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Diagnosis Coding - Articles

Q/A: How Many Diagnosis Codes do I use?
April 15th, 2019 - Wyn Staheli, Director of Research
Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that? Answer: More is not always better. You only need to ...
Corrections and Updates
April 1st, 2019 - Wyn Staheli, Director of Research
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics. Published Articles We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...
Spinal Cord Stimulator Used for Chronic Pain
April 1st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes. ICD-10-CM Diagnosis Codes ...
Pain Codes in ICD-10-CM
March 27th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
When coding with ICD-10-CM, pain codes can be found in different sections: The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ...
How to Report Imaging (X-Rays) of the Thumb
March 18th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
Billing Guidelines for Repositioning
March 4th, 2019 - Wyn Staheli, Director of Research
Code 95992 has some very limited payer payment guidelines which need to be understood for proper reimbursement. Many payer policies consider this service bundled with Evaluation and Management Services, therefore, it would not be separately payable if there was an E/M service performed on the same date. Some providers have reported having trouble ...
BC Advantage Now Offering Q-Pro CEUs!
February 5th, 2019 - Find-A-Code
We are excited to announce BC Advantage is now offering Q-Pro CEUs! It is now even easier to get your QPro CEUs and stay current with BC Advantage: offering news, CEUs, webinars and more. BC Advantage is the largest independent resource provider in the industry for Medical Coders, Medical Billers,...

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The Diabetic Patient and Medical Manifestations
December 20th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Treating a diabetic patient with medical oral complications may be covered under the patient's medical plan. With the patient's oral health at risk, the medical portion may reimburse for certain procedures, since medical plans only pay from medical necessity the treatment must be considered...
Present on Admission POA Indicator
November 26th, 2018 - BC Advantage
This article will focus on the Present on Admission (POA) indicator which is used as a method of reporting whether a patient’s diagnoses are present at the time they are admitted to a facility. We’ll look at a few scenarios to determine the correct reporting of POA and the impact...
Diagnosis Coding for Cardiology
November 8th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Diseases of the Circulatory system are found in Chapter 9 and reported with I00 through I99 according to the following sections: Acute rheumatic fever (I00-I02)Chronic rheumatic heart diseases (I05-I09)Hypertensive diseases (I10-I16)Ischemic heart diseases (I20-I25)Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)Other forms of heart disease (I30-I52)Cerebrovascular diseases (I60-I69)Diseases of arteries, ...
Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder
October 19th, 2018 - Wyn Staheli, Director of Research
The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...
Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?
October 16th, 2018 - Wyn Staheli, Director of Research
Question: We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...
HCC - Acceptable Provider Interpretation for Diagnostic Testing
October 1st, 2018 - Wyn Staheli, Director of Research
The following table is taken from the Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance dated 2017-09-27 (see References). It is a listing of acceptable provider interpretation of diagnostic testing. Acceptable Examples include: Cardiology and Vascular Surgeons Echocardiogram (including Doppler, Duplex, Color flow of the heart vessels) EKG (electrocardiogram) – Stress test, Cardiac ...
2019 Code Changes are Just Around the Corner - Are You Ready?
September 24th, 2018 - Wyn Staheli, Director of Research
The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...
Why Is Medicare Denying My Claims for Mammography and Breast Biopsies?
June 4th, 2018 - BC Advantage
When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out. The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63. The Centers for Medicare & Medicaid Services (CMS) will...
Preventive Medicine: Annual Wellness Visit
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Annual Wellness Visit Procedure Codes G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 99385: Initial comprehensive preventive medicine evaluation and management of an individual including ...
Preventive Medicine: Bone Mass Measurements
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Bone Mass Measurements Procedure Codes G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078: Computed tomography, bone mineral density study, 1 or more ...
Preventive Medicine: Breast Cancer Genetic Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Breast Cancer Genetic Screening Procedure Codes 81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 ...
Preventive Medicine: Cardiovascular Disease Screening Tests
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Cardiovascular Disease Screening Tests Procedure Codes 80061: Lipid panel. This panel must include the following: Cholesterol, serum, total Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) Triglycerides 82465: Cholesterol, serum, total 83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 84478: Triglycerides 83721: Lipoprotein, direct measurement; LDL cholesterol 83719: Lipoprotein, ...
