Oncology Coding - Gear Up for New Transfusion-Reaction Codes

As you all know, ICD-9 2011 will go into effect on October 1, 2010. So if you have patients who get blood transfusions, gear up for some key changes to your diagnosis coding choices later this year. CMS has provided proposed updates for ICD-9 2011, and transfusion-reaction codes are everywhere.

Broaden your iron overload options

Right now, under ICD 2010, if you need to code hemochromatosis, you will need to code 275.0. But when ICD-9 2011 goes into effect, you will have more specific options to code hemochromatosis. This time ICD-9 intends to make 275.0 invalid and replace it with the following: 275.01, 275.02, 275.03, and 275.09.

When the ICD-9 2011 becomes official, you will have to pay close attention to any notes with the codes to ensure you're pairing your case to the right ICD-9 option for your Oncology practice. ICD-9 2011 also intends to expand the current 276.6 to include 276.61 and 276.69. Another proposal would expand 287.4 to include the 287.41 and 287.49. This change would allow precise reporting of posttransfusion purpura (PTP), which normally arises five to 12 days after transfusion of blood components. What's more, the addition of 999.83 has been proposed; this would have placed it under 999.8. However, the proposed rule lists 780.66 placing FNHTR under 780.6.

Apart from all these, a slew of other potential new transfusion-reaction codes add specificity to reporting incompatibility reaction type and timing (acute or delayed).

Acute: Acute hemolytic transfusion reaction (AHTR) is accelerated destruction of red blood cells less than 24 hours after transfusion. The proposed codes which specify acute are 999.62, 999.72, 999.77, and 999.84.

Delayed: On the other hand, delayed hemolytic transfusion reaction (DHTR) refers to "accelerated destruction of red blood cells which normally manifests 24 hours to 28 days after a transfusion." The proposed codes include 999.63, 999.73, 999.78, and 999.85.

So with more than 130 proposed new codes, there are chances you will need to use at least some of them for your patients. As such, you need to stay informed of all the ICD-9 2011 code changes. One way of doing so from the comforts of your office or meeting room is an audio conference. On signing up for such a conference, you also stand to acquire CEUs.

Audioeducator offers audio conferences and provides advanced Learning Opportunities about ICD-9 2011 code changes through audio conferences through all types of audio conferences and exceptional series of training CD's, DVD's & Tapes.

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Diagnosis of Mental Disorders by Clinical Psychologists - Is it Unethical?

According to their ethical code...which usually becomes part of a state's licensing statutes...the unethics of diagnosing mental disorders by clinical psychologists is a problem.

Clinical psychology has its roots in psychometrics...the scientific measurement of mental functions. The earliest and most commonly known example of this is IQ testing.

For a Ph.D. in clinical psychology...students had to know and use the scientific literature...then to design and carry out publishable scientific research.

If they couldn't...it didn't matter how caring they were in the clinic. They didn't get a Ph.D. because the Code of Ethics For Psychologists -- Standard 2.04 says clearly...

Psychologists' work is based upon established scientific...knowledge of the discipline.

And the 'disorders' in the Diagnostic and Statistical Manual (DSM)...the diagnostic bible...are not determined by scientific investigation. Scientific knowledge is missing in the diagnostic practice of clinical psychology.

A clinical psychologist diagnoses a 'disorder' by matching symptoms to descriptions in the DSM. Good science requires a standard of what's normal before you can decide what is abnormal. But normal and disordered are never defined to differentiate them. So the extent of any 'disorder' can't be measured.

Despite its requirement to be scientific in its activities...the profession became 'medicalized' and adopted the procedures and the jargon of psychiatry -- which has never claimed to be a scientific discipline. It uses borrowed terms like...mental health...psychotherapy...psychopathology...psychiatric diagnosis. And it often relies on medication to manage symptoms in patients.

Why would psychologists use unethical methods?

Unfortunately the incentives...or pressures...are great for psychologists to use unvalidated diagnoses. Insurance companies...who pay psychologists...and the courts...that use them as expert witnesses...put great emphasis on diagnosis of mental disorder.

How could this affect me?

It wouldn't be such a serious matter...except a diagnosis of psychiatric disorder can have unexpected negative consequences in people's lives. When they don't know who uses diagnostic data or how...people even can lose their liberty based on unvalidated disorders.

If you see a clinical psychologist and you use insurance to pay for psychotherapy...a diagnosis is usually required...and may legally be shared with the insurer's affiliated companies.

This data sharing may have negative results (e.g., denial of employment)...which the therapist may not have explored with you. If not...then your agreement to put diagnostic data on the insurance form was not informed consent.

However, the Code of Ethics For Psychologists requires informed consent to share information (Standard 3.10) by discussing...

1. the involvement of third parties (e.g., an insurance company or credit card company and their affiliates) and limits of confidentiality. (Standard 10.01).

2. by discussing the foreseeable uses of the information generated through their psychological activities. (Standard 4.02)

How do I know psychiatric diagnosis isn't scientific?

With the DSM-III the American Psychiatric Association tried to validate the psychiatric diagnosis of 'disorders'...using scientific methods to answer the question: Would clinicians...independently evaluating the same symptoms...arrive at the same diagnosis?

The results were discouraging. Clinician agreement was very variable. This makes almost all mental health diagnoses arbitrary. But they are put in medical records as facts.

And this arbitrariness infects the next edition of the manual (DSM-V). The physicians candidly assert they may never establish the scientific validity of these 'disorders'...

Limitations in the current diagnostic paradigm...embodied in the current

DSM-IV...suggest that future research efforts...exclusively focused on

refining the DSM-defined syndromes...may never be successful...in

uncovering their underlying [causes].

So, the 'disorders' are...and will remain scientifically unreliable opinion.

You can read about the future DSM-V at the url listed below.

How are psychiatric disorders discovered if they're not scientific?

They aren't discovered...most are created. Committees of physicians (and a few non-physicians) decide...intuitively...what a mental disorder is.

For example...if a child is no good at arithmetic...she may be diagnosed with 315.1 Mathematics Disorder. Difficulty with arithmetic may be due to lack of interest. But that's not a disorder. Or it may be due to neurological problems. Which makes it a genuine medical issue...not an arbitrary psychiatric disorder.

What should I do?

You can remember that psychologists are required to practice from established scientific knowledge. They must have your informed consent to share information...such as a diagnosis. So...lacking those things...you should have concerns in this age of massive government and corporate data bases.

And you should raise any concerns about the unethics of diagnosing mental disorders with your psychologist or other therapist. But first know what their ethical requirements are. The url for psychologists is below. For other professions just type into a search engine "ethics for..." and add the name of the profession.

If you and your clinical psychologist haven't discussed these things...which might make you decide not to use insurance benefits...your relationship may be on vague ethical grounds...which are inadequate to protect you...the consumer...from unwanted consequences.

Can I still see a psychologist if I don't want a psychiatric diagnosis?

Of course. It's very doable. And I'll cover how in another article.

Thomas Drummond, Ph.D. is trained in clinical, developmental and neuropsychology. He has worked with the problems of clergy and religious of the catholic church for more than 20 years. The solution to most of their problems was not diagnosis...but definition of proper boundaries in their relationships with people.

Learn more at http://www.boundaries-for-effective-ministry.org

For issues about medical records go to privacyrights.org

For psychologists' ethics http://www.apa.org

For DSM-V issues [http://dsm5.org/planning.cfm]

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OBGYN Coding - Deliver Postpartum V Codes With Care

Bonus: Get exposure to ICD-10 coding equivalents

Question: A mentally-retarded patient who delivered at home was admitted to the hospital for postpartum care. She delivered the placenta at home, and once she was admitted, there were no complications. However the ob-gyn did perform a first degree laceration repair. I am not sure what diagnosis code to go for. Should I take a look at routine postpartum care or pregnancy complications? And in case I use a complication code, what would the fifth digit to a "1" or "0?"

