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Modifier 25 Abuse: Use It Properly
Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) is the most important modifier for pediatricians in Current Procedural Terminology (CPT®). It creates the opportunity to capture physician work done when separate E/M services are provided at the time of another E/M visit or procedural service. This allows for more efficient use of your time and may save the patient another visit. However, use of this modifier has been associated with frustration because many payers, including Medicaid, do not recognize it. The landscape is now changing, with many major payers facing the pressure of successful class-action lawsuits requiring them to recognize and follow CPT guidelines, including modifier 25.
Source: aap

Coding For Infectious Diseases.
Coding for bacteremia, septicemia, sepsis, systemic inflammatory response syndrome (SIRS), severe sepsis and septic shock can be quite perplexing. It is important for the coder to have an understanding of the medical terms and coding guidelines related to these conditions. This article will cover some of the key points on these topics.
Bacteremia
Bacteremia is the presence of bacteria in the blood and denotes only an abnormal laboratory finding. If sepsis symptoms are present, the healthcare provider should be queried for clarification. All coding should be based on the physician's documentation. Coders should not code based on laboratory or radiology findings. Coding issues related to inconsistent, missing or contradictory documentation must be resolved by the provider. Whenever the coder has concerns about the diagnosis, a query should be submitted to the provider for clarification.
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Coding Of Neoplasms In ICD 10 CM
The neoplasm chapter in ICD-10-CM has undergone some significant changes. Just as in ICD-9-CM, neoplasms are classified primarily by site and behavior (benign, carcinoma in-situ, malignant, uncertain behavior, and unspecified). However, in ICD-10-CM there are additional neoplasms that are now classified by morphology (histologic type). Therefore, selecting the most specific code for some types of neoplasms will require documentation of the histologic type of the neoplasm.
General Guidelines for Neoplasm Coding.
To assign the most specific code possible, documentation must be reviewed to determine the histologic behavior which may be benign, in-situ, malignant or of uncertain behavior. Malignant neoplasms must be further differentiated as primary or secondary. Records containing documentation of a primary malignant neoplasm should also be reviewed for documentation of any secondary or metastatic sites.
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Tracking the Ebola Outbreak In ICD10
The ongoing outbreak of the Ebola virus is an example of the way transitioning to ICD-10 can benefit the ability of public health officials to respond to global pandemics.
Ebola Virus.
The Ebola virus is front page news everywhere you turn. Tracking of the Ebola outbreak in the United States with coded data is imprecise due to the lack of a specific code for Ebola in ICD-9-CM. This is yet another reason that the ICD-10-CM/PCS code sets need to be implemented on October 1, 2015.
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Medical Necessity In ICD 10
In order to successfully transition to ICD-10, healthcare providers will need to change more than the actual codes they use; they’ll also have to change the way they think about coding. Because in addition to choosing the right code from a list of 68,000 possibilities, providers must ensure that the code they choose most accurately reflects the specific condition they’re treating so it supports the medical necessity of their services.
See more at : icd10monitor

Coding GERD in ICD-10-CM
Overview
Gastroesophageal reflux disease (GERD) is the most common disease encountered by the gastroenterologist. It is equally likely that the primary care providers will find that complaints related to reflux disease constitute a large proportion of their practice. The following guideline will provide an overview of GERD and its presentation,management of this common and important disease and comparison between ICD9 and Icd 10 Coding pattern.
Symptoms
Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth or have heartburn. However, if these symptoms interfere with your daily life it is time to see your physician.
Other symptoms that occur less frequently but can indicate that you could have GERD are:
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Reporting pain in ICD 10 CM.
Once ICD-10 is implemented on October 1st, coders will need to be ready to assign the appropriate codes for reporting different types of pain in different encounters. In this article we’ll give you a run-down of how pain is classified in ICD-10, as well as the rules for sequencing the pain codes.
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How ready is your practice for ICD-10 implementation?
Simple strategies on documentation concepts will help your organization. Understanding how the documentation impacts the total patient experience will go a long way to addressing the need for improved documentation. And considering the recent legislation, better documentation is essential to meet the standards for quality initiatives.No matter where you are in the implementation process, assisting your provider should be first on your mind. It’s not too late to still get ready and make improvements. Waiting until closer to the implementation date will not only disrupt your strategy, but it will also have you diving deeper into your financial reserves to make sure you can be ready on time. Any time we have a new initiative there will be issues. But the only one who can prepare and protect your practice is you
Source: ICD 10 Monitor

