July 15, 2022 | By J. Paul Spencer, CPC, COC Chances are, based on who we are and what we do, we’ve all been there. Out of nowhere, completely out of context of our day-to-day work as auditors and administrative professionals in the world of healthcare, a conversation is started with someone who is…
October 29, 2021 | Edward Townley CPC, CEMC, CUC, ROCC, Founder, Cogent9 Consulting This is the time of year that we receive our new coding manuals. First the ICD-10, which becomes effective October 1 and CPT and HCPCS manuals which come nearer to the end of the calendar year, and effective January 1. For…
October 1, 2021 | By Grant Huang, CPC, CPMA A year and half into the coronavirus pandemic, confusion still remains over a variety of remote services that are often lumped into the same category as telehealth but have their own unique codes and billing guidelines. CMS has given them the somewhat unwieldy label of…
August 27, 2021 | By Jamee Black, CPC, COC, CPMA One of the most difficult determinations of Number and Complexity of Problems Addressed is complicated vs uncomplicated. When selecting Number and Complexity of Problems Addressed, the complication of treatment required should not be considered. The Risk of Complications of Patient Management is where the treatment…
August 20, 2021 | By J. Paul Spencer, CPC, COC In my role as a compliance consultant specializing in carrier audit response, a lot of items are brought to my attention on a daily basis, with the bearer of said items asking questions such as, “What’s this?” and “Do I have to respond to…
November 6, 2020 | By Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA, CEMA-O Pumpkin spiced lattes are back at Starbucks, the days are getting shorter, there is a crispness in the air (in some parts of the country, anyway), and the 2021 ICD-10-CM guidelines have gone into effect. These are all signs we…
January 10, 2020 | By David Glaser Skepticism is a vital trait in the coding and billing process. Constant questioning is necessary because when you receive guidance from consultants and contractors it may be both clear and categorical, but it’s possible that upon objective review, you will realize it is also cockamamie. For…
March 20, 2020 | By Shannon DeConda, CPC, CPC-1, CPMA, CEMC, CMSCS Step 1: Telehealth Consent In order to conduct a patient encounter as a telehealth service, the patient must consent to this modality. The consent should include the patient’s explicit agreement to being treated via telehealth rather than in a face-to-face encounter. Each…
April 10, 2020 | By Jill Young, CPC, CEDC, CIMC The Centers for Disease Control and Prevention (CDC) released its ICD-10 documentation guidelines for COVID-19, using the newly adopted code U07.1. You can find the CDC’s guidance document here https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf. The information shows an effective date range from April 1, 2020 through September 30,…
April 17, 2020 | By Priscilla J. Alfaro, MD, FAAP, CPC, CPMA, COC, CFE ICD-10 was finally officially implemented on October 1, 2015. One of the intents of moving to ICD-10 was to enable and encourage reporting diagnoses with a higher level of specificity. Many payers expect claims to contain specific codes to support the…