ICD-10-CM Code Changes Broken Down by Specialty

Knowing what ICD-10-CM code changes you need to focus on updating this Fall can be like finding a needle a haystack. ICD-10-CM code changes for 2020 include 324 code changes (273 new, 21 deleted, and 30 revised codes) – and you need to hone in on the ones you need to educate staff on, watch out […]
2018 ICD-10 Update

2018 Update to ICD-10-CM is Here

As of October 1st, your outpatient claims will be expected to incorporate the new 2018 ICD0-10-CM code, which include 360 new, 142 deleted, and 226 revised codes going live.  Just like last year’s changes, many of the new codes provide more specificity to your diagnoses. This means you’ll need to work with your clinicians to […]
ICD-10 Diagnosis

Get Specific: Encounter Type Often Drives 7th Character … and Medical Necessity

When choosing the most accurate ICD-10 diagnosis code, you’re often required to include all seven characters to prove the medical necessity for a procedure or office visit. If not, your chances of having the claim denied are significantly increased. Nailing down that seventh character can be vital for getting your claims paid the first time […]
Ortho Management

Ortho Management (97760) Billing

Can an orthopedic practice bill for orthotic management? One of the most commonly asked question is, “Can I bill 97760?” If you are an orthopedic practice, you really can’t. This is because it should always be a therapy service, and it has to be under a therapy plan of care. If your physician asks an […]
ICD-10 Combination Codes

Use ICD-10 Combination Codes to Avoid Denials, Speed Payments

With more than 71,000 ICD-10 codes this year, your diagnosis coding can be more confusing than ever. One key to limiting that confusion is to know how to easily identify and when to use combination codes. These codes link symptoms, manifestations or complications with a particular diagnosis. Use them correctly, and you’ve got medical necessity […]
Medicare Claims Denied

Medicare Claims Denied For NCCI Edits

What do you do when an insurance payer denies a claim for NCCI edits, but it is contrary to the NCCI edits found on CMS’s website? Whose edit guidelines take precedence? When you are looking at NCCI verses a local coverage determination, the local coverage determination trumps the NCCI. One of the reasons for this […]
Symptoms and Confirmed Diagnoses Codes

Know When to Code for Symptoms and Confirmed Diagnoses to Support Your Claims

When you’re assigning diagnoses for a patient encounter, if you have a confirmed diagnosis, that’s what you use. You don’t need to submit the patient’s signs and symptoms too. But there are times when you need both to support your claim to receive the reimbursement you deserve. When relying on signs and symptoms codes, there […]
Unspecified Code Denials

4 Steps to Head Off Unspecified Code Denials

As if diagnosis coding isn’t hard enough, ICD-10-CM includes a whole group of unspecified codes that will almost ensure your claims end up in the denial pile. But there are a few steps you can take early on that can prevent this from happening. ICD-10 offers a great deal more specificity, and payers expect you […]
Denial Tracking

With Grace Period Over, Denial Tracking Is the Answer

On Oct. 1, you lost the ICD-10 reporting grace period that the Centers for Medicare and Medicaid Services (CMS) granted to help ease you into complying with the new diagnosis coding system. So, why should you care? For the past year, you’ve been receiving payments for claims that were coded close to the target.  All […]
ICD-10-CM Code

Laterality Frequently Unlocks ICD-10-CM Code Accuracy

To get your claims reimbursed, payers demand that you be as specific as possible with your ICD-10-CM code assignment. Often this means you must identify laterality and accurately adjust your coding to avoid claim denials and payer audits. When CMS implemented ICD-10, the number of diagnosis codes went from 14,000 to 68,000 — a massive jump. […]