Answer: Under most situations where the ob-gyn treated no problems during the admission, you would have to go for code V24.0 (Postpartum care and examination; immediately after delivery) on the admission date and V24.2 (Routine postpartum follow-up) for any subsequent routine care.

However in this case, your physician also repaired a first degree laceration (CPT code for 59300, Episiotomy or vaginal repair, by other than attending physician). As such, you may consider this to be an admission for a postpartum condition and instead go for 664.04 (First degree perineal laceration). The fifth digit can't be "1" or "0" as the patient delivered before her admission and of course you know her delivery status. The fifth digit must be "4" in this case to indicate a purely postpartum condition. Optionally you may report V24.0 and V24.2 as your secondary diagnoses, however they're not required in this case.

ICD-10: In the immediate future, you will replace ICD-9 codes V24.0 and V24.2 with ICD-10 codes Z39.0 (Encounter for care and examination of mother immediately after delivery) and Z39.2 (Encounter for routine postpartum follow-up), respectively. Code O70.0 (First degree perineal laceration during delivery) will replace 664.04.

Suzanne Leder, M.Phil., CPC, COBGC is a ob-gyn coding [http://www.codingconferences.com/ob_gyn_1209cds.htm]. Alert editor for five years and counting. Also, she holds a specialty OB/GYN coding certification. Currently, she is an Executive Editor at the Coding Institute and has covered topics in cardiology, physical medicine and rehab, gastroenterology, neurology, neurosurgery, orthopedics, and otolaryngology.

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Medical Coding Resource - Ask How Far the Scope Went

While reviewing the physician's notes, how should you count exam elements when they are obtained through a scope such as 31231 or 31575? Do those elements support the E/M and the scope or just one or the other? You always thought the elements collected via the scope support the procedure only.

If you're reporting an evaluation & management service 99201-99215, Office or other outpatient visit...) with modifier 25 (Significant, separately identifiable Evaluation & Management service by the same physician on the same day of the procedure or other service) and reporting the scope separately, don't include the endoscopy finding in the exam section of the E/M service. The evaluation & management service must be separately identifiable from the scope procedure.

When the ENT uses the same flexible scope to view the nasal passages, nasopharynx and/or the larynx, making the right code choice is tough. The standard answer is that you code the scope that goes the farthest (since you have to pass the other organs on the way) and what scope is dictated based on the diagnosis medical necessity.

For instance, if the ENT examines the larynx with a flexible scope, the proper code is 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) even if the examiner inspected the nasal cavity and nasopharynx on the way down. If the examiner finds a problem further down than he had initially planned to examine, rethink the code choice. For example, if the ENT intends to carry out a nasal endoscopy (31231, Nasal endoscopy,diagnostic, unilateral or bilateral [separate procedure]) and then sees a nasopharyngeal mass that prompts him to pass the scope to the nasopharynx, 92511(Nasopharyngoscopy with endoscope [separate procedure]) is the right code.

To end with, look at the patient's chief complaint and why the ENT chose to do an endoscopy. The diagnosis must assist the procedure. For instance, if the patient has chronic sinusitis, 31231 would be right; if the patient has suspected postnasal drip, 31575 would be proper.

Remember: ENTs often get caught up trying to code 31575 when they are checking the terminal end of the tubes in the nasopharynx. If the diagnosis is eustachian tube dysfunction (381.81), there's no necessity to examine all the way to the larynx. Stopping at the nasopharynx, (92511) is what supports this diagnosis, and sometimes that is even met with a denial and requires appeal.

For more specialty-specific articles to assist your coding, sign up for a medical coding resource like the Coding Institute.

The Coding Institute is dedicated to offering quality products and services to help healthcare organizations succeed. We are primarily focused on providing specialty-specific content, codesets, continuing education opportunities, consulting services, and a supportive community of healthcare professionals and experts.

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The Importance of Medical Billing Codes

The process of medical billing is an interaction between a health care professional and the insurance company. By submitting and following up on insurance claims, healthcare providers receive payment for services they render. Medical billing codes play an important role in this process because they determine the amount of reimbursement the healthcare provider receives. Various codes exist for diagnosis, treatment, drugs, dental services, Medicare, and hospital treatment.

When a patient visits the doctor, a medical record is created. The doctor issues a diagnosis or cites a reason for the visit. A level of service is established, based on patient history, comprehensiveness of a physical examination, and complexity of medical decision making. This service level is subsequently converted to standardized procedure code taken from the Current Procedural Terminology (CPT) database. The diagnosis is also translated to a numerical code, taken from an ICD-9-CM database.

To arrive at these codes, medical coders translate the doctor notes from the patient visit into the proper numerical sequences. Treatment and diagnosis codes are listed on the claim form transmitted to the insurance company. Electronic transmission is the most common method, replacing paper forms used in the past. Medical claim adjusters or examiners with the insurance company process the claims. An approved claim is reimbursed at a certain percentage of billed services pre-negotiated by the insurance company and healthcare provider.

If a medical coder does not understand how to determine and assign the correct codes, the claim will be rejected by the insurance company. A rejected claim is returned to the healthcare provider, usually in the form of an electronic remittance advice or explanation of benefits, also called an EOB. The provider must then decipher the information, reconcile the details with the claim originally submitted, make any necessary corrections to the claim, and submit the revised claim to the insurance company.

Though these extra steps may not seem time or labor intensive for one claim, consider the hundreds of claims submitted by a single healthcare provider each week. In some cases, claims may be rejected and resubmitted multiple times before they are paid in full. It is not uncommon for a provider to eventually give up and accept incomplete reimbursement. To avoid loss of income for the provider, medical coders should assign the correct codes the first time the claim is submitted.

Nearly 50 percent of the time, a claim is either denied, rejected, or overpaid. This is due to the highly complex nature of some claims and errors resulting from similarities that exist with diagnoses. In some cases, the insurance company is to blame for attempting to get away without covering certain services. After the medical coder makes a small adjustment and resubmits the claim with relevant documentation, the denial may be overturned.

On October 01, 2013, the ICD-10-CM database will replace the ICD-9-CM version. Medical coders must become familiar with the medical billing codes contained in this database, so they can hit the ground running when submitting insurance claims in the future. Properly coding each claim ensures that the healthcare provider is accurately reimbursed.

It is imperative that medical billing codes are entered properly when submitting forms to insurance companies for reimbursement for services rendered. If you are experiencing denials or other challenges due to improper medical billing codes being submitted on forms, visit All-Things-Medical-Billing.com today for more assistance and information.

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Settle On Which Primary Code This Case Suggests: +33225

Start by analyzing the report excerpt

An incision was made along the left deltopectoral groove, and an ICD pocket was dissected out, was geared up with extensive dissection.

Three different guidewires were advanced into the left subclavian vein using the Seldinger technique across the open pocket. The middle of these wires were then used to further a coronary sinus sheath for placement of the left ventricular lead. With some complexity, we were in the end able to advance the coronary sinus sheath in the mid coronary sinus and an angiogram was obtained. After this a left ventricular lead was advanced in the lateral cardiac vein and the tip was advanced to the near LV apex. Electrical testing was done at three separate locations and the rest of these noted a lead impedance of 840 ohms and an R wave value of 17.1 mV.

After this, the bipolar right ventricular defibrillator active fixation lead was advanced to the right ventricle, various areas were checked and the lead was lastly fixated along the RV. Next the bipolar right ventricular defibrillator active fixation lead was advanced to the right atrium. Various areas checked and the lead was in the end fixated along the RV septum and tested.

Post this, a bipolar screw in type right atrial lead was advanced to the right atrium and the lead was fixated to the right atrial wall. Then the coronary sinus sheath was removed with the cutting device maintaining a good lead position of the LV lead.

All three leads were then sutured to the pectoral fascia over the Silastic sleeves; the pocket was then irrigated. Pretty soon the leads were attached to the ICD/BiV device. Then the ICD was placed in the pacer pocket after a standard dose of thrombin material in the pocket. Pocket was then sutured closed.