ICD 10 Guidelines On Specific Diagnosis Or Conditions In Anemia
Anemia is a condition in which the number of red blood cells or the amount of hemoglobin (the protein that carries oxygen in them) is low.
Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts of the body. When the number of red blood cells is reduced or the amount of hemoglobin in them is low, the blood cannot carry an adequate supply of oxygen. An inadequate supply of oxygen in the tissues produces the symptoms of anemia.
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Guidelines for reporting conditions associated with COPD.
Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.
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How to Document and Code for Hypertensive Diseases in ICD-10
According to the Centers for Disease Control and Prevention (CDC), hypertension affects one in three adults in the United States, or approximately 68 million people. It contributes to one out of every seven deaths and to nearly half of all cardiovascular disease–related deaths, including stroke. ICD-10-CM codes for hypertension are similar to those in ICD-9-CM. Coding for hypertension (without complications) is easier in ICD-10-CM because there is no “benign” vs. “malignant” issue — there is only essential hypertension, indicated by code I10 Essential (primary) hypertension.
If hypertension affects a body system, combination codes come into play. The code set addresses Hypertensive heart disease with category I11, Hypertensive chronic kidney disease with category I12, and Hypertensive heart and chronic kidney disease with category I13
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Coding changes for adverse effects and poisoning in ICD10
One of the challenges in ICD-10 is understanding the difference between coding for adverse effects and poisonings. You have to understand the difference between the two, and you have to also understand the coding differences.
When coding for adverse effects in ICD-9, you must code first the “reaction” followed by the E code (external causes) identifying the substance that caused the adverse reaction. This E code comes from the therapeutic column. This is different from coding a poisoning, for which we first report the poisoning code followed by the reaction and then the E code, which identifies the substance as well as how the patient was poisoned (e.g., accident, suicide, assault, or undetermined).
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How proper coding can help prove medical necessity.
For a service to be considered medically necessary, it must be reasonable and necessary to diagnose or treat a patient’s medical condition. When submitting claims for payment, the diagnosis codes reported with the service tells the payer "why" a service was performed. The diagnosis reported helps support the medical necessity of the procedure. The provider must document the diagnosis for all procedures that are performed. The provider also must include the diagnosis for each diagnostic test ordered. A common error seen when reviewing medical documentation is that the provider will document a diagnosis and indicate tests ordered, but it is unclear that all the tests ordered are for the diagnosis documented in the assessment.
For example, the patient presents with right knee pain and the physician performs an arthrocentesis. He also orders a chest X-ray. The only diagnosis documented is knee pain. The knee pain supports the medical necessity for performing the arthrocentesis, but it does not support the medical necessity for the chest X-ray. In this case, the provider should be queried why the chest X-ray was ordered so the proper diagnosis can be reported. The provider may have wanted a knee X-ray and made a mistake when writing his orders. By asking the provider for clarification, you have prevented the performance of an unnecessary test because the provider really intended to order a knee X-ray. In this case, the knee pain would support the order of the knee X-ray. If the provider intended to order a chest X-ray, by asking for clarification you can report the service with a more appropriate ICD-9-CM code and eliminate a claim denial. In this example, the arthrocentesis is reported with procedure code 20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) and diagnosis code 719.46 Pain in joint; lower leg. The code for the X-ray is selected based on the anatomic site and number of views obtained.
Source: Physicians Practice

Difference between ICD9 CM and ICD10 CM
While there are many steps a practice needs to take to get ready for ICD-10, the ones that most affect providers are documentation improvement and understanding which codes will change for their practice specifically.
The best way to prepare for the coding changes is code mapping the most frequently used codes in your practice. Depending on the practice, it could be the top 20 codes or top 100. For many primary-care providers, the number will be more like 20 codes to 50 codes. Mapping these top ICD-9 codes to their ICD-10 equivalents will help providers get a feel for the new codes and prepare to start using them. Providers should not rely entirely on an ICD-9 to ICD-10 crosswalk because some new codes have many very specific options.
See more at: Health Works Collective