Preventive Medicine: Cervical Dysplasia Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Cervical Dysplasia Screening Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...
Preventive Medicine: Colorectal Cancer Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Colorectal Cancer Screening Procedure Codes G0104: Colorectal cancer screening; flexible sigmoidoscopy G0105: Colorectal cancer screening; colonoscopy on individual at high risk G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0122: Colorectal cancer screening; barium ...
Preventive Medicine: Contraceptive Methods
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Contraceptive Methods Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...
Preventive Medicine: Dental Caries in Children
May 9th, 2018 - Find-A-Code
Preventive Medicine Topics Page Dental Caries in Children Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional ICD-10-CM 99188: No specific diagnoses Frequency 99188: No specific frequency guidelines Additional Information 99188 Covered for children from birth until their seventh birthday Find-A-Code™ - Preventive Services - The information ...
Preventive Medicine: Diabetes Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Diabetes Screening Procedure Codes 82947: Glucose; quantitative, blood (except reagent strip) 82948: Glucose; blood, reagent strip 82950: Glucose; post glucose dose (includes glucose) 82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to ...
Preventive Medicine: General Procedures
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page General Procedures Procedure Codes 36415: Collection of venous blood by venipuncture 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List ...
Preventive Medicine: Glaucoma Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Glaucoma Screening Procedure Codes G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist ICD-10-CM G0117-G0118: Z13.5 Frequency G0117-G0118: Once a year Additional information G0117-G0118 Coverage as is indicated with ...
Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and Administration
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Hepatitis B Virus (HBV) Vaccine and Administration Procedure Codes G0010: Administration of hepatitis b vaccine 90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743: Hepatitis ...
Preventive Medicine: Hepatitis C Virus (HCV) Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Hepatitis C Virus (HCV) Screening Procedure Codes G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 86804: Hepatitis C antibody; confirmatory test (eg, ...
Preventive Medicine: Human Immunodeficiency Virus (HIV) Screening
May 9th, 2018 - Brandon Herman, QCC
Preventive Medicine Topics Page Human Immunodeficiency Virus (HIV) Screening Procedure Codes G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 ...
Preventive Medicine: Human Papilomavirus (HPV) Vaccine and Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Human Papilomavirus (HPV) Vaccine and Screening Procedure Codes 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, ...
Preventive Medicine: Influenza Virus Vaccine and Administration
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Influenza Virus Vaccine and Administration Procedure Codes Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Q2036: Influenza virus vaccine, split virus, when administered to individuals ...
Preventive Medicine: Lung Cancer Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Lung Cancer Screening Procedure Codes G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) G0297: Low dose ct scan (ldct) for lung cancer screening S8092: Electron beam computed tomography (also ...
Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention Procedure Codes G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, ...
Preventive Medicine: Newborn Screenings/Tests
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Newborn Screenings/Tests Procedure Codes 82775: Galactose-1-phosphate uridyl transferase; quantitative 83498: Hydroxyprogesterone, 17-d 82017: Acylcarnitines; quantitative, each specimen 82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 82261: Biotinidase, each specimen 83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 83021: Hemoglobin ...
Preventive Medicine: Pneumococcal Vaccine and Administration
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Pneumococcal Vaccine and Administration Procedure Codes G0009: Administration of pneumococcal vaccine 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use ICD-10-CM G0009, ...
Preventive Medicine: Prostate Cancer Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Prostate Cancer Screening Procedure Codes G0102: Prostate cancer screening; digital rectal examination G0103: Prostate cancer screening; prostate specific antigen test (PSA) ICD-10-CM G0102-G0103: Z12.5 Frequency G0102-G0103: Once annually Additional Information G0102-G0103 Only for males aged 50 and older G0102 Copayment and deductible may apply, consult your payer Find-A-Code™ - Preventive Services - ...
Preventive Medicine: Screening Children for Visual Acuity
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Screening Children for Visual Acuity Procedure Codes 99173: Screening test of visual acuity, quantitative, bilateral ICD-10-CM 99173: Z00.121, Z00.129, Z00.100, Z00.101 Frequency 99173: No specific frequency guidelines Additional Information 99173 Not covered by Medicare for preventative care Some policies will only cover as preventive for children, consult your payer Find-A-Code™ - Preventive ...
