Tag - Medical Coding Services

Medical Billing

Coding Guidelines For Podiatry Medical Billing

Podiatry is a medical specialty devoted to studying complications related to the foot. Which involves diagnosis, medication,  and surgical treatment.

Services offered by the podiatry specialist are paid by the insurance companies or in case if some services are excluded from the insurance coverage then the patient is liable to pay for them. 

Podiatry medical billing proves to be complicated as it essentially treats the elderly, which is a large set population covered by Medicare. Which demands additional efforts in the medical billing and coding process.

As there is a higher possibility of a coding error, which results in claims denials and loss of revenues. And an additional effort to make your coding compliant with the recent guidelines by Medicare increased the workload of podiatry practices.

Recently a coding guideline was issued for Podiatry practices. For efficient billing activity, you must be compliant with these guidelines.

Coding Guidelines For Podiatry Medical Billing

Proper coding is imperative for clean claim submission. Codes are applied to describe the treatment and diagnosis provided to the patient to prevent claim denial and increase revenues.

There are varieties of codes, some are considered for one operative procedure, while some are applied in an obscure form of treatment.

Based on the insurer company requirement multiple codes are set with each other. A thorough evaluation of all these codes is important for your practice. In case of any error, you may face claim denials which will eventually increase your account receivable. Moreover, coding experts should keep themselves up to date for the new policy regulation by Medicare. 

For some services modifiers are required, they are used to give additional information to the payers about the treatment and services under certain circumstances. 

The policy guideline for Podiatry practices under healthcare Medicare are given below: 

Excluded Services 

There are multiple services that are not covered by Medicare including general routine foot care, except under the following conditions: 

  • When it is mandatory with other treatment procedures. 
  • During the diagnosis and treatment of ulcer wounds 
  • Trimming nail following a fracture. 
  • Subluxation of the foot, an exception in the case of ankle dislocation.
  • Flat foot and some devices except therapeutic and orthotic shoes. 
  • Metabolic, neurologic, and peripheral vascular disease.
  • Treatment of warts and Mycotic nails. 
  • The treatment of mycotic nails can only be covered when there is clinical evidence of mycosis in toenails and the patient is ambulatory. In the case of non-ambulatory, the extent of secondary infection should be taken into consideration. 

Covered Services 

Under the new policy guideline, the covered services include a diagnosis involving hyperkeratotic lesions,non-dystrophic nails, debridement of nails, and dystrophic nails.

And foot exams for people with diabetic sensory neuropathy.

There are many other chronic diseases that are covered under new policy guidelines

List of Codes

Below are some of the procedural or diagnosis codes, which are given for reference purposes only.

  • CPT Code  11055 is applied for cutting benign hyperkeratotic lesions.
  • CPT Code  11719  is applied for trimming non-dystrophic nails.
  • CPT Code  11720  is applied for the debridement of nails.
  • CPT Code  G0127  is applied  for trimming of dystrophic nails
  • CPT Code  G0245 is applied for Primary administration of a diabetic patient with diabetic sensory neuropathy following a loss of protective sensation.
  • CPT Code  G0247  is applied for Routine foot care by a practitioner of a diabetic patient with diabetic sensory neuropathy following a loss of protective sensation. 

Modifiers

Modifiers are used as additional information to the players in coding. These modifiers are utilized with the codes. The modifiers Q7 for 1 class A findings, Q8 for Two class B findings, Q9 for One class B, and 2 Class C findings. Below is the description of each modifier: 

Q7- One Class A findings

This modifier is specifically used in the case of nontraumatic amputation of the lower extremity (A serious complication of diabetic neuropathy and peripheral vascular disease)  or integral skeletal portion.

Q8- Two Class B findings

This modifier is applied in case of the absence of posterior tibial pulse, advanced trophic changes, and absent Dorsalis Pedis artery pulse.

Q9- One Class B & Two class C findings

This modifier is used in edema, paresthesia, burning, temperature fluctuations, and claudication.

For more information, you can see the updated document of Podiatry Policy guidelines. 

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Billing Codes

3 Billing Codes Every Physician Should Know

Medical Billing Codes are a crucial part of RCM or Revenue Cycle Management which enables the communication between medical practitioners and insurers.

Physicians and other practitioners are always looking for different ways to increase revenue. One of the basic ways that medical providers miss out on generating revenue is by not billing for services that are provided.

Coding mistakes are common, whether from a lack of understanding of using the right codes at the right time or having a lack of knowledge about certain codes.

In this blog, we talk about what medical coding is and the different types of codes we see today. We also look at 3 codes that are often underrated or are often unknown to the billing staff. 