The patient was given propofol and the following establishment of adequate general anesthesia. Ventricular fibrillation was induced; the advice analyzed and delivered three different DC counter shocks, at last at 36V and the patient converted back to normal sinus rhythm. Patient was awakened from sedation minus obvious side effects.

Find your first stop at an add-on code

The case study appears to be a new implant of a Biventricular Defibrillator with follow-up testing at implant. While making your way through the first two paragraphs, you should train eyes on the terms describing placement of the left ventricular lead through the coronary sinus. The proper code for this portion is +33225.

Documentation tip: You may see this lead referred to as either a left ventricular (LV) lead or coronary sinus lead.

Add the primary code for that add-on code

The next few paragraphs of the documentation describe lead fixation for the right ventricle (RV) and the right atrium (RA). Also the cardiologist attaches the leads to the device, places the device in the pacer pocket, and sutures the pocket closed. All of this is covered by one code: 33249. Add-on note: CPT code lists33249 as a proper primary code for add-on code +33225. Remember that 'add-on' codes are always carried out in addition to the primary service or procedure and must never be reported as a stand-alone code.

Defib testing earns the final code

The last paragraph of the case study excerpt describes 93641. With defib testing, you want to see impedance in the documentation. Generally physicians will state something like 'Ventricular fibrillation was induced. The device analyzed and delivered 3 separate DC countershocks, at last at 36V and the patient converted back to normal sinus rhythm. The high-voltage impedance was 45 ohms.

Term tip: The defibrillation threshold (DFT) is the minimum energy amount required during ventricular arrhythmia to defibrillate the heart reliably. Knowing the patient's DFT aids the cardiologist confirm that the cardioverter-defibrillator (ICD) programming will provide enough of a surprise to defibrillate the patient's heart.

Ensure your practice hits these points

In a situation like this, the doctor would typically use fluoroscopy, as well; however, it is not documented in this case. No documentation of fluoroscopy means you should not bill fluoroscopy. When fluoroscopy is documented, you should go for 71090-26.

ICD-9: What's more, the case study does not mention indications for you to select ICD-9 diagnosis codes. Minus a VT [ventricular tachycardia] diagnosis or information relating to primary prevention criteria, this cannot be coded. Either you have to have a payable diagnosis for the ICD or data to support adding a Q0 modifier to 33249.

What's more, check your local requirements for diagnosis codes that support medical necessity for 33225.

We provide you simple, instant connection to official code descriptors & guidelines and other tools for ICD-9 coding, HCPCS codes that help coders and billers to excel in the work they do every day.

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The History Of Medical Coding And The Primary Types Used Today

In the early 1900s, it was realized that in order to cope with maintaining medical records of patients and payments by insurance companies for medical expenses, a unified coding system was required to be developed. Medical insurance companies were finding it increasingly difficult to justify making different payments to two or more patients who had contacted the same illness and been through the same procedure.

The health industry realized that there was an urgent need to develop a standardized method of tracking patients' diagnosis, procedure or treatment. This would also provide uniform standards for billing insurance companies for health services. Asides from this medical coding could be used for a variety of applications in health care, medicine and medical information. These include:

- Statistical analysis of diseases

- Help in decision support systems

- Ability to access and monitor epidemic outbreaks.

There are two main classifications of medical coding, which are statistical and nomenclature. In statistical coding, similar clinical concepts are grouped together into categories. The reason for doing this is so as not to make them too voluminous. Statistical coding also has an 'others' or 'unspecified' category for conditions that cannot be classified in the specified categories. In nomenclature coding, which is the one most commonly used in medical coding, there is a separate code for every clinical concept. These medical codes are grouped into:

- Diagnostic codes

- Procedural codes

- Pharmaceutical codes

- Topographical codes

Diagnostic codes: In health care diagnostic codes are used to identify and group diseases, disorders, symptoms, human response patterns, and medical signs. There is no single purpose code and each code is assigned for a distinct purpose. The codes are revised when new knowledge is attained.

Procedural codes: these are numeric or alphanumeric codes that are used to identify specific medical procedures taken by medical professionals.

Pharmaceutical codes: These codes are assigned to uniquely identify medications. There are several coding systems used worldwide.

Topographical codes: In medicine, topographical codes are used to identify a specific location in the human body.

In the United States the American Medical Association have developed their own medical coding systems and patients can use these codes to determine their diagnosis and treatment and also to check their billing from the health service provider or payments received from the insurers. The World Health Organization maintains several sets of international classifications that help in facilitating comparing of health related data. Some countries have adapted and are using these systems for their own health care systems.

If you're looking for information about Medical Coding Certification & Training, we have more great tools and resources on our website http://www.medicalcodingtrainingcertification.com

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Business Startup Ideas - Start a Medical Coding/Transcription Business

You're no doubt reading this because you want to work from home and are looking for a few business startup ideas. You may want to escape prairie-dog-town, home-school your children, or finally do something on your own. Whatever your reason, you can start and grow your medical coder or transcription business by leveraging your past work experience and high level of motivation, and professionalism. There are lots of folks who can empower and enable you.

Medical Coding: When you go to the Doctor for medical help, your diagnosis along with the clinical procedure used to treat your illness or condition is given a code. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) set the standards for the classification systems that healthcare providers must use. Under HIPAA certain codes must be used to identify specific diagnosis and clinical procedures on claims, encounter forms and other electronic transactions. That's where the Medical Coder comes in. These professionals are responsible for translating healthcare providers' diagnostic and procedural phrases into coded form. They do this by reviewing and analyzing health records to identify relevant diagnoses and procedures so the appropriate code can be applied.

Codes are published by the U.S. government as a multi-volume set. These codes are being continually updated as new diseases are discovered and identified and new technologies emerge. Coding is performed through a review of the health record on each patient. The coder transforms the documented medical descriptions of patient diagnosis and procedures into numerical codes. Accurate and timely coding does a number of things:

1) provides information useful in the management of diseases and improving the quality of health care,

2) provides data to assure that the appropriate services are being performed,

3) assures the health care facility is promptly and appropriately reimbursed and

4) provides information about the diagnosis and procedure to the people paying for the services.

Although certification in Medical coding is voluntary in the USA, most medical professionals do every bit they can to minimize risk. Coding is a key element in the billing function and compliance with regulatory and other requirements. Therefore, some customers may specifically ask for documented proof of your experience, qualifications, skills, and certification. Remember, the coding must be done right the first time. The doctor has to pay for each code on the bill. Insurance companies will usually pay claims in a timely fashion when the correct codes are used. The doctor has to pay again for each wrong code. Therefore accuracy is vital.

You can augment what you lack in coding experience by showcasing your work experience, high level of professionalism and motivation, your passion for excellence and your dedication to continual learning. Remember you are contracting for services as an independent business owner. You may be able to negotiate with a provider to perform work in their office, gain their trust and later move the work to your home.

If you're not familiar with Coding and are uncomfortable pursuing this line of work just yet, you may want to take a look at Medical Transcription as a way to gain some background and experience

Medical Transcription: The core of performing the job of Medical Transcription is listening and writing. You will also see this important work referred to as healthcare documentation specialist. You are in effect a medical language specialist who interprets and transcribes dictation by medical professionals. You are a trusted professional who accurately and confidentially captures patient care information by converting voice-recorded reports into text format. You are entrusted with private and personal information to ensure that the information captured is an accurate record of what is dictated. Performing this work requires the ability to interpret dictation correctly and to protect patient records. You must possess the people skills necessary to work directly with medical doctors, surgeons, and other specialists and health care professionals. You do not have to have a certification for this line of work. However, you will have more credibility and probably make more money if you do.

You will have to learn the voice of the person you are transcribing; that may take some time. You will be expected to understand and accurately transcribe medical terminology, anatomy and physiology, diagnostic procedures, pharmacology and treatment assessments. The dictation can range anywhere from ten seconds to ten minutes. Your job is to get this dictation converted into a text file as soon as possible. You then format the reports; edit them for mistakes in translation, punctuation, or grammar; and check for consistency and any wording that doesn't make sense medically.

