Medical Coding Career

ICD 10 is scarry and ICD 11 is comming

2011-10-16T00:05:00.000-07:00

ICD 10 came into use among the WHO member countries in 1994 and the United States completed revising ICD 10 to ICD-10-CM in 2003 and it then took more than a decade for the United States to implement ICD-10-CM i.e. in 2013. Implementation of ICD-10-CM in Oct 2013 is usually described as Y2K of medical coding, because of the huge transition that involves not only medical coding training but also transition of IT system associated with the revenue cycle management of providers and payers. This implementation will cause backlogs for several months and even after complete transition productivity will come down due to complexity of ICD-10-CM. The ICD-10-CM is so complex and extensive that crosswalk software would not produce desired results as it will throw too many options to choose from and thus requiring the coders to work more like an analyst than rather a medical coder of present day.

Now, many are asking the question that since ICD 11 is in development then why not directly implement ICD 11 instead of ICD 10. The alpha draft of ICD 11 was made online in July in 2011 and the final draft is expected to be available by 2015. Although ICD 11 will be ready by 2015, it may take at least two decades for its implementation in the United States. According to a study, ICD 10 implementation will cost around six to 14 billions dollars in a time span of three-years. This is a costly investment by the US health care industry and hence the industry will not be ready anytime soon to spend another 10-20 billions dollars for ICD 11 implementation.

Intraoperative Radiation Therapy CPT Codes

2011-10-06T08:26:00.000-07:00

New CPT codes for intraoperative radiation therapy have been introduced and are to be used beginning 2012 . These new codes for electronic brachytherapy are as follows:

77424 IORT delivery, x-ray, single treatment session
77469 IORT management

Electronic Brachytherapy is a minimally invasive procedure and is completed in just one session. This allows the patient to resume normal life activities sooner than any other therapy present today . Other therapeutic alternatives for intraoperative radiotherapy require five to seven weeks of treatment courses.

AHIMA approves Career Step Medical Coding Course

2011-10-06T07:50:00.000-07:00

Career Step's inpatient and outpatient medical coding and billing online courses have been approved by AHIMA. Career Step is a leading online training school for entry-level medical coding and billing professionals for years. They have gained national level repute and respect for their training methods and professionalism. They have a placement cell for the students they train and have placed students with 700 companies. Apart from medical coding and billing, Career Step also has training courses in medical transcription, pharmacy assistant, and administrative assistant.

Career Step has recently been listed among the top educational institutes in the Inc. Magazine's 5000 list of private American companies. Career Step has also won several honors and awards at the national level.

ICD 10 would bring more opportunites for coders

2011-09-24T09:45:00.000-07:00

ICD 10 implementation is usually described as Y2K of medical coding. As Y2K brought huge opportunities for software professionals, ICD 10 would do the same for medical coding professionals. Coding is going to become much more complex and coders would be required to apply their analytical skills to choose from 100's of codes rather than just remembering a few codes.

Productivity will go down by about 23-50%. Even after complete transition, coding productivity will not reach the Pre-ICD-10 levels so hospitals will be required to hire new coders to compensate for lower productivity. It is also expected that many senior coders who are in their fifties and sixties would leave their jobs rather than learn the new system, thus creating opportunities for the new coders. Also, ICD 10 implementation will require the creation of new data analyst positions in the hospitals thus increasing the opportunities for medical coders.

Coding Depression

2011-09-24T09:25:00.000-07:00

Here is a list of some of the common depression codes.

Depression NOS 311

Depression with Anxiety 300.4
Depression Recurrent 296.30
Depression Situational 309.0
Major Depression Nos 296.20
Depression Reactive 300.4
Manic Depression 296.80
Depression Psychotic 296.20
Neurotic Depression 300.4
Brief Depressive Reaction 309.0
Prolonged Depressive Reaction 309.1
Depression Acute 296.20

Coding Epistaxis

2011-08-28T05:35:00.000-07:00

CPT codes for control of epistaxis are in the range 30901-30906. The physician may apply manual hand pressure to control the epistaxis, and no CPT code is assigned for this service, as it is included in E/M service. To control the epistaxis various types of nasal balloons, rocket, nasal sponge or tampoons eg. Rhino Rocket are used. The CPT codes for epistaxis control are unilateral in nature and require the use of modifiers LT or RT for unilateral services and modifier 50 for bilateral service.

CPT codes 30901 and 30903 are used for epistaxis control anterior
CPT codes 30905 and 30906 are used for epistaxis control posterior

Level II HCPCS Finger Modifiers

2011-08-28T05:26:00.000-07:00

Many coders are confused when it comes to HCPCS finger modifiers. Here is a simple rule that can help remember the HCPCS finger modifiers. The first digit is the thumb, followed by index finger, middle finger, ring finger, and little finger or pinky.

The Thumb is the first digit of hand

Index finger is is closest to the thumb and is the the second digit of the hand.

Middle finger is the third digit of human hand.
Ring finger is the fourth digit of the hand.
Pinky finger also called as little finger fifth digit of human hand.

Here are the HCPCS finger modifiers.
F1 Left hand, second digit -Left Hand Index finger

F2 Left hand, third digit - Left hand Middle finger or forefinger.
F3 Left hand, fourth digit - Left hand Ring finger
F4 Left hand, fifth digit - left Hand Pinky finger or little finger.
F5 Right hand, thumb - Right hand Thumb
F6 Right hand, second digit - Right Hand Index finger
F7 Right hand, third digit - Right hand Middle finger or forefinger.
F8 Right hand, fourth digit - Right hand Ring finger
F9 Right hand, fifth digit - Right Hand Pinky finger or little finger
FA Left hand, thumb - Left hand thumb.

EMTALA - Emergency Medical Treatment and Labor Act

2011-07-26T09:28:00.000-07:00

EMTALA, also known as the patient anti dumping statute law, mandates that if an individual approached a hospital with an emergency medical condition (EMC) or labor and requests examination or treatment for the EMC, the hospital cannot deny this person any services that are required for the EMC even if the person is not able to pay the bill or does not have any insurance coverage of any type. This law is enforced by CMS and is applicable to all medicare and medicaid approved hospitals, critical care access hospitals, and hospitals with specialized services. Failing to enforce this law will result in loss of all medicare and medicaid payments and also there can be some monetary penalties on the hospital or physician who showed negligence. The law requires that the hospital provide the individual with stabilization services and if the hospital finds that it does not have the resources and ability to treat the condition then it is the responsibility of the hospital to arrange appropriate transfer to a facility where the condition can be stabilized. The law also states that the hospital where the patient is being transferred for specialized services should accept the transfer and treat the patient appropriately. The hospitals liability under EMLATA ends when the EMC is stabilized or the hospital admits the patient due to unstable EMC.

What are the different types of healthcare providers

2011-07-26T09:10:00.000-07:00

Here is a list of different types of providers

Ambulatory Surgical Centers (ASC) Center : Ambulatory Surgery Centers (ACS) are centers where minor or small procedures are carried out and patient are not required to stay more than twhenty four hours in the hospital. These are also called outpatient surgery centers or same day surgery centers.

Fee-For-Service Providers (FFS) : FFS payment model involves payment for each service offered and there is no bundling and unbundling involved. Every service whether it is part of bigger service is paid seperately.
Clinical Labs Center : Clinical lab centers provide laboratory tests

Anesthesia Center : Anesthesia centers are specialized in anesthesia.

Critical Access Hospitals Center:
Durable Medical Equipment (DME) Center
Federally Qualified Health Centers (FQHC) Center
Skilled Nursing Facility Center

Hospital Center
Practice Administration Center
Rural Health Clinics Center

Pharmacist Center Physician Center
Home Health Agency (HHA)

Center Hospice Center

Case Mix Index (CMI)

2011-04-23T21:59:00.000-07:00

The Case Mix Index (CMI) can be used to adjust the average cost per patient (or day) for a given hospital relative to the adjusted average cost for other hospitals by dividing the average cost per patient (or day) by the hospital's calculated CMI. The adjusted average cost per patient would reflect the charges reported for the types of cases treated in that year.

For example, if Hospital A has an average cost per patient of $1,000 and a CMI of 0.80 for a given year, their adjusted cost per patient is $1,000 / 0.80 = $1,250. Likewise, if Hospital B has an average cost per patient of $1,500 and a CMI of 1.25, their adjusted cost per patient is $1,500 / 1.25 = $1,200.
Therefore, if a hospital has a CMI greater than 1.00, their adjusted cost per patient or per day will be lowered and conversely if a hospital has a CMI less than 1.00, their adjusted cost will be higher.
Calculation of the Office of Statewide Health Planning and Development’s
(OSHPD) Case Mix Index (CMI)
To calculate the CMI, OSHPD uses Medicare Severity-Diagnosis Related Groups (MS-DRGs) weights assigned by the Centers for Medicare & Medicaid Services (CMS).

Patients are assigned to one of over 700 MS-DRGs (based on the principal and secondary diagnoses, age, procedures performed, the presence of co-morbidity and/or complications, discharge status, and gender).

Each MS-DRG has a numeric weight* reflecting the national “average hospital resource consumption” by patients for that MS-DRG, relative to the national “average hospital resource consumption” of all patients.

Although the MS-DRG weights are based on resource consumption by Medicare patients, OSHPD applies them to all patient discharge data reported by hospitals in California during the course of a calendar year.

The OSHPD case mix index is then calculated by averaging the MS-DRG weight of patients discharged within the calendar year, i.e., the sum of the MS-DRG weights divided by the number of patients.
*CMS implements revisions to the MS-DRG weights on October 1, the beginning of the Federal fiscal year. These are published annually in Table 5 of the Federal Register. OSHPD uses the version released October 1 on their data for the following calendar year.

Present-on-admission indicator (POA)

2011-04-23T00:09:00.000-07:00

POA refers to conditions that are present at the time an order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department (ED), observation, and outpatient surgery, are considered
POA. Coders should report a POA indicator for a principal diagnosis, as well as any secondary diagnoses or E codes. POA ties in with MS-DRGs because even though a condition may be classifi ed as a CC or MCC, that do not mean that it will affect the MS-DRG assignment. This is because as of October 1, 2008, hospitals will not receive additional payments for cases in which one of eight conditions develops but was not POA. CMS will reimburse these cases as though the secondary diagnoses were not clinically present.

Consider the following example:
A patient was admitted with acute atrial fibrillation and developed a decubitus ulcer during the hospitalization, which is identified by a POA of “N.”
The DRG assignment would be MS-DRG 309; however, because the decubitus ulcer was not POA, CMS will calculate this case as though it were not present. This would result in MS-DRG 310.

The UB-04 includes an indicator field specifically designed for POA assignment. Coders have to determine whether a condition was POA when the patient was admitted to the hospital or whether it developed during the hospital stay. Once coders find this information, they can report one of the following indicators in the proper field:

• Y/Yes: Present at the time of inpatient admission
• N/No: Not present at the time of inpatient admission
• U/Unknown: The documentation is insufficient to
determine if the condition was present at the time of
inpatient admission
• W/Clinically Undetermined: The provider is unable to
clinically determine whether the condition was present
at the time of inpatient admission

Coders can use several documents to decipher POA
information:
• ED notes:
• History and physical (H&P)
• Progress notes
• Consults
• Admission forms
• Laboratory and x-ray reports
Coders should remember that admission forms, lab reports, and x-ray reports don’t support a POA indicator. To assign POA, coders must rely on a treating physician’s
documentation.

Automated coding systems

2011-04-22T23:34:00.000-07:00

Automated coding systems hold the potential for was conducted to acquire a better understanding of increased coding speed and accuracy compared to the accuracy of an automated coding system, unaided human coders. One automated system, LifeCode, as compared to experienced human coders. LifeCode®, uses Natural Language Processing (NLP)techniques to provide both syntactic and semantic Methodology understanding to the complex job of autocoding [1]. LifeCode processes the transcribed text of emergency A study was designed to test LifeCode against both medicine records to assign procedure codes (Current production coders and expert consultants in Procedural Terminology or CPTC codes - including emergency medicine coding. In order avoid bias from Evaluation and Management or E&M codes) and the study sponsors (A-Life Medical, Inc. which diagnosis codes (International Classification of markets LifeCode) and also to keep the human coders Diseases, version 9, or ICD-9 codes).

Automated coding systems send computer-generated codes directly to billing with little or any human intervention. While a completely automated coding process may be part of our future, the technology used today relies on the expertise of a qualified clinical coder. Thousands of records can be coded in minutes instead of time-consuming, one-at-a-time manual systems. Automated coding systems learn as they code, helping you eliminate trivial words, common misspellings, and standardize abbreviations.

Completely automated approaches are faster than human coders, but are they as accurate? According to a study conducted to access the accuracy of LifeCode in emergency department coding, the final conclusion made was LifeCode is as accurate as the human coders used in that study and offers the potential for increased coding consistency and productivity.

Computer Assisted Coding

2011-04-22T23:11:00.000-07:00

CAC is defined by the American Health Information Management Association (AHIMA) as the: “use of computer software that automatically generates a set of medical codes for review, validation and use, based upon clinical documentation provided by healthcare practitioners.” Currently, there are two technology options for CAC. The first is natural language processing (NLP)and the second is structured input. These computer assisted models relies on human intervention to review, validate and approve (or edit) codes generated by the computer system.

For each record, the The NLP system places these codes into a review queue for the coder to review, edit, approve and finalize. Coders begin the coding process by viewing “suggested” codes instead of working from scratch. As this white paper will discuss, coders starting with a list of recommended codes greatly improves productivity and elevates the coder’s role from researcher to quality data analyst. In order for NLP engines to be most effective, electronic documents (transcription or voice files)should be based on some type of template or standard format. NLP works best is outpatient. This is because clinical documentation
in these settings is often already electronic (dictated or template-based) and there are a limited number of medical terms.

Structured input for CAC is most commonly seen in the physician office setting. The clinician uses a hand-held computer system to document his or her visit. As the clinician points and clicks on words and phrases, sentences and paragraphs are created. Diagnoses and procedures that should be coded are automatically identified and mapped to the correct clinical code. Once the codes are assigned, they are then presented to the clinician for confirmation and may or may not be forwarded to a coder for manual code review.

Advantages of CAC
1. CAC makes the coder more productive, makes coding more consistent and further automates the coding process.
2. Using CACs coding backlogs can be avoided.
3. There are current and future anti-fraud initiatives that can be supported through the use of CAC.

Are CAC and medical coders compatible?
CAC is a technology tool that helps the coder become more productive. By giving coders “suggested” codes, the system expedites the entire coding process and transitions coders from researchers to data quality analysts. According to AHIMA, “CAC technology should be viewed as a tool to assist coding staff rather than as a replacement for coding staff.” At first, the coders admit that they were skeptical about the capabilities of the NLP engine. However,
once they became familiar with CAC’s capabilities, they became confident with the system. Coders who use CAC tools every day report that they would never consider going back to a manual form of coding.

Finally, Sandra Leonard, CCS, CCS-P, comments, “It was always my dream to work from home. CodeRunner(A CAC from medquest) made my dream come true. It is an extremely user-friendly system and an excellent coding tool – nothing better!”

With CAC, the coder’s role changes in a positive way. Coders are now focused exclusively on doing just one piece – the coding.

Reference: http://www.medquist.com/Portals/0/whitepapers/Coding%20Productivity%20Whitepaper.pdf

what is the difference between joint injections and arthrograms

2011-04-21T06:51:00.002-07:00

From coding point of view, the only difference between joint injections and arthrogram is that arthrograms involve the use of imaging devices like fluoroscopy after injecting the medicine into the joint and there will be a supervision and interpretation report dictated by the physician for the arthrogram. On the other hand joint injection reports does have supervision and interpretation reports associated with them.

Coding diabetes and gangrene

2011-04-21T06:51:00.001-07:00

Coding diabetes with gangrene can be confusing. Here we will illustrate how to code by using three different scenarios. One thing we need to understand well before coding is that unlike all other conditions where the physician need to specifically relate correlation between diabetes and the condition, we can directly assume that gangrene and osteomyelitis are because of diabetes even if the physician has not documented the cause and effect relation. This rule applies unless there is a documentation that states that gangrene and osteomyelitis are not related to diabetes.

Here are some of the scenarios:
Gangrene and atherosclerosis of the extremities that is due to non insulin- dependent diabetes mellitus (NIDDM) : Assign code 250.70, Diabetes with peripheral vascular disorders as the principal diagnosis. Assign code 440.24, Atherosclerosis of extremities with gangrene, as an additional diagnosis. Do not assign code 785 .4, Gangrene, as this condition is included in the fifth digit for subcategory 440.2, Atherosclerosis of arteries of the extremities.

Coding Clinic March/April 1986, Volume 3, Number 2, Page 12 says
If no other "cause and effect" relationship has been established for the gangrene, assume that the gangrene is the consequence of a diabetic peripheral vascular circulatory disorder, 250.70, and add code 785.4 for gangrene. This is especially true when the gangrene is of the lower extremity. If there is a history of trauma, such as an open wound that became infected and progressed to gangrene, code it as open wound, complicated, and add code 785.4 for gangrene and 250.0 for diabetes.

Diabetic arteriosclerosis with gangrene is coded to 250.7X, 440.2, Arteriosclerosis of arteries of the extremities and 785.4, Gangrene.

Diabetic gangrene is 250.7x, 785.4.

Gangrene is not always the result of diabetes and can have different causes or no causes.

Diabetes with gangrene

CCS passing Score

2011-04-17T01:45:00.000-07:00

The passing Score for Part I CCS Exam - Multiple-choice section is 30 questions correct out of 50.

The passing Score for Part II CCS Exam - Coding section is 223 out of 340.

The current passing scale score for the CCA examination is 300 out of 400.
The passing score for Part II CCS-P Exam - Coding section is 222 out of 300.

Candidates must pass both parts I and II to receive an overall passing score on the CCS-P exam and CCS exam

Certified Coding Specialist (CCS) Examination Content Outline

2011-04-17T01:36:00.000-07:00

Number of Questions on Exam: 60 multiple-choice (Part 1) / 13 Medical Record Coding (Part 2)
Exam Time: 4 hours

DOMAIN I. Health Information Documentation (15%)
TASKS.
1. Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology, and medical terminology to identify codeable diagnoses and/or procedures.
2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s).
3. Consult with physicians and other healthcare providers to obtain further clinical documentation to assist with code assignment.
4. Consult reference materials to facilitate code assignment.
5. Identify patient encounter type.
6. Identify and post charges for healthcare services based on documentation.

DOMAIN II. Diagnosis Coding (20%)
TASKS.
1. Select the diagnoses that require coding according to current coding and reporting requirements for acute care (inpatient) services.
2. Select the diagnoses that require coding according to current coding and reporting requirements for outpatient services.
3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for the encounter that require coding.
4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions (such as Uniform Hospital Discharge Data Set [UHDDS])
5. Apply the official ICD-9-CM coding guidelines.

DOMAIN III. Procedure Coding (20%)
TASKS.
1. Select the procedures that require coding according to current coding and reporting requirements for acute care (inpatient) services.
2. Select the procedures that require coding according to current coding and reporting requirements for outpatient services.
3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding.
4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (such as UHDDS).
5. Apply the official ICD-9-CM coding guidelines.
6. Apply the official CPT/HCPCS Level II coding guidelines.

DOMAIN IV. Regulatory Guidelines and Reporting Requirements for Acute Care (Inpatient) Service (10%)
TASKS.
1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and procedures that require coding according to UHDDS definitions and Coding Clinic for ICD-9-CM.
2. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment.
3. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions.
4. Assign the appropriate discharge disposition.

DOMAIN V. Regulatory Guidelines and Reporting Requirements for Outpatient Services (10%)
TASKS.
1. Select the reason for encounter, pertinent secondary conditions, primary procedure, and other procedures that require coding according to UHDDS definitions, CPT Assistant, Coding Clinic for ICD-9-CM, and HCPCS.
2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:
a. Modifiers
b. CPT/ HCPCS Level II
c. Medical necessity
d. Evaluation and Management code assignment (facility reporting)

DOMAIN VI. Data Quality and Management (8%)
TASKS.
1. Assess the quality of coded data.
2. Educate healthcare providers regarding reimbursement methodologies, documentation rules, and regulations related to coding.
3. Analyze health record documentation for quality and completeness of coding.
4. Review the accuracy of abstracted data elements for data base integrity and claims processing.
5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code Editor (MCE) and Outpatient Code Editor (OCE).

