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Diagnosis Coding - Articles

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...
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 ...
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 ...
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 ...

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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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