So how do you set a reasonable expectation? Let's say your customer (doctor) sees a patient every 15 minutes and he works a ten hour day. Let's also assume that your deadline for submitting transcriptions is 24 hours. That is forty transcriptions due in 24 hours. Procrastination is not a trait that works well in this profession. The point here is to negotiate a turn-around time that makes you successful and pleases your customer. If you are not very fast at transcription, you may want to start out by quoting a rate by the page. This also provides your customer a tangible audit of the amount of work you have completed. Discover what a nominal turnaround time is. If it is 24 hours, then comply with that requirement. You may be able to fit in a few more customers and still make your commitments. Be sure to factor in the interruptions for taking children to school, their doctor, and the occasional emergency. Pace yourself and set reasonable expectations for you and your customer. Remind them that you are only a phone call or email away.

If you have little or no experience as a medical transcriber, you may want to land a part-time gig and build your skills and your credibility. Meanwhile, you can set aside some time to train at home and earn your certification.

If you are an experienced medical transcriber - get your business card and brochure in the hands of healthcare professionals. Ask for a trial run and at least a referral.

Bottom line: You'll never know unless you try.

Jeff is a leading authority on Corporate Transformation and Development. He has written more than 20 publications on Leadership, Cultural Transformation, Change Management, and Corporate Development including: Transitional Development 101, A Discussion of International Relief in the 21st Century; Leadership, the Lost Key to Effective Process Improvement; A PMO by Any Other Name; and Are Faith-Based NGO's Based on More Than Faith?

He is a driving force in the development of small businesses and is passionate to share Business Startup Ideas and to offer leadership and mentoring in pursuit of furthering the small business.

Jeff also supports International Development by supporting Anthropology, Missiology and PermaCulture projects in the Amazon River basin and the Andes Mountains that are designed to facilitate growth while preserving the indigenous culture.

http://www.EagleServices.US

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How to Bill Chiropractic Diagnosis Codes For Medicare

Billing chiropractic services for a Medicare patient can seem complicated due to the number of rules that are specific to the chiropractic profession. In this article, we will focus on how to bill diagnosis codes correctly.

For chiropractic claims, since Medicare only covers spinal manipulation for the correction of a subluxation, we must begin by having a diagnosis of subluxation in the first position (primary) of the diagnosis codes.

On a HCFA claim form, this is Box 21D.

The only "approved" primary diagnosis codes (ICD-9) that Medicare will accept for chiropractic claims are as follows:

-- 739.0 Nonallopathic lesions of the head region not elsewhere classified

-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified

-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified

-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified

-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified

-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified

A word about terminology. Some chiropractors and code books refer to these diagnoses as subluxations, segmental dysfunction or use similar terms. For example, 739.1 may be listed as cervical subluxation in some coding books or reference materials. Regardless of how you "name" the diagnosis, these codes in the list above are the only primary codes that apply to chiropractic services in the Medicare program.

The use of these codes does not guarantee reimbursement, however, because the patient's medical record must document that CMS coverage criteria (medical necessity) has been met.

A big caution here, though. Failing to use these codes in the primary (1st position) diagnosis will virtually guarantee a DENIAL!

So, be sure to use the correct diagnosis codes when billing Medicare for chiropractic claims and you have taken the first step in getting your claim paid!

Tom Necela, DC, CPC is the President of The Strategic Chiropractor, a consulting firm dedicated to helping chiropractors maximize reimbursements and minimize their risk of audits by teaching sound billing, coding, documentation and collections strategies. If you'd like more information about Dr. Necela's consulting programs (which include a Documentation Self-Audit), go to http://www.strategicdc.com

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Medical Coding - The Importance Of This Growing Profession

Medical coding is medical terminology and represents the system of coding in medical field. This is the process of transforming the descriptions, diagnosis and procedures that take place in a doctor's office into universal codes used across the profession. Codes are prepared after taking information from various sources, such as health care centers and scientific laboratories. The purpose of gathering this information is to inculcate the maximum of the coding disease with the diagnosis. The application of medical coding is used for a variety of purposes, including the analysis of the disease and therapeutic conditions, decision systems based on the knowledge of the diagnosis, and application in widespread health programs.

The coding system makes things easier to interpret and enables doctors and other medical professionals to better understand and document patient medical records, knowing the history of the disease on the same level. In other words, it can be said that people throughout the world are at equal level of knowledge when they use the codes for knowing the history of a specific procedure or a disease. Thus, it removes doubts and brings a mutual level of sharing, through which it is easier to understand the severity and the intensity of the patient's symptoms.

Under this classification, all similar diseases are kept under one group. For example, all contagious diseases, such as flu and athlete's foot, are represented by a similar group of codes. While chronic diseases like diabetes, joint arthritis and other disorders are kept in one group. The purpose of this type of classification is not only to help the practitioner but also to assist researchers in making further advancement in the field. Thus, the history is updated and the researchers know what the codes mean. It also helps in the treatment of the patients when moved from one place to another, and a doctor can understand the whole story (or history) from the written code.

Medical coding is not merely a system made by anyone who knows the ABC's of the coding, as it has gone through much more than that. It is estimated that it will cross the top professionals in the next decade, as one of the highest paying jobs and can further be started as a business of its own. As such, the awareness of the importance of the medical coding is increasing by the day and more students are enrolling to get diplomas for becoming professionals, which are fast becoming as respected and demanded as doctors and nurses themselves.

If you're ready to start your Medical Coding Training & Certification, we have more great tools and resources on our website http://www.medicalcodingtrainingcertification.com

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The Medical Coding Jobs

The jobs in the field related to the medical process are fast gaining popularity. This field offers jobs as the medical coding for the individuals who are looking forward to work in the health care sector. One of the best attributes of such jobs is that it offers a number of opportunities in which the individuals can work from home. As a medical coding professional the individuals are expected to be articulate so that the coding, billing and the issues related to the claims can be solved smoothly.

The professional who are involved to work in the medical coding process need to keep a strict check on the information pertaining to the claims, treatments, coding and communication with both the patient and the other parties involved. Another thing to be kept in mind is that the communication should be in accordance with the HIPAA privacy and security standards. The professionals will have to deal with the matters of coding as well as billing in some of the cases. For those who are opting for such type of a job from home, it offers one of the greatest benefits of working making use of the flexible schedules. But, one has to be attentive to the issues of management that deal with promptness, accuracy, coding, data entry and even claims.

The hospitals or the other medical institutions forward the information pertaining to the various aspects of the patient to the medical billing office on regular basis, which also has the complete list of the procedures a patient already has or will go through. The job of the medical coder is to seek the correct diagnosis code along with the correct codes of the procedures and treatments mentioned and list them down on the bills or other official documents, making use of the medical software available for this purpose.

Once this information is fed into the software, an electronic bill is generated which is forwarded to the various clearing house who double check it to curb the chances of errors. The acceptation of these bills is dependent on the accuracy of the codes allotted. The medical coding jobs can be outsourced to be undertaken by companies on contractual or permanent basis as well. Most of the times, the chief customers of such companies are hospitals, clinics, consultation firms etc.

The individuals who excel at such jobs can take this opportunity seriously to turn it into flourishing businesses, which requires very little investment. However, it is always better to get experience in the industry prior to making such decisions. Moreover, one has to ensure uninterrupted communication connections for their office, which means opting for facilities like; internet connectivity, telephone, fax machines etc.

Here you will learn about what is a medical coding and medical coding jobs.