DOMAIN VII. Information and Communication Technologies (5%)
TASKS.
1. Use computer to ensure data collection, storage, analysis, and reporting of information.
2. Use common software applications (for example, word processing, spreadsheets, and e-mail) in the execution of work processes.
3. Use specialized software in the completion of HIM processes.
DOMAIN VIII. Privacy, Confidentiality, Legal, and Ethical Issues (6%)
TASKS.
1. Apply policies and procedures for access and disclosure of personal health information.
2. Apply AHIMA Code of Ethics/Standards of Ethical Coding.
3. Recognize/report privacy issues/problems.
4. Protect data integrity and validity using software or hardware technology.

DOMAIN IX. Compliance (6%)
TASKS.
1. Participate in the development of institutional coding policies to ensure compliance with official coding rules and guidelines.
2. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards.
3. Monitor compliance with organization-wide health record documentation and coding guidelines.
4. Recognize/report compliance concerns/findings

DOMAIN I. Health Information

Documentation (15%)
TASKS.
1. Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology, and medical terminology to identify codeable diagnoses and/or procedures.
2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s).
3. Consult with physicians and other healthcare providers to obtain further clinical documentation to assist with code assignment.
4. Consult reference materials to facilitate code assignment.
5. Identify patient encounter type.
6. Identify and post charges for healthcare services based on documentation.

DOMAIN II. Diagnosis Coding (20%)
TASKS.
1. Select the diagnoses that require coding according to current coding and reporting requirements for acute care (inpatient) services.
2. Select the diagnoses that require coding according to current coding and reporting requirements for outpatient services.
3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for the encounter that require coding.
4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions (such as Uniform Hospital Discharge Data Set [UHDDS])
5. Apply the official ICD-9-CM coding guidelines.

DOMAIN III. Procedure Coding (20%)
TASKS.
1. Select the procedures that require coding according to current coding and reporting requirements for acute care (inpatient) services.
2. Select the procedures that require coding according to current coding and reporting requirements for outpatient services.
3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding.
4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (such as UHDDS).
5. Apply the official ICD-9-CM coding guidelines.
6. Apply the official CPT/HCPCS Level II coding guidelines.

DOMAIN IV. Regulatory Guidelines and Reporting Requirements for Acute Care (Inpatient) Service (10%)
TASKS.
1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and procedures that require coding according to UHDDS definitions and Coding Clinic for ICD-9-CM.
2. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment.
3. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions.
4. Assign the appropriate discharge disposition.

DOMAIN V. Regulatory Guidelines and Reporting Requirements for Outpatient Services (10%)
TASKS.
1. Select the reason for encounter, pertinent secondary conditions, primary procedure, and other procedures that require coding according to UHDDS definitions, CPT Assistant, Coding Clinic for ICD-9-CM, and HCPCS.
2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:
a. Modifiers
b. CPT/ HCPCS Level II
c. Medical necessity
d. Evaluation and Management code assignment (facility reporting)

DOMAIN VI. Data Quality and Management (8%)
TASKS.
1. Assess the quality of coded data.
2. Educate healthcare providers regarding reimbursement methodologies, documentation rules, and regulations related to coding.
3. Analyze health record documentation for quality and completeness of coding.
4. Review the accuracy of abstracted data elements for data base integrity and claims processing.
5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code Editor (MCE) and Outpatient Code Editor (OCE).

DOMAIN VII. Information and Communication Technologies (5%)
TASKS.
1. Use computer to ensure data collection, storage, analysis, and reporting of information.
2. Use common software applications (for example, word processing, spreadsheets, and e-mail) in the execution of work processes.
3. Use specialized software in the completion of HIM processes.
DOMAIN VIII. Privacy, Confidentiality, Legal, and Ethical Issues (6%)
TASKS.
1. Apply policies and procedures for access and disclosure of personal health information.
2. Apply AHIMA Code of Ethics/Standards of Ethical Coding.
3. Recognize/report privacy issues/problems.
4. Protect data integrity and validity using software or hardware technology.

DOMAIN IX. Compliance (6%)
TASKS.
1. Participate in the development of institutional coding policies to ensure compliance with official coding rules and guidelines.
2. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards.
3. Monitor compliance with organization-wide health record documentation and coding guidelines.
4. Recognize/report compliance concerns/findings

What elements affect DRGs

2011-03-04T20:09:00.000-08:00

There are four main elements that are taken into consideration by a DRG grouper software to generate a DRG. These four elements are

1.Surgical procedure codes
2.Diagnosis
3. Discharge Status
4. Patient's age
5. Patient's gender

The surgical procedure codes, the diagnosis, and the patient's age and gender are used to determine the correct DRG assignments. If any one of them is coded incorrectly on the claim form, the resulting DRG will l be wrong. One can understand that primary procedure and diagnosis codes will affect DRGs, but how does patient's age and gender affect DRG?

Some DRG weights are age dependent. For example, if a person younger than 17 is hospitalized for cellulitis, the DRG is 279 and the weight is .7785. If the patient is older then 17 then the DRG is 277 with weight of 0.8877. Patients gender also plays a role if you assign a DRG for pregnancy and the patient is a male. The claim will be rejected.

Coding alcohol and drug abuse and dependence

2011-03-04T19:47:00.000-08:00

Alcohol and drug abuse and dependence coding are classified into psychiatric section of ICD and the treatment for these conditions require drug or alcohol rehab. The most confusing part of abuse and dependence coding in ICD is the fifth digit for the type of abuse or dependence. According to coding clinic the fifth digit should be assigned depending upon physician documentation and not on the time frame or pattern of drug or alcohol abuse. The following are the options for fifth digit assignment.

continuous
episodic
remission
unspecified

The selection of fifth digit is based on physician documentation of the words like "continuous", "episodic", and "remission." Even if there is documentation of abuse or dependence of drug or alcohol in the past and still the patient is using the drug/alcohol we cannot assume it as continuous abuse. It should be coded as unspecified abuse as long as the physician documents it as "continuous abuse."

If there is history of alcohol or drug abuse and there is no other documentation of abuse then according to coding clinic we can code it as remission.

ICD 10 Training

2011-02-27T02:24:00.000-08:00

Here are some of the ICD 10 Training courses available in the market.

Ingenix online ICD 10 Training
An eLearning training will cover all aspects of ICD 10 implementation organized in a logical progression with 17 one-hour modules in a webminar format with training manual and ICD-10 code books.
Price: $1495 for Non AAPC members
Price: $1295 for AAPC members

AAPC ICD 10 Training
The training covers fundamentals of ICD-10-CM, with an in-depth review of the new guidelines. You will have coding scenarios for each of the guidelines. You can either go for classroom learning (boot camps) held across the country or distance learning.
Price: Classroom Learning $595 (Members:$495)
Price: Distance Learning
ICD-10 CM Module $595.00 (Members: $395)
ICD-10 PCS Module (inpatient) $595.00 (Members: $395)
ICD-10 CM & PCS $895.00 (Members: $695)

HCPro's expert ICD 10 Boot Camps
HCPro's has one and two-day ICD-10 Basics Boot Camps. These courses use practical examples and hands-on learning to introduce students to the most important aspects of ICD-10-CM and ICD-10-PCS coding. HCPro will also offer the course in an interactive online format beginning in February 2011.

AHIMA Academy for ICD-10-CM/PCS
The academy includes a combination of online courses (self-paced) and face-to-face training, offered at several locations and dates throughout the year.
http://www.ahima.org/icd10/academy.aspx

A CODER’S REVIEW
Price: $46.99
This is an online course on the basic concepts of ICD-10-CM & PCS.

Cancer Registry

2011-02-26T21:10:00.000-08:00

Cancer registrar performs collection and coding of morphology and stages of cancers in compliance with the American College of Surgeons Commission on Cancer (ACS/COC). In this role, you will report cancer cases to FCDS and the state cancer registry, as required by law. To be considered, you must be a certified tumor registrar (CTR) with solid experience abstracting multiple cancer sites with a full knowledge of all required data elements within the registry data set;

Cancer Registrar maintains components of the Cancer Registry and the computerized data collection system for cancer cases consistent with medical, administrative, ethical, legal, and accreditation requirements paying special attention to compliance with the American College of Surgeons’ requirements for an approved program. He/she abstracts and codes clinical data using the ELEKTA IMPAC METRIQ software, obtains long-term follow-up data, and analyzes health records according to standards. He/she processes, maintains, compiles and reports this health information data. While working at non-CoC-approved facilities, the Cancer Registrar abstracts all cancer cases deemed reportable to the New York State Cancer Registry in accordance with the Cancer Research Improvement Act of 1997, using the Abstract Plus software.

Knowledge, Skill and Ability
· Thorough knowledge of ICD-O-3 coding, AJCC staging, and SEER Summary Staging.
· Knowledge of FORDS manual standards.
· Computer literate, knowledge & experience with Abstract Plus and IMPAC Medical Registry Services (MRS) software

WORKING CONDITIONS:
Individual works in an office setting utilizing computer to enter cancer registry data

Clinical Documentation Specialist

2011-02-26T20:57:00.000-08:00

The Clinical Documentation Specialist performs concurrent & retrospective reviews of the medical record, issues physician inquiries and interacts with the medical staff and other caregivers in an effort to assure complete and accurate documentation of the patient's clinical picture and the treatment provided. The CDS acts as a liaison between coding professionals and the medical staff. Obtains and promotes appropriate clinical documentation through extensive interaction with physicians, nursing staff, other patient caregiver and coding staff to ensure that the documentation of the level of service rendered to the patient and the patient's clinical complexity is complete and accurate.

The Clinical Documentation Specialist evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation for inpatient encounters that impact the code selection and resulting DRG/MS-DRG/APR-DRG’s groups and payment, address documentation issues and recognize opportunities for DRG/MS-DRG/APR-DRG’s validation. Query physicians when record information is conflicting, ambiguous or incomplete and would significantly affect coding and/or DRG/MS-DRG/APR-DRG’s assignment and/or the Severity of Illness and Risk of Mortality Scores. Act as a liaison between clinical and coding teams.

What is a RAC Audit?

2011-02-25T18:45:00.000-08:00

RAC stands for recovery audit contractors. Do not be confused RAC with medical auditors who audit medical records, but RAC is totally different concept. Presently there are four RACs in the United States each for a specific region. Each RAC is responsible for identifying overpayment and underpayments in approximately ¼ of the country.

The goal of the recovery audit program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be over payments or underpayments. Over payments can occur when health care providers submit claims that do not meet Medicare’s coding or medical necessity policies. Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

How RACS works
RACS are companies who has been selected by CMS to identify improper payments to the providers by Medicare. Presently there are four Recovery Audit Contractors. These contractors uses their own software and methods to find discrepancies and identify improper payments. They are facilitated with the database of claims paid by the medicare and they use this database for their investigation of improper claims payment. Suspicious claims are picked and their medical records are requested from the providers. The providers are required to promptly respond to RAC requests for medical records. These medical records are then manually reviewed by expert and certified coders and other staff to find any discrepancy and providers are notified of it if any. If the provider disagrees with the RAC determination, they can file an appeal within 120-days. If it is determined that an overpayment has been made then the providers has to return the overpaid amount to the Medicare Trust. If there is an underpayment then the underpaid amount is paid back to the provider by the Medicare Trust.

Usually overpayment results from incorrect coding, duplicate submission of claims, and overcoding.

Types of DRG Systems

2011-02-22T20:58:00.000-08:00

DRG technology has experienced an evolutionary development process. The
later generations of DRG systems have incorporated the improvements made by
earlier generations. DRG systems that have been developed in the US include:
• Medicare DRGs
• Refined DRGs (RDRGs)
• All Patient DRGs (AP-DRG5)
• Severity DRGs (SDRGs)
• All Patient Refined DRGs (APR-DRGs)
• International-Refined DRGs (IR-DRGs)

Each of these DRG systems were created to address specific limitations in the
original DRGs. The first DRG system was designed by Yale University to cater the needs of Medicare.

DRGs classify patients into clinically cohesive groups that demonstrate similar
consumption of hospital resources and length-of-stay-patterns. Besides
reimbursement, DRGs have two major functions. The first is to evaluate the
quality of care. Since all cases in a DRG are clinically similar, analysis of
treatment protocols, related conditions or demographic distribution can be done.
Critical pathways are designed around DRGs. Benchmarking and outcome
analysis can be launched using the DRG clinical framework. Quality reviews can
be performed to access coding practices and physician documentation. Ongoing
education of physicians, coders, nurses and utilization review personnel can be
guided to the results of DRG analysis.

Secondly, DRGs assist in evaluating the utilization of services. Each DRG
represents the average resources needed to treat patients grouped to that DRG
relative to the national average of resources used to treat all Medicare patients.
The DRG assigned to each hospital inpatient stay relates to the hospital casemix
(i.e. the types of patient the hospital treats). The casemix index is determined by
averaging the DRG relative weights for all hospital inpatients. Medicare
computes the casemix adjustment for each fiscal year based upon the casemix
data received. The casemix index is then used to adjust the hospital base rate,
which is a factor in computing the total hospital payment under the prospective
payment system. The formula for computing the hospital payment for each DRG
is as follows:
DRG Relative Weight x Hospital Base Rate = Hospital Payment
The hospital casemix complexity includes the following patient attributes:
• Severity of illness
• Prognosis
• Treatment difficulty
• Need for intervention
• Resource intensity
However, the purpose of the DRG is to relate casemix to resource utilization
only. Reimbursement is adjusted to reflect the resource utilization and does not
take into consideration severity of illness, prognosis, treatment difficulty or need
for intervention.

Psychiatric coding guidelines

2011-02-22T20:49:00.000-08:00

Psychiatric coding involves coding for detox and rehab services. During the stay of the patient in inpatient psychiatric clinic efforts are also made to find out relapse triggers for drug and alcohol dependence and abuse.

Detox Meds: Librium is used for detoxification. Folic acid and Thiamine are also used for alcohol dependence and should not be confused if anemia is documented in the medical record. Anemia should be picked only if physician documents so.

Rehab methods: Group therapy

Psychiatric diagnosis are categorized in Axis like Axis I, Axis II, Axis IV.

Axis I are acute psychiatric condition like depression, anxiety, bipolar disorder.
Axis II are related to personality disorder and mental retardation
Axis III are medical condition like diabetes, hypertension etc.
Axis IV are stressor's like unemployment, homelessness, history of physical abuse etc.

New CPT Hip Arthroscopy Codes for FAI lesions

2011-02-06T05:35:00.000-08:00

CPT has added three new hip arthroscopy codes in 2011 relating to treatment of FAI (femoroacetabular impingment). Earlier an unlisted arthroscopic code 29999 was used to represent these procedures. The following are the new CPT hip arthroscopic codes:

29914 Arthroscopic Femoroplasty
29915 Arthroscopic Acetabuloplasty
29916 Arthroscopic Labral Repair

Codes 29914, 29915, 29916 should not be reported along with CPT codes 29962 or 29963 and if you are coding in Quantum, you will get an NCCI edit. Also 29916 should not be used if labral repair is secondary to acetabuloplasty.

Femoroplasty is done for treatment of cam lesions which results from FAI(femoroacetabular impingment). Acetabuloplaty is done for treatment of pincer lesion which also results from FAI (femoroacetabular impingment). Sometimes a patient can have both pincer and cam lesions at the same time.

Do you use Quantum? If not its' time to use

2011-02-06T05:33:00.000-08:00

Information technology has been adopted across all the verticals of life and has and has resulted in better efficiency in terms of management, forecast, and productivity. Medical coding industry is lagging behind in the use of information technology. Most of the medical coding companies including one of the biggest names still using excel sheets for submitting their codes to the clients. Using excel sheets for coding makes the job of a coder very cumbersome, stress full, and boring. Although in recent years some software products like Quantum from Qudramed have been developed, but medical coding companies have not yet adopted such technology. Quantum is a web based software with all the tools and software that are required for coding embedded into it. It has Stedmens medical dictionary, coding clinic, CPT assistant updates, etc. It also flashes NCCI edits during coding thus making the task of coders easy. It shows edits for combination codes when required. With Quantum reports generation applications, one can generate various types of reports that can be used for quality analyse. Reports based on coded date, admit date, etc.

Quantum is a web based product and is a bit slow, but this will no impact the productivity of a coder. In fact, as it highlights the NCCI edits and give hints about combination codes, it will reduce the time the coder otherwise would require to check for status indicators and modifiers from some other sources.

Medical coders once acquainted with Quantum would not like to return to other ways for submitting their work.

Pregnency Delivery Coding

2011-01-22T05:25:00.000-08:00

Do be afraid of pregnancy delivery coding. It is one of the most easiest coding as most of the procedures and ICD codes are routine. Usually the patient arrives for supervision or with abdominal pain and then starts getting contractions leading to delivery. Here we will be concentrating on procedure codes only. Here we discuss some of the commonly used procedures during labor and delivery.

ICD 9 CM obstetrical codes: 72-75
If the patient delivers spontaneously without any surgical intervention then we need to 73.59 "Manually assisted Delivery."

Rotation of fetal head
If physician performs rotation of fetal head in case of breech presentation with or without success before delivery and this can be represented by code
72.4 Forceps rotation of fetal head (key-in-lock rotation)
73.51 Manual rotation of fetal head

The physician may choose to induce labor for some reasons and this is represented by
73.01 Artificial rupture of membranes for induction of labor
Also the physician may induce artificial rupture of membranes after the onset of labor and this is represented by 73.09.

Forceps
For low forceps, high forceps, and mid forceps operation appropriate codes from category 72 should be used.

73.3 Failed forceps
This code should be used for failed forceps or trial forceps.

Episiotomy 73.6
If episiotomy if performed then 73.6 should be used. This code includes episiorrhaphy and should not be used if forceps are used or vacuum extraction is used for delivery if which case appropriate forceps and vacuum extraction codes should be used.

Cesarean section
If cesarean section is done along with hysterectomy, myomectomy, and sterlization then these should be coded separately.

Coding Debridements

2011-01-22T02:33:00.000-08:00

Debridement codes in CPT are found in intugmentry section even if the debridement is deep into subcutaneous tissue and till the bone level. There are debridement codes in medicine section of CPT also and these codes should be used if debridement is at dermal and epidermal levels. If debridement is beyond dermal layer into the subcutaneous tissue then CPT codes from intugmentry should be used. Intugmentry section debridement codes can be classified as for debridement of fracture, eczamatous skin, and necrotic skin. Debridement codes in the medicine section are as follows:

97597-97598: Selective wound debridement involving waterjets, suction, or scissors.
97602 : Non selective wound debridement involves dressing or enzymatic method.

ICD 9 CM Debridement codes
ICD 9 CM has codes for excisional debridment(86.22) and non excisional debridmenrt( 86.28). Excisional debridement requires removal of tissue with scissors and merely scrubbing by scissor or any sharp object is not called an excisional debridement.
Simple Debridement of skin in preparation of surgery or procedure like suturing should not be coded as it is included in the procedure being done.

Foot care coding

2011-01-16T05:51:00.000-08:00

Routine foot care includes paring and removal of corns and calluses, trimming, cutting, debriding, clipping of nails. Routine foot care is not covered in many policies unless it is medically necessary. Conditions like diabetes, peripheral vascular disease, and/or peripheral neuropathy, or pain due to thickening or infection of nails, or pain due to ambulation need to be documented and related to foot care so as to justify billing the above mentioned services. The following conditions also satisfy the medical necessity for foot care billing:
chronic thrombophlenitis.
Buergers disease
arteriosclerosis obliterans.

CPT has codes for removal of corns and calluses and it should not be confused that since there are codes in the CPT manual to represent these services they can be billed. The removal of corns and calluses should be meet the definition of medical necessity like there is pain due to corns and callus so as to be coded and billed else the claim will be rejected by the payer.

Coding Arthroplasties Knee and HIP

2011-01-16T05:14:00.000-08:00

Coding arthroplasties can be quite easy if one is aware of the code ranges and their descriptions. Arthroplasty involves the use of prosthetic joint and can be either total i.e. involving the whole joint or partial i.e. hemiarthroplasties involving partial or one compartment of the joint.

