Mark patient’s symptoms until you get a definite diagnosis.
Bird-fancier’s lung classifies as a type of hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis or EAA), which is caused by bird droppings. A patient who presents with this condition is typically diagnosed with 495.2 (Bird-fancier’s lung) under the ICD-9-cm.
Effective October 1, 2013, ICD-10 changes 495.2 to J67.2, keeping descriptor unaffected. You should note no difference to the function of the new ICD-10 code. Code J67.2, as its ICD-9 counterpart 495.2, applies to budgerigar fancier’s disease and pigeon fancier’s disease.
Key: Your ob-gyn’s documentation must emphasize the unusual difficulty.
Last month, SuperCoder.com’s Ob-Gyn Specialty Corner asked what your biggest ob-gyn challenge is, and the overwhelming response was “how to report lysis of adhesions separately.” You can ethically report lysis of adhesions with your ob-gyn’s primary surgery, either with a specific code or with Modifier 22, in these situations:
- The lysis of adhesions is extensive. Words to look for in the record might include “very difficult,” “unusually difficult,” and so on.
- The adhesions are in a different anatomic site from the main procedure(s).
Remember: Pelvic adhesions are bands of fibrous scar tissue that can form in the abdomen and pelvis after surgery or due to infection. Because adhesions connect organs and tissue that are normally separated, they can lead to a variety of…
Question: What diagnosis code should we report for resolved back pain? Does ICD-9 include a code for “resolved” at all, or do we just code the problem the patient had at the previous visit?
Follow 1997 guidelines when counting elements, and ethically bump pay approximately $33.
The next time your FP sees a patient with a long list of chronic – but stable – problems, use this 3-step process to guide your target=”_blank”>SuperCoder medical coding – and start recouping deserved revenue for these chronic condition visits.
Step 1: Choose Your Documentation Guidelines
In the past, you needed to think of the 1997 E/M documentation guidelines when your physician treated chronic conditions. The 1997 guidelines count recording the status of three or more chronic conditions as an extended history of present illness (HPI), which is one element of either a detailed or comprehensive history. By inference, the 1997 guidelines count documentation of the status of one or two chronic conditions as a brief HPI, which is one element of a problem focused or expanded problem-focused history.
<It’s time to improve your billing, documentation.
The RAC program is coming to Medicaid, and that means the audit contractors may become a much bigger threat to your reimbursement than they have been under Medicare.
Last year’s Patient Protection and Affordable Care Act’s require that RACs audit Medicaid claims just like they do Medicare claims (see Eli’s HCW, Vol. XX, No. 11, p. 85). Because RACs’ income is specifically tied to the amount they recover, and is based on a percentage of the overpayments they identify, you can expect they’ll be looking through your claims with a fine-toothed comb.
Prepare now: Despite assumptions to…
Dysuria refers to difficulty or pain during urination. Currently, you report this condition with 788.1 (Dysuria), but this code expands into two options as of October 1, 2013:
- R30.0, Dysuria
- R30.9, Painful micturition, unspecified
Documentation tip: If the provider documents “Strangury,” then you should report R30.0. If he documents “painful urination NOS,” then you should report R30.9.
Skipping this step may lead to angry patients and lost reimbursement.
You know that you need to have a Medicare patient sign an advance beneficiary notice (ABN) when your carrier won’t cover a procedure or service your dermatologist is going to perform. But what about non-Medicare patients — should they you use an ABN? Follow this expert guidance to ensure you get paid for every service your dermatologist performs while avoiding patient problems by sending bills the patient wasn’t expecting.
Don’t Skip ABNs for Private Payers
You should, in fact, use some form of waiver or ABN-inspired document for patients who do not have Medicare coverage but you know the insurance they do have won’t cover a service or procedure. Doing so not only increases your chances of collecting from the patient but is…
Expanded diagnosis code sets will allow coders to classify whether skin cancer is basal, squamous, or unspecified.
On October 1, dermatology coders will be able to more accurately report the location of carcinomas and other neoplasms of the skin.
The Centers for Medicare & Medicaid Service (CMS) has released its proposed changes to ICD-9 Code, and they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that will specify whether the malignant neoplasm is basal cell, squamous cell, or unspecified.
Example: Now, dermatology coders would report 173.0 (Other malignant neoplasm of skin of lip) for any non-melanoma malignant neoplasm of the lip. But when ICD-9 2012 becomes effective on October 1, 2011, coders can choose from:
Including provider signatures is a basic documentation requirement for your patient charts, but can also be a daily challenge for ED coders trying to get busy providers to sign on the dotted line each time. Check your answers against our experts’ advice to verify your group’s signature compliance.
Pay Attention to Medicare Signature Criteria
Question 1: Some of our physicians use handwritten signatures on their charts and others prefer electronic signatures. Is either kind acceptable?
Answer 1: According to CMS documents, “Medicare requires a legible identifier for services provided/ ordered.” That “identifier” — or signature — can be electronic or handwritten, as long as the provider meets certain criteria. Legible first and last names, a legible first initial with last name, or even an illegible signature over a printed or typed name are acceptable. You’re also covered if the provider’s signature is…