Preventive Medicine: Screening for Anemia
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Screening for Anemia Procedure Codes 85004: Blood count; automated differential WBC count 85014: Blood count; hematocrit (Hct) 85013: Blood count; spun microhematocrit 85018: Blood count; hemoglobin (Hgb) 80055: Obstetric panel ICD-10-CM 85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0 80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, ...
Preventive Medicine: Screening Gynecological Examination
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Screening Gynecological Examination Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...
Preventive Medicine: Screening Mammography
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Screening Mammography Procedure Codes 77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057: Screening mammography, bilateral ...
Preventive Medicine: Screening Pap Tests
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Screening Pap Tests Procedure Codes G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation ...
Preventive Medicine: Therapy for Fall Prevention
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Therapy for Fall Prevention Procedure Codes 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, ...
Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) Procedure Codes 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real ...
Q/A: What Code do I Use for Supraspinatus and Infraspinatus Tendonitis?
May 7th, 2018 - Wyn Staheli, Director of Research
Is there a better code for supraspinatus and infraspinatus tendonitis than the one for a rotator cuff tear?
Q/A: I am Having Trouble with a Claim Rejection on my PI Claim. What do I do?
April 12th, 2018 - Wyn Staheli, Director of Research
Question: I have a patient that was involved in a PI case. His lawyers are asking that we bill his insurance company first. This particular patient has xxxx insurance and the clearing house is rejecting the claim based on "ERROR 3430-Invalid principal diagnosis code." We lead with diagnosis code V43.52XA, could we change the position of the V43.52XA code? Or should we submit a paper claim for the case instead?
CPT Code for DOT exams
March 13th, 2018 - Wyn Staheli, Director of Research
Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?
Z Codes That May Only be Principal/First-Listed Diagnosis
February 28th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Z Codes That May Only be Principal/First-Listed Diagnosis According to 2018 Guidelines section: 1;C.21.c.16, the following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined: Z00 Encounter for general examination without ...
Pre-Existing or Gestational?
February 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
It is important to make a clear distinction between pre-existing conditions and conditions brought on by the pregnancy (gestational) or pregnancy related conditions. Condition Detail: Was the condition pre-existing (i.e., present before pregnancy)? Trimester: When did the pregnancy-related condition develop? Casual Relationship: Establish the relationship between the pregnancy and the complication (e.g., preeclampsia) Code examples: O99.011 Anemia ...
Important CDI and Coding Updates
February 1st, 2018 - Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS
COPD and Pneumonia The requirement for code J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) to be coded first when a patient has pneumonia and COPD has been eliminated as of October 1. The 2018 version of ICD-10-CM replaced the "use additional code" with "code also." According...
Patients Undergoing a Bone Marrow Transplant (BMT)
February 1st, 2018 - Find-A-Code
Accoring to Wisconsin Physicians Service Insurance Corporation L34699, when using J2820 for patients undergoing a bone marrow transplant (BMT), 2 diagnosis codes are required:1) Z76.82 Awaiting organ transplant status2) Pick a code from one of these categories: C81- Hodgkin Lymphoma C82- Follicular Lymphoma Non-follicular Lymphoma C83.1- Mantle cell lymphoma C83.3- Diffuse large B-cell lymphoma C83.7- Burkitt lymphoma C83.8- Other (Intravascular large B-cell lymphoma, Primary effusion B-cell lymphoma, or Lymphoid granulomatosis) Mature T/NK-cell lymphomas C84.4- Peripheral T-cell ...
Q and A: Coding Mixed Cardiogenic and Septic Shock
February 1st, 2018 - BC Advantage
Q: If the attending documented, "likely mixed cardiogenic and septic shock," can I assign codes R57.0 and R65.21? A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember,...
Traumatic Subluxation Coding Controversy
February 1st, 2018 - Wyn Staheli, Director of Research
There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...
Comprehensive Searches with Find-A-Code
January 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Find-A-Code is an exhaustive library of knowledge, the key to being successful while using this incredible tool is understanding how to find the information you need and what is available to you. Check out a few of our Comprehensive search tools. ...
Aftercare Z Codes
January 29th, 2018 - Find-A-Code
Aftercare visit codes cover situations when the initial treatment of a disease has been performed, and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, ...