Hip Arthroplasty CPT codes 27125-27132
Hip arthroplasties can be total or hemiarthroplasty. Hemiarthroplasty involves either acetabular or femoral component replacement, whereas total hip arthroplasty involve prosthetic replacement of both acetabular and femoral components. Hemiarthroplasty is also called as bipolar arthroplasty. CPT codes are as follows:
Hemarthroplasty 27125
Total hip arthroplasty 27130

Sometimes a previous hip surgery need to be revised to total hip arthroplasty and CPT code 27132 can be used to represent such situations. Hip fractures requiring arthroplasty are coded to 27236. Corresponding ICD 9 CM codes for hip arthroplasty are:
Partial hip replacement: 81.52
Total hip replacement: 81.51
Type of bearing surface(prosthesis): 00.74-00.77

Knee Arthroplasty
Knee arhroplasty is of two types unicompartmental and total. Unicomparmental knee artroplasty involves single compartment whereas total knee arthropalsty involves two compartments. If an arthroscopy is done previous to knee replacement, then it is required to code arthroscopy and related arthroscopic procedure with 59 modifier. If open retinacular release is done during the knee replacement surgery then it should not be reported as it is included in the knee replacement code. The following are the CPT codes:

Unicompartental knee arthroplasty: CPT 27446, ICD 81.54
Total knee arthroplasty: CPT 27447 ICD 81.54
Revision of total knee arthrplasty: CPT 27487, ICD 81.55
Removal of total knee prosthesis: CPT 27488, ICD 80.06

Integumentary coding made easy

2011-01-02T02:13:00.000-08:00

Here are some of the CPT intugmentry system codes that cause confusion and need better understanding.

Paring and Cutting: Paring means debridement of lesion not destruction
CPT codes 11055-11057 represent paring and cutting of benign hyperkeratotic lesions like corns and callus. These codes are not for all benign lesions but only for any benign lesion that can be classified as hyperkeratotic corns and callus are just two examples given in the CPT assistant but these codes can be used for any hyperkeratotic lesions. For destruction of hyperkeratotic lesion 17000-17004 should be used.

Medicare does not reimburse for routine foot care. CPT Codes 11055-11057 will only be reimbursed by Medicare if the treatment is medically necessary. The first of the two ICD-9-CM Codes must be:

700 Corns and callosities
701.1 Keratoderma acquired
757.39 Other specified congenital anomalies of skin

The second ICD-9-CM Code must be one of the following:

686.9 Unspecified local infection of skin and
subcutaneous tissue
729.5 Pain in limb

Skin biopsy codes 11100-11101 are for per lesion so when a physician takes more than one biopsy sample of the same lesion at the same session only 11100 should be coded not 11101. There is a separate code for biopsy of eyelid 67810.

Skin Tags: Skin tags are also known as skin polyps or fibroepithelial polyps, Soft fibromas, or papilloma. Skin tag treatment include excision, cryotherapy, ligation, shave biopsy, electrocautery, laser therapy, curettage and cautery, and skin biopsy. CPT codes 11200 and 11201 can be reported for removal of skin tags by any method.

Excision
CPT defines excision as full-thickness (through the dermis) removal of a lesion and includes a simple closure.

Anesthesia Coding Guidelines

2010-12-31T08:19:00.000-08:00

Services included in anesthesia codes
Interpretation of lab values
Arterial line insertion for blood pressure monitoring
Administration of blood or fluid
Usual monitoring services like temperature, blood pressure, oximetry, ECG,
The usual preoperative and postoperative visits
Capnography and mass spectroectry
Placement of IVs for fluid or medication administration

Services not included in Anesthesia Package
Insertion of Swan-Ganz catheter
Emergency Intubation
Central venous pressure line
Unusual forms of monitoring such as placement of central venous lines
Pain management injections or placement of epidural for postoperative pain management
Critical care visits
Arterial catheter
Transesophageal echocardiography

Anesthesia Modifiers
Physical Status modifiers
P1 - Normal health Patient
P2 - Patient with mild systemic disease
P3 - Patient with severe systemic disease
P4 - Patient with severe systemic disease that is a constant threat to life
P5 - Moribund Patient not expected to survive w/out operation
Medicare does not recognize physical status modifiers.

CPT and HCPCS Modifiers
23 - Unusual anesthesia
32 - Mandated services
AA - Anesthesia performed by the anesthesiologist
AD - Medical supervision by a physician; more than four concurrent anesthesia services
QX - CRNA service with medical direction by a physician
QY - Medical direction of one CRNA by a physician
QZ - CRNA service without medical direction by a physician
QK - Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QS - Monitored anesthesia care (an informational modifier, does not affect reimbursement)

Anesthesia time begins when the anesthesiologist begin to prepare the patient for anesthesia. Anesthesia time ends when the anesthesiologist is no longer in personal attendance. Anesthesia time is calculated in intervals of 15 minutes

Coding Pain Management

2010-12-11T05:38:00.000-08:00

Transforaminal epidural injection: 64479-64484
Transforaminal epidural injection is given at the nerve root in to the epidural space(64479-64484). The injection is passed through the foramen to reach the nerve root. These are unilateral codes and require 50 modifier for bilateral injections. The physician injects at the nerve root like L4 or between the vertebral interspaces like L4-L5.

Interlaminar injections: 62310-62311
Interlaminar injections are given in to epidural or subarahnoid space through lamina without passing through the foramen. The injection goes directly into the lamina unlike previous one which has to go through foramen and then lamina. These are nonneurolytic injections for diagnostic or therapeutic purposes including anesthetic, steroid, opoid or other substances. These injections also includes contrast if given.

Facet joint injections: 64422-64427
Code Range 64470-64472 is for injection of steroid and/or an anesthetic.
If any other type of substance is injected may be nondestructive or pulsed radiofrequency use 64999. Facet joint injection codes are unilateral and modifier 50 should be used for bilateral procedures. If a Neurolytic is injected for destruction, code range is 62280-62284.

Trigger point injection: 20550-20553
CPT codes 20552-20553 are reported only once per session. CPT code 20551 should be reported one time for multiple or single injections to a single tendon origin or tendon insertion performed. Injections to multiple tendon origins or tendon insertions are reported one time for each injection. For dry needling technique use unlisted procedure code 20999. Imaging guidance is reported separately like 77002 for fluoroscopic, 76942 for ultrasound, and 77021 for MR.

Coding spinal arthrodesis procedures

2010-12-11T02:02:00.004-08:00

Before coding spinal arthrodesis procedures also called as spinal fusion, one must understand the actual procedures that the physician does. Lets have a look at the procedures involved in spinal fusion or arthrodesis.

The physician first performs spinal fusion either by anterior, posterior, or transverse method. One the fusion of vertebra is accomplished, the physician may perform insertion of intervertebral biomechanical devices like synthetic cages or methylmethacrylate. This will require the use of bone grafts for better fixation of the intervertebral devices. The physician may also take a bone marrow aspirate and and mix it with bone grafts before applying them. The bone grafts can be taken either from the same incision or through a separate incision else the physician may also prefer to use premanufactured bonegrafts called as allografts. Before placing the intervertebral cages the physican performs partial or medial laminectomy, diskectomy, and or foraminotomy to prepare the interspace. Once the cages are fixed, the physician performs spinal instrumentation.

CPT codes for arthrodesis and fusion: 22548-22812
CPT codes for application of spinal instrumentation: 22840-22855
CPT codes for spinal bone graft: 20930-20938
CPT codes for partial laminectomy with diskectomty posterior approach: 63020-63035
CPT codes for partial laminectomy with diskectomty anterior approach: 63075-63078

CPT codes for bone grafts, intervertebral cages, and spinal instrumentation are addon codes and are exempt from 51 modifier.

Autografts are grafts taken from the same patient.
Allografts are grafts taken from same species usually from cadavers.
Morselized bone grafts are small pieces or bone powder.
Structural bone graft is a single bone piece.

If the same type of graft is used more than only then only one code should represent it.

Upcoding

2010-12-11T02:02:00.003-08:00

Upcoding refers to the practice of coding services which are not actually provided. This can be intentional or unintentional. Radiology coders should be aware that coding all that is documented in the conclusion of radiology reports can result in upcoding. For example, if a multibody CT Scan is done to access the extent of malignancy, the coders should not pick codes for cholelithiasis, kidney stones, calcifications if documented in the result of the CT Scan, as these are incidental findings and are not related to the purpose of imaging i.e. to access the malignancy. In the same way, if abdomen x-ray is done for abdominal pain, the radiologist may document degeneration of lumbar intervertebral disk which should not be coded.

bundling and unbundling

2010-11-27T08:09:00.000-08:00

The term “bundling” in medical coding and especially CPT procedure coding refers to the method of coding two or more procedures as a single service or procedure as the smaller of the two procedure is part of the big procedure and so cannot be billed separately along the bigger inclusive procedure. One simple example is when an IV Push injection is given you can only code for IV Push code 96374 and one cannot code CPT intramuscular injection code 96372 for the IV Push service because injection procedure 96372 is inclusive part of IV Push procedure. When two separate services one IV Push and one intramuscular injection on the same day then we can bill for these two services separately provided 59 modifier is used along with IM injection code to indicate the payer that these are two distinct procedures and not a single IV push.

This is termed “unbundling” refers to the practice of reporting the two bundled services separately to double the reimbursement collected from Medicare and other payers. This may lead to liability under the FCA.

What is Medical Coding Compliance

2010-11-27T07:55:00.000-08:00

The Centers for Medicare & Medicaid Services (CMS) has developed compliance program guidelines for Medicare fee-for-service Contractors. The compliance programmes are fundamentally designed to establish a culture within an organization that promotes the prevention, detection and resolution of instances of conduct that do not conform to federal and state law, or to federal healthcare program requirements.

An effective compliance program should both articulate and demonstrate the Contractor’s commitment to ethical and legal business conduct. The governing body of the organization, including the board of directors, chief executive officer and senior management, are tasked with the responsibility to provide ethical leadership and to ensure that adequate systems are in place to facilitate ethical and legal conduct.

The development and implementation of a compliance program is voluntary. A compliance program is not a panacea guaranteed to eliminate the risk that fraud, waste, abuse or inefficiency will occur. Nevertheless, CMS believes that the establishment of an effective compliance program will protect the Medicare Trust Fund by significantly reducing the risk of unlawful or improper conduct, and will likely lead to other programmatic efficiencies.

What is Medical Auditing?

2010-11-26T22:18:00.000-08:00

A medical auditor is a coder capable of reviewing medical documentation and the assigned procedure and diagnosis codes to determine if those coding assignments are appropriate. This determination is based on ethical coding guidelines and the application of CMS/AMA Documentation Guidelines.

Medical Auditor Job Description:
Medical Auditor performs necessary operations relating to the audits of medical records to identify discrepancies, in accordance with established procedures. Provides medical resource information to determine the accuracy of claims. Prepares necessary forms and proper documentation required performing audits and contracting issues. Identifies discrepancies in charges and provides educational support for problem areas. Communicates with hospital departments regarding discrepancies between charges and documentation in Medical Records. Perform medical audits to verify that billed charges match the documentation found in the medical record. All audit efforts are performed to ensure accurate reimbursement. Medical auditors serve as a resource on charge appropriateness and/or charge documentation issues. Providers need to do RAC audits and deal with payer denials. Physicians have regular audits done to be compliant with documentation and coding to improve revenue cycle. Ensuring medical necessity, correct coding and compliance with regulatory issues, a medical audit focuses on many areas of a practice. A medical auditor should have good understanding of the following:

Compliance and Regulatory Guideline Knowledge
Coding Concepts
Scope and Statistical Sampling Methodologies
Medical Record Auditing Skills and Abstraction Ability
Quality Assurance and Risk Analysis
Communication of Results and Findings
The Medical Record

Medical Auditing Certifications:
Certified Professional Medical Auditor (CPMA) from AAPC
AAMAS also provides CMAS certification

Diagnosis Related Group (DRG)

2010-10-23T05:19:00.000-07:00

Diagnosis-related groups (DRG) is a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay. The beneficiary’s principal diagnosis and up to eight secondary diagnoses that indicate comorbidities and complications will determine the DRG assignment. Similarly, DRG assignment can be affected by up to six procedures furnished during the stay. The Centers for Medicare & Medicaid Services (CMS) reviews the DRG definitions annually to ensure that each group continues to include cases with clinically similar conditions that require comparable amounts of inpatient resources. When the review shows that subsets of clinically similar cases within a DRG consume significantly different amounts of resources, they may be assigned to a different DRG with comparable resource use or a new DRG may be created.
For discharges occurring on or after October 1, 2007, a new DRG system called Medicare Severity (MS)-DRG is being used to better account for severity of illness and resource consumption for Medicare beneficiaries. Use of MS-DRGs was transitioned during a two-year period. For the period October 1, 2007 through September 30, 2008, payment was based on a 50/50 blend of MS-DRGs and the previous DRG system. Beginning October 1, 2008 (fiscal year [FY] 2009) and after, payment is based solely on the MS-DRGs.

There are three levels of severity in the MS-DRGs based on secondary diagnosis codes:

1) MCC - Major Complication/Comorbidity, which reflect the highest level of severity

2) CC Complication/Comorbidity, which is the next level of severity;

3) Non-CC Non-Complication/Comorbidity, which do not significantly affect severity of illness and resource use.

Inpatient Prospective Payment System and Reimbursement Process

2010-10-23T05:08:00.002-07:00

Inpatient Prospective Payment System and Reimbursement Process
Facilities contract with Medicare to furnish acute hospital inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit covers beneficiaries for 90 days of care per episode of illness with an additional 60 day lifetime reserve. Illness episodes begin when beneficiaries are admitted and end after they have been out of the hospital or Skilled Nursing Facility (SNF) for 60 consecutive days.
Generally, hospitals receive Medicare IPPS payment on a per discharge or per case basis for Medicare beneficiaries with inpatient stays. Related therapeutic outpatient department services provided within three days prior to admission are included in the payment for the inpatient stay and may not be separately billed. Discharges are assigned to diagnosis-related groups (DRG), a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay.

The IPPS per-discharge payment is based on two national base payment rates or standardized amounts:
1. One that provides for operating expenses and another for capital expenses. The payment rates are adjusted to account for. The costs associated with the beneficiary's clinical condition and related treatment relative to the costs of the average Medicare case (i.e., the DRG relative weight, as described in the How Payment Rates n a per discharge or per
2. Market conditions in the facility's location relative to national conditions (i.e., the wage index, as outpatient department.

In addition to these adjusted per discharge base payment, hospitals can qualify for outlier payments for cases that are extremely costly and receive additional payments per discharge for the indirect costs of graduate medical education (IME) if they train residents in approved graduate medical education (GME) programs, treating a disproportionate share of low-income patients, and the use of certain new technologies. Hospitals that train residents in approved GME programs receive a payment separate from the IPPS for the direct costs of GME, while the operating and capital payment rates for these hospitals are increased to reflect the higher indirect patient care costs of teaching hospitals relative to non-teaching hospitals or IME. Operating and capital payment rates are also increased for facilities that treat a disproportionate share of low-income patients. In addition, hospitals may be paid an additional amount for treating patients with certain approved technologies that are new and costly and offer a substantial clinical improvement over existing treatments available to Medicare beneficiaries. Finally, payment is reduced when a beneficiary has a short length of stay (LOS) and is transferred to another acute care hospital or in some circumstances, to a post-acute care setting.

Inpatient Prospective Payment System and Reimbursement Process

lab cpt codes

2010-10-16T03:17:00.000-07:00

Laboratory Chemistry Tests

Lipid Metabolism Tests
Total Cholesterol 82465
HDL 83718
LDL 83721
Triglycerides 84478
Lp(a) Apolipoprotein 82172

Cardiac/Liver/Biliary Tests:
CK/CPK 82550
CK,MB 82553
LD 83615
AST 84450
ALT 84460
ALP 84075
GGT 82977
Bilirubin, total 82247
Bilirubin, direct 82248
Total Protein 84155
Albumin 82040

Laboratory Chemistry Tests
Hepatic Function Panel (6 tests) 80058
Basic Metabolic Panel (7 tests) 80049
Electrolyte Panel (4 tests) 80051
Comprehensive Metabolic Panel (12 tests) 80054
Lipid Panel (Chol, HDL, Triglycerides) 80061

Diabetes Tests
Glucose, quantitative blood type 82947
Glucose on home use meter-type device 82962/82962
Hemoglobin A1c 83036
Glucose Tolerance Test, initial 3 specimens 82951
Glucose Tolerance Test, each additional specimen > 3 82952
Fructosamine 82985

Individual Chemistry Tests
Phosphorous 84100
Calcium 82310
Uric Acid 84550
Amylase 82150
Magnesium 83735
Iron 83540
TIBC 83550
Ferritin 82728
Prostate Specific Antigen (PSA) 84153
Troponin T 84512

Thyroid Tests:
TSH 84443
Thyroxine, total 84436
T3 Uptake 84479

Renal Function Tests
BUN 84520
Creatinine 82565

Therapeutic Drug Monitoring:
Theophylline 80198
Digoxin 80162
Drug Screening (THC, Cocaine, etc.) multiple drug classes 80100

Pregnancy Tests: HCG quantitative serum 84702

MRI CPT procedure codes

2010-10-16T02:49:00.000-07:00

MRI CPT procedure codes

70551 Brain w/o contrast
70553 Brain w/ & w/o contrast

70544 Angiography, Head; w/o contrast
70547 Angiography, Neck; w/o contrast

70336 TMJ (UNI or BILAT)
70540 Orbit, Face & Neck, Carotids(pituitary, IAC’s)

73221 Upper extremity, joint (shoulder, elbow, wrist, hand)
73220 Upper extremity, other than joint (humerus, forearm)

71550 Chest
71555 Angio, Chest
72146 Thoracic Spine w/o contrast

77021 VAC Breast Biopsy
77059 Bilateral Breast Imaging
77058 Unilateral Breast Imaging

74181 Abdomen w/o contrast
74181-52 Cholangiogram
74185 Angio, Abdomen w/ & w/o contrast

72148 Lumbar w/o contrast
72158 Lumbar w/ & w/o contrast

72195 Pelvis w/o contrast
72196 Pelvis w/ contrast
72197 Pelvis w/o contrast

71555 MRA Chest
72198 MRA Pelvis
73225 MRA Upper Extremity
73725 MRA Lower Extremity

73720 Lower Extremity, other than joint (thigh, lower leg, foot) w/ & w/o contrast
73721 Lower Extremity, joint (hip, knee, ankle, foot) w/o contrast
73725 Angio, Lower Extremities

Outpatient coding guidelines

2010-10-16T02:26:00.001-07:00

Outpatient coding guidelines differ from inpatient coding guidelines and has been listed below.

1. The primary diagnosis should be the condition which is the principle cause of patient visit established after study.
2. Differential diagnosis stated by the physician in the final impression should not coded instead symptoms must be coded. For example physician may state UTI/diverticulitis in the final impression, which should not be coded instead symptoms like abdominal pain should be coded as final diagnosis.
3. Laboratory and radiology findings interpreted by the physician can be coded as diagnosis in outpatient coding.
4. Acute state of a disease should be coded before chronic state if both exists. For example if the final diagnosis is acute and chronic bronchitis, acute bronchitis should be coded first and than chronic bronchitis.
5. Conditions stated by the physician by words "likely", "possible", "Rule out" are not coded in outpatient coding and instead symptoms need to be coded.

Radiology coding tips for radiology coders

2010-10-08T21:33:00.001-07:00

Radiology coding involves coding of radilogy charts like CT's, MRI's, X-rays, Ultrasounds, nuclear medicine, mammograms. Here we attempt to detail all the scenarios that a radiology coders experiances while coding radiology charts. One basic rule in radiology coding is that if the radiology report are normal than indications should be coded as primary diagnosis. For example, if cough is the indication for chest x-ray and the x-ray report is normal, than cough should coded as primary diagnosis, and if x-ray findings is pneumonia than pneumonia is coded as final diagnosis.

Chest X-rays are taken after abnormal PPD skin test. Here abnormal PPD result ICD-9 code 795.5 should be used as admitting diagnosis and final diagnosis could be the x-ray findings or 795.5 in case of normal results.

