Category: Coding & Documentation

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Medicare’s New Documentation Rules Impact Practices

Medicare’s New Documentation Rules Impact Practices AAOSNow – April 2019  by Margaret M. Maley Surgeons instructing billing staff to bill “insurance only” is a scenario that is all too common in orthopaedic practices. In effect, the practice is waiving the patient’s copay, coinsurance, and deductible amounts and accepting whatever amount the insurance company will pay. In...

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Wound Care Coding

Wound Care Coding SCCM Critical Connections – December 2018  by Deborah Grider The wound care (97597-97598) and debridement codes (11042-11047) are used for debridement of wounds that are intended to heal by secondary intention. Some conditions that support medical necessity include infections, chronic venous ulcers, and diabetic ulcers, to name a few. Many insurance carriers, including...

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Scientific Analysis for Medical Liability Claims

Scientific Analysis for Medical Liability Claims AAOSNow – December 2018  by Michael Marks, MD In orthopaedics, as in much of medicine, improvements in patient care are achieved when processes are developed to analyze outcomes. Medical professional liability (MPL) claims can serve as lagging indicators or signals of serious problems in the delivery of care. Medical liability...

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Is Your Practice Optimizing Coding Resources?

Is Your Practice Optimizing Coding Resources? AAOSNow – December 2018  by Sarah Wiskerchen If not, you may be at risk for claim denials or lost revenue Is your billing team or third-party billing service using the right resources, rules, and guidelines when assembling claims and managing denials? When substantiating coding or appealing claims, you must base...

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Answers to Five Common Coding Questions

Answers to Five Common Coding Questions AAOS Now – October 2018 by Margaret M. Maley, BSN, MS and Sarah Wiskerchen What orthopaedic surgeons, practice managers, and staff want to know In this article, we discuss five concerns from surgeons and their staff that are currently “trending.” 1. Vendor advice = a flashing yellow light Question: Our orthopaedic...

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Are Online Coding Discussions Putting Your Practice at Risk?

Are Online Coding Discussions Putting Your Practice at Risk? Medical Office Manager – October 2018 by Cheryl Toth, MBA Here’s an email we recently saw while monitoring a specialty coding listserv: Subject: Acromioplasty and hardware removal with total shoulder arthroplasty Hello All, We have a surgeon that says I am not an aggressive coder because I...

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2019 CPT® Coding for Skin Biopsies

2019 CPT® Coding for Skin Biopsies ICD10 Monitor – September 2018 by Deborah Grider, CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP Skin biopsy codes are changing. EDITOR’S NOTE: This is the second installment in a two-part series on the 2019 CPT® codes released recently by the American Medical Association. For many years we have used two...

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AMA Releases 2019 CPT® Code Set

AMA Releases 2019 CPT® Code Set ICD10 Monitor – September 2018 by Deborah Grider, CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP New code changes number 335. The new current procedural terminology (CPT®) codes have been released with 335 code changes in 2019.  There were many code revisions with guideline, description and instructional note changes.   Let’s look...

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Reasons Why Diagnostic Coding Matters in Value-based Care

Reasons Why Diagnostic Coding Matters in Value-based Care AAOS Now – September 2018 by Margaret M. Maley, BSN, MS Payers are great at collecting data. They use the information to develop payment policies, determine reimbursement rates, and, increasingly, to negotiate value-based contracts. Payers profit because they know how much it costs to take care of...

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