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Medical Coding Billing As Part and Parcel of Healthcare

Upon diagnosis and treatment of a patient, the doctor is responsible to document the details as part of paperwork. All this information is later utilized in the processes for medical coding, billing and ultimately translated into payment. Although this is a process normally conducted away from the public eye, back office employees who perform the task of medical coding are specialists in selecting medical codes to match the doctors' diagnoses of patients' ailments. These codes are important details of reference when it comes to requesting payment from insurance companies and private payers. If a patient has an existing health insurance policy, these coding experts also check to verify whether claims can be made against the policy.

In order to comprehend what medical coding and billing is about, individuals interested in this field need to receive proper training. They can opt to enroll in courses from local educational establishments or distance learning providers. Since certification is required for active practice, it is best to check that the course selected is certified by the medical authorities. A certified coding expert is responsible to check and organize a patient's records, bills and statements before proceeding for medical coding. Billing is then generated based on correct codes entered into the system. Utilizing computer systems to carry out this task has taken a considerable load off as the coding and billing process is more efficient and effective. Reports on statistics, billing, mortality, morbidity and others are easily produced for submission to relevant authorities as well as for internal scrutiny where required.

In line with constant change in the medical industry, those involved in medical coding and billing are expected to keep themselves updated through continuing medical education. Changes are constantly imposed on billing procedures, insurance schemes offered on a public and private scale, workers' compensation, disease and diagnosis coding systems, procedure and treatment codes, physicians' fee scale and many more.

Since these experts are a required workforce by healthcare institutions and practitioners, they can either work within large institutions or offer themselves as outsourced service providers to smaller establishments or clinics.

Dennis enjoys writing on wide range of topics such as Medical billing and Medical coding billing. You may visit for more details.

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ICD10 Codes - The Shocking Truth

October 2013 seems a long way away with little need to prepare now for the changes from ICD9 to ICD10 codes but I recently learned the shocking truth. The Healthcare Billing and Management Association held a conference in Boca Raton this month with a session attended by approximately 200 medical billers on the new ICD10 codes. Even though I have looked into the changes and even written on them, I was shocked to hear all that is really involved. We all need to start paying attention now.

My original questions revolved around whether all doctors will be expected to start using ICD10 codes on a specific day and will all the insurance companies be ready to accept them on that same day or will it be more of a transitional thing like the NPI numbers were.

My first surprise was that ICD10 codes are already in effect in all the rest of the world. Other countries have been using them for years. We are way behind the times with regard to the rest of the world.

My second surprise was that ICD9 codes are not just being expanded. ICD10 codes are totally different than ICD9 codes. We won't just add another number and there aren't just a few small changes. ICD10 codes will identify much more information about the visit than ICD9s do. ICD10 codes will contain an expansion of disease classification with greater specificity. They will be much more detailed and will help identify fraudulent billing practices. There will be no 1 to 1 crosswalk. This means that a 309.28 will not equal a A40258Z. You won't take an ICD9 and turn it into an ICD10. They are completely different.

My next thought was how are my doctors going to learn all these codes? We bill many small specialty practices. Many of our chiropractors still do not understand the requirements by Medicare for the ICD9 codes. How are they ever going to get the ICD10 ones right? How are our psychiatrists, psychologists and social workers going to learn ICD10 coding? Most of these are single practitioners who work alone and do not hire a coder.

ICD10 coding will require more clinical information such as "did the patient use tobacco", "did the patient use alcohol", "which finger was cut", "which part of the finger", "was the nail damaged". The new codes will contain alpha characters as well as numeric. The number 1 can mean 15 different things. It is estimated that it will require 24 - 40 hours of classroom education to understand the concepts of ICD10 coding.

Another consideration with the codes now using alpha characters as well as numeric is whether your software will allow you to use alpha characters. If you are using a web based software this won't be a problem, but if you have a server based software, you will want to check with your vendor and make sure you will be able to submit alpha characters in diagnosis codes.

The speaker felt that unspecified codes may be a problem as insurance carriers have yet to tell us if they will pay on unspecified codes with the new changes. Pre-authorization policies will have to be rewritten. Workers comp is not subject to ICD10 changes so some companies say they will not process the ICD10 codes. For a period of time both ICD9 and ICD10 codes will be in effect. Does this sound confusing enough to the average biller yet?

Then came the bombshell. Insurance carriers are not ready for ICD10 codes and most of them won't be ready. Many have announced that they will try to translate the ICD10 code back into an ICD9 code to pay the claim. This means doctors will be translating the ICD9 codes they are familiar with into a new unfamiliar ICD10 code and the insurance carriers will be translating this ICD10 code back into hopefully the same ICD9 code to pay the claim. I can only imagine the problems this will present.

As one of the speakers said "Hold onto your butts! It's going to be a rough ride!"

Alice Scott and her partner/daughter Michele Redmond offer a free forum where you can keep up with current changes which affect medical billing. You can ask questions relating to medical billing or read about what is happening to others in the field. They also offer a free newsletter and informative website with many articles on medical billing. Alice and Michele have authored 9 books on medical billing which are offered for sale on Amazon.com and as immediate digital downloads from their websites.

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Medical Billing and Coding Books Are Different

Documenting the various facts and figures is very much essential and unavoidable when you do a medical insurance claim. All data should be entered in a clear and precise manner. For this, the coder should be aware of the very many billing codes that are generally used during the procedural and diagnosis level.  You can see the procedural codes in the CPT code book and the diagnosis codes in the ICD9 code books. Both are updated and published in a yearly basis. The CPT codes are published by the AMA (American Medical Association) from 1963 onwards and it was started because of the necessity of a standard to coding and terminology that was urgently needed.

Now from the passing of time 'medical coding' has become a complete arena by itself and these days you will be able to find many courses for teaching all about them. Almost all the insurance companies go by the individual codes and the coding industry has become of great importance. So we can see the true value of medical boding books and the significance of these books in the present world of medical insurance billing. Every year new version is given to these books and you must understand that insurance companies won't accept out-dated codes. If you by any chance happen to quote the out-dated codes there is every possibility of your claim getting denied!

Generally four categories of coding books are available like the CPT (Current Procedural Terminology), ICD9 (International classification of Diseases, HCPCS (Healthcare Common Procedure Coding System) and RBRVS (Recourse Based Relative Value Scale). You should be familiar with at least these four books in order to be a good and successful coder.

CPT code books contain the descriptions of the various services and procedures of physicians detailed using different CPT codes listed both in numerical and alphabetical way. Under each and every code, clear-cut explanations are given so that there are no ambiguities between the different services and procedures of physicians. Every year these codes are updated and coder should be aware of this fact. The CPT code books also contain a record of 'modifiers' which specify whether a service is modified or not. These AMA notified CPT modifiers are the 'two digit' numeric codes which are listed after the procedural codes.

As far as the ICD9 code books are concerned, they give the details of the coding system relating to the grouping and classifying of various diseases and covering the actual facts regarding them. Mainly these codes are employed in registering the incidence of medical diagnoses. Here also the listing is done both alphabetically and numerically and is updated annually.

HCPCS code books will give you the codes which are to be used with respect to the products, supplies and services which are not covered in the CPT code book. Some of the areas covered in this book are the ambulance services, durable medical equipments, and prosthetics/orthotics products. This code book also gives the coder an idea about the coding of the various materials which are used outside of the treatment place. This code book will be of much help to the insurance providers, the billing service centers who are doing the billing work for the providers, and agencies which offer services or supplies to the patient.

It is the RBRVS code book that determines the true value regarding the money paid to the medical facility providers including a physician is determined. Learning the latest version of RBRVS code book and acting accordingly is really a vital part in coding jobs. You must be always familiar with the renewed version of the RBRVS code book.