Breast mammographic studies are done either for diagnostic purposes or for routine screening. For diagnostic mammographic studies code the indication (lump, density, calcifications) as admitting diagnosis and mammographic findings as final diagnosis. If mammographic findings are normal then indications are coded as final diagnosis.

For screening mammograms, screening codes should be sequenced first and mammographic findings can be coded as additional codes.

Sometimes, you will have two radiology reports one for screening and one diagnostic. In such a situation diagnostic codes should be sequenced first and than screening codes. For example a screening mammogram report and a dexa bone scan for osteoporosis. Osteoporosis code is sequenced first followed by screening mammogram code.

Dexa scans do not have any assessments most of the time so primary diagnosis shouled be the reason for doing dexa.

Commonly used CPT Radiology Codes

2010-10-08T21:29:00.005-07:00

Common CPT Radiology Codes:

70160 Nasal bones, minimum of 3 views
70210 Sinuses, less than 3 views
70220 Sinuses, complete, minimum of 3 views

70250 Skull, less than 4 views
70260 Skull, minimum of 4 views

70328 Temporomandibular joint, unilateral
70330 Temporomandibular joint, bilateral

71010 Chest, frontal
71020 Chest, 2 views
71021 Chest, with apical lordotic procedure
71022 Chest, with oblique projections

71100 Ribs, unilateral, 2 views
71101 Ribs, including posteroanterior chest, minimum of 3 views
71110 Ribs, bilateral; 3 views
71111 Ribs, including posteroanterior chest, minimum of 4 views

72010 Spine, entire, anteroposterior and lateral
72020 Spine, single view (C1,T1,L1,TL1)
72040 Spine, cervical; 2 or 3 views (C2,C3)
72050 Spine, cervical; minimum of 4 views (C5)
72052 Spine, cervical; complete, including oblique and flexion and/or extension
studies (C7)
72070 Spine, thoracic, 2 views (T2)
72072 Spine, thoracic, 3 views
72074 Spine, thoracic, minimum of 4 views
72080 Spine, thoracolumbar, 2 views

72100 Spine, lumbosacral; 2 or 3 views (L2)
72110 Spine, lumbosacral; minimum of 4 views (L4)
72114 Spine, lumbosacral; complete, including bending views
72120 Lumbosacral, bending views only, minimum of 4 views

72170 Pelvis; 1 or 2 views
72200 Sacroiliac joints, less than 3 views
72202 Sacroiliac joints; 3 or more views
72220 Sacrum and coccyx, minimum of 2 views
73000 Clavicle, complete
73010 Scapula, complete

73020 Shoulder; 1 view
73030 Shoulder; complete, minimum of 2 views
73050 Acromioclavicular joints, bilateral, with or without weighted distraction

73060 Humerus, minimum of 2 views

73070 Elbow, 2 views
73080 Elbow, complete, minimum of 3 views

73090 Forearm, 2 views

73100 Wrist; 2 views
73110 Wrist; complete, minimum of 3 views

73120 Hand; 2 views
73130 Hand; minimum of 3 views

73140 Finger or fingers; minimum of 2 views

73500 Hip; unilateral,1 view
73510 Hip; complete, minimum of 2 views
73520 Hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis
73540 Pelvis and hips, infant or child, minimum of 2 views

73550 Femur, 2 views

73560 Knee; 1 or 2 views
73562 Knee; 3 views
73564 Knee; complete, 4 or more views

73590 Tibia and fibula; 2 views
73592 Tibia and fibular, lower extremity, infant, minimum of 2 views

73600 Ankle; 2 views
73610 Ankle: complete, minimum of 3 views

73620 Foot, 2 views
73630 Foot; complete, minimum of 3 views

73650 Calcaneus, minimum of 2 views

73660 Toe or toes, minimum of 2 views

74000 Abdomen; single anteroposterior view

76066 Joint survey, single view, 1 or more joints (specify)

76499 Unlisted procedure

76140 Consultation on x-ray examination made elsewhere, written report

72125 CT, cervical spine without contrast
72126 With contrast

72128 CT, thoracic spine without contrast
72129 With contrast

72131 CT, lumbar spine without contrast
72132 With contrast

72141 MRI, cervical spine without contrast
72142 With contrast
72156 Without and with contrast

72146 MRI, thoracic spine without contrast
72147 With contrast
72157 Without and with contrast

72148 MRI, lumbar spine without contrast
72149 With contrast
72158 Without and with contrast

73221 MRI shoulder, elbow, wrist, without contrast
73222 With contrast
73223 Without and with contrast

72195 MRI pelvis, without contrast

73721 MRI hip, knee, ankle, foot without contrast
73722 With contrast
73723 Without and with contrast

Medical Coding Employment

2010-10-08T21:29:00.003-07:00

Medical coding is a secure and safe career with excellent career outlook for the coming decades. According to the US Department of Labor, medical coding industry will grow faster than the average for all industries over the next decade. In the United States, medical coding employment will remain growing for coming decades due to rapidly aging population. With growing employment the salaries of medical coding professionals have also increased over the years. Medical records and health information technicians work in pleasant and comfortable offices. This is one of the few health-related occupations in which there is no direct hands-on patient care.

According to a 2007 survey conducted by American Health Information Management Association (AHIMA), the average salaries for medical coding professionals increased to $34,400 from about $30,000 in 2006.

Medical coders and billers are employed in hospitals,offices of physicians, nursing care facilities, outpatient care centers, and home health care services. Technicians also may be employed outside of health care facilities, such as in Federal Government agencies. Employment of medical coders and billers is expected to increase by 20 percent, much faster than the average for all occupations through 2018.

Medical Coding Work Environment

2010-10-08T21:29:00.001-07:00

Medical coders and billers work in a pleasant and comfortable environment like that of IT companies. This is one of the few health-related occupations in which there is no direct hands-on patient care.

Medical coders usually work a typical 40-45 hour week depending upon the facility or hospital employed. Some overtime may be required. Home based medical coding positions are also availeble but they require at least two-three years of prior experiance. You will have access to internet altohugh use of cellphones is prohibited in medical coding companies due to HIPPA compliance. Every medical coder will have a copy of ICD, CPT, HCPCS and also other useful coding books so your desk will be full of books and papers. Every now and then there you will need to attennd meetings and seminars so as to educate yourself of the changes the occur frequently in ICD, CPT, medical regulations, etc.

What Medical Coding Certifications are good for me?

2010-08-07T04:26:00.000-07:00

What are medical coding certifications and which is better?
First lets have a look at medical coding certifications that are much valued in the medical coding industry. Certifications from AHIMA and AAPC enjoy faith and value from from the employer in the medical coding industry. These certifications are as follows:

•AHIMA Medical Coding Certifications:
Certified Coding Associate (CCA)
Certified Coding Specialist (CCS)
Certified Coding Specialist-Physician-based (CCS-P)

•AAPC Medical Coding Certifications:
Certified Professional Coder (CPC)
Certified Professional Coder-Hospital (CPC-H)
Certified Professional Coder-Payer (CPC-P)

Which medical coding certification is good for me?
There is a general understanding in medical coding industry that AHIMA certifications are highly revered and advantageous than AAPC certifications. That's true, but AAPC certifications have their own advatages. AAPC certifications are designed for outpatient and ER coding, whereas AHIMA certifications are necessary for inpatient coding. So if you are an outpatient coder than AAPC is the certification you should look for, and if you plan to go for inpatient coding, than AHIMA certification is a must. Passing CCS-P or CCS certification exam is tough and requires good understading of CPT which will only come after two-three years of work experiance, so if you have less than a year of work experiance in medical coding and want to go for certification, then go for CPC which is much easy to pass than CCS.

Medical Coding Exam

2010-08-07T04:03:00.000-07:00

Medical coding practice exams are free and designed to test understanding of ICD, CPT, HCPCS.

1. What is HCPCS ?
HCPCS stands for Healthcare common procedural coding system. It consists of CPT codes known as level I HCPCS codes and HCPCS level II codes that represent hospital supplies, drugs, dental codes, etc.

2. The patient has a Tailors bunion at 5th metatarsal and the physician performs bunioncetomy what is the CPT code that represent this service?
Ans. 28110: Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)

3. The physician does a knee arthroscopic notchplasty of femoral condyl what is the code to represent this?
Ans. Arthroscopic chondroplasty includes notchplasty so CPT code would be 29877. If only arthroscopic notchplasty is done report 29999.

4. The patient underwent rubberband ligation of two hemorrhid colums what is the CPT code to represent this?
Ans. Code 46221. It should be reported only once regardless of how many hemorrhoids are ligated.

5. The patient underwent arthroscopic chondroplasty in lateral and medial compartments what CPT codes are required to represent this service?
Ans. 29877. Report 29877 only once even if chondroplasty is performed in more than one compartment.

6. The patient underwent a colonoscopy and polypectomty of three polyps by snare technique and one polyp was removed by Jumbo forceps.
Ans. Use 45385 for polypectomy by snare technique. 45385 includes multiple polypectomes.
Report 45384 for hot biopsy polypectomy (Jumbo forceps).

7. The patient has a history COPD and final impression is Chronic Bronchitis. What is the ICD code?
Ans. 491.21 is the combination code for chronic bronchitis and COPD.

8. The patinet decompensated COPD ?
Ans. 491.21 : Decompensated or exacerbated COPD is coded to 491.21

9. The patient has COPD and emphysema?
Ans. 492.8

10. The patient was given Normal saline solution for 25 minues and then Pepcid for one hour what are the CPT codes?
Ans. 96365 for IV infusion for one hour. IV hydration (NSS) if given less than 30 minutes is not coded.

11. The physician excised a breast lesion by preoperative placement of radiological marker?
Ans. 19125 and placment of radiologicl marker is included in this code.

12. Placement of Quinton Catheter for a patient 50 years old.
Ans. 36558: Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump age 5 years or older

13. Repair of laceration of palate in the mouth less than 2 cm
Ans. 42180: Repair, laceration of palate; up to two cm

14. Placement of Mediport Catheter for a patient 50 years old.
Ans. 36561: Insertion of tunneled centrally inserted central venous access device, with subcutaneous port age 5 years or older

15. Cystoureteroscopy with lithotripsy and placement of Double J stent?
Ans. 52323 Lithotripsy
52332 Double J stent placement

CPC and CCS coding boot camps

2010-08-06T09:56:00.000-07:00

CPC and CCS certifiacton boot camps helps clear your CPC and CCS medical coding certifications exams with flying colors as they are designed and structured by highly experianced and certified instructors. Boot camps are intense and detailed courses aimed improving coding concepts and principles for correct coding. Boot Camp are for those with a strong current background in Medical Coding. These camps are not for beginners or intermedite coders. These camps are usually for 3-5 days fulltime and consists of lecture, individual exercises, coding activities and a daily mock exam. Those who are looking for CPC and CCS certification classes and training should go for these boot camps. Some of the boot camps are as follows:

Codingcert CPC boot camp
HCPRO CPC and CCS boot camps
Coderclass.com CPC boot camp
A+ Coding Institute's CPC Boot Camp
San Francisco Medical Coding Institute:www.sfmci.com
Mostnc CPC Boot Camp: mostnc.com/Boot_Camp.html

CPC Exam Questions

2010-08-05T07:53:00.000-07:00

CPC Exam Questions Part I

1. The physician performs cone biopsy of cervix by loop electrosurgical excision procedure (LEEP). What is the CPT code for this?

57522

2. Hysteroscopic dilation and currettage of uterus for abnorma uterine bleeding?
58558

3. Dilation and currettege of uterus for treatment of incomplete abortion?
59812

4. Control of epistaxis with silvernitrate?

30901: silernitrate is used for chemical cautery

5. Creation of arteriovenous anastomosis for dialyis by cephalic transposition?

36818

6. Revision of arteriovenous fistula?

36832

7. The physician performs left cariac catheterization and during the procedure also performs ventriculography and coronary angiography. What are the CPT injection and S/I codes for this procedure?

36210 Left Heart Cath
93543
93545
93555
93556

8. The physician performs left and right carotid angiography by using femoral vein as vascular access site what codes would represent this service ?

36215
36216

9. Transforaminal epidural injection of anesthetic agent or steroid at L4-L5 using flouroscopic guidence?

66483
77003

10. Epidural injection of neurolytic substance at L4-L5?

66282

11. Extracapsular repair of cataract with intraocular lens implantation requiring suturing?

66482

12. The patient has phymosis of foreskin the physician performes surgery for repair of phymosis what CPT code would represent this service?

54150

13. The physician documents a diagnosis of hypertensive congestive heart failure. What are the ICD codes to represnt this?

402.11
428.0

14. The patient has candidial diaper rash what are the ICD codes for this?

112.3
691.0

15. What is LIMA?

LIMA stands for left iternal mammary atery and is used as a graft in CABG.

CPC Exam Questions Part II

1. What is the code for peak flow(vital capacity)?
94150

2. The patient came with sore throat a rapid strep was ordered what is the CPT code for rapid strep?
87880

3. The patient Urine HCG pregnency test what CPT code would represent this?

81025

4. The patient was diagnosed with cardiac arrest the physician does cardiopulmonary resuscitation and intubation what are the CPT codes that represent this?
92950, 31500

5. What is the modifier to represent a service that is repeated by the same physician on the same visit ?

76

6. The patient was given an infusion of Pepcid, Vasotec, and Benedryl from 10 a.m to 11a.m. what are the codes that will represent this service?
96365, 96368

7. The patient camw with fracture of distil tibia and the physician aplied posterior splint give the CPT code?
29515

8. The physician gives a diagnosis of micotic nails due to diabetes what ICD codes will represent this?

250.00 111.9

9. What is the ICD 9 code for allergic rhinoconjunctivitis?

372.05

10. What code would represent open reduction of Galeazzi fracture?

25525

11. The physician performs lumbar L4-L5 fusion by posterior approach and partial fecetectomy, foraminotomy what are the CPT codes that represent his services?

22612
63030

12. The physician performs posterior interbody fusion of L4-L5 interspace and minimal diskectomy give CPT codes representig this service?

22618

13. What is the difference between morselized and structutal bone grafts?

Morselized bone grafts are pieces of bones that are used to fill spaces while structual bone graft is compact bone graft.

14. What is the difference between autograft an allograft?

Autografts are grafts that are tken from the patient's own body while allograft are taken from some other inividuals.

15. What modifier indicates decision for surgery?
57

Tags: cpc exam questions and answers

Heart / Cardiac Catheterization Coding Left/Right

2010-07-31T05:55:00.000-07:00

CPT coding of cardiac catheterizations is quite easy. There are a limited set of codes that are to be used. Let us first understand what is done during cardiac catheterization.

The physician accesses the femoral artery and passes the catheter with/without gudewire to reach the aorta and may/maynot perform aorogram. Then the cathter is reached to LCA ostium and coronary angiography is performed. The physican then performs ventriculogram. For angiographies first contrast injections are performed followed by radiologic imaging. The physician also takes reading various heart readings for which no codes are requied.

CPT coding of cardiac catheterization involves codes for cardiac catheterizations, injections and angiograms i.e. radiologic supervision and interpretation.

Get your cath code first—it will most frequently be either of the following:

Right heart catheterization (93501 which will start from the femoral vein)
(37.21) (88.52)
Left heart catheterization (93510 which will start from the femoral artery)
(37.22) (88.53)
Combined left and right heart catheterization (93526 which will include the femoral artery and vein)
(37.23) (88.54)

CPT codes for cardiac injection (93539-93545)
There are specific codes for bypass arteries or native main arteries (e.g. mammary)
(93539 don’t append modifier-51)
(88.55 or 88.56)
bypass veins (93540 don’t append modifier-51),
(88.55 or 88.56)
native arteries and veins; also called coronary angiography (93545
don’t append modifier-51)
(88.55 or 88.56)
as well as aortography (93544
don’t append modifier-51 ) for the aorta
(88.42)
and heart chambers: the ventricles and atria; also called ventricular or atrial
angiography (93542; 93543 append modifier-51 )

(88.52, 88.53, or 88.56)

- then your S&I codes (93555-93556
don’t append modifier-51
)
(included in 88.52-88.56)
93555 goes with 93542 and 93543 only representing the heart chambers
93556 goes with all the other injection codes.

For ICD-9-CM coding of the injection and imaging portion of the cardiac cath:
First of all, note that procedures classified to 89.6x are not coded with cardiac
cath
You use only 88.55 or 88.56 for all coronary vessel imaging—there is no
distinction made between the different types of coronary vessels and bygrafts. In most
cases, a two catheters are referenced (88.56), but if only one catheter is referenced, you
would use 88.55.

For the heart chambers, you use one code for the right heart structures in a right
heart cath (88.52), one code for the left heart structures in a left heart cath (88.53), and
one code for combined heart structures in a combined heart cath (88.55).

Common Cardio Abbreviations:
LIMA: left internal mammary artery
OM: obtuse marginal artery
ICA: intercranial/internal carotid artery
ECA: extracranial/external carotid artery
CCA: common carotid artery
SVC: superior vena cava
IVC: inferior vena cava

Don’t forget modifiers to identify coronary arteries and recall that any branches of
these arteries are not recognized for separate CPT code reporting:
LC—left circumflex coronary artery
RC—right coronary artery
LD—left anterior descending artery

Final Tips:

Note: a left heart cath must include the catheter passing the aortic valve into the left heart
chambers, otherwise code 93508 should be used. You must also note the approach when
considering your initial cath codes: there are several others types of left heart caths codes
and combined types of cath codes such as retrograde by cutdown (93511) for a left heart
cath and left ventricular puncture for a left heart cath (93514) and for a combined heart
cath (93528).

If contrast is used, be sure that it is captured via chargemaster or otherwise—this is
separately reimbursed. Codes most likely will be Q9949 or Q9950 based on the specified
type of material. Be sure to report the proper number of units used. Other supplies are

Coding Cystoscopy and Transurethral Procedures

2010-07-31T05:20:00.000-07:00

CPT codes for cystoscopy, cystoureteroscopy and cystouretheroscopy codes are in 52000-52700 range.

CPT code 52353 cystoureteroscopy with lithotripsy involves fragmentation of ureteral calculus with a grapser and also includes removal of calculus (CPT 52352). CPT code 52325 should be used when fragmentation of ureteral calculus is done using ultrasonic or hydrolic technique (ESWL).

CPT code 52332 is used for placement of permanent indwelling stent like Double J. Cystoscopic placement or removal of a temporary ureteral catheter (52005) is included in 52320-52355.

CPT Coding Knee Arthroscopy

2010-07-23T08:53:00.000-07:00

CPT codes 29866-29887 are used to report knee arthroscopy procedures.

HCPCS code G0289, Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee, is also used in some instances for Medicare claims.

Considering that only one compartment of knee is involved, we see what codes can be coded and what are bundled together

CPT code 29875 limited synovectomy and or plica resection is bundled into CPT chondroplasty and CPT menisectomy codes 29877 and 29880. Hence if plica resection, which is part of synovium, and chondroplasy are performed in the same compartment at the same session, only chondroplasty should be reported. Similarly if limited synovectomy and menisectomy is done in the same compartment, only menisectomy code 29880-29881 should be reported.

Most of the the time synovectoy is performed for better visualization during arthroscopy as it obstructs the view of the physician and hence shoud not be coded as it is included in the procedure being done.

Major synovectomy is an extensive procedure and includes condroplasty.

Abrasion chondroplasty includes chondroplasy. Abrasion chondroplasty involves microfractures or drilling to the bone till bleeding for better regeneration.

Femoral notchplasty if performed alone is coded to 29999 unlisted arthroscopic code. Femoral notchplasty is included in chondroplasty so if chondroplasty is peformed it should not be reported seperately.

Femoral notchplasty is also included in anterior cruciate ligament reconstruction hence should not be coded seperately when ACL is performed.

CPT code for arthroscopic loose body removal should be coded only if no other procedure is performed in the same compartment of the knee. For loose bodies greater than 1 CM a seperate code can be used.

Use CPT code 29873 for Arthroscopic lateral release for patellar dislocations.

Knee Compartments:
From CPT coding prospective there are three knee compartments patellofemoral, medial, and lateral. Medical femoral condyle and lateral femoral condyle are part of medical and lateral compartments respectively.

