Medical Coding Simplified

E very 17 minutes another man dies from prostate cancer in the United States. September is National Prostate Cancer Awareness Month and a great time to help raise awareness about this disease. Prostate cancer is the most common cancer and the second leading cause of cancer death among American men. In 2019, nearly 175,000 men will receive a diagnosis of prostate cancer , with an estimated 32,000 deaths from this disease by year’s end. Early detection is key to living prostate cancer-free; help spread the word and know how to code/bill for prostate cancer screening services. Prostate Cancer Basics Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate, a walnut-shaped gland that sits at the base of the bladder. Currently, there are nearly 3.1 million American men living with the disease and one in nine American men will have prostate cancer during his lifetime. Despite the startling number of men stricken with this diseas...

Here is what we know about surprise billing. One in 10 insured adults have said they’ve received a surprise bill in the past year. The average surprise bill is more than $600, which is more than 40 percent of families would be able to pay without borrowing or selling something. Many surprise bills are thousands of dollars, with some greater than 600 percent more than Medicare would have paid for the same service. Groups of physicians—particularly emergency physicians and anesthesiologists—stay out of insurance networks, levy outrageously high bills on unsuspecting patients, and maximize their revenue. This is their business model. These groups of physicians have organized to gain market power, often with the backing of a private equity firm. They take advantage of the fact that, in most cases, patients do not get to choose them: Ancillary providers such as emergency doctors or anesthesiologists, which patients typically do not choose, are more likely to send a surprise bill. ...

Velan Medical Coding Training course is proud to announce that one of our students Samata Haldule has successfully cleared the CPC Exam on the first try! Her score is equally stunning at 89% Her dedication and hard work led to this achievement. She had devoted a lot of time for studying our online medical coding training course and it has yielded good result. She was focused and exceptionally confident. That trait played a role as well.  The mindset to pass and go on to become a medical coder is necessary for any aspiring student. Though we all have some doubts and feel lost at times, persevering in the journey shows your true grit and spirit. Set your goal and achieve it. Anyone can do this. All we need is the focus, determination, and interest in enhancing our professional career. She will soon be joining a coding company as a Certified Medical Coder Wishing her all the best for her future and let her successes continue!!

In countries like the US, citizens are investing in health insurance plans, which are directly increasing the demand for medical coders’. Recently got an opportunity to interact with a few life sciences students. That is when I asked a student who seemed keen about getting into the pharma industry: “What if you don’t get your desired job profile”? This question actually was a bolt from the blue as he was baffled and realized he didn’t have a plan B. Every year, a large number of science students pass out with an ambition to become a nurse, a doctor, a pharmacist or a medical professional. While only a few get to achieve their goals, many life sciences graduates are unable to decide on an alternate career option. There is nothing to get worried about as the healthcare sector provides plenty of other options, but not many take these. While there might be various reasons for this, the primary factor is a lack of awareness the many prospects that are present in this field. ...

The letter " x ” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The " x ” also allows for future expansion of the codes. When reporting ICD - 10 - CM codes, coders must add a placeholder so the seventh character is in the correct position. Not every ICD-10-CM code with a seventh character has a sixth character—or even a fifth or fourth character for that matter. This frequently occurs with poisonings and injuries. The letter "x” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The "x” also allows for future expansion of the codes. When reporting ICD-10-CM codes, coders must add a placeholder so the seventh character is in the correct position. Without this placeholder to ensure characters appear in the correct positions, codes are invalid. For example, a patient presents with an accidental poisoning by an antiallergic drug. For the initial ...

It’s every physician’s worst nightmare: Receive payment for services rendered, but then a payer identifies an aberrant pattern in claims data, audits the records, decides it has overpaid the practice, and recoups those funds. That money you already allocated for overhead, staff salaries, bonuses, or new medical equipment? Gone. With one post-payment audit, you now owe thousands of dollars or more. The good news is, physicians can take steps to focus on accurate billing and avoid costly recoupments. This article explores five billing vulnerabilities and provides tips to maintain compliance. E/M coding: Four tips to select the correct level Payers don’t usually deny evaluation and management (E/M) codes on the front end, says Toni Elhoms, CCS, CPC, a provider coding and education consultant in Denver. It isn’t until they look at the totality of the data retrospectively—long after physicians are paid—that financial penalties ensue, she adds. “Payers are like the IRS,” says ...

Small differences in sepsis and SIRS guidelines can result in major differences in reimbursement. Sepsis, systemic inflammatory response syndrome (SIRS), and septicemia have historically been difficult to code. ICD-10-CM has introduced lots of changes to sepsis and SIRS coding. It’s critical to code sepsis properly due to the impact the diagnosis has on reimbursement. For example, consider the following case study: A 39-year-old patient was admitted with the diagnosis of community-acquired pneumonia in the setting of presumptive influenza and concurrent sepsis. In the history and physical exam, it was documented that the patient had sepsis and SIRS, meeting the criteria of leukocytosis, fever, and tachypnea, with pneumonia as the source. The sputum culture was positive for pseudomonas pneumonia. The patient had a six-day stay. The discharge diagnoses were influenza with pneumonia bacterial superinfection, positive for pseudomonas, as well as acidosis, asthma exa...