Coding for Pain in ICD-10-CM
January 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The following codes are the most common Pain codes used in ICD-10 G89.0                      Central pain syndrome   Chronic Condition G89.11‑G89.18         G89.1 Acute pain, not elsewhere classified G89.21‑G89.29         G89.2 Chronic pain, not elsewhere classified G89.3                      Neoplasm related pain (acute) (chronic)   Chronic Condition G89.4                      Chronic pain syndrome There are more specific pain ...
Non-Coronary Vascular Stents: Mesenteric Vessels
January 29th, 2018 - Find-A-Code
The following information is according to Novitas Solutions L35084. Mesenteric vessels: This includes Acute mesenteric ischemia Chronic mesenteric ischemia Mesenteric thrombosis Dissection or any other vascular insufficiency resulting in gastrointestinal symptoms Stenting of the mesenteric vessels is covered only when angioplasty of the vessels would not suffice and after the patient has had a thorough medical evaluation and management of symptoms, and for whom surgical intervention is the likely ...
Observation Z Codes
January 29th, 2018 - Find-A-Code
There are three observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out. The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected ...
Non-Coronary Vascular Stents: Brachiocephalic arteries
January 16th, 2018 - Find-A-Code
According to Novitas Solutions L35084 Brachiocephalic arteries (including subclavian, except carotid bifurcation): Stenting may be indicated for treatment of flow-limiting stenosis resulting in conditions such as: Subclavian steal syndrome Upper extremity claudication Ischemic rest pain of the arm and hand Non-healing tissue ulceration Focal gangrene. CPT codes: 37236 37237 ICD-10-CM codes: G45.8 - Other transient cerebral ischemic attacks and related syndromes Unspecified atherosclerosis of native arteries of extremities I70.201 - right leg I70.202 - left leg I70.203 - ...
Non-Coronary Vascular Stents: Renal artery
January 16th, 2018 - Find-A-Code
The following information is according to Novitas Solutions L35084. Renal artery: Stenting may be indicated for renal artery stenosis causing renovascular hypertension (see below) or renal insufficiency as well as post-transplant renal artery stenosis, arterial aneurysm or dissection. Renal artery angioplasty with or without stenting is covered for renal artery stenosis manifested by at least one of the following conditions: Recurrent (“flash”) pulmonary edema without cardiac ...
Antiresorptive Osteonecrosis of the Jaws
January 9th, 2018 - Find-A-Code
Osteonecrosis is a serious bone disease caused when the bone is starved of its normal blood supply. Because bone is living tissue, without a good supply of oxygenated blood, it becomes weakened and then dies. Scientists have not been able to identify the exact cause of osteonecrosis of the jaws, but they have ...
Billing Electrotherapy with AcuKnee
January 9th, 2018 - Christine Woolstenhulme
This code is commonly used to bill for AcuKnee products. Per AcuKnee, “NMES and electrotherapy may be covered by most insurance providers, provided the following criteria are met;” Documentation of chronic pain or muscle atrophy 3 months or longer Must document improvement Must have physician document medical necessity/Prescription Appropriate authorization from your insurance provider Suggested codes when billing 64550 initial electrotherapy education and placement E0720 Electrotherapy unit itself E0731 Garment ...
Diagnosis billing with J0888
January 9th, 2018 - Find-A-Code
The following information is from LCD L36276. The diagnosis codes listed below require the use of the EC modifier (ESA administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy) when submitting claims for J0888. In addition, these diagnosis codes are marked with an * indicating they require a dual diagnosis. The ...
ICD-10-PCS Coding the Approach
January 9th, 2018 - Find-A-Code
When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using. There are seven approaches. They are listed below with their ...
Non-Coronary Vascular Stents: Inferior vena cava and iliofemoral veins
January 9th, 2018 - Find-A-Code
The following information is according to Novitas Solutions, L35084. Inferior vena cava and iliofemoral veins: This includes vena cava and iliofemoral venous occlusions and stenosis due to the following Post-radiation venous stenosis Congenital stenoses or webs Extrinsic venous compression (May-Thurner syndrome) Thrombophlebitis and symptomatic post-traumatic venous stenosis. CPT codes: 37238 37239 ICD-10-CM codes: Phlebitis and thrombophlebitis I80.10 - of unspecified femoral vein I80.11 - of right femoral vein I80.12 - of left femoral vein I80.13 - of femoral vein, bilateral I80.211 - of right iliac vein I80.212 - of left iliac vein I80.213 - of iliac vein, bilateral I80.219 - of unspecified iliac vein I80.8 - of ...