Coding Arthroscopy Shoulder Procedures

2010-07-20T08:37:00.000-07:00

CPT codes for shoulder arthroscopy requires good understanding of shoulder anatomy.

Arthroscopic coracoplasty (partial resection of the coracoid process’s posterolateral side) is not included in 29826. Report 29999.

CPT does not have a code for arthroscopic posterior remplissage, so report 29999 (Unlisted procedure, arthroscopy).

CPT code 29828 Arthroscopic biceps tenodesis does not include the arthroscopic bicep tenotomy. Report 29999 (Unlisted procedure, arthroscopy)

SLAP lesion is a superior labrum lesion not inferor labrum. Repair of a torn labrum should not be coded to 29807 because 29807 represents repair of SLAP tear and all labral tears are not SLAP tears. According to AAOS report 29806 with 29807 only if the SLAP lesion repair is Type 2 or Type 4. For the other 5 types of SLAP lesions, it may not be appropriate to report 29807 with 29806.

Repair (debridement) of a type I SLAP lesion is always coded as 29822 (Arthroscopic debridement, limited). Repairs of types II and IV SLAP lesions are coded 29807 (Repair SLAP lesion) because an actual repair is performed.

Type III SLAP lesions are bucket-handle tears and can be either debrided or repaired; use 29822 or 29807, whichever is appropriate. Adding code 29806 (Arthroscopy, shoulder, surgical, capsulorrhaphy) for repair of a SLAP lesion is never appropriate unless there is a capsular defect in an area different than the SLAP. This is one of the most common coding errors. Even if a staple or other device goes through the capsule to repair the SLAP, capsulorrhaphy should not be coded separately.

A partial synovectomy (29820) or limited debridement (29822) would consist of work done in just a portion of the shoulder, such as the front or the back of the shoulder. To support a complete synovectomy (29821) or extensive debridement (29823), the documentation should support work in BOTH the front and back of the shoulder.

CPT code for arthroscopic distal clavicle resection includes extensive debridement.

HCPCS Codes

2010-07-06T07:02:00.000-07:00

What are HCPCS codes?
HCPCS stands for the Healthcare Common Procedure Coding System. HCPCS codes can are divided into two sets of codes. The first, or Level I, code set is a five-digit numeric code that contains the Physician's Current Procedural Terminology (CPT) maintained by the American Medical Association. The CPT is comprised of descriptive terms and identifying codes used primarily for billing for services provided by physicians and other healthcare professionals. The second code set, or Level II, is a code set for medical services not included in Level I, such as durable medical equipment, prosthetics, orthotics and supplies. These codes are alpha-numeric in that they begin with a single letter, such as an A or D in the case of durable medical equipment, followed by four numbers.

HCPCS codes were developed to simplify medical billing. There are a number of items with HCPCS codes that Medicare categorically does not cover. Whether an item with a HCPCS code is covered under a particular state Medicaid program depends on whether the item meets the state=s definition of durable medical equipment, prosthetics, orthotics, or any other service covered in that state.

HCPCS codes can be found (although not easily) on the CMS website, http://www.cms.hhs.gov/home/medicare.asp. Under coding, click on AHCPCS Release and Code Sets.@ Then click on AAlpha-Numeric HCPCS@ on the left. Click on the A2008 Alpha-Numeric HCPCS File@ and download the ZIP file.

cpt hcpcs code, hcpcs code, hcpc code,

Medical Coding Colleges

2010-07-05T08:29:00.000-07:00

Medical Coding Colleges

CNI College Coding School in Orange County
The California State University, East Bay offers Certificate in Medical Billing and Coding
MTI College's healthcare school offers medical billing and coding program at MTI College california.
Kaplan College Riverside, offers California Medical Billing and Coding Programs
Brighton College is accredited by the Accrediting Commission of the Distance Education and Training Council (DETC), Washington D.C.
Anthem Education Group medical coding and billig diploma at following locations
Anthem College - Aurora, Beaverton, Kansas City, Milwaukee, Minneapolis, Cherry Hill, Jersey City, Las Vegas, New York, North Brunswick, Parsippany, Springfield, Memphis, Nashville, Orlando, Sacramento, Dallas

Sanford-Brown colleges offering medical coding are located at Atlanta GA, Middleburg Heights OH, Collinsville IL, Cranston RI, Dallas TX, Dearborn MI, Farmington CT,Fenton MO, Fort Lauderdale FL, Garden City NY, Grand Rapids MI, Hazelwood MO, Houston TX, Iselin NJ, Indianapolis IN, Jacksonville FL, Landover MD, Milwaukee WI, Monroeville PA, New York NY, North Loop TX, Phoenix AZ, San Antonio TX, St. Peters MO, Tampa FL, Tinley Park IL, Trevose PA, White Plains NY, Vienna VA

Mandl School in New York City.
The Academy of Health Care Professions offers medical coding programmes in Texas
Remington College's Medical Billing and Coding Program is available at the following campuses: Baton Rouge, Cleveland, Cleveland West, Colorado Springs(1), Dallas, Ft. Worth, Houston, Houston Southeast, North Houston, Lafayette, Little Rock, Memphis, Mobile, Nashville and Shreveport.
Westwood College Dallas - Dallas, Fort Worth, Houston South

Healthcare Coding

2010-07-04T02:08:00.000-07:00

Healthcare coding also known as medical coding is encription of medical records data using universally recognized coding languages such as ICD, CPT, HCPCS. The purpose of healthcare coding in US is primarily for reimbursement of healthcare insurance claims. In healthcare coding, the medical records are scanned by a coding specialist and all the diagnosis, procedures, medical history, adverse effects are assigned ICD, CPT, or HCPCS codes thus each code represents a particular disease, procedure, or surgical intervention. Insurance companies pay claims according to the codes that are associated with a claim.

Healthcare coding industry can be said as recession proof industry because even during recession there was good demand for healthcare coding specialists. The future prospects of healthcare coding is also bright as the healthcare overhaul in the United States guarantees continue increased demand for healthcare coding professionals.

Healthcare coding industry can be said to be last to be effected by outsourcing as hospitals are still reluctant to outsoource coding work. This is because a single wrong code can result in a significant loss of revenue for the hospitals. So the hospitals want the coders to work in hospital itself, so as and when if they get any dought regarding coding, they could clarify it with the physicians right away.

CT Scan CPT Codes

2010-05-23T02:51:00.000-07:00

Here are CT scan CPT codes for various anatomical sites. CPT has distinct codes for CT scans without contrast, CT scan with contrast, and CT scan following contrast for all anatomical sites. For example CT Scan of abdomen without contrast, CT scan of abdomen with contrast, and CT scan of abomen following contrast will have three different codes.

Head and soft tissue of neck: 70450-70498
Chest: 71010-71555
Thorax: 71250-71270
Spine(cervical, lumbar, thoracic,: 72125 -73202
Lower Extremities: 73700-73702
Abdomen and pelvis: 74150-74170

Inpatient Patient Coding Training Courses

2010-05-23T00:22:00.000-07:00

If you are looking for getting into inpatient coding then followiing are some of the training courses available for getting trained in inpatient coding.

The Certified Coder Boot Camp from HCPRO
This course is designed for individuals with outpatient coding experience. It focuses on Inpatient Hospital Coding. The course emphasizes inpatient coding guidelines, abstracting inpatient medical records and DRG ("Diagnosis Related Grouping") assignment. It is a full time one week course and costs arouns 200 USD.
For more information Contact Customer Service at 800/780-0584 or bootcamps@hcpro.com.

Inpatient Coding: DRG Assignment training course from HCPRO
It is an online training course intended to master DRG coding costs $49.00. Contact: customerservice@hcpro.com.

Careerstep Inpatient Coding traning courses
Career Step has a training course for inpatient medical facilities. You'll be fully trained to accurately code inpatient diagnosis and procedures from medical records and complete the billing and reimbursement process. The Career Step Inpatient and Outpatient Medical Coding and Billing program can be completed in 640 hours, or 4 months of full-time study. It is an online programme costs around $2250.
Tags: Inpatient Patient Coding Training Courses, DRG training,

Inpatient coding vs Outpatient coding

2010-05-23T00:21:00.000-07:00

Medical coding is broadly divided into two categories inpatient coding and outpatient coding. Here are some of the differences. Outpatient coding involves coding charts where the hospital stay is limited to 24 hours. The patient is treated and discharged within 24 hours. Outpatient coding is far easier than inpatient coding. In inpatient coding, the patient is admitted and remains in the hospital til he recovers thus making the hospital stay more than one day. Inpatient coding requires coding of services of each day of the hospital stay thus making is more and more difficult if the hospital stay becomes longer and longer. For procedural coding in outpatient CPT codes are used whereas in inpatient coding ICD procedure are used. In outpatient coding dignosis like suspected, ruleout, probable, or consistent are not coded and instead respective symptoms are codes whereas in inpatient coding all such diagnosis are coded as current conditions. In outpatient coding, abnormal findings are coded as given by the physician whereas in inpatient coding abnormal findings are not coded and reported unless the provider indicates their clinical significance.

Inpatient operative reports are very exhaustive and may have hundreds of pages.
One more difference between inpatient and outpatient coding is the usge of DRG coding in inpatient coding so the skill sets required for inpatient coding also include DRG expertise.

Tags: difference between inpatient outpatient coding, inpatient outpatient coding similar different, medical coders, americal academy of professional coders, healthcare industry, ICD 9

CPT Modifiers

2010-05-15T23:39:00.000-07:00

CPT Modifier definition: CPT modifiers are combination of two characters letters or alphanumeric codes that are meant to convey additional information regarding the procedure or services offered by the physician or hospital. These codes are appended to CPT codes. The additional information that can be conveyed by these codes includes wheather a procedure is discontinued, done on the left or right side, reduced, multiple procedures done in the same session, etc.

Proper use of CPT code modifiers: Proper use of CPT modifiers is necessary for accurate billing. Modifiers used inappropriately will affect the payment.

Some of the examples of CPT modifiers are
CPT mdifier 59 for distinct services
CPT modifier 51 for Multiple services
CPT modifiers LT and RT to indicate left and right side
CPT modifier 25 to be used with E/M code along with any other distinct CPT service provided on the same day of service.
CPT modifier 52 for reduced services.
CPT modifier 26 to identify professional component in radiology.
CPT modifier 76 for repeat procedure by the same physician
CPT modifier 53 for discontinued procedure

Coding infusions and injections

2010-05-14T23:14:00.000-07:00

Coding infusions and injections in ICD and CPT

CPT has the following CPT codes for infusions
96365 IVPB initial hour
96366 IVPB each subsequent hour same drug
96367 IVPB each subsequent new drug(sequential infusion)
96368 Concurrent infusion
96374 IVP initial substance or drug
96375 IVP new substance or drug
96372 Intramuscular Injection

CPT code 96368 is reported only once per encounter.
CPT code 96367 is used only once per sequential infusion of same infusate mix
To qualify for each additional hour code "96366" infusion should be more than 30 minutes else it is includes in previous hour. For infusions of 15 minutes or less 96374 should be used.

CPT has the following CPT codes for injections
Injection with physicians supervision 96372 (physician coding)
Injection without physician supervision 99211 (physician coding)
Hospital coding report 96372 when the physician is not present.
Non-antineoplastic hormonal therapy injections: 96372
Anti-neoplastic nonhormonal therapy injection therapy: 96401
anti-neoplastic hormonal therapy injection therapy: 96402
Allergen immunotherapy injections: 95115-95117

Modifier 59 should be used with 96372 if used with infusion codes.

ICD procedure codes for infusions and injections
99.21 Antibiotic injection
99.23 Steroid Injection
99.17 Insulin Injection
99.29 Injection other substance

Secondary Malignant Neoplasm ICD codes

2010-05-08T22:50:00.000-07:00

Here is a list of diagnosis codes for secondary malignant neoplasms that are usually encountered.

secondary malignant neoplasm lung: 197.0
secondary malignant neoplasm brain: 198.5
secondary malignant neoplasm axaillary lymph nodes: 196.3
secondary malignant neoplasm brain: 198.3
secondary malignant neoplasm bone and bone marrow: 198.5
secondary malignant neoplasm kidney: 198.0

Tags: icd code secondary malignant neoplasm of lung
diagnosis code 197.0 secondary malignant

ICD 9 Cancer codes

2010-05-08T22:21:00.000-07:00

Here is a list of ICD 9 codes for commonly encountered cancers

icd 9 breast cancer: 174.9
icd 9 skin cancer: 173.9 (skin cancer NOS)
icd 9 basal cell carcinoma: 173.x (fourth digit is site specific)
icd 9 cervical cancer: 180.9
icd 9 ovarian cancer: 183.0
icd 9 uterine cancer: 179
icd 9 code for prostate cancer: 185
icd 9 bladder cancer: 188.9
icd 9 colon cancer: 153.9
icd 9 kidney cancer: 189.0
icd 9 rectal cancer: 154.9
icd 9 colorectal cancer: 154.0
icd 9 lung cancer: 162.9
icd 9 liver cancer: 155.0
icd 9 squamous cell carcinoma: 173.9 ( squamous cell carcinoma NOS is considered as skin cancer)
icd 9 melanoma: 172.x (Melanoma NOS is considered as skin carcinoma)
malignant melanoma icd 9: 172.x (fourth digit is site specific of skin)
icd 9 basal cell carcinoma: 173.9
icd 9 code stomach cancer: 151.9
icd 9 code pancreatic cancer: 157.9

icd 9 codes

2010-05-08T08:04:00.000-07:00

icd 9 code for asthma 493.90
icd 9 code fpr end stage copd 491.20
icd 9 code for emphysema 492.8
icd 9 code for chf 428.0
icd 9 code for gerd 530.81
icd 9 code for chronic bronchitis 491
icd 9 code hiatal hernia 553.3
icd 9 code ibs 564.1
icd 9 code gastritis 535.50
icd 9 code heartburn 787.1
icd 9 code eosinophilic esophagitis 530.13
icd 9 code barrett's esophagus 530.85

Coding Wound Care in ICD and CPT

2010-05-08T00:25:00.000-07:00

Wound care coding in CPT and ICD

Wound in ICD refers to open wound even if the documentation does not mention the word "open wound." CPT has the following code sets for repair or suturing of open wounds. These codes include Adhesives (surgical) (tissue). Application of adhesive strips (butterfly) is included in E/M and ICD will guide you to omit code.

Repair-Simple 12001-12021
Simple repair includes single layer closure.
Repair-Intermediate 12031-12057 (Multilayer closure or simple repair with extensive cleaning or debridement)
Repair-Complex 13100-13160

CPT also has codes for closure of wound dehisence
12020 Simple closure of superficial wound dehiscence
12021 Simple closure of superficial wound dehiscence with packing
13160 Secondary closure of surgical wound or dehiscence, extensive or complicated

Simple debridement is included in repair codes, but if extensive debridement or prolonged cleanseing is carried out with intermediate or complex repair then it sholuld be reported seperately. Full thickness repair of lip and eyelid are not included in these series.

ICD 9 repair codes
08.81 Eyelid/Eyebrown
08.83 Eyelid Laceration partial Thickness
18.4 External Ear
21.81 Nose
24.32 Gum
27.51 Lip
27.52 Mouth
86.59 Skin any other sites

Tags: Coding Wound Care in ICD and CPT, Coding Wound repair, Meical Coding Wound Care

Vaccination Diagnosis Codes

2010-05-07T23:46:00.000-07:00

Pediarix vaccination is a serum of five vaccines Diphtheria, Tetanus, Pertussis, Hepatitis B, and Poliomyelitis. It is coded to V06.8. DTaP + HCB + IPV is a serum of Diphtheria, Tetanus, Pertussis, HCB, and Poliomyelitis. This is coded to V06.8. H1N1 vaccine is coded to V04.81.
RotaTeq Rotarix is coded to V04.81.
Hepatitis A & Hepatitis B vaccines are both coded to V05.3

ICD 9 CM has codes for vaccination not carried out for various reasons. This codes are in subcategory V64.0x

Tags: Vaccination Diagnosis Codes

ICD 9 code follow up

2010-05-07T23:30:00.000-07:00

If the encounter is for follow-up of a condition and the condition is still present (not resolved) the condition would be coded and not the V67.59. The physician may used terms like "improved" and "resolving" for a condition that that still needs treatment. If the encounter is to follow-up a chronic condition, such as HTN, asthma, obesity, code the chronic condition as the first listed dx - do not assign the V67.59 in these types of cases.

When a follow-up examination is conducted to determine if there is any evidence of recurring or metastasizing cancers and no evidence of malignancy is found, the case is classified to the V67 category.

V67.09 Surgery only
V67.1 Radiation therapy only or radiation therapy following surgery
V67.2 Chemotherapy only or chemotherapy following surgery or radiation

If the follow-up examination reveals recurrence or metastasis, category code V67 would not be used.

Follow-up Postop total knee replacement is coded to V54.81
Following treatment of healed fracture is coded to V67.4
Follow-up examination following psychotherapy and other treatment for mental disorder is coded to v67.3
Unspecified followup exam is coded to V67.9

Tags : ICD 9 code follow up ICD 9 followup

Medical Coding Abbreviations

2010-05-07T23:17:00.000-07:00

Some of the commenly used medical coding abbreviations are

TTP - Tender to palpation
RRR - Regular rate and rhythm
AODM - Adult onset diabetes mellitus
IDDM - Insulin dependent diabetes mellitus
NIDDM- Non Insulin Dependent diabetes mellitus
BA- Bronchial Asthma
GERD - gastroesophageal reflux
C - with
S - without
IM - Intramuscular Injection
IV Intravenous infusion
IVP - Intravenous push
IVPB - Intravenous push Bolus
URI - Upper Respiratory Infection
UTI - Urinary tract infection
OM - Otitis Media
CXR - Chest Xray
MRI - Magnetic Resonence Imaging
CT - Computer Tomography
PO - Per Ora
PRN - As Required
F/U - Follow up
Rx - Prescription
W/ - With
W/O - With out
BMI - Body mass Index
DM - Diabetes Mellitus
HTN - Hypertension
HPL/HL - Hyperlipidemia
H/O - History of
CP - Chest pain
SOB - Shortness of Breath
SX - Symptoms
LMP - last menstrual period
CAD - Coronary Artery Disease
WNL - within normal limits
bid - twice
npo - Nothing per mouth
u/a - Urine analysis
tsp - tablespoon
q6h - every 6 hours
WCC - well child check
sz - seizures
r/o - ruleout
d/o - disorder
s/p - status post

Medical Coding Abbreviations, Medical Coding Abbreviations

ER CPT and ICD Procedure Codes

2010-05-07T23:07:00.000-07:00

Coding Emergency Rooom visits, here are some of the commonly used ER CPT and ICD Procedure Codes

CPT code ICD procedure codes

36415 Blood draw 38.99
94760 Pulse Ox single 89.38
94761 Pulse Ox multiple times
93005 EKG 89.52
94150 peak flow (vital capacity) 89.37
87880 rapid strep
94640 Nebulizer treatment (Use modifier 76 if more than once) 93.94
81025 urine HCG
82962 finger stick
81002 urine dip stick
10060 Incision and drainage 86.04
10061 Incision and drainage with packing 86.04
36600 arterial bloog gasses (ABG) 38.98
82962 glucose blood test (fasting glucose)
92950 cardiopulmonary resuscitation (CPR) 99.60
92960 defibrillation 99.62
31500 Endotracheal intubation 96.04
30901 Epistaxis control any approach anterior 21.0x
90935 Hemodialysis 39.95
36556 Insertion of central venous cath nontunnedled
49450 Gastrostomy replacement 97.02
90801 Psychiatric interview 94.19

Vaccinations immunogloblin codes mostly Td and rabiess 90703,90718, 90714, 90471, 90801

Splints: Posterior splint is short leg splint
ICD 9 procedure code: 93.54
29125 Short arm splint
29130 Finger splint, static
29505 Long leg splint
29515 Short leg splint
29530 knee immobalizer

Skin repair and suturing codes
12001-16036 86.59
Pressure dressing 93.56

Radiology codes for CT, X-ray, Ultrasound, MRI, KUB

Modifier AI Principal Physician of Record

2010-05-06T07:18:00.000-07:00

Modifier “-AI,” defined as “Principal Physician of Record,” is used by the admitting or attending physician who oversees the patient’s care, as distinct from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI” in addition to the initial visit code. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed.