Dr. Adam L. Alpers invites you to access and gain knowledge in medical billing and coding by visiting http://www.medbillingncoding.com
This program was developed for providers to gain quick and easy understanding of some of the most needed information in billing and coding. You do the work, now get paid for what you do. To Learn and Earn more, check it out today: http://www.medbillingncoding.com

Copyright - Adam L. Alpers. All Rights Reserved Worldwide

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Medical Coding and Billing Specialist

Medical coding and billing is a field in healthcare industry, where an individual need not spend years learning in school and yet master his skills in it. You will find them in various healthcare settings such as: doctors' dispensaries, private or public hospitals, dental practices, pharmacies, laboratories, etc. Playing a significant part in the healthcare industry you will also find Medical coding and billing specialists running their own business. Medical coders ensure exact analysis of patient diagnosis as well as about its procedures whereas medical billers ensure that insurance agencies, providers of workers' compensation, Medicare and Medicaid timely receive patient reimbursement forms. You will find many of them skilled in both areas as medical coding and billing.

Medical coding

Also referred as medical analysis is a process where for medical procedures and diagnosis specify its universal codes in alphanumeric or numeric form. Medical coders refer to patient's medical record available in department, lab technology reports as well as doctor's report for determination of procedures and diagnosis to be coded. Coders track down details of injuries or diseases and procedures adopted for the treatment given to patients. Medical codes are used on reimbursement claim forms to be submitted to insurance agencies, on diagnostic request forms and Medicare and Medicaid for payment of claims. It is also used for internal facilities for healthcare service provider for the purpose of research as well as marketing.

Medical billing

Medical billing is a process handled by medical billing specialist who represents claims to health insurance agencies to confirm reimbursement to a patient for the services provided by a healthcare service provider. They also follow up and deal with problematic issues of patients on unpaid claims with insurance agencies, Medicare and Medicaid. Medical billing process remains same regardless of whether the insurance agency is privately owned or is owned by the government.

Qualifications of medical billing and coding specialist

In the healthcare industry the profession of medical coding and billing specialists is heavily in demand. Medical billing specialists with a Bachelor's degree in health information management or equivalent are placed higher at management positions, though they may not possess substantial practical knowledge or experience. You will also find the medical coding and billing specialists who possess a relevant diploma course or a certificate.

HIPAA

It is essential for a medical billing specialist to have detail knowledge and understanding of HIPPA an abbreviation of Health Insurance Portability and Accountability Act for which they also receive training. The act protects patient health information privacy whether it is in spoken, written or in electronic form and can adversely affect many levels working in the healthcare industry.

You may learn more about medical coding systems from the most reliable sources available in the healthcare industry.
For more information visit us at: http://www.offshoremedicalbilling.com OR just e-mail us your requirements on info@offshoremedicalbilling.com to get an instant quote.

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How to Bill Chiropractic Diagnosis Codes For Medicare

Billing chiropractic services for a Medicare patient can seem complicated due to the number of rules that are specific to the chiropractic profession. In this article, we will focus on how to bill diagnosis codes correctly.

For chiropractic claims, since Medicare only covers spinal manipulation for the correction of a subluxation, we must begin by having a diagnosis of subluxation in the first position (primary) of the diagnosis codes.

On a HCFA claim form, this is Box 21D.

The only "approved" primary diagnosis codes (ICD-9) that Medicare will accept for chiropractic claims are as follows:

-- 739.0 Nonallopathic lesions of the head region not elsewhere classified

-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified

-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified

-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified

-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified

-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified

A word about terminology. Some chiropractors and code books refer to these diagnoses as subluxations, segmental dysfunction or use similar terms. For example, 739.1 may be listed as cervical subluxation in some coding books or reference materials. Regardless of how you "name" the diagnosis, these codes in the list above are the only primary codes that apply to chiropractic services in the Medicare program.

The use of these codes does not guarantee reimbursement, however, because the patient's medical record must document that CMS coverage criteria (medical necessity) has been met.

A big caution here, though. Failing to use these codes in the primary (1st position) diagnosis will virtually guarantee a DENIAL!

So, be sure to use the correct diagnosis codes when billing Medicare for chiropractic claims and you have taken the first step in getting your claim paid!

Tom Necela, DC, CPC is the President of The Strategic Chiropractor, a consulting firm dedicated to helping chiropractors maximize reimbursements and minimize their risk of audits by teaching sound billing, coding, documentation and collections strategies. If you'd like more information about Dr. Necela's consulting programs (which include a Documentation Self-Audit), go to http://www.strategicdc.com

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Medical Coding Resource - Ask How Far the Scope Went

While reviewing the physician's notes, how should you count exam elements when they are obtained through a scope such as 31231 or 31575? Do those elements support the E/M and the scope or just one or the other? You always thought the elements collected via the scope support the procedure only.

If you're reporting an evaluation & management service 99201-99215, Office or other outpatient visit...) with modifier 25 (Significant, separately identifiable Evaluation & Management service by the same physician on the same day of the procedure or other service) and reporting the scope separately, don't include the endoscopy finding in the exam section of the E/M service. The evaluation & management service must be separately identifiable from the scope procedure.

When the ENT uses the same flexible scope to view the nasal passages, nasopharynx and/or the larynx, making the right code choice is tough. The standard answer is that you code the scope that goes the farthest (since you have to pass the other organs on the way) and what scope is dictated based on the diagnosis medical necessity.

For instance, if the ENT examines the larynx with a flexible scope, the proper code is 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) even if the examiner inspected the nasal cavity and nasopharynx on the way down. If the examiner finds a problem further down than he had initially planned to examine, rethink the code choice. For example, if the ENT intends to carry out a nasal endoscopy (31231, Nasal endoscopy,diagnostic, unilateral or bilateral [separate procedure]) and then sees a nasopharyngeal mass that prompts him to pass the scope to the nasopharynx, 92511(Nasopharyngoscopy with endoscope [separate procedure]) is the right code.

To end with, look at the patient's chief complaint and why the ENT chose to do an endoscopy. The diagnosis must assist the procedure. For instance, if the patient has chronic sinusitis, 31231 would be right; if the patient has suspected postnasal drip, 31575 would be proper.

Remember: ENTs often get caught up trying to code 31575 when they are checking the terminal end of the tubes in the nasopharynx. If the diagnosis is eustachian tube dysfunction (381.81), there's no necessity to examine all the way to the larynx. Stopping at the nasopharynx, (92511) is what supports this diagnosis, and sometimes that is even met with a denial and requires appeal.

For more specialty-specific articles to assist your coding, sign up for a medical coding resource like the Coding Institute.

The Coding Institute is dedicated to offering quality products and services to help healthcare organizations succeed. We are primarily focused on providing specialty-specific content, codesets, continuing education opportunities, consulting services, and a supportive community of healthcare professionals and experts.

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Defining Medical Coding And Related Terms

The term 'coding' represents the specific systems used for allotting codes to objects or things of the same kind. These codes may not be understandable for the public, but the person dealing with the specific system is well aware of these codes and identifies the objects through them. Codes may be alphanumeric, numeric or both. When maintaining a record, codes are used in place of name or detail of the objects. The term 'medical coding' stands for the transformation of description of diseases, injuries, as well as healthcare procedures in numeric or alphanumeric designations.

In other words, in the medical field, codes are the indicators of the complete record of the diagnosis, procedures, and tests to be performed. Coding in all health related clinics permit to have an access to the complete history of the patient suffering from a specific disease, illness or injury under a given code. This code is very helpful when it comes to billing and all pharmacies throughout the world that are run on the basis of these codes. Suppose, for example, that you are at a clinic; if you want to know about the history, symptoms, diagnosis and treatment of any disease, you can simply enter the corresponding medical code in the search box and all the results will be complied and displayed for you.

A person who has an education in medical coding and works in the field is known as 'medical coder'. In the current decade, medical coders are high in demand. As doctors and nurses are always needed, the demand for medical coders grows as well. The reason for this is that these professionals help doctors and nurses and other medical staff to make money and stay in business, and are very helpful in training new staff in the office or facility. In order to become a successful coder, you must have sufficient practice and should not have repetition in making errors, as wrong codes could affect the reputation and the economy of the business. For instance, different coded medicines have different prices. When a wrong code is entered in the billing data, the price of that code is included instead of the real medicine taken by the customer.