Preventive Medicine with a New Patient
January 9th, 2018 - Find-A-Code
When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required. New Patient: A patient that has not received any professional services i.e., E&M or any other face to face service from the physician or group within the ...
Diagnosis Coding with Diagnostic Testing
January 4th, 2018 - Marge McQuade, CMSCS, CHCI, CPOM
Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns. If a physician confirms a diagnosis based on the results of a diagnostic ...
Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
January 3rd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There is important information that must be included when documenting injuries and external cause codes in ICD-10-CM. There are expanded sections on poisonings and toxins making it more convenient to code, as ICD-10-CM is very specific. When using a code from Chapter 19. Injury, Poisoning and Certain other Consequences of External ...
Abuse, Neglect, or Maltreatment
January 3rd, 2018 - Wyn Staheli
According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence: An appropriate code from category T74- (confirmed) or T76- (suspected) Any accompanying mental ...
Q/A: Physical Exam for Military (Specifically Feet)
November 8th, 2017 - Codepedia
Q: We had a patient come to our podiatry clinic to get a physical for her feet to qualify for ROTC activities. They came back clear of any deformities, defects, etc. Our scribes listed this visit diagnosis as Z00.00 (Encounter for general adult medical examination without abnormal findings) which seems correct ...
ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath
September 12th, 2017 - BC Advantage
This document is intended to be used as a guide to help coding professionals when coding healthcare encounters of those individuals affected by a hurricane.
Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
August 11th, 2017 - Chris Woolstenhulme, CPC, CMRS
There is important information that must be included when documenting injuries and external cause codes in ICD-10-CM. There are expanded sections on poisonings and toxins making it more convenient to code, as ICD-10-CM is very specific. When using a code from Chapter 19 (Injury, Poisoning and Certain other Consequences of External ...
Don’t Overlook Diagnosis Codes During Coding Audits
July 14th, 2017 - Betty Stump, MHA, RHIT, CPC, CCS-P, CPMA, CDIP
Coding auditors focus much of their attention exclusively on C.P.T. codes during the review process. After all, codes reported for E and M visits, surgical procedures, and diagnostic services are what generate revenue to the provider or facility. Even more importantly, errors in reporting these services are frequently what give ...
Code Position Matters, Using the X Place Holder
June 28th, 2017 - Chris Woolstenhulme, CPC, CMRS
Using the X Place holder is not optional. Be sure you understand how to use it. If the code you are using requires a the Character such as the A - initial encounter, D - subsequent encounter or S- sequela, you understand the "X" Place holder. Not all Codes requiring a 7th ...
Rules for Choosing the First Listed Diagnosis
May 5th, 2017 - Chris Woolstenhulme, CPC, CMRS
The ICD-10-CM Guidelines will direct you when coding as to which diagnosis should be first listed and what should not be listed first. Pay careful attention to ensure correct coding and avoid claim denial. There are a few basic rules you should be familiar with as well as common issues when ...
Definitions for Character #3 of PCS Codes Medical and Surgical Root Operations
April 12th, 2017 - Chris Woolstenhulme, CPC, CMRS
Character #3 of PCS codes Medical and Surgical Root operations definitions Alteration Modifying the anatomic structure of a body part without affecting the function of the body part Bypass Altering the route of passage of the contents of a tubular body part Change Taking out or off a device from a body part, and putting back an ...
Principal Diagnosis
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
The official guidelines for ICD-10-CM have very specific rules in determining principal diagnosis. However, it is imperative to note that it is necessary to be aware of the coding conventions in the ICD-10-CM Tabular List and Alphabetic Index as they take precedence over the official coding guidelines. Also, consider the ...
Z Codes That May Only be Principal/First-Listed Diagnosis
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
The following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined: Z00 Encounter for general examination without complaint, suspected or reported diagnosis Except: Z00.6 Z01 Encounter for other special examination without complaint, suspected ...