The primary purpose of this modifier is to identify the principal physician of record on the initial hospital and nursing home visit codes. It is not necessary to reject claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or outpatient codes). Follow-up visits in the facility setting may be billed as subsequent hospital care visits and subsequent nursing facility care visits as is the current policy. In all cases, physicians shall bill the available code that most appropriately describes the level of the services provided.

Tags: modifier AI decision chart, cms modifier AI

ICD Screening mammogram coding

2010-05-04T07:20:00.000-07:00

ICD 9 CM Catagoty V76 is for screening examination of breast including screening mammograms. ICD 9 CM Catagoty 793 describes abnormal mammogram findings.

V76.11 Screening mammogram for high-risk patient
V76.12 Other screening mammogram
793.81 Mammographic microcalcification
793.82 Inconclusive mammogram
793.89 Other (abnormal) findings on radiological examination of breast

High risk patient are those who have a history of breast cancer or there is a family hstory of breast cancer. Here are some examples of screening mammograms with normal results i.e normal mammogram.
1. Screening mammogram for a patient with history of breast cancer: V76.11, V10.3
2, Screening mammogram for a patient with family history of breast cancer: V76.11, V16.3
3. Screening mammogram : V76.12

Here are some examples of screening mammograms with abnormal findings i.e calcifications, dense breast, nodules, microcalcifications.

1. Screening mammogram for a patient with history of breast cancer and mammographic findnigs include clacifications: V76.11, 793.89, V10.3
2. Screening mammogram for a patient with history of breast cancer and mammographic findnigs include nodules: V76.11, 793.89, V10.3
3. Screening mammogram for a patient with history of breast cancer and mammographic findnigs dense breast: V76.11, 793.82, V10.3
4. Screening mammogram for a patient with family history of breast cancer and mammographic findnigs dense breast: V76.11, 793.82, V16.3

If the patient has a history of breast cancer with resection and came for diagnoistic mammogram with is normal then the codes will be: V67.09, V10.3

Tags:
ICD 9 unspecified abnormal mammogram
screening mammogram ICD 9 code
ICD 9 screening mammogram
other screening mammogram v76 12
diagnosis code other screening mammogram

Emergency Room/Department Coding Guidelines

2010-05-02T07:07:00.000-07:00

Emergency Room/Department coding is one of the most simple type of coding. It involves diagnostic coding and simple procedural coding(CPT/HCPCS).

Assign ICD-9-CM diagnosis codes for the Admitting Dx and all Other Dx. Other diagnoses would include all chronic conditions that the patient may have and other documented diagnoses that would justify the tests performed in the ER. These codes are picked up for medical necessity purposes. The first listed diagnosis should be the primary diagnosis for which the patient came to the ER for. ICD-9-CM and CPT procedure codes need to be assigned for procedures. E-codes need to be assigned as per ICD-9-CM Official Guidelines for Coding and Reporting (for injuries, poisonings and adverse effect of drugs).

Some common Emergency Room/Department (ER/ED) procedures are:

Sutures
Casting/Splintings/Strappings
Any scopes (ie: EGD, Laryngoscopy)
Reductions/Manipulations
IV’s, IVP’s and IVPB
SQ & IM Injections
Arthrocentesis
Drainage of Abscess
Cardioversion
Transfusions
Hemodialysis
Shots/Vaccines (administration and vaccine product)
Foreign Body Removal
Nasal Packings/Cautery
Foley Caths
Spinal taps
ABG (36600)
Nebulizer Treatments
X-rays, CT, Ultrasounds, MRI
Labs
EKG
Pulse Ox
Venous Puncture/Lab Draw (36415)

These are general Emergency Room/Department (ER/ED) guidelines. However guidelines vary slightly from facility to facility. Also some of the procedures will be chargemastered so no need to code them.

Tags: Emergency department coding, emergency medicine coding, urgent care coding, career emergency room coding, emergency room coding guidelines

IV Infusions and Hydration coding guidelines

2010-05-01T23:33:00.000-07:00

What are the guidelines for sequencing IVPD, IVP, and hydration infusions?
According to CPT for facility coding chemotherapy services are primary to
theraputic, prophylactic and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. Hydration codes are facility reporting only. For physician reporting initial code that best describes the primary reason for the encounter should be reported irrespective of the order in which the infusions or injections occur.

According to CPT we can report 96374 and 96361, but we cannot report 96360 and 96375 so 96374 is primary to 96360.

What are the guidelines for coding Hydration ie. how to determine hydration Vs Infusion?
Hydration may be billed separately only if it is given prior to or subsequent to drug infusion. If it is given concurrently to facilitate drug delivery, it is considered included in the drug infusion. If hydration is less than 30 minutes then it is not billable and the reson is that if it is less than that then it is not therapeutic and cannot be dehydration. Also look at the rate the fluids are running at, that will tell you if it is for hydration and not just for convenience. Therapeutic rate is 125cc/hr. Heplock and KVO(keep vein open) are not coded.

Saline soluton, D5W(dextrose 5% water), Hypotonic solution, Ringer Lactate, DW( Distilled water) are some of the solutions used along with other drug infusions and also as hydration. If any medication is used along with these then it is therapy 90765 not hydration 90760 and any saline fluid use is incidental and not to be reported.

Here are the CPT codes for infusion and hydration

IV infusion Bolus (IVPB) is an infusion that runs more than 15 minutes. Less than or upto 15 minutes is coded as IVP.

96365 Inital drug first hour
96366 Same drug each additional hour
96367 New drug each additional hour
96368 Used to indicate concurrent infusion of two or more drugs

Intravnous Push (IVP) is an infusion which runs up to 15 minutes
96374 (This code should not be used if 96365 or 96360 are in use instead use 96375 with appropriate units for number of drugs)
96375

Salne infusion that run for more than 30 minutes are considered as theurapeutic hydration. Saline infusion for less than 30 minute is not coded.
96360 (This code should not be used if 96365 is in use instead use 96361 with appropriate units for number of hours of hydration)
96361

Intramuscular Injection
96372 (Need to use 59 modifier in if used conjunction with above codes)

Medicare HCC Coding

2010-05-01T22:22:00.000-07:00

These are CMS Hierarchical Condition Categories. Medicare has classified about 3,000 of the 14,000 ICD-9 diagnosis codes into HCCs or categories designating chronic conditions that end up costing them more money over the long run, such as diabetes, kidney failure, old MI, etc. When patients are assigned these ICD-9 codes, Medicare sees those beneficiaries as being more severely ill than the "average" Medicare beneficiary. For the Medicare Advantage members, this could result in higher reimbursement. Some of the conditions included in the model are status conditions, like s/p BKA or artificial openings (i.e. colostomy, tracheostomy, etc.). Certain fractures and conditions like respiratory failure are part of the model, but may or may not be chronic in nature.

In this program you are funded by diagnosis codes, not CPT codes. The sicker the patient (the more diagnoses) the more funding you receive. Never paid on CPT code level.

HCC codes are given a severity ranking. More specific codes have a higher ranking than unspecified codes. You code as you normally would but just make sure that you are coding with ICD-9 codes as specific as possible and using all the codes that apply to that visit per the documentation. If you use codes with a higher HCC ranking, you get more "credit". For example, if a patient is diabetic and they have other problems associated or caused by the diabetes, use the most specific codes 250.4x or 250.5x, etc instead of 250.0x.

Tags: HCC Coding. Medicare HCC Coding, HCC coding jobs

ICD-10 Recertification

2010-04-01T06:39:00.000-07:00

To ensure employers continue to have confidence in CPC's ability to accurately code the current codesets, once ICD-10 is implemented (thus protecting all 60,000 credential holders), and that those credentials truly represent one’s ability to code under the current code set, AAPC members holding a credential will have two years to pass an open-book, online ICD-10 proficiency test. All certified coders are required to pass the validation by September 30, 2014 to maintain certification.

You will be given two (2) years to take and pass, beginning October 1, 2012 (one year before implementation of ICD-10) and ending September 30, 2014 (one year after implementation)
There will be 75 questions
It will be open-book, online and un-proctored
Coders will have two (2) attempts at passing for the $60 administration fee

Medical Coding Companies in Bangalore (Bengaluru)

2010-04-01T06:05:00.000-07:00

Medical Coding Companies in Bangalore (Bengaluru)

Accenture Hires medical coders in Bangalore with minimum of 2-5 years of experiance.

Health Office is a Business Processing Outsourcing Company specializing in the field of Medical Transcriptionin, medical billing, medical coding at Bangalore.

Omega Healthcare is one the premier offshore providers of medical coding, billing, accounts receivable management, claims processing, and healthcare revenue management. The company has center in Bangalore.

Tags: Medical Coding Companies in Bangalore (Bengaluru)

Medical Coding Companies in Chennai

2010-04-01T00:14:00.000-07:00

Medical Coding Companies in Chennai

Accenture Hires medical coders in Chennai with minimum of 2-5 years of experiance.

Dell Perot Systems Corporation is a leading player in medical coding

ISEO Systems Pvt Ltd

Zenta Private Limited is a world-class knowledge process outsourcing (KPO) and business process outsourcing (BPO) company. The caompany has its center in Chennai.

Omega Healthcare is one the premier offshore providers of medical coding, billing, accounts receivable management, claims processing, and healthcare revenue management. The company has center in Chennai.

e4e Healthcare Services Chennai is a healthcare BPO with medical coding domain.

Technosoft Corporation, Chennai provides medical coding services.

Apollo Health Street Limited, Chennai provides medical coding services.

Tags: Medical Coding Companies in Chennai

MedAssurant Coding - Working from Home

2010-03-31T06:52:00.000-07:00

MedAssurant Coding - Working from Home Reviews

MedAssurant, Inc. is a leading provider of nationwide medical data abstraction, analysis, and verification solutions for the U.S. healthcare industry.

What is the type of work at MedAssurant?

Medassurant is hired by insurance companies to see if patient fits into a better ICD-9 code. You will get an assignment i.e. doctor's office/clinic/hospital and you need to go there on scheduled day. What you need to do is review charts and look for other diseases not known and you then scan all documents into the computer upload information. If ther is no field assignments then you you review charts online.

From what I understand is for coding/reviewing positions your salary is not dependent at all on experience or education but on where you live. There will be times when you will not get full. There will be weeks/months without a full load of work so paycheck may be much less than it should be. There employee contract states that there is a 2 year NON-COMPETE contract that you are required to sign. They do not guarantee 40 hours, but you have to be available for 40 hours. They also require that you complete the 30 hours of training, pass the test and perform your first review before they will pay you for the training. Payment is ontime and no delays.

If anyone has any good or bad experiances with MedAssurant pls keep comment so as to benefit other coders...

Tags: MedAssurant careers, reviews, salary, medassurant jobs, medassurant for nurses, working medassurant

Medical coding training in Georgia, Maryland, NJ, Michigan, NYC, louisiana, MN, South Carolina, Indianapolis, Florida, CT, Massachusetts, California

2010-03-20T07:05:00.000-07:00

Medical coding training schools in Georgia, Maryland, NJ, Michigan, NYC, louisiana, MN, South Carolina, Indianapolis, Florida, CT, Massachusetts, California, illinois, Ohia, Michigan

Andrewsschool medical coding and transcription training
Licensed by the Oklahoma Board of Private Vocational Schools
This is an online course available nationwide. Cost of tuition is $3,800. Students can enroll with a minimum down payment of $1,000. We allow two years to pay at no interest.
www.andrewsschool.com

The Allen School Online Medical Billing and Coding Training
The Allen School Online Medical Insurance Billing & Coding program prepares you for Certified Coding Associate (CCA) certification from the American Health Information Management Association. This is an Accelerated Program (9 months versus 15 months at other schools) designed to prepare students for entry-level positions (CCA track) or advanced positions (CSS track) as Medical Insurance Billing & Coding associates in physician’s offices, clinics and hospitals
www.online.allenschool.edu

The CODEMED School of Professional Medical Coding
Approved by American Health Information Management Association (AHIMA)
Offers Coding Certificate program
www.codemedschool.com

Lincoln's Collegs Online Medical Coding and Billing
www.lincolnonline.edu/programs/online-associate-degrees/online-medical-coding-and-billing#

Tags: Medical coding training schools in Georgia, Maryland, NJ, Michigan, NYC, louisiana, MN, South Carolina, Indianapolis, Florida, CT, Massachusetts, California, illinois, Ohia, Michigan, India

Medical Coding and Billing Scholarships

2010-02-25T06:55:00.000-08:00

The following are some of the medical coding and billing scholarships available in the United States.

The Federal Pell Grant Program

The Federal Pell Grant Program provides need-based grants to low-income undergraduate and certain postbaccalaureate students to promote access to postsecondary education. Federal Pell Grants are direct grants awarded through participating institutions to students with financial need. A Federal Pell Grant does not have to be repaid.
To Know More Visit www2.ed.gov/programs/fpg/index.html

The AHIMA Foundation Medical Coding and Billing Scholarships
The AHIMA Foundation is the philanthropic and charitable arm of AHIMA and offers the following scholarships for HIM people (medical coding and billing).

Merit Scholarships
The Foundation offers scholarships to students currently enrolled in accredited health information management programs. There are three levels of scholarships offered: $1,000 for a HIT AA degree student; $1,200 for a HIA BA/BS degree student; and $2,500 for a credentialed professional pursuing a masters or doctoral degree in an area related to HIM practice.

Tuition Reimbursement and Medical Coding Loan Forgiveness Program
A limited number of loan forgiveness opportunities are available to anyone majoring in Health Information Technology (the career pathway for professional clinical coding) at a CAHIIM/AHIMA accredited college. Recipients are awarded $5,000 in exchange for one year of work as a coding specialist at Partners Health Care (maximum $10,000 for 2 years). Applications are reviewed in May and November; finalists will be interviewed. For further information and also other offers visit www.partners.org/pcwd/content/education/financialAid.aspx

Scholarship For Military Spouses from MyCAA
Military Spouse Career Advancement Accounts (MyCAA)funds 100% of the cost of tuition and fees for medical coding and billing courses ar Allied School to military spouses.

Sarah Bush Lincoln Volunteer Guild Coding Scholarships
To be eligible, applicants must be accepted into or currently enrolled in a hospital-related health care professional curriculum. The school to be attended must be accredited or recognized as an approved program by the appropriate agencies.

Scholarships are awarded for an academic year and are based on a student’s scholastic achievement, financial need and the availability of funds.

All application packets must be received by the volunteer services office no later than April 1, 2010.
cstoner@sblhs.org.
www.sarahbush.org

Tags: medical coding and billing scholarships

CCS, CCS-P, CPC, CPC-H Exam Study Guides

2010-02-24T09:51:00.000-08:00

CCS Exam Study Guides

Coding in Context
Case Studies for Advanced Practice
(Ahima's Coding Series)

Professional Review Guide For The CCS Examination, 2009 Edition
by Patricia Schnering
A very popular CCS exam review guide
aka "PRG study guide" for CCS

Certified Coding Specialist (CCS) Review Guide, 2009 Edition
By Jennifer Hornung Garvin
AHIMA, May 2009, 2nd edition
coding practice, case studies, review

CCS Coding Exam Review 2009: The Certification Step
By Carol J. Buck
Comprehensive CCS coverage, with CD

The Extra Step: Facility Based Coding Practice
By Carol Buck
Rreal-world coding cases to prepare for CCS and CPC-H exams
Over 100 cases in 13 specialties
Study Guide Series by Linda Kobayashi

CCS-P Exam Study Guides
Certified Coding Specialist (CCS-P) Physician-based: Exam Preparation
By Anita Hazelwood, Lynn Kuehn, Carol Venable
AHIMA, Jan 2009, 1st edition
Exam simulation, case studies

Professional Review Guide for the CCS-P Examination, 2009 Edition
"PRG study guide" for CCS-P
Updated yearly

CCS-P Coding Exam Review 2008: The Certification Step
B Carol Buck

Coding Review for National Certification: Passing the CPC and CCS-P Exams new review guide
By Mary Harmon
Career Education

The Extra Step, Physician-Based Coding Practice, 2009 Edition
By Carol J. Buck
Real-world coding cases to prepare for the CPC and CCS-P exams

CCA Exam Study Guides
Professional Review Guide for the CCA Examination: 2009 Edition
By Patricia Schnering
"PRG study guide" for the CCA exam

CPC Exam Study Guides
CPC Coding Exam Review 2009: The Certification Step
By Carol Buck
Review for the CPC and CCS-P exams
Includes all the content sections of the exam and practice exams with answers and rationales
Companion CD with the pre- and post-exams

Coding Review for National Certification: Passing the CPC and CCS-P Exams New review guide
By Mary Harmon
Career Education

The Extra Step, Physician-Based Coding Practice, 2009 Edition
By Carol J. Buck
Real-world coding cases to prepare for the CPC and CCS-P exams

CPC-H Exam Study Guides CPC-H Coding Exam Review 2008: The Certification Step 2008
By Carol Buck
Complete exam review with CD

The Extra Step: Facility Based Coding Practice
B Carol Buck
Real-world coding cases to prepare for CCS and CPC-H exams
Over 100 cases in 13 specialties

Other Useful Medical Coding certification exams books
ICD-9-CM Coding Handbook 2009, with Answers
By Faye Brown

ICD-9-CM Coding Handbook, with Answers, 2010 Revised Edition
Faye Brown

Practice medical coding test

2010-02-20T07:52:00.000-08:00

If you are preparing for CPC or CCS exams here is one practice test. This test also has sample questions on anatomy.

1. Complete the following statement, “Medically necessary services are . . . “

a. Consistent with the symptoms or diagnosis of the illness or injury being treated.
b. Reasonable. That is, in line with mainstream medical practice.
c. Reasonable and necessary for the patient’s condition and not performed primarily for the convenience of the patient, the attending physician, or the supplier.
d. All of the above.