ICD 10 Guidelines for Coding Diabetes
Diabetes Mellitus.
In type 1 diabetes mellitus (DM), beta cells are destroyed by an autoimmune process that usually leads to a complete loss of insulin production. The majority of patients who develop type 1 DM will do so prior to age 25, with an increased prevalence due to heredity or in patients with other autoimmune diseases. Type 1 DM patients are dependent on insulin.
In type 2 DM, the pancreas continues to produce insulin but doesn’t produce enough and doesn’t utilize it properly (insulin resistance).
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Obstetric Coding in ICD-10-CM/PCS
Similar to ICD-9-CM, ICD-10-CM obstetric codes in chapter 15 have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in addition to chapter 15 codes to further specify conditions.
The episode of care (delivered, antepartum, postpartum) is no longer a secondary axis of classification for obstetric codes. Instead, the majority of codes have a final character identifying the trimester of pregnancy in which the condition occurred.
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Icd10 documentation for chest pain
Chest pain is a common complaint in the urgent care setting, and is not always related to an acute heart condition. The characteristics of chest pain depend on the cause, and may be described as ischemic, nonischemic, noncardiac gastroesphageal, pulmonary, or musculoskeletal.
Ischemic cardiac diagnoses includes angina, myocardial infarction, aortic stenosis, hypertrophic cardiomyopathy, and coronary vasospasm. Nonischemic cardiac causes of chest pain include pericarditits, aortic dissection, and mitral valve prolapse.
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Coding changes for adverse effects and poisoning in ICD10
One of the challenges in ICD-10 is understanding the difference between coding for adverse effects and poisonings. You have to understand the difference between the two, and you have to also understand the coding differences.
When coding for adverse effects in ICD-9, you must code first the "reaction” followed by the E code (external causes) identifying the substance that caused the adverse reaction. This E code comes from the therapeutic column. This is different from coding a poisoning, for which we first report the poisoning code followed by the reaction and then the E code, which identifies the substance as well as how the patient was poisoned (e.g., accident, suicide, assault, or undetermined).
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Knee pain
Knee pain is a common symptom in people of all ages. It may start suddenly, often after an injury or exercise. Knee pain may also began as a mild discomfort, then slowly worsen.
Source: Read More

How proper coding can help prove medical necessity.
For a service to be considered medically necessary, it must be reasonable and necessary to diagnose or treat a patient’s medical condition. When submitting claims for payment, the diagnosis codes reported with the service tells the payer "why" a service was performed. The diagnosis reported helps support the medical necessity of the procedure. The provider must document the diagnosis for all procedures that are performed. The provider also must include the diagnosis for each diagnostic test ordered. A common error seen when reviewing medical documentation is that the provider will document a diagnosis and indicate tests ordered, but it is unclear that all the tests ordered are for the diagnosis documented in the assessment.
For example, the patient presents with right knee pain and the physician performs an arthrocentesis. He also orders a chest X-ray. The only diagnosis documented is knee pain. The knee pain supports the medical necessity for performing the arthrocentesis, but it does not support the medical necessity for the chest X-ray.
In this case, the provider should be queried why the chest X-ray was ordered so the proper diagnosis can be reported. The provider may have wanted a knee X-ray and made a mistake when writing his orders. By asking the provider for clarification, you have prevented the performance of an unnecessary test because the provider really intended to order a knee X-ray. In this case, the knee pain would support the order of the knee X-ray. If the provider intended to order a chest X-ray, by asking for clarification you can report the service with a more appropriate ICD-9-CM code and eliminate a claim denial. In this example, the arthrocentesis is reported with procedure code 20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) and diagnosis code (ICD 9 code 719.46/ICD10 code M25.569) Pain in joint; lower leg. The code for the X-ray is selected based on the anatomic site and number of views obtained.
Source: Proper Coding Can Help Prove Medical Necessity

Reporting of codes for colonoscopy.
Summary
Understand the new rules and definitions for diagnostic colonoscopy to make sure your practice is not losing out on big reimbursement dollars.
Note the AMA’s revision to the definition of colonoscopy. The description of colonoscopy prior to 2015 stated "proximal to the splenic flexure.” Starting January 1, 2015, the procedure must go farther, namely, to the cecum or small intestine anastomosis.
The new colonoscopy description refers to "the examination of the entire colon, from the rectum to the cecum,” as stated in the 2015 CPT manual under the CPT Coding Guidelines, Endoscopy.
The procedural revision adds further complexity to this service, which historically has given practices trouble. Practices submitting 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) were denied 11% of the time, at an average loss of $845 per denial, per the most current data source, 2013 Medicare claims data. Read Full Article ..