This should be avoided, as knowing about the codes, and how to use them, can earn medical firms a decent amount of income that was previously missed.

Medical Coding 

Medical coding is a technological advancement that has made the medical process so much simpler than it used to be before.

Medical codes translate huge reports into codes used within the healthcare industry. Summarising often piled-up medical reports into efficient codes.

A medical coder is responsible for translating huge medical reports of physicians into medical codes. These people work behind the scenes in different settings, ensuring all appropriate information is coded consistently and accurately.

After a patient is treated by a medical provider, the process of billing starts where the insurance company needs to understand what medical service was provided to further process the bill.

To make things simpler and have a common language, specific codes are entered into the software to give the insurance company accurate details.

The role of a medical coder is basically to provide the information in a way that is easy to understand and effective.

There are the three main codes used today: Current Procedure Terminology (CPT), International Classification of Diseases (ICD), and Health Care Procedural Coding System HCPCS. The code sets help coders to document the condition of a patient and also describe the procedures performed on the patient.

Different Types Of Medical Codes

ICD-International Classification Of Diseases

The ICD was designed as a health care classification system that provided diagnostic codes that classified diseases, including classifications of different symptoms, and external causes of the illness or injury.

The ICD is a system developed by the World Health Organization (WHO) and ten international centers in collaboration.

The idea was that the medical terms and bills reported by physicians examiners can group them for statistics. In the US, the National Center for Health Statistics manages any alterations to the codes alongside the WHO.

CPT (Current Procedural Terminology)

CPT codes offer doctors and professionals a language for coding their medical services and procedures to make reporting efficient and increase accuracy.

Administrative management, like claims processing and guidelines for medical care reviews, also uses CPT codes. The terminology used in CPT is the most widely accepted across the country which helps in reporting medical, radiology, surgical, anesthesiology, laboratory, evaluation, and management services under public and private medical insurance programs.

CPT codes contain five digits which are either numeric or alphanumeric, depending on the category of the medical service. CPT code descriptors utilize common standards so that users have a common understanding of the clinical health care model.

HCPCS (Healthcare Common Procedure Coding System)

HCPCS or Healthcare Common Procedure Coding System is another coding system used across the US.

The Healthcare Common Procedure Coding System is a collection of codes that represent procedures, products, supplies, and services that are provided to Medicare receivers and people enrolled in private medical insurance programs. The HCPCS codes consist of Level I, II, and III codes.

  • Level I codes are the AMA’s CPT codes which are numeric.
  • Level II codes are the alphanumeric code sets. These primarily include non-physician products and procedures.
  • Level III codes or HCPCS local codes were developed by Medicaid agencies, and private insurers, and are used in specific programs included in the HCPCS coding book. These codes are preferred by payers compared to the Level I and Level II code sets. However, Level III codes are not recognized nationwide.

Why Is Medical Coding Helpful And Issues Of Inaccurate Coding?

Medical Codes are a common language between payers and medical providers and are used for communication for billing. The financial importance present in the case of medical billing a provider has to be accurate in entering codes for the given medical treatment. 

Why inaccurate codes are bad:

  • One case of inaccurate codes is “Up-coding”. This is when a code is recorded for a higher level of service, however, the service provided to the patient was not as high. This makes Up-coding a serious offense and entering accurate codes is crucial. 
  • Vice versa, “Down-coding” is entered at a lower level of cost than what was provided to the patient. Down-coding is often not done on purpose, instead, it requires both the provider and the coders to be trained and educated on the losses the firm may face if down-coding takes place.

3 Billing Codes To Keep A Look Out For

Telephone Services (99441-99443)

Due to doctors being busy these days, especially since the emergence of the COVID-19 pandemic, patients skipping the line and calling to speak to the doctor is not rare anymore. CPT codes include codes specifically for telephone services provided by physicians and other healthcare providers.

Used for reporting E/M services provided over the phone, telephone codes can only be used for regular patients, not for patients who come in for a face-to-face visit within 24 hours. Time is a crucial factor, as codes are different for different durations.

Emergency (99058)

Patients needing an emergency visit are coded “99058”. This code is used if a patient demands and needs immediate attention from the medical provider, which will as a result, cause disruption in the schedule of other appointments. This code can only be used for in-office visits.

Health Assessment (96160)

Code 96160 is used to provide a health risk assessment on a patient, with or without a guardian. It is used when assessing risk diseases and disorders, like those pointing to mental health.

Outsource To Med-Miles LLC

Medical Coding is a very complicated procedure that requires you to stay up-to-date on the latest coding updates in order to avoid errors and omissions and to generate a lot of revenue for your practice.

