gasping for air, and cessation of breathing while sleeping for short periods of time are common symptoms of a condition called obstructive sleep apnea.  Sleep apnea affects nearly 22 million Americans, and according to the Cleveland Clinic,…

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Posted and filed under Coding, Compliance, Healthcare.

How to Code Transitional Care Management

Transitional Care Management (TCM) codes are used to report patients who are transitioning from inpatient hospital, observation, skilled nursing/nursing facility, or rehabilitation to the patients’ normal community settings such as their home, domiciliary, rest home or assisted living settings. The patient’s transition to a normal community setting is not the only requirement of the TCM…

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Posted and filed under Coding, Healthcare.
health revenue

Mining for Revenue: Turning 15 Cents into an HMO Dollar

Like most clinics, your office has probably decided to accept Medicare Advantage plans by now. So what is your plan of attack? Most providers are going to say that it is time to get each patient enrolled in these plans into the office for the all-important health assessment. Most office managers are going to prepare…

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Posted and filed under YouBeTheCoder.
people learning

You Be the Coder: June

38 year old Female presented to the office for scheduled Essure sterilization. Patient identified, local anesthesia administered and the patient was placed in dorsal recumbent position. The physician uses a speculum to open the cervix and then places the hysteroscope to carry the coils into the fallopian tubes. Multiple attempts were taken to place the…

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Posted and filed under Coding.
ekg line

Coding for Cardiac Catheterization

Cardiac catheterization is a diagnostic test to examine the heart or coronary vessels or both. There are two sets of codes differentiated by examination for congenital and all other conditions. The corresponding “code map” demonstrates correct coding for noncongenital cardiac catheterizations. Regardless of the target disease cardiac catheterization includes: conscious sedation, introduction, roadmapping angiography, positioning…

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Posted and filed under Coding, Healthcare.
stethoscope

History of Present Illness: Severity

Severity is a statement or a rating of intensity (0-10) from the patient that indicates the degree or measurement of how bad the chief complaint is. This rating not only is documented based on 0-10 scale, but it can be captured using phrases such as: worsening, improving, and increasing. An auditor performing a medical necessity…

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Posted and filed under Healthcare.
health costs

Template to Fulfill Home Health Requirements

Open door forums are being held to discuss the use of a template to aid in fulfilling the face-to-face requirement for Medicare beneficiaries receiving home health care. “In fiscal year (FY) 2014, the Comprehensive Error Rate Testing (CERT) program found that more than half (51.4 percent) of the home health claims were paid improperly. Of…

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Posted and filed under Coding, Healthcare.
pain management

Pain Management Specialty

The pain management specialty has seen more than its share of coding and reimbursement changes throughout the past few years. 2015 brought another round of changes for this specialty: a major revision to a commonly used coding set, reimbursement rate changes, and bundling of needle placement guidance with joint injections, to name a few.  …

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Posted and filed under FWA, Healthcare.
Gavel and Stethescope

12 Healthcare Fraud, Waste, & Abuse Facts

Fraud accounts for 19% of the $600 to $800B in waste in the U.S. healthcare system annually, including everything from bogus Medicare claims to kickbacks for worthless treatments and other services. 57% of insurers expect to see an increase in fraud losses this year on personal insurance lines (mainly auto and home insurance), while only 5% of…

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