2. In the SOAP format of medical record documentation, what term describes the section of the medical record that contains the notes for the physician’s examination of the key components of the E/M codes (what the physician observes)?

a. Subjective
b. Objective
c. Assessment
d. Plan

3. Referring to the SOAP format, the following statement would be found in what section of the medical record: “The patient is a 10-year-old female who has experienced right ear pain starting last night after dinner.”

a. Subjective
b. Objective
c. Assessment
d. Plan

4. In what portion of the medical record would you find the following statement: “Patient to apply ice pack around ankle three times a day to prevent further swelling; Tylenol as needed to relieve pain.”

a. Subjective
b. Objective
c. Assessment
d. Plan

5. The intentional misrepresentation by either providers or beneficiaries to obtain or receive payment for services is referred to as:

a. Unbundling
b. Fraud
c. Limiting Charges
d. All of the above

6. The prefix “path-“ means:

a. System
b. Organ
c. Disease
d. Cell

7. One of the three bones that constitutes the pelvic girdle is called:

a. Ileum
b. Lunette
c. Coccyx
d. Ilium

8. A laryngoscopy is:

a. A visual examination of the larynx
b. The inflammation of the larynx
c. The defective development of the larynx
d. An instrument used to examine the membrane of the larynx

9. The term “carcinoma in situ” refers to:

a. A malignant neoplasm found at the original site
b. A secondary or metastasized neoplasm
c. Malignancies that are confined or noninvasive
d. Tissue that is beginning to exhibit neoplastic behavior

10. A 6-year-old girl fell on the playground at school. An x-ray revealed a distal radial fracture. Where is this located?

a. Thumb side of lower forearm
b. Outside lower leg
c. Just below elbow on the thumb side
d. Lower part of the upper arm

11. Which term describes the most important reason for the care provided to the patient; that is, the first diagnosis code listed on the insurance form?

a. Complications
b. Adverse effect
c. Primary diagnosis
d. Symptoms

12. The term “adverse effect” means:

a. Secondary diagnosis code used to identify the external cause for a condition for which the patient is being seen
b. A morbid phenomenon or departure from the normal structure, function, or sensation experienced by the patient and indicative of the disease
c. The term denoting name of the disease or syndrome a person has or is believed to have
d. None of the above

13. Which of the following is a FALSE statement?

a. When only ancillary services are provided, list the appropriate V code first and the problem or condition second.
b. Code the primary diagnosis code first followed by the secondary, tertiary, and so on. Code any co-existing conditions that affect the treatment of the patient for the visit or procedure as supplementary information.
c. Only code a chronic diagnosis once, as it is not applicable to the patient’s current treatment.
d. Identify the service(s) or visit(s) for circumstances other than the disease or injury such as follow-up care

14. The symbol [ ] indicates:

a. Synonyms, alternate wording, or explanatory phrases
b. Supplementary words that may be present or absent without affecting the code assignment
c. A series of terms, each of which is modified by the statement appearing to the right
d. The code is specified

15. Which reference manual contains a listing of “V” and “E” codes as well as a numerical listing that classifies groups of disease and injury codes according to etiology and organ system?

a. CPT
b. HCPCS
c. ICD-9-CM VOL I
d. ICD-9-CM VOL II

16. A 16-year-old female was admitted to the ER for abdominal pain, nausea and vomiting, and diarrhea. Upon discharge, she was diagnosed with a ruptured ovarian cyst.

a. 789.0
b. 620.2
c. 789.03
d. 620.2, 789.03

17. A superficial burn to the right shoulder.

a. 942.04
b. 943.40
c. 943.15
d. 692.71

18. A four-week-old infant who is admitted for pyloric stenosis.

a. 750.5
b. 537.0
c. 779.3
d. 536.2

19. HCPCS is the acronym for:

a. Health Care Procedure Coding System
b. Health Coding Procedural Counting System
c. HCFA Common Procedure Coding System
d. Hospital Coding Procedural Care Services

20. Chose the appropriate HCPCS code for a semi-rigid, thermoplastic foam, two-piece cervical collar.

a. L0120
b. E0943
c. E0942
d. L0172

21. What is the HCPCS code for 1 cc of Testosterone Cypionate 50 mg?

a. J1090
b. J1060
c. J0900
d. J3140

22. Which modifier indicates diagnostic mammogram converted from screening mammogram on the same day?

a. –59
b. –58
c. –AT
d. –GH

23. What is the HCPCS code for wound closure using tissue adhesive(s) only?

a. A6250
b. G0168
c. A6265
d. G0170

24. Which of the following is the correct HCPCS code for 250 mg of Cyclosporin, parenteral?

a. J7502
b. J7516
c. K0121
d. J7515

25. Which modifier is used to describe a CLIA waived test?

a. QP
b. QW
c. GA
d. SG

26. In the CPT-4 text, what does the bullet symbol (•) represent?

a. Revised codes
b. New codes
c. Add-on codes
d. Service includes surgical procedure only

27. When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding which of the following modifiers?

a. –54
b. –66
c. –59
d. –62

28. When a patient is in a postoperative period and returns to the operating room for an unrelated procedure by the same physician, which of the following modifiers would you attach to the procedure being performed?

a. –59
b. –24
c. –78
d. –79

29. Evaluation and Management services were performed on an established patient in which the decision to perform a major surgery scheduled for the following morning was made. The patient was counseled for 15 minutes regarding treatment options, risks, and projected outcome. Which of the following modifiers would be appended to the service performed?

a. –56
b. –52
c. –50
d. –57

30. In the CPT-4 text, what does the following symbol represent (+)?

a. Revised codes
b. New codes
c. Add-on codes
d. Service includes surgical procedure only

31. The index in the CPT-4 text is arranged with main term entries. These main term entries will fall into one or more of four categories. Identify the four categories.

a. The procedure or service performed; the anatomical site involved; the condition; the modifying term.
b. The procedure or service performed; the organ or anatomical site; the code range; the synonym, eponym, or abbreviation.
c. The procedure or service performed; the organ or other anatomical site; the condition; the synonym, eponym, or abbreviation.
d. The modifying terms; the anatomical site; the disease; the synonyms, eponyms, or abbreviations.

32. A three-year-old established patient presents to her pediatrician for an earache and abdominal pain. The physician documented the chief complaint, a brief HPI, and problem pertinent system review. An examination of the respiratory system and the abdomen was performed. The physician prescribed an antibiotic and clear liquids for gastroenteritis. Select the E/M service code for this visit.

a. 99212
b. 99202
c. 99213
d. 99203

33. An out-of-state patient came to visit a Nephrologist to establish temporary care. The patient filled out a detailed history form, which was reviewed by the MD and his documentation recorded in the patient’s chart. The Nephrologist performed a detailed exam and made arrangements for local dialysis care. This history, exam, and medical decision-making took approximately thirty minutes. In addition, the physician spent 40 minutes with the patient and a family member discussing the new treatment options available for Chronic Renal Failure by addressing the patient concerns regarding the medical treatment he is receiving from his own Nephrologist. Code this encounter.

a. 99244
b. 99203-21
c. 99203, 99354
d. 99291

34. A routine E/M visit to stabilize a patient in ICU/CCU utilizes what code range?

a. 99234-99236
b. 99231-99233
c. 99291-99292
d. 99271-99275
35. The descriptors for the levels of E/M services recognize seven components in defining the levels of E/M services. Which components are considered the key components in selecting an E/M level of service?

a. Counseling, Time, and Examination
b. History, Examination, and Medical Decision Making
c. History, Time, and Medical Decision Making
d. Time, Examination, and Medical Decision Making

36. In the case where a patient is held in observation for more than two calendar dates, the physician must bill subsequent services furnished prior to the discharge utilizing which code range?

a. 99211-99215
b. 99201-99205
c. 99234-99236
d. 99231-99233

37. A physician is requested to stand by during a high-risk delivery of a newborn. The physician was on standby for forty-five minutes. Which code would be billed for this standby service?

a. 99436
b. 99360
c. 99360 x 2
d. 99431

38. What code would be reported for the delivery and discharge of a newborn on the same day?

a. 99431
b. 99432
c. 99435
d. 99238

39. Spinal anesthesia is defined as:

a. An injection of a local anesthetic solution into the subarachnoid space of the lumbar region to block the roots of the spinal nerves
b. The spinal nerves are blocked with injected local anesthetic agent into the epidural space of the spinal cord
c. When muscular relaxation occurs throughout the body, the muscles lose their tone; ocular movements cease; the pupils are centrally fixed.
d. None of the above

40. Continuous epidural analgesia for labor and a cesarean delivery

a. 00857-P1
b. 00955-P1
c. 59514-47
d. 88050-P1

41. Which of the following is not needed when billing for Monitored Anesthesiology Care (MAC)?

a. Modifier –QS
b. Total minutes of anesthesia service
c. Modifier –66
d. Documentation

42. A patient required an epidural in place for four days. The anesthesiologist checked it every day. How would daily visits be coded for an anesthesiologist when the patient’s primary physician also saw the patient?

a. 00700
b. 00850
c. 01996
d. 11760

43. When an anesthesiologist is utilized to provide services to a patient with a broken fibula requiring cast repair, the anesthesia services are reported with code(s):

a. 01462
b. 27780-47
c. 01490
d. 01999

44. Anesthesia complicated by emergency conditions would require the use of what modifier or CPT code?

a. –23
b. P5
c. 99100
d. 99140

45. Code the cryosurgery of a 1.5 cm pre-malignant lesion on the left forearm:

a. 17000
b. 17250
c. 17304
d. 17262

46. What would define the removal of an entire lesion for pathological review:

a. Destruction
b. Biopsy, incisional
c. Biopsy, excisional
d. Shaving

47. A patient, suffering from a hypertrophic breast condition, presents to the surgeon’s office surgical suite to have breast tissue removed due to her back pain this condition has caused. The physician removes 221 grams of tissue from the right breast and 284 grams of tissue from the left breast. Select the appropriate code(s) for this procedure.

a. 19316 x 2
b. 19324-50
c. 19324
d. 19318-50

48. Debridement is the process of removing dead tissue, eschar, dirt, foreign material, or debris from all except:

a. Burns
b. Wounds
c. Orifices
d. Infected skin

49. Code the excision of a 2.5 cm malignant lip lesion and two malignant lesions of the chest, each 1.5 cm in diameter.

a. 11643, 11602-51 x 2
b. 11403, 11402-51 x 2
c. 11643, 11602 x 2
d. 11200

50. Code the destruction of three benign facial lesions.
a. 17000, 17003 x 2
b. 17000 x 3
c. 17260 x 3
d. 11305 x 3
51. “No man’s land” is:

a. the palm of the hand
b. the middle bone of the fingers to the wrist
c. the crease in the palm closest to the fingers and the middle bone of the fingers
d. the crease in the palm closest to the fingers and the wrist

52. Code the closed treatment of a carpal bone fracture (not scaphoid), with manipulation.

a. 25635
b. 25624
c. 25645
d. 25628

53. Code a repeat closed treatment of a femoral shaft fracture with manipulation by the same physician who performed the initial treatment.

a. 27502-77
b. 27506-76
c. 27507-77
d. 27502-76

54. Code a knee amputation of the right leg just above the knee.

a. 27598
b. 27590
c. 27290
d. 28825

55. Code an arthocentesis into the acromioclavicular joint of the left shoulder.

a. 20550
b. 20610
c. 20605
d. 20600

Answers:
1. D 2. B 3. A 4. D 5. B 6. C 7. D 8. A 9. A 10. A
11. C 12. B 13. A 14. A 15. C 16. B 17. C 18. A 19. A 20. D
21. A 22. D 23. B 24. A 25. B 26. A 27. D 28. D 29. D 30. C
31. D 32. A 33. C 34. B 35. B

Tags:medical coding sample test, medical coding practice exams, certified professional coder practice exam, practice medical coding test

Free CPC practice exam

2010-01-24T04:07:00.000-08:00

If you are a medical coder or a medical coding student and preparing for CCS or CPC exam, here are some Free CPC practice exam questions which you help you prepare for the exam.

Following are Free CPC practice exams for CPC and CCS exams

1. Advancedweb has a series of Free CPC practice exams to assist all of you who are preparing to take the CCS and CCS-P examinations.
http://health-information.advanceweb.com/Article/Understanding-How-to-Code-Colonoscopies.aspx

http://health-information.advanceweb.com/Article/Coding-Knee-Arthroscopies-Can-Be-Tricky.aspx

Free CPC practice exams from Advanceweb

2. Test your knowledge with 20 new practice exam questions for 2009, free from JustCoding.
http://www.justcoding.com/exam_questions.cfm?qid=SCP

3. AHIMA has developed sample question paper Free CPC practice exams.
http://www.ahima.org/certification/documents/ccs_sample_questions.pdf

4. You can also try this Free CPC practice exams
www.hcpro.com/content/61715.pdf
http://medical-coding-carers.blogspot.com/2009/12/cpt-coding-questions-skin-and.html

Tags: free cpc practice exam, cpc practice exam 2009, ccs exam prep, ccs prep course, ccs p exam prep, ccs test questions

Global Period for Surgical Procedures

2010-01-15T19:11:00.000-08:00

Global Period for Surgical Procedures from a Medicare perspective, surgical procedures include the following services when furnished by the physician who performs the surgery:

The decision for surgery is not part of the surgical package and should be separately coded using an E/M code.

Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures;
Intraoperative services that are a usual and necessary part of a surgical procedure;
All additional medical or surgical services required of the physician during the postoperative period of the surgery because of complications not requiring additional trips to the operating room;
Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;
Postsurgical pain management;
Certain supplies;
Miscellaneous services (e.g., dressing changes; local incision care; removal of operative packs; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes).

There are a few distinctions between the Medicare and CPT package:
First, unlike CPT, Medicare includes in the surgical package treatment of complications that do not require additional trips to the operating room.
Second, unlike CPT, the postoperative part of Medicare's global period is not open-ended. Medicare assigns postoperative global periods of 90 days to major surgeries and either zero or 10 days to minor surgeries and endoscopies. Any services beyond the Medicare postoperative global period, even if related to the procedure, are separately reportable.

Calculating Global Period for Surgical Procedures:

Each surgery CPT has a Global surgery status indicator in which the minor surgery has Global surgery status indicator of 10 days and the major surgery has Global surgery status indicator of 90 days.

To determine the global period for minor surgeries:

Count the day of surgery (Pre-operative and Intra-operative services would be on the same day of surgery) and 10 days immediately following the date of surgery.

To determine the global period for major surgeries:

Count 1 day immediately before the day of surgery (Pre-operative), the day of surgery (Intra-operative), and the 90 days immediately following the date of surgery (Post-operative / follow ups)

Global Period for Surgical Procedures calculator for the major surgery is available at

http://www.medicarenhic.com/providers/billing/billing_calc_global_period.html

Tags: Global Period for Surgical Procedures, Global Period for Surgical Procedures

Career Step Medical Coding Reviews

2010-01-14T02:54:00.000-08:00

Career Step is a leading national medical coding training school and have heard a lot of positive feedback about them. They were interviewed on Good Morning America and they won Best of State in Utah for best technical school. There are some people who underwent career step medical coding training and are not satisfied but majoiry of students are happy and say it is very affordable, you can complete at your own pace and have got jobs.

Career Step has over 15 years of experience in training individuals for the healthcare industry. The training programs are designed in collaboration with industry experts and employers to ensure that you gain exactly the knowledge and skills you’ll need to excel in the workplace

Career Step medical coding has industry ties to help students in job placements. You'll have access to personal job search consultations, interview training, resume and cover letter help, and more.

Career Step was recognized as an "Inc. 500 Company" - ranked the 335th fastest growing privately-held business in the country, according to Inc. Magazine. The Career Step programs have been featured on CNN, Good Morning America, and the Wall Street News Hour.

Tuition Assistance Program (Needs-Based) - Prospective students who can demonstrate economic hardship may APPLY for needs-based financial assistance through Career Step's enrollment counselors to be considered for a reduced enrollment cost

You can aslo gain as Career Step has a good almuni in the medical coding industry

Medical Coding Training in India

2010-01-13T21:35:00.000-08:00

Medical Coding Training institutes and schools in Indian cities : Hyderabad, Chennai, Bangalore, Delhi, Coimbatore, Mumbai, Pune,Thiruvananthapuram

Medical Coding Training Schools in Hyderabad

Ocean Technologies
Hyderabad-38,
Ph: 040-64513546, 9390083502

TransCode Solutions
Hyderabad
Phone: 040- 39121067
Mobile: 9985277066

Medical Coding Experts
Hyderabad
Mobile: 91 9966933693, 9849301333

I-solutions
Hyderabad
www.i-solutions.co.in

Dr G coding
Hyderabad India
Tel.: 919966933693

Medical Coding Training Schools in Chennai

Yogam BPO solutions
Chennai
Phone:044-22260700/9840040143
Duration : 6 Weeks / Flexible two hours a day
Fees: 4000 Rs / Each course

Techskills
Annanagar, Chennai-40
Ph: 044- 42615429 / 42612315 / 9884945769
www.techskills.co.in
Valasaravakkm Branch ; 044-42772326

Itargettech
Thiruvalluvar Nagar , Mugappair East, Chennai-37
Phone : 044 45586045
Website : www.itargettech.com

Medical Coding Training Schools in Bangalore

OCEAN TECHNOLOGIES
Marthalli Bangalore
Website : www.oceantechnologies.co.in

IOCB Bangalore(www.iocbindia.org)
IOCB Institute Of Computational Biology
Bangalore-560 002,Tel-080 4157 1426
Email: compbioindia@gmail.com

Tags: Medical Coding Training institutes and schools in Indian,Hyderabad, Chennai, Bangalore, Delhi, Coimbatore, Mumbai, Pune, Thiruvananthapuram, medical coding courses, medical coding classes

CPT codes for biopsy

2010-01-12T02:33:00.000-08:00

CPT codes for biopsy

CPT codes for bone biopsy
20220 Biopsy superficial bones with trocar or needle
20225 Biopsy deep bones with trocar or needle
38221 Biopsy of bone marrow
20999 Biopsy of bone other than listed below

The following are the superficial bones
Ankle, carpall/metacarpals, clavicle, Ilium, patella, phalanges(foot/hand),
pelvic(iliac crest), ribs, scapula, spinous process, sternum, tarsals/metatarsals,
thorax(ribs/sternum), wrist, and vertebra.

The following are taken as deep bones
Femur/hips, ischium, humerous, radius/ulna, and tibia/fibula.

CPT code for Liver Biopsy
47000 Percutaneous needle biopsy of Liver
47001 Percutaneous needle biopsy of Liver when done for indicated purpose at time of other major procedure. This code should be used in addition to the major procedure
47100 Open biopsy of Liver also called wedge biopsy

Transgugular Liver biopsy with selective cath (renal/jugular)
37200 Transcatheter biopsy
36011 SELECTIVE CATH
75970 Transcath biopsy S/I

PT code for Lung Biopsy
32405 Percutaneous biopsy of lung or mediastunum (transthoracic)
32095 Open biopst of lung or pleura(Limited without exploration)
32100 Open biopst of lung or pleura with exploration (Major)

CPT code for Skin Biopsy
Anus 46999 unlisted anal procedure
External ear 69100 Biopsy of external ear
Eyebrow 11100 Biopsy of skin
Eyelid 67810 Biopsy of eyelid
Vulva 56005 Biopsy of vulva single lesion
Other skin 11100 Biopsy of skin

CPT code for soft tissue(fascia) Biopsy
Abdomen 22999
arm, upper 24065
back/flank 21920
foot/toes 28899
forearm/wrist 25065
hand/finger 26989
head 21499
lower leg(tibia/fibula/ankle) 27613
neck/thorax 21550
pelvis/hip 27040
shoulder 23065
spine(vertebral column) 21920
Thigh (femur/knee) 27323
Unspecified/Not Listed Above 20999

CPT code for Muscle Biopsy
20200 Open biopsy of superficial muslcle
20205 Open biopsy of deep muslcle (subfascial, intramuscular)
20206 Percutaneous needle biopsy of muscle

CPT code for Thyroid Biopsy
60100 Percutaneous needle core biopsy of thyroid
60699 Open or incisional biopsy of deep thyroid (Unlisted proc)

CPT code for Salivary gland and duct biopsy
42400 Percutaneous needle core biopsy of salivary gland/duct
42405 Open or incisional biopsy of salivary gland/duct

CPT code for pancreas and pancreatic duct biopsy
48102 Percutaneous needle core biopsy of pancreas/pancreatic duct
48100 Open or incisional biopsy of pancreas

If fine needle aspiration is also done during biopsy procedure than codes 10021 or 10022 should also be used in addition to the biopsy codes.

If Radiologic Guidance is also performed then appropriate supervision and interpretation codes should also be used as follows:

CT 77012
Flouroscopy 77002
MRI 77021
Ultrasound 76942
No/unspecified No Code

Medical Coding Salary

2010-01-12T00:48:00.000-08:00

Medical coding salary depend upon the type of coding i.e. inpatient, outpatient, ambulatory, etc. It also depends upon location and workplace like hospital, physician office, insurance company.

Inpatient medical coders get the highest salary with an average salary of 70,000-80,000 plus 5,000 signing bonus. Also ambulatory surgery coders are paid better then outptient or ER coders. Medical coders also work as consultants and are paid on per case basis .i.e. usually two dollers for outpatient and ER cases and upto ten dollers for inpatient per inpatient case. For example, if a coder codes 100 ER on a day, his earning for that day will be 200 dollers. Similarly if an inpatient coder codes 50 cases on a day his earning for that day will be 500 dollers.

Education also plays a role in determining the salary of a medical coder. According to a salary survey of AAPC medical coders with master's degrees earn more than coders with bachelor's degree. According to AAPC salary survery 2009, average salary of entry level coders is 30,323 and with three years of experiance 33,584 and with five years experiance is 69,770. Certified coders earn more than uncertified coders. Salary of medical coding professionals is increasing every year as there is a shortage of experianced coders and as the first baby boomers have crossed the age of 60 years requiring more medical care.

Work from home
Medical coding companies are offering home based medical coding jobs for experianced coders and this trend is on a rise due to shortage of coders and improved internet technology.

Other Benefits
Other Benefits apart from salary, employers sponsor certification exam and also pay for renewal every year. Many medical coding companies also offer a variety of benefits including medical, dental, optical, 401k, and paid leaves and many more.

Breast biopsy CPT Codes: Percutaneous, Stereotactic, Open

2010-01-11T22:15:00.000-08:00

CPT coding of breast biopsies will wary depending upon the approach, device, and imaging guidence used.