Diagnostic Criteria for Behavioral Health
February 16th, 2017 - Wyn Staheli
In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include: History: This can include the patient's personal history as well as that of the patient's family. Physical exam: The healthcare provider will try to rule out physical problems ...
Clinical Scenario for Coding with ICD-10-CM: Abdominal Pain
January 31st, 2017 - Chris Woolstenhulme, CPC, CMRS
Chief Complaint • “My stomach hurts and I feel full of gas.” History • 47 year old male with mid-abdominal epigastric pain, associated with severe nausea & vomiting; unable to keep down any food or liquid. Pain has become “severe” and constant. • Has had an estimated 13 pound weight loss over the past ...
ICD-10 Changes for 2017
August 3rd, 2016 - Wyn Staheli
The Centers for Medicare & Medicaid Services (CMS) recently released the Proposed Rule regarding the updates to the ICD-10-CM and ICD-10-PCS code sets for Fiscal Year 2017 which begins October 1, 2016. Comments regarding the proposed ICD changes are due May 6th and CMS has stated that the Final Rule ...
When can I use “unspecified” codes? What about “other”?
August 3rd, 2016 - Dr. Evan Gwilliam
The official guidelines for ICD-10-CM define the conventions used in the code set. In section 1.A.6, we learn the following about some common abbreviations in the Tabular List:
ICD-10 Roundup: Private Practice Radiologists Share How Prepared They Were for ICD-10
June 7th, 2016 - Practice Suite
In October 2015, the entire U.S. medical community made a controversial shift to the 10th Edition of International Classification of Diseases (ICD-10). The road to ICD-10 was marked with multiple delays, primarily due to concerns that physician-owned practices were not prepared for the ...
What Does It Mean To Scrub An Insurance Claim?
December 29th, 2015 - David Greene, MD
During the rigorous training physicians undergo to learn their craft, very little education is received on how to deal with submitting claims to insurance companies. It’s unfortunately a necessary evil, as surgeons who contract with insurance companies rely on that reimbursement as the...
Reporting Administration Codes with Vaccines
December 29th, 2015 - Allison Singer, CPC
When it comes to billing for vaccines, the rules for reporting administration codes can be tricky. Reporting the right vaccine code alone is not enough to guarantee proper billing. Most billing scenarios allow providers to charge for both the vaccine product and the administration of the vaccine...
ICD-10 TRANSITION IS FRUSTRATING FOR MEDICAL PRACTICES
October 14th, 2015 - Adam Smith
The dust has settled. ICD-10 is here. Now what? ICD10 is finally here. And it is not welcome in healthcare circles. Healthcare organizations will have to grapple with thousands of new codes, high overheads and workflow disruptions. The real impact of the revised coding set will be felt in a few...
Status on ICD-10 Implementation [Infographic]
September 9th, 2015 - Adam Smith
We will be using ICD-10 in a few weeks. But before that do you know the status on ICD-10 implementation?Do you know how the ICD-10 will impact your practice's revenue What changes can happen? Claim Errors will Increase A/R Could Rise Rise in Claim Denial Rates Physicians...
How to research coding questions
June 1st, 2015 - Christina Benjamin
How to Research Answers to Coding Questions Perform a search of the discussion board or listserv website prior to posting a new question. For your search terms, include specific words such as the diagnostic statement or procedure statement or the specific code number or ...
Basics of Diagnosis Coding
March 17th, 2015 - Betsy Nicoletti
Diagnosis coding is the process of translating narrative medical description into a code. CMS Coding and Reporting Guidelines for diagnosis coding: Use the ICD-9-CM codes that describe the patient's diagnosis, symptom, complaint, condition, or problem. Use the ICD-9-CM code that is...
All About Screening and Diagnostic Mammograms
March 17th, 2015 - George Lawson
When billing for mammograms, documentation must include the purpose and the result of the procedure. Two major purposes of mammogram are diagnostic and screening. It can also be used mammography to guide other procedures. Tip 1: Confirm the Purpose Determine the purpose of the procedure; i.e....