Medical coders are even beginning to start their own businesses and can earn a lot of money while sitting at home, as many healthcare facilities are outsources these needs, rather than hiring a full-time person or staff. Because of this, the spectrum of job opportunities in the field continue to become more diverse, thus appealing to an even broader market of career hopefuls.

If you're looking for information about Medical Coding Certification & Training, we have more great tools and resources on our website http://www.medicalcodingtrainingcertification.com

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Business Startup Ideas - Start a Medical Coding/Transcription Business

You're no doubt reading this because you want to work from home and are looking for a few business startup ideas. You may want to escape prairie-dog-town, home-school your children, or finally do something on your own. Whatever your reason, you can start and grow your medical coder or transcription business by leveraging your past work experience and high level of motivation, and professionalism. There are lots of folks who can empower and enable you.

Medical Coding: When you go to the Doctor for medical help, your diagnosis along with the clinical procedure used to treat your illness or condition is given a code. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) set the standards for the classification systems that healthcare providers must use. Under HIPAA certain codes must be used to identify specific diagnosis and clinical procedures on claims, encounter forms and other electronic transactions. That's where the Medical Coder comes in. These professionals are responsible for translating healthcare providers' diagnostic and procedural phrases into coded form. They do this by reviewing and analyzing health records to identify relevant diagnoses and procedures so the appropriate code can be applied.

Codes are published by the U.S. government as a multi-volume set. These codes are being continually updated as new diseases are discovered and identified and new technologies emerge. Coding is performed through a review of the health record on each patient. The coder transforms the documented medical descriptions of patient diagnosis and procedures into numerical codes. Accurate and timely coding does a number of things:

1) provides information useful in the management of diseases and improving the quality of health care,

2) provides data to assure that the appropriate services are being performed,

3) assures the health care facility is promptly and appropriately reimbursed and

4) provides information about the diagnosis and procedure to the people paying for the services.

Although certification in Medical coding is voluntary in the USA, most medical professionals do every bit they can to minimize risk. Coding is a key element in the billing function and compliance with regulatory and other requirements. Therefore, some customers may specifically ask for documented proof of your experience, qualifications, skills, and certification. Remember, the coding must be done right the first time. The doctor has to pay for each code on the bill. Insurance companies will usually pay claims in a timely fashion when the correct codes are used. The doctor has to pay again for each wrong code. Therefore accuracy is vital.

You can augment what you lack in coding experience by showcasing your work experience, high level of professionalism and motivation, your passion for excellence and your dedication to continual learning. Remember you are contracting for services as an independent business owner. You may be able to negotiate with a provider to perform work in their office, gain their trust and later move the work to your home.

If you're not familiar with Coding and are uncomfortable pursuing this line of work just yet, you may want to take a look at Medical Transcription as a way to gain some background and experience

Medical Transcription: The core of performing the job of Medical Transcription is listening and writing. You will also see this important work referred to as healthcare documentation specialist. You are in effect a medical language specialist who interprets and transcribes dictation by medical professionals. You are a trusted professional who accurately and confidentially captures patient care information by converting voice-recorded reports into text format. You are entrusted with private and personal information to ensure that the information captured is an accurate record of what is dictated. Performing this work requires the ability to interpret dictation correctly and to protect patient records. You must possess the people skills necessary to work directly with medical doctors, surgeons, and other specialists and health care professionals. You do not have to have a certification for this line of work. However, you will have more credibility and probably make more money if you do.

You will have to learn the voice of the person you are transcribing; that may take some time. You will be expected to understand and accurately transcribe medical terminology, anatomy and physiology, diagnostic procedures, pharmacology and treatment assessments. The dictation can range anywhere from ten seconds to ten minutes. Your job is to get this dictation converted into a text file as soon as possible. You then format the reports; edit them for mistakes in translation, punctuation, or grammar; and check for consistency and any wording that doesn't make sense medically.

So how do you set a reasonable expectation? Let's say your customer (doctor) sees a patient every 15 minutes and he works a ten hour day. Let's also assume that your deadline for submitting transcriptions is 24 hours. That is forty transcriptions due in 24 hours. Procrastination is not a trait that works well in this profession. The point here is to negotiate a turn-around time that makes you successful and pleases your customer. If you are not very fast at transcription, you may want to start out by quoting a rate by the page. This also provides your customer a tangible audit of the amount of work you have completed. Discover what a nominal turnaround time is. If it is 24 hours, then comply with that requirement. You may be able to fit in a few more customers and still make your commitments. Be sure to factor in the interruptions for taking children to school, their doctor, and the occasional emergency. Pace yourself and set reasonable expectations for you and your customer. Remind them that you are only a phone call or email away.

If you have little or no experience as a medical transcriber, you may want to land a part-time gig and build your skills and your credibility. Meanwhile, you can set aside some time to train at home and earn your certification.

If you are an experienced medical transcriber - get your business card and brochure in the hands of healthcare professionals. Ask for a trial run and at least a referral.

Bottom line: You'll never know unless you try.

Jeff is a leading authority on Corporate Transformation and Development. He has written more than 20 publications on Leadership, Cultural Transformation, Change Management, and Corporate Development including: Transitional Development 101, A Discussion of International Relief in the 21st Century; Leadership, the Lost Key to Effective Process Improvement; A PMO by Any Other Name; and Are Faith-Based NGO's Based on More Than Faith?

He is a driving force in the development of small businesses and is passionate to share Business Startup Ideas and to offer leadership and mentoring in pursuit of furthering the small business.

Jeff also supports International Development by supporting Anthropology, Missiology and PermaCulture projects in the Amazon River basin and the Andes Mountains that are designed to facilitate growth while preserving the indigenous culture.

http://www.EagleServices.US

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Understanding The Relationship Between Medical Billing And Medical Coding

Coding is the process of assigning of symbols, abbreviations or numeric and alphanumeric characters to represent some of kind of information. From a consumer's point of view, it makes the whole procedure very systematic and easy to deal with. The code instills the complete data and history of the description stored. With the growing technology and coding mechanisms available, the medical field is one area in which coding is proven useful. Medical coding is the process of transforming detailed history, symptoms, diagnosis and health-related procedures of diseases in numeric or alphanumeric systems. The application serves many purposes, and the classification is universal in nature and complacent while dealing.

Medical coding is often associated with another procedure, known as medical billing. Here, coding stands for the allotment of codes to different medical objects present in a premises, and the biller uses these codes for billing purposes. He or she uses the coder's codes for creating invoices which are entered into a computer and checked for the codes. The result is the total amount of the net purchased items. Many online training schools and medical colleges are on the run which offer complete education programs for medical coding and billing. They enable a coder to do certain jobs, which include:

- Allotting codes

- Decoding

- Convincing insurance companies

Do not think that these programs are a mere waste of time and money and those who cannot be doctors or nurses join this field. If this is your line of thought, you are absolutely wrong, as coding is as important in the healthcare field for learning directions as is navigators when sailing a sea. Medical coding is primarily used for the running of healthcare programs and keeping the history of the certain diagnosis with the tests used. Patients can use these codes to know about their diagnosis, to seek the services provided by their practitioner and they can even double-check their billing, using these codes.

There are different systems of coding, one of the most common of which is CPT. CPT Stands for Current Procedural Terminology Codes. These codes are developed by the American Medical Association and go through a complete process, after which these codes are submitted to the insurance companies or the payers. Hence, these medical codes keep three parties interlinked through reliable feelings. These parties include patients, insurance companies, various medical practitioners, and any other associates in a given practice.

If you're ready to start your Medical Coding Training & Certification, we have more great tools and resources on our website http://www.medicalcodingtrainingcertification.com

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Home Health Coding - Complicated Surgical Wounds

If a patient's surgical wound may be complicated, but the coding need not be. Heed these three simple steps to ensure the accurately reporting all the care your agency provides.

1. Know when it is complicated:

A complication is a problem that takes place during the healing process of the initial surgical procedure which impacts healing negatively, says Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C. For instance, an infected surgical wound is thought of as complicated.