The follwoing approaches are used:

1. Fina Needle spiration biopsy wherein lesion is aspirated or suctioned out through a fine needle.
2. Percutaneous needle core biopsy with and without imaging
a.Percutaneous Needle Core
b.Vaccum Asisted device
3. Excisional(open)biopsy by an incision.

Breast biopsy CPT Codes for FNA
10021 Fine needle aspiration without imaging guidance
10022 Fine needle aspiration with imaging guidance

Breast biopsy CPT codes for percutaneous needle biopsy other than fine needle aspiration
19100 Biopsy of breast, percutaneous, needle core, without imaging guidance
19102 Biopsy of breast, percutaneous, needle core with imaging guidance

Vaccum Assisted Breast Biopsy
Vacuum-assisted biopsy allows removal of multiple tissue samples in a single attempt unlike core needle biopsy wherein several separate needle insertions are required for multiple samples. It relies on stereotactic mammography or ultrasound imaging.

Breast biopsy CPT codes
19103 Percutaneous automated vacuum assisted or rotating biopsy device with imaging guidance

Stereotactic breast biopsy cpt codes
The mammotome, MIBB, and TRAP probes are Stereotactic probes. The procedure coding will remain the same. Only imaging guidence code will change to stereotactic localization guidance (77031).

Needle Localization
A needle localization biopsy is done when an abnormality is seen on mammogram but no lump can be felt on physical exam. The biopsy is used to make a precise diagnosis and develop a treatment plan

19295 Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration (List separately in addition to code for primary procedure

19295 should be used in conjunction with code 10022, 19102, 19103

Breast biopsy CPT codes for excisional(open) approach through incision into breast
19101 open, incisional

Breast Biopsy imaging (MRI,ultrasound)Guidence CPT codes
Stereotactic localization guidance (77031)
Mammographic guidance (77032)
CT guidance (77012)
MR guidance (77021)
Ultrasound guidance (76942)

Tags: ultrasound guided breast biopsy,

Is Medical Coding a good career ?

2010-01-07T06:22:00.000-08:00

Medical coding career is one of the fastest growing profession in the US. Even during the recession, when there were layoffs and salary cuts common across every sector, medical coding industry grew and credentialed medical coders saw their average salaries rise 4 percent to $44,750 a year.

A good career should be recession proof and growth oriented and medical coding has both the things. Medical coding also offers the advantage of working from home after a few years of experiance.

Employment opportunitis exists at hospitals, medical coding companies, nursing homes, Medicare, medical billing companies, etc.

Medical coding is a vast and diverse field thus open for unlimited opportunities and growth. If one if open for hardwork and positive attitude then one will never regret choosing the good medical coding career as a profession.

Tags: Is Medical Coding a good career, medical coding career guide, medical coding job outlook

ICD 9 code for Elevated Troponin or (Createnine Kinase) CK's

2010-01-06T07:21:00.000-08:00

ICD 9 code for Elevated Troponin or (Createnine Kinase) CK's

Creatine kinase (CK), also known as creatine phosphokinase (CPK) or phospho-creatine kinase (and sometimes wrongfully as creatinine kinase), is an enzyme present primarily in the heart and skeletal muscles, and also brain.

Any injury to any of these structures will lead to a measurable increase in CK levels.

ICD 9 code for Createnine Kinase

790.5 Other Nonspecific Abnormal Serum Enzyme Levels

Troponin is a complex of three regulatory proteins that is integral to muscle contraction in skeletal and cardiac muscle. Elevated troponin levels indicate myocardial injury but may occur in critically ill patients.

ICD 9 code for Elevated Troponin
There is no ICD-9 code specific for elevated cardiac bimarker (troponin). Following ICD 9 code can be used for Elevated Troponin levels

790.99 Other Abnormal Findings On Examination Of Blood

ICD 9 code for Antibody Titers

2010-01-06T06:59:00.000-08:00

ICD 9 code for Antibody Titers

Antibody titer is a laboratory test that measures the presence and amount of antibodies in blood. The antibody level in the blood is a reflection of past exposure to an antigen or to something that the body does not recognize as belonging to itself. The body uses antibodies to attack and remove foreign substances.

The physician may order a titer to see if you had an infection in the past (for example, chickenpox) or to decide which immunizations you need. In diseases such as systemic lupus erythematosus (SLE) and other autoimmune disorders and in infection such as mononucleosis or viral hepatitis.

ICD 9 code for Antibody Titer tests

V72.61 Antibody Response Examination.
Immunity status testing

V72.61 should be used as a diagnostic code for titor examinations

Tags: ICD code for antibody titor, titor examination code

RHIT Exam

2009-12-25T22:46:00.000-08:00

RHIT Exam

RHIT Stands for Registered Health Information Technician. You can move on from that and become an R.H.I.A. (Administrator). R.H.I.T. is an A.A.S and it is what is being sought after by hospitals and doctor's offices. With the R.H.I.T. you can get your foot in the door in medical records etc., before moving into coding. It is difficult to get into coding without experience. I would recommend going to one of the CAHIM accredited schools for your training.

In order to go for the RHIT/RHIA, you need tomake sure that you go through an HIM program that is CAHIM-accredited. Go to the Ahima.org website and it will give you a list of schools. Unfortunately, the BA won't really make much of a dent, although your having taken A&P and med terminology is definitely a plus (they may be transferable).

For colleges offering CAHIM-accredited courses check

www.ahima.org or www.ahima.org/careers/college_search/search.asp.

How to prepare for RHIT Exam prep and what are the study guides?

As far as what to expect on the test, make sure that you know terms and other information regarding computer technology in general and how it relates to health information. Also, there will be a lot of questions on HR, HIPAA type issues, and know your graphs and what they are used for.

The PRG book/CD is among the best resources for studying. The PRG is a great tool for helping show you what areas are going to be tested. The PRG also has one mock RHIT Exam test.

The AHIMA book has the AHIMA exam prep book and three mock RHIT Exams. The AHIMA CD also had learning modes and simulation modes. Using both will prepare really well but some RHIT's used just the PRG and came out just fine too.

The OHIMA online prep is also available.

Is there any free sample question paper available for RHIT Exam?

Yes, AHIMA has one free sample paper on there site.

Visit: http://www.ahima.org/certification/rhit/sample.aspx

Who should take RHIT Certification?

What type of coding are you doing in the hospital setting? Inpatient, ER, Outpatient surgery, Outpatient Ancillary Dx services? I recommend taking a certification test that coincides with the current job that you do. If you are coding and think that you will continue to just code, I recommend the following:

Inpatient/ER/ Outpatient surgery coding = CCS ( AHIMA)

Ancillary Dx procedures ( Lab, Radiology, etc.) = CPC-H ( AAPC)

Coding/ frequent HIM Admin. = RHIT

HIM Admin = RHIA

Phys. office coding= CCS-P ( AHIMA) or CPC - P ( AAPC)

The CCS is best suited for Inpatient/ER coder. The RHIT exam is great if you want to be a HIM supervisor/coder. The other credentials CCS, CPC-H are the two best credentials to obtain if you are going to continue down the path of a hospital (facility) coder.

Tags: need advice please rhit exam, rhit practice exam, rhit mock exam, registered health information technician rhit, rhit exam prep, rhit exam questions, rhit practice exam, rhia exam prep, rhit study guide, rhit certification exam

Medical coding from home

2009-12-10T06:02:00.000-08:00

Look at any HIM periodical and you'll see numerous advertisements for clinical coders, some offering sign-on bonuses as high as $10,000. Why such a high price tag? Many healthcare organizations today are experiencing a shortage of qualified coders.

What is medical coding?

A: Every service (test, office visit, injection, surgical procedure, etc.) in the provision of medical care has a numeric code associated with it designed to provide some commonality of terms in order that the companies who pay the claims (health insurance companies, HMOs, etc.) can identify the patient’s problem, and the service provided sufficient to allow them to pay on a predetermined basis under the care and coverage limits of an insurance plan. The codes are also used for statistical data. The CPT (Current Procedural Terminology) codes exist for an office call, an injection, an x-ray, right on to the most detailed brain surgery. International Disease Codes (ICD) are the number systems assigned for diagnoses, even patient complaints (headache, upset stomach, etc.). The combination of using these codes, ICD and CPT, tell the payer what was wrong with the patient and what service was performed.

Q: What kind of training does coding require?

A: The first requirement is medical terminology training (or a good background in medicine, such as nursing). Formerly, there are two to four year college programs to learn coding, however, one can learn medical coding through technical schools, correspondence courses, and simple, concise, yet thorough on-line home study programs within a short period of time(six months).

Q: Does coding require certification?

A: Medical coding employers prefer coders who have certification but due to shortage of trained coders even those who do not have certifiaction are employed. you can get your certification from AHIMA or AAPC.

Q: How much money can I make?

A: According to the industry standards, starting salary is about $35,000 per year, higher in some areas of the country. A typical coding firm charges $17 per outpatient report to code, and the average per report time involvement is two to ten minutes. People working from home, dials the hospital system, codes the charts and charges 70 cents per code. Coders often become the "gatekeepers" for the preauthorization process for employers and insurance companies.

Q: What kinds of employers, or companies, require coders?

A: Virtually every provider, individual doctor, clinic, hospital involved in patient care requires coders. Several of the larger MT companies also offer coding to their clients. The profession has enormous potential. One hospital alone may have as many as 50 or more coders on staff. Then there are standalone clnics, urgent and semiurgent care and surgical, mental health centers and nursing homes, choropractors, etc.

In addition, insurance companies, contract care providers, governmental agencies, law firms, third party administrators, billing and practice management companies, need coders.

Q: Is there a ready market for the skills acquired in coding?

A: Health care in America is an explosive industry accounting for the top 3 producers in gross national product (and income), and still outpaces all but a few industrial sectors in growth. Four million jobs will open up in the next ten years in the health care industry, and many, many of those positions are outside the care-giving arena specifically, such as consulting firms and claims-review/auditing firms. Coding is sufficiently specialized that coders are paid exceptionally well, are and will remain in very high demand.

Statistically, Health Information Management (HIM), of which coding is a part, is a rapidly growing field and is expected to outpace average job growth rates in other fields through the year 2006. According to the Occupational Outlook Handbook, 2003 Edition, produced by Bureau of Labor Statistics of the U.S. Department of Labor, health information technicians are projected to be one of the 20 fastest growing occupations.

Q: How far you go with this expertise?

A: Once you become proficient in coding many opportunities exist. Consulting is an excellent business for coding experts, either independently, or for a consulting firm. Coders often undertake auditing functions. Independent fraud analysts are also in demand and often are paid a percentage of what they save insurance companies. One of the most common uses for fraud analysis is in state sponsored Worker's Compensation Funds, where fraud is rampant, accounting for a burgeoning percentage of America's health care costs. Many consultants and fraud analysts set up their own businesses and work at home. Consulting is a great field for nurses looking for a change in career.

Gatekeeping is another interesting job potential requiring terminology and coding. The gatekeeper is contacted when a policy holder needs a medical service for which the gatekeeper's intervention is required to determine the lowest possible costs without jeopardizing care, such as a surgery procedure, or a series of visits to a physical therapist. The gatekeeper refers to the policy's coverage and limits, refers to the appropriate code or codes, and determines what the payer (e.g., insurance company or employer) will pay for it, or determines whether the service is excluded. Depending on the health care plan, the gatekeeper then tells the patient which provider in the network is prepared to accept what the payer offers along with deductibles or copayments. If the patient decides to go outside this recommended network of care providers, then s/he will be responsible to cover any differential of the predetermined amount the payer is willing to pay. Gatekeepers commonly earn $60,000 to $100,000 a year. Many nurses fill these jobs.

Many employers are self-insured, which means that they establish a reserve account (like insurance companies) to pay for the medical care of their employees. "Third-Party Administrators" (TPAs) contract to manage the process. Gatekeepers perform the services to get the best economoic deal possible for patients and payers.

Q: Can coding be done at home?

A: Formerly, it was a little cumbersome since one needed various forms and even patient charts; however, with the advent of all the new technology (computerized faxes, scanners, transfer of information back and forth through the Internet), it is now possible and acceptable to do the coding at home either as a contractor or an employee for a hospital or doctor’s office. National companies fill a niche too and subcontract the work to home-based contractors. You will find a number of them using the Web. Read a forward looking article that agrees with our concept:

Q: How do home coders get the patient information?

A: Records are obtained in various ways: picking up the forms/documents, faxing (encryption for privacy issues), and remote dial up access to provider computer data. Technology has improved the ability to move this information around quite readily.

Q: What does medical coding have to do with transcription?

A: That's a simple one. Medical transcriptionists type the reports coders review to determine the treatment and diagnostic codes. Medical transcriptionists make excellent coders because of their knowledge of medicine, and, they have the document on their screen when completed. Many dictators now include the ICD or CPT code in their dictation.

Q: What does medical coding have to do with billing?

A: When a care provider performs a service, s/he will dictate a report or note on the services provided. That textual document becomes a part of the primary record, and the coder reviews it in order to abstract and codify what was done. The codes are then printed on statements and insurance claims forms as an abbreviated way to define problem/s and service/s. Offering the combined service of coding and billing is an excellent approach to a private practice provider. Since coding drives the entire billing process, it is imperative that both skills are included in a career path planning process.

Q: Is there coding software?

A: Most large clinical providers and virtually all hospitals already have it (and it's easy to learn to use). For private and clinical practice, Meditec has used such software extensively and recommends the Alpha II software. You may purchase the AlphaII software here on the website. Remember that software is a tool and doesn't eliminate the need to learn basic coding.

Q: Is there anything else I should know?

A: Yes: Medical Terminology

Coding Pregnancy Ultrasounds

2009-12-08T07:53:00.000-08:00

Coding Pregnancy Ultrasounds

The category V28 in ICD-9-CM should be used for diagnostic coding for encounters involving antenatal screening of the mother. Codes from V28 category should be used as admitting diagnosis and also primary diagnosis if the result of the screening tests are normal. If the result of the screening test is abnormal, then the primary diagnosis should be "abnormal findings" and admitting diagnosis will be from the V28 category.

Another scenario is screening for suspected fetal conditions affecting management of mother (655.00-655.93,656.00-656.93,657.00-657.03,658.00-658.93). In this scenario, codes from (655.00-655.93,656.00-656.93,657.00-657.03,658.00-658.93) should be used for admitting diagnosis. If the suspected condition is found, than the condition should be coded and if it is not found than "suspected fetal conditions not found (V89.01-V89.09)" should be used as primary diagnosis.

Category V28 has further subcatagories as follows:

V28 Encounter for antenatal screening of mother
V28.0 Screening for chromosomal anomalies by amniocentesis
V28.1 Screening for raised alpha-fetoprotein levels in amniotic fluid
V28.2 Other screening based on amniocentesis
V28.3 Encounter for routine screening for malformation using ultrasonics
V28.4 Screening for fetal growth retardation using ultrasonics
V28.5 Screening for isoimmunization
V28.6 Screening for Streptococcus B
V28.8 Other specified antenatal screening
V28.81 Encounter for fetal anatomic survey
V28.82 Encounter for screening for risk of pre-term labor
V28.89 Other specified antenatal screening
(Chorionic villus sampling, Genomic screening, Nuchal translucency testing, Proteomic screening)
V28.9 Unspecified antenatal screening

Code V28.89 can be used for all other special antenatal screenings like fetal viability, size and dates, cervical length, etc.

For genetic counseling and testing use V26.31-V26.39 codes.
Encounter for routine fetal ultrasound NOS use V28.3

CPT Coding Questions - Skin and Integumentary

2009-12-05T07:36:00.000-08:00

Here are CPT Coding Questions from Skin and Integumentary with answers

Q 1. The patient came with a 2 cm laceration on his hand and 2 cm on his leg. the physician performed a single layer closure of both the wound . Which is the correct
CPT code for the services provided by the physician.

A. 12002
B. 12013
C. 12001
D. 12011

Ans. A

Q2. The patient has a 3 cm superficial laceration on his hand. After examining the patient, the physician applied sterri strips to the woound . Which is the correct
CPT code for the services provided by the physician.

A. 12002
B. 12013
C. 12001
D. None of the above

Ans: D. Application of sterri strips is included in E/M code an does not need any CPT code

Q3. The patient has 2 cm complex laceration on his finger. The physician debrided the wound and performed a layred closure of the subcutaneous tissue and skin . Which is the correct
CPT code for the services provided by the physician.

A. 12032
B. 12034
C. 12001
D. None of the above

Ans: A. This is an intermediate wound closure of finger of length less than 2.5 cm

Q4. The patient has 2 cm complex laceration on his face. The physician extensive debrided the wound and performed a layred closure of the subcutaneous tissue and skin . Which is the correct
CPT code for the services provided by the physician.

A. 12032
B. 12034
C. 12051
D. None of the above

Ans: C. When extensive debridement or clening is performed with intermediate wound closure then it become a complex closure.

Q5. The patient has an abscess of his face. The physician performed incision and drainage of the abscess . Which is the correct
CPT code for the services provided by the physician.

A. 10060
B. 10061
C. 10160
D. None of the above

Ans: A. Incision an drainage of abscess, simple

Q6. The patient has an abscess of his face. The physician performed incision and drainage of the abscess and also did packing. Which is the correct
CPT code for the services provided by the physician.

A. 10060
B. 10061
C. 10160
D. None of the above

Ans: B. Incision an drainage of abscess with packing will be coded to 1&D complex

Q7. The patient comes with a subungual hematoma. The physician drained the hematoma. Which is the correct
CPT code for the services provided by the physician.

A. 11740
B. 11719
C. 11760
D. None of the above

Ans: A. The proceure is Evacuation of subungual hematoma

Q8. The patient has an ingrown toenail. The physician peformed excision of ingrown toenail. Which is the correct
CPT code for the services provided by the physician.

A. 11750
B. 11760
C. 11762
D. 11765

Ans: A. The proceure is Excision of nail partial or complete nail for permanent removal

Q9. The patient has been diagnosed with actinic keratosis. The physician peformed electrocautery on a lesion on his face. Which is the correct
CPT code for the services provided by the physician.

A. 11740
B. 17000
C. 17004
D. 17261

Ans: B. The proceure is destruction of premalignent lesion, single lesion

Q10. The patient has a burn on his hand with blisters, which is 5% of total body surface area. The physician applied silvadine dressing. which is the correct
CPT code for the services provided by the physician.

A. 16000
B. 16020
C. 16030
D. 16035

Ans: B. Since there are blisters it is second degree burn. So the proceure is Dressings and/or debridement of partial-thickness burns, intial or subsequent; small

Tags: Here are CPT Coding Questions from Skin and Integumentary with answers, CPT sample questions

CCS Versus CPC

2009-12-01T07:44:00.000-08:00

AHIMA (CCS) Versus AAPC (CPC) which is better?

There is a lengthy debate as to which of two certifications CCS or CPC are good choices and which will yield better result. The AAPC webiste states that the CPC is a physician/provider-based coding cert. Hospitals are usually looking for facility-based coding certifications, as those credentials apply to their line of business & clinical setting.

Hospital certified coders generally code in the hospital (e.g., CPC-H, CCS) and physician certified coders (e.g., CPC, CCS-P) usually code in provider-based settings (e.g., clinics, offices, billing units, etc). It is normal to have certification in the market where you expect to work. So, to some extent, those with the CPC are not necessarily appropriate for the hospital coding environment. Their certification is not in hospital coding.

If you want to code in the hosptial, physician office, home health, or anywhere else, seek certification specific to that setting.

Also, many other employers want to see an additional certifications instead of one like CPC or CCS-P. Regardless of your experience, companies feel more comfortable knowing that you do have the knowledge by showing your accomplishements. That is why pursuing CPC-H and CCS certs after CPC or CCS-P will help.

There is no single coding credential that covers all coding, across all settings. For example, coders in the nursing home settings have no option for certification in their specialty.

Both organizations are very reputable. If you are interested in being an inpatient coder than AHIMA is the organization to be associated with. Where it comes to physician based coding, the AAPC is a terrific organization with ongoing support and education. They are continually growing and improving. If you want to bill for physician services, hospital outpatient or if you workfor a payer and adjudicate physician or outpatient claims, you probably want