ICD-10 updates start to hit coverage determinations, Medicare manual
August 5th, 2014 - Scott Kraft
By now, most physician practices have given up on dreams of another delay in the implementation of ICD-10-CM and started to take steps to train staff and engage with vendors about their readiness for the Oct. 1, 2014 changeover. CMS and its Medicare Administrative Contractors (MACs) are taking...
In latest ICD-10 update, CMS plans limited end-to-end testing
April 30th, 2014 - Scott Kraft
A select few – a small sample group of providers that CMS says will represent a broad cross-section of provider types – will be selected to participate in end-to-end ICD-10-CM claims processing and payment testing this summer, CMS says in a recent update to its ICD-10 implementation...
Dreams of permanent pay fix fade as House passes one-year SGR fix; ICD-10 also faces potential delay
March 27th, 2014 - Scott Kraft
Leaders on Capitol Hill spent so much time debating, discussing and even reaching a tentative deal on a permanent repeal to the Sustainable Growth Rate (SGR) formula that has caused so much payment uncertainty for physician practices that people started to think it would actually happen. It looks...
CMS launches ICD-10-CM assistance site for small practices
February 28th, 2014 - Scott Kraft
CMS introduced a new web site specifically targeted at helping small physician practices with the transition to ICD-10-CM coding, which is still set to take place October 1. The agency announced the site at the recent HIMSS conference in Orlando, Fla. The web site, located at www.roadto10.org.,...
CMS-1500 form revised to fit more diagnosis codes, less patient demographic information
February 28th, 2014 - Scott Kraft
CMS-1500 form revised to fit more diagnosis codes, less patient demographic information It doesn’t get used nearly as much as it used to, but there is a new CMS-1500 claim form that has been revised slightly to fit more diagnosis codes and to facilitate the transition to the ICD-10-CM coding...
A Funny Thing Happened on the Way to an ICD-10 Gap Analysis
October 25th, 2013 - Codapedia Editor
You’ve heard the scary facts, maybe even from me. The number of diagnosis codes is increasing from about 16,000 in ICD-9 to 70,000 in ICD-10. The sky is falling. I usually add, we won’t be able to memorize diagnosis codes any more. And then I did a gap analysis for a women’s...
ICD-10 updates for LCDs, articles due by April 10, 2014
September 10th, 2013 - Scott Kraft
Take out your ICD-10 implementation plan and write down the date of April 10, 2014. That’s the day that CMS has instructed its Medicare Administrative Contractors (MACs) to publish all of the updated local coverage determinations (LCDs) that need to have ICD-10-CM codes replace ICD-9 codes....
ICD-10: The Wave (or Tsunami) of the Future
March 22nd, 2013 - Allison Singer, CPC
ICD-10: The Wave (or Tsunami) of the Future For many people, simply hearing the words “ICD-10” is enough to cause headaches, indigestion and a sudden compulsion to find a new career. It is the looming healthcare change that many professionals hope will go away completely or be delayed...
Preparing for ICD-10
February 25th, 2013 - Codapedia Editor
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Countdown to ICD-10
September 16th, 2011 - Codapedia Editor
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Updating Superbills for the New Year
July 7th, 2011 - Allison Singer, CPC
Coding Corner - Updating Superbills for the New Year Summer is ending and fall is just around the corner. Kids are going back to school, football season has begun, and for coders, it is the time of year when the first set of major encounter form revisions takes place. Form updates and revisions are...
Psychiatric diagnoses in primary care
April 10th, 2009 - Codapedia Editor
Anyone who has tried to get an appointment with a psychiatrist can tell you how difficult it is to find the right mental health professional, and get an appointment. In fact, much of the frontline of psychiatric diagnosis and treatment happens in primary care offices. The problem is, how can they...
PPD Testing
March 3rd, 2009 - Codapedia Editor
To bill for placing the purified protein derivative (PPD) skin test,use CPT® code 86580. Use this code when the nurse or medical assistant places the test on the patient's skin. The CPT® definition of the code is: Skin test, tuberculosis, intradermal. The code has a technical component...
Psychiatric diagnosis codes for office visits
March 2nd, 2009 - Codapedia Editor
Many coders report that using a psychiatric diagnosis code on a claim for an office visit results in a denial. Physicians want to know what they can do about it. Unfortunately, not very much. Primary care practices provide a lot of mental health services in their offices. When they submit these...

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