Tip: According to Adam, there is no time limit to coding a surgical wound as complicated. Even if the complication takes place sometime after surgery, you can still code for the wound as complicated.

2. Get to the right code

See under "complication" in the alphabetic index of your coding manual to start your search, says Adams. After this, verify the code in the tabular list, and follow the directions for any additional codes. Adam points out, there're many complication codes for wounds of all types in chapter 17 at 996.xx (Complications peculiar to certain specified procedures), 997.6x (Amputation stump complication), 998.3x (Disruption of wound), and 998.5x (Postoperative infection) for postoperative wound complications. Moreover, look to 998.83 (Non-healing surgical wound) and 997.xx (Complications affecting specified body systems, not elsewhere classified).

3. Do not turn to aftercare:

Although your agency is providing care post-surgery, you should not use an aftercare V code when the surgical wound is complicated. In this case, the complication code trumps the aftercare V code in this case. As per coding guidelines, "The aftercare V code shouldn't be used if treatment is directed at a present, acute disease or injury. The diagnosis code should be used in these cases."

But you may once in a while find an exception to this rule. For instance, if your agency is caring for an infected surgical wound which requires IV care, you would make use of the right complication codes to report the wound, but you could still list V58.81 (Fitting and adjustment of vascular catheter) and V58.62 (Long-term (current use of antibiotics).

Another instance: Adams says that instructional notes at 996.4x (Mechanical complication of internal orthopedic device, implant, and graft) and 996.66 (Infection and inflammatory reaction due to internal joint prosthesis) counsels coders to "use additional code to identify the prosthetic joint with mechanical complication or infection (V43.60-V43.69)."

Take a look at these two coding scenarios

A patient of yours has come home after a coronary artery bypass graft (CABG) for coronary atherosclerosis (CAD) of his native artery. He needs constant observation and assessment of the surgical incision on his leg with three areas of incisional separation but with no signs of infection. He's a bit weak but does not have chest pain anymore. The patient has diabetes with fasting blood sugar of 109 and diabetic peripheral angiopathy. He also has benign prostatic hyperplasia with urinary retention and frequent urinary tract infections and will be planned for a transurethral resection of the prostrate pretty soon. Your orders are meant for skilled nursing and physical therapy coding.

Jan Mater-Cavagnero MA, HCS-D, specializes in diagnosis coding for home health agencies, as well as the wide variety of issues that impact the hospice industry. Jan is an editor-in-chief for Eli Healthcare, where she has written Home Health ICD-9 Alert for five years.

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Why to Use the Established Patient Code 99214 Versus 99213?

Research shows that 61% of Doctors use 99213 to bill for an Established Patient Visit. Many Doctors may be down coding when the visit could justify a higher-level code. CPT Code 99213 is used normally when a patient is not sick and is relatively healthy. For example, a patient cuts his arm but if a patient has an immune disorder or the cut is infected it would be better to bill with a higher-level code.

When you decide it's necessary to code at a higher-level it's important to be mindful of the time you have spent with the patient. Also it does well to keep in mind anything that has moved the focus to another initial complaint can also call for a higher-level code such as 99214. It's important that when a Doctor decides to use a higher-level code, they need to make sure to document, document, document! Good chart notes by a Doctor will help to back up the usage of a higher-level code if it has been denied by the Insurance Company. If the patient has discussed with the Doctor more than one problem, it would be appropriate to add all the diagnosis codes to the claim to meet the criteria for billing at that higher-level code.

A suggestion used by other Doctors for tracking the time spent with a patient would be to have a clock in each exam room and when the Doctor begins their exam, they would write down the time the exam begins and ends on the back of the Superbill. If the Doctor decides that they need to consult with another Doctor regarding their patient, while the patient is still in their office, this time too should be tracked. Writing the time on the back of the Superbill is so the patient does not see the Doctor looking at their watch, which could make the patient feel they are in a hurry and also the patient will most likely never see the time written on the back.

Doctors do well to talk with their Insurance Biller and Staff to let them know that they would like to implement this practice. The majority of Insurance Billers are in an office away from the hands-on patient care that's taking place in the office or the Doctor is using an off-site billing service. Communication with the Insurance Biller, Front Office, Nurses or Back Office Assistants is very important to implement any new practice within the office. A Medical Office that has good communication and cooperation have such a profound affect on any Medical Practice.

Doctors may be hesitant to change from billing 99213 to 99214 for office visits but when they sit down and calculate the time spent, they most likely will recognize they have been giving away hours of their day for free.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full "Interview with Marina Hall" visit her website at http://www.inscoding.com/aboutus.php

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The Differences Between ICD-9 Codes and ICD-10 Codes

Are you a professional medical coder? Then you have an important job, because your careful coding is vital for proper diagnoses, to monitor the health of the general population, accurate reimbursement, the smooth operation of facilities that provide medical care and more. That's why a firm understanding and comprehensive training for the ICD-10 transition will be incremental to your medical coding career.

ICD-10 will replace ICD-9 on October 1, 2013 as the Unites State's industry-wide coding system. Don't stress. According to the AAPC, ICD-10-CM shares many similarities with ICD-9-CM, like the guidelines, conventions and rules. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to ICD-10-CM coding with the proper training. However, as a professional medical coder, there are several important differences between the two coding systems that you will need to prepare for.

According to the AAPC, Major Differences Between ICD-9-CM and ICD-10-CM Include:


ICD-9-CM is mostly made up of numeric codes with three to five digits. ICD-10-CM will consist of alphanumeric codes with three to seven digits. The expanded characters of the diagnosis codes will provide more information concerning disease type, severity and anatomic site.

ICD-9-CM has about 13,600 codes and ICD-10-CM will consist of approximately 69,000 codes.

A single ICD-10-CM code can be found to not only pinpoint a particular disease, but also its current manifestation.

The current ICD-9-CM coding system does not require mapping. A two-year transition period, will allow access to both ICD-9 and ICD-10 coding systems until the transition is complete. Mapping will be required so that equivalent codes can be found for outcomes studies, medical necessity edits and more.

These major differences will impact information technology and software.

The transition to ICD-10-CM will help solve certain challenges that exist with the ICD-9-CM coding system. In fact, according to the American Medical Association (AMA), a primary concern today with ICD-9 is the lack of specificity of the information conveyed in the codes. The ICD-10 coding system seeks to ratify this challenge with characters in the code that identify left or right, initial encounter versus subsequent encounter and other important clinical information. With ICD-10, codes will increase in detail, offering more information, and also, greater laterality.

Another challenge with ICD-9 is that some of the chapters have reached capacity, so there is no way to add new codes. To help ratify this, new codes have been assigned to various chapters. However, this often makes it difficult for these codes to be located. Under the ICD-10 coding system, codes have increased in character length, which greatly increases the number of codes for future use and decreases the chances that chapters will run out of codes.

Overall, the move from ICD-9 code sets to ICD-10 code sets will mean more details, terminology changes and expanded concepts for laterality, injuries and other related factors. According to the AMA, while the complexity of ICD-10 will provide many benefits, the complexity also enhances the need for comprehensive ICD-10 training in order to fully grasp the changes that accompany the new code sets.

Early ICD-10 preparation is a smart choice. With advanced preparation, you can allow yourself adequate time to grasp all the necessary changes, as well as increase your marketability to health care facilities, doctors and more, who will need ICD-10 trained individuals to help ensure a smooth transition.

Consider taking an online ICD-10 course and enjoy the flexibility of self-paced learning that allows you to keep your career on track, focus on other personal responsibilities when needed and study 24/7 - in other words, when it's most convenient for you. Before you know it, the October 1, 2013 deadline will be here, so take charge, seek out flexible, online ICD-10 training and gain the peace-of-mind and career edge you deserve.

Are you a professional medical coder? Learn about ICD-10 Codes changes and how to prepare for ICD-10.

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