It’s a tedious task that takes up too much of your time and distracts you from your dream goal. To get yourself out of these burdensome tasks, there are Medical Billing Companies that can help you by providing Medical Billing Services Like Med-miles LLC.

So if you hand over these tasks to our team of experts who can handle the Medical Coding operations appropriately that would be a bigger step towards success.

Save Your Time Today! Call us at (888) 598-9181 for Medical Coding Services.

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Coding Errors

8 Medical Coding Errors To Avoid

In the medical billing process, coding errors lead to claim denials, loss of revenue, and in the worst-case scenario, it is viewed as a fraudulent act that results in fines and imprisonment. 

It’s crucial for every health service provider to avoid coding errors, which may disrupt their revenue cycle. The possibility of coding errors is very high, especially if some inexperienced coders are executing it. You can reduce the coding errors to some extent by observing some of the most common coding errors faced by the coders. 

For your convenience, we broke down those coding errors below.

1.  Unbundling:

In medical Coding unbundling is described as Using multiple codes for a single part of a medical procedure, when it can be covered by using a single code. This process can increase the amount which you claim to the insurer.

2. Upcoding:

It refers to the coding error in which the patient has been charged for the services and treatment which is more expensive than the actual treatment and procedure actually performed. This activity is a clear violation of the False Claim Act and if someone did it intentionally then he can face some serious consequences. 

3. Improper Reporting:

Sometimes incorrect or missing information of patients like his name, address, and diagnosis can cause problems. It is one of the most common mistakes which was done by service providers. It not only includes misinformation about the patient but also the insurance company. This information is very essential for the coders to submit a successful claim to the insurance company, any interruption in these records can lead to denied claims. So, an accurate record is essential for proper coding.

4. Duplicate Billing:

It is the type of error in which a patient has been charged multiple times for services or treatment. It is one of the most common problems in the medical billing process. It might be the result of re-submitting the claim. This error can be reduced by checking the patient’s code and making sure of the accuracy and multiple coding.

5. Under coding:

It is referred to a situation in which the patient is not charged fully for all the treatment or services he availed from the service provider. Under coding is usually considered as the opposite of upcoding. Usually, the service providers did under coding to avoid the audit. It is considered an illegal activity that results in loss of revenue and lower reimbursement rates.

Despite the fact that most of the service providers do under coding to get rid of auditing. But in most cases, it occurs due to not knowing the exact coding. In any of those cases, it is still considered an illegal activity that should be avoided.

6. Overusing Modifier 22:

 modifier 22 is used to indicate the increased procedural services, which is the measure of complexity and length of the services. There is a need for proper documentation because sometimes physicians added the services and treatment which is not required.

7. Avoiding NCCI Edits:

    NCCI refers to the national correct coding initiative. It helps the service provider to ensure the proper coding setup and avoid improper payments. It was introduced by the center for medicare and Medicaid services.

This is set up by NCCI edits which convert the bundling component codes into the inclusive code.

According to American Medical Association” It is an automated prepayment edit that is reached by analyzing every pair of codes billed for the same patient on the date of the same services by the same provider to see if an edit exists in the NCCI” this system use CPT modifier to overcome the denial rate and the code will be denied if any NCCI edit exists. So, checking the NCCI edits helped you to avoid coding errors. 

8. Unlisted Codes Without Documentations:

These are the codes that are assigned to record the treatment and procedures of services that have no specified CPT code. There is a need for proper documentation for the effective use of unlisted codes.

Also Read 7 TIPS FOR REFINING YOUR MEDICAL CODING PRODUCTIVITY AND EFFICIENCY

How You Can Avoid Coding Errors?

 These coding errors prove to be very dangerous and damaging if not addressed on the time it leads to the loss of revenue and in extreme cases a fine and imprisonment could be imposed for violating the FCA. There are a few things explained below which can help you to avoid coding errors.

Proper Training:

 You can simply avoid the coding errors with the help of the proper training of your coding team, most of the coding errors occur due to negligence in coding. You can minimize those small errors with effective training of your staff members to avoid any future problems.

Automation:

You can also use the software which can help you to detect even minor errors in your coding. This process simply helps you in error-free coding which results in successful claim submission. 

Outsourcing:

As coding is a very complex procedure, errors and omissions are very common. It took lots of revenue and investment to train your team members to do proper coding Since it not only demands investment but is also a very time-consuming task.

So, it’s better to hand over these processes to a team of experts who can handle the coding operation appropriately and help you to save your time and money.

Med-Miles has a team that is expert in providing coding services, we have an excellent record of submitting successful claims. We help many of our clients to eliminate the denial rates for a successful cash flow. Need more information? Call us at (888) 598-9181.

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