The first step to finding the most accurate code is to confirm that you are working with the correct version of the ICD-10-CM Official Guidelines for Coding and Reporting. The correct version may be the most recent update, or – in the context of retrospective coding– it may need to be a previous version that […]
Diagnosis coding
Diagnosis coding establishes the medical necessity for a service, and can be the source of denials. Accurate and specific diagnosis coding is also important for groups that are part of ACO or have risk-contracts in communicating the acuity of a panel of patients.
“xxxA” – ICD-10-CM Placeholder Code X and 7th Character Extension
When I was reviewing terms people use to find CodingIntel I was surprised to find that people were searching for “xxxA.” At first, I was afraid searchers were looking for a different kind of site….or sight. I hope some searchers were looking for information about placeholder code X and 7th character extension A. These are […]
ICD-10-CM Conventions, Structure, and Format: Section I.A
As you read this article, it will be helpful if you have the ICD-10-CM book in front of you. You can download a pdf copy here. And even if you don’t download the entire book, download the Official Guidelines instead. There are four cooperating parties to ICD-10-CM. They publish and update the official guidelines for […]
IRE Inpatient Determinations: Case Studies | Webinar
Recorded August 13th, 2024
Guest Presenter Dr. Amarin “Ty” Alexander
Independent Review Entities review inpatient records for diagnostic accuracy and DRG determinations. This case-study focused webinar will describe important ICD-10-CM Guidelines that establish the rules for these decisions.
HCC Coding: V24 to V28
The transition from V24 to V28 of the HCC model is almost in the rear view mirror. For most groups with risk contracts, this really is old news. We’ve left the video for another year for anyone who needs to catch up on the overview of the change. CMS pays Medicare Advantage (MA) plans using […]
HCC Transition from V24 to V28 | Webinar
Recorded July 20, 2023
CMS is transitioning risk coding from the 2020 V24 model to V28 beginning in 2024. This webinar will provide an overview of HCC coding, its purpose and methodology. We’ll describe the changes and enumerate some of the key differences in coefficients for commonly used conditions between V24 and V28. And finally, learning from OIG audits of Medicare Advantage Organizations and HCC coding, identify diagnosis codes that are frequently incorrectly reported.
Diagnosis Coding for Biopsy Sent for Pathology
Question: What diagnosis code should you use when sending a skin biopsy to pathology? a) D48.5 Neoplasm of uncertain behavior of skin, or b) D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
Diagnosis Coding for Screening Colonoscopy
Some of you have read CodingIntel’s article on coding for screening colonoscopy. The questions we get about that article are almost all related to diagnosis coding. The CPT®/HCPCS coding and the modifiers don’t raise many questions, but clinicians, coders, and patients frequently ask about correct diagnosis coding and sequencing of those codes. We posed these […]
HCC’s in Brief | The Difference Between CMS-HCC and HHS-HCC
Demographics and diagnoses Risk adjusted diagnosis coding is a model used to predict future health care costs based on demographics and diagnoses. It is most commonly used by Medicare to set rates for patients who are in Medicare Advantage plans. A Medicare Advantage plan is paid different amounts for the Medicare patients they cover. The […]
HCC Coding: Round Up of Chronic Conditions
This article will describe risk coding for a few common, chronic illnesses. This article isn’t comprehensive about all chronic conditions. My focus in this article is on commonly seen conditions in medical practices. If a condition is prevalent, then coding for it accurately is important in risk based diagnosis coding. Key points in coding chronic […]
Can you Screen for an Existing Condition? | Diagnosis Coding for Lab Services
Sometimes, the hardest thing about coding for preventive services isn’t the visit at all. It’s the labs. Patients come in for an annual physical and believe that all of the lab work done that day or in preparation for that day will be covered as part of their preventive service. And we know what that […]
Risk Coding for Medical Practices and Outpatient Services
Introduction to Risk Coding for Medical Practices and Outpatient Services Recorded May, 2022 You can find CodingIntel’s 2023 webinar at this link: https://codingintel.com/hcc-coding-changes-webinar/ Where do we find the rules for assigning diagnosis codes in medical practices? The diagnosis codes don’t just get the claim paid, they also determine the patient’s risk score and the risk […]
HCC Diagnosis Coding: Can you Add a Code from the Past Medical History?
This post describes rules for office/outpatient coding, not facility/DRG rules. Recently a fellow coder wrote to me about risk adjusted diagnosis coding. She was responding to an article that I wrote in which I stated the conditions listed in the past medical history should not be included on the claim form by the coder. I […]
What’s the Difference Between B20 and Z21? Which is Right for Positive HIV Status?
In this post ICD-10-CM diagnosis coding for positive HIV status Medical practice reimbursement for individual claims based on CPT® Common HIV diagnosis codes Question: For an HIV positive patient without symptoms, is the correct diagnosis code Z21 or B20? What difference does it make to reimbursement? Answer: Following ICD-10 guidelines, a patient with HIV status […]
Diagnosis Coding for Tick Bites
Question: Why is it so hard to have correct diagnosis coding for tick bites? And, how is it coded? Answer: The search function in electronic health records leads clinicians astray. And, diagnosis coding for tick bites requires two diagnosis codes, because it is an injury. It requires a code from the injury chapter in the […]
Pecked By a Parrot. Oh No, Not Again!
When we first implemented ICD-10, we all had a lot of fun with the ICD-10-CM external cause codes. But, do we need to use them? The answer to that is no according to the official guidelines and yes if your payers require them. Here is what the official ICD-10-CM guidelines say, “There is no national […]