‘Twas the night before auditing, and all through the floor, The auditors prepped, ready to explore. The charts were all stacked, each file in its place, While audit reports awaited their grace. The coders were dreaming of claims they’d submit, But the auditors knew they’d have to review it. With…

AI can be used in practice management to improve patient care, help automate the coding process, and streamline administrative tasks, among other things. Click The Full Article (AHIMA membership required).

Eligibility: What Is It, Anyway? April 2024 Beth Timpson Schleeper, COC, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, CPC-I, CEMC, CANPC, CEMA, CMCS, CMRS To be sure that your practice is paid for services rendered, you want to verify every patient’s eligibility for medical coverage. Why? Because the turnaround time…

OBR Oncology August 7, 2023 Torrey Kim interviewed me for his article “Updated ICD-10-CM Oncology Codes Announced: Important Changes to Know”. Click to Read the Article

What It Is and What a Practice Needs to Know The Comprehensive Error Rate Testing (CERT) program is a crucial component of the Medicare program that helps ensure the government is paying only for the services and care that beneficiaries actually receive. The program is designed to identify improper payments…

The pandemic and the public health emergency (PHE) it brought along with it, have changed how health care is delivered.  Commercial payors have been more amenable to paying for telehealth services in prior years.  Due to the pandemic, CMS decided to relax its guidelines on telehealth acceptance and payment.  More…

CMS issued a final rule on the Medicare Physician Fee Schedule and some other policies that are slated to start on or after January 1, 2021.  The 1,994 page document has a lot of information on many different policies, so a few important ones will be highlighted here, but you…

The last big change for Evaluation and Management (E/M) coding was in 2010 when Medicare stopped accepting consultations. Not since 1997 have the guidelines gone through such a big adjustment. Due to the pandemic, though, many practices are not prepared for this upcoming change. This article will look at an overview…

In CPT this year, there are new Category I codes for Principal Care Management (PCM). CPT CODE DESCRIPTION #•99424 Principal care management services, for a single high-risk disease…; first 30 minutes provided personally by a physician or OQHCP, per calendar month #+•99425       each additional 30 minutes provided personally by…

Question: I am unsure what ICD-10 diagnosis codes should go on a claim for an encounter.  Here is an example: a patient is seen for a nagging cough/cold symptoms.  Since the patient has hypertension, the doctor told her there are certain over-the-counter medications she should not take.   He then gives…

Question: A patient came in for two punch biopsies due to dermatitis that wouldn’t clear after treatment for a few months.  The doctor thinks that he should be able to bill an E/M with the visit, but I say no.  Who is right?  Answer:  I don’t like giving this answer,…

Question: One point of clarification I’ve wondered about. What defines the chronicity of the condition? Is it if it’s lasted more than one year already for the patient or is it if we know that it’s going to last more than a year even if it’s only lasted a few months?…

Question: When I am performing a shave biopsy, I append diagnosis code D48.5 to the service.  My coder is telling me that it is incorrect, and I should use D49.2 instead.  Who is correct?  Answer: The coder is correct on this one.  D48.5 is Neoplasm of Uncertain Behavior of Skin…