Append the right modifier for services during global surgery period.
Summary
The first step in understanding how to use modifiers during the postoperative global surgical period is to understand the definition for the global surgical package. There are differences in the way the global surgical package is defined under the AMA'S CPT rules and under Medicare.
According to CPT, the surgical package includes "typical postoperative care follow up,” the treatment of complications is not included in the surgical package. According to Medicare, all follow up care-including the treatment of complications, is included in the 10 or 90 day global period unless the patient is returned to an operating room for the management of complication.
For a patient requiring extra attention during the surgical period, one will want to append the correct modifier for additional or unusual services to make sure you receive the payment.
Typically, the global surgery period for a given procedure covers pre-op and post-op care, yet special circumstances dictate the need for additional services, which is where utilizing the correct modifier use comes in. Being specific with the documentation about the exact procedures, including anatomy as well as decision making, not only will clear documentation but will also strengthen your case in the event of an audit.
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Senators confident ICD-10 is a go
It looks like the stars could at last be aligned for ICD-10. After years of angst and multiple delays, comes a government report that indicates the Centers for Medicare & Medicaid have done the necessary testing to move forward.
At least that's how Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) interpret the Government Accountability Office report released Feb. 6.
"As demonstrated by this report, the provider outreach and responsiveness to stakeholder concerns from CMS have kept the agency on track to upgrade to the next level of healthcare coding," said Hatch said in a statement.
"While additional testing will be needed to ensure its success, the transition to the new system will streamline the management of healthcare records and improve patient care. I will continue to keep a close eye on this issue but see no reason for any delay past the October deadline." Read More..

Google Revamps Results Pages for Health-Related Searches
On Tuesday, Google announced that is working with the Mayo Clinic to display accurate results for health-related queries in a new way, MedCity News reports (Verel, MedCity News, 2/10).
According to Google, about one in 20 Google searches is for a health-related term.
In a blog post, Google Product Manager Prem Ramaswami said that over the next few days Google will leverage its Knowledge Graph -- a Google function that creates a "smarter" search by combining the companies search algorithm with internal and publicly available datasets -- to display relevant health information in a box at the top of a user's search results page.
The information will be pulled from trusted medical websites and has been vetted by a team of doctors at Google and another team at the Mayo Clinic (Comstock, MobiHealthNews, 2/10). An average of about 11 physicians will have inspected the information (MedCity News, 2/10). Read More..

US House Committee to Hold Hearing on ICD-10 Implementation
A key Congressional committee will be holding a stakeholder hearing on ICD-10-CM/PCS implementation next week. The "Examining ICD-10 Implementation" hearing, set for 10:15 am ET on February 11, is being held by the influential House Energy and Commerce Committee's subcommittee on healthcare, which is chaired by Rep. Joe Pitts (R-PA).
"This hearing is an important opportunity to hear about the state of preparedness of all those involved and ensure that we are continuing to move forward in health care technology," Pitts said in a press release announcing the hearing . Read More..

Mounting Efforts to Delay ICD-10 Go Down Swinging
Despite a significant lobbying effort mounted by a small but very vocal minority within the healthcare industry, the implementation of ICD-10 is expected to proceed without further delay.
The failed push marked a third attempt to delay the Oct. 1, 2015 ICD-10 implementation deadline well into 2017. Members of Congress rejected the request to include language that would again delay ICD-10 in the lame-duck omnibus spending bill that was passed by Congress on Dec. 11 and ratify by the Senate on Dec. 13. Read More..

Five Reasons to be Thankful for ICD-10
The following is a guest blog post by Wendy Coplan-Gould, RHIA, Founder and President of HRS Coding.
It's Thanksgiving weekend-a time for reflection and gratitude. Thoughts typically turn to family, friends, health, and life's many other blessings. In addition to all of these, this Thanksgiving I suggest that the healthcare industry also include ICD-10 in our list of godsends. Here are five reasons why: Read More..

ICD-10 - Is Everyone Ready?
ICD-10 costs for small physician practices are significantly much lower than expected, according to a new study released today by the Professional Association of Health Care Office Management (PAHCOM). The survey of 276 physician practices of fewer than six providers revealed that total ICD-10 transition costs for an entire practice averaged $8,167. Per provider expenditures averaged $3,430 for a practice with a single provider to $1,838 for a practice with six providers. There were insufficient responses from larger practices with seven or more providers so these practices were not included in the analysis. Read More..