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Sales Presentation Template For Medical Coding

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Transcript: Medical Necessity Medical necessity and patient diagnosis: Claims are paid by insurance companies based on what CPT (Medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians) code submitted. In order to submit a CPT code, it must attach ICD codes along with the CPT claim. Documentation For example, if the patient came in with a fever and sore throat, and billed for a urinalysis, then insurance would not pay for it. This is because it is not medically necessary to perform a urinalysis on a patient who is not having any urinary symptoms or problems. This means that not only does the doctor have to document everything that is done in the office, but also has to do because of specific diagnoses. Usually this is not very difficult, because providers perform procedures based on the patient's diagnosis. If not documented, the rationale for ordering diagnostic or other services should be easily inferred. The patient’s progress, response to and changes in treatment and revisions in the diagnosis should be documented. The CPT and ICD-9-CM codes reported on the health insurance claim form or billing statement should be supported by the documentation in the medical record. ICD Code: The International Classification of Diseases. Ex: ICD Code is 462 and its description is acute pharyngitis. Good documentation is the key to correct coding of E/M services Documentation for each encounter must stand alone. Proper sequencing of diagnoses. Provide specific and descriptive documentation. It is related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care and decision by patient health plan that the treatment, test, or procedure is necessary for patient health or to treat a diagnosed medical problem. CPT Code: Current Procedural Terminology is a five digit numeric code that is used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are approximately 7,800 CPT codes ranging from 00100 through 99499. Ex: Service code 85025 means blood count, complete (CBC). For example, when patients come into the office with more than one diagnosis and have more than one procedure performed. If a patient has a suspected urinary tract infection, but also has a fever and sore throat, then the doctor might perform a urinalysis as well as a strep throat swab. It must link the correct diagnosis (urinary tract infection) with the correct procedure (urinalysis), in order for the insurance to pay. If the billed codes not link the procedures correctly, then insurance will deny all of the procedures for medical necessity. Remember, if it's not documented, it never happened, so if doctor forgets to write the urinalysis down, then the insurance company will assume it never happened. What this means is that if they request records for office visit, and billed for a urinalysis, then they will not pay for it, because it's not written down in the chart. Common Denials 1. VP III and HVS examination if both ordered any one will be accepted by insurance. 2. Antibody Hepatitis C test is not covered under ANC screening profile, Please don’t order with ANC profile. 3. Routine Vitamin D testing is considered by Daman as a form of screening and should therefore only be covered under plans that include screening benefits. Vitamin D test is only supported for certain medical conditions such as proven osteoporosis, rickets, osteopenia, malabsorption syndromes and renal disease or drugs that affects vitamin D metabolism. 4. If Vitamin D test and ESR test both ordered- anyone will be accepted by insurance. 5. Don’t order Uric acid test with ESR, CRP, Rheumatoid factor for Arthritis related problems-anyone will be accepted by insurance. clinical example Medical Billing Errors Medical Coding Medical coding: is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the health care record, such as the transcription of the physician's notes, laboratory results, radiologic results, and other sources. There must be a reason for every visit (the ICD code), whether it is getting a Lab test, Scan, doing a colonoscopy, performing a surgery, procedure and visiting the doctor's office. When submits CPT code to insurance companies, they must attach with proper related ICD codes as part of the documentation in accordance with generally accepted standards of medical practice. Example 1, a patient presents to the office with chest pain and the physician orders an electrocardiogram (ECG). A 12-lead ECG performed in the office and interpreted by a physician is reported with CPT® code 93000. The reason the physician orders the ECG is because the patient is complaining of chest pain. The diagnosis code for

Medical Coding

Transcript: Medical Coding What is Medical Coding? What even is Medcial Coding? Medical Billing and Coding is the pracitce of helping physicians and health care center get reimbursed for services given to their patients. It is the translation of medical terms for diagnoses and procedues into code numbers from standardized code sets. The objective to coding Objective Provider -To prepare a standardized bill for services given to the patient. Payer -To determine the amount to be paid to the provider Billing specialist Patient Account Representative Electronical Claim Processor Coding Specialist Reimbursement Specialist Private Consultant Claims Processor Claims Analyst Medical Coders Career Track Career Tracks Coders are responsible for abstracting and assigning the accurate code on the claims. Coders check a variety of sources within the patients medical records (doctors note, lab test, image tests). Assign CPT codes, ICD-10-CPT and HCPCS codes. What does a Medical Coder do? What does a coder do? 1. Assess documentation for completness and clairty. 2. Determine their provider, patient type, place, and payer. 3. Abstract the diagnoses and procedures. 4.Assign the accurate codes. 5. Verify the codes are compliant. 6. Release the codes for billing Medical Coding steps Steps Correct coding plays a signicant role in resource utilization and reimbursment. Correct code assignment permits access to medical records by diagnoses and procedures for use in clinical care and research. Correct code assignment is benefical to healthy policy development and planning. Benefits of Coding Benefits Acute care hospitals Hospitals Skilled nursing facilities Long-term acute care facilities Rehab facilities Home health agencies Hopices Special care facilities Clinics Surgery centers Medical Coder's working environment Evironment Without coding, we wouldn't have the luxry of being able to have our insurance companies pay for some of hospital expenses Conclusion Conclusion

Medical Coding

Transcript: What is... Medical Coding? Caroline Patton Medical coding 101 Think of medical coding as a translation between a medical report to a medical claim by turning every piece of information into a specific code. WHAT But wait...How does that work? Breaking it down ? Anytime you receive medical treatment a medical report is formed by your doctor. Typically these medical reports include A LOT of information like: Patients condition Doctors diagnosis Prescriptions Medical Procedures When all of this information is collected it is then turned into a specific medical code that is uniform across each system. So why do we use codes?Couldn't we just use the the medical notes from the doctor? But why? Lets find out.. WHY? Remember when I said that there is A LOT of information in one medical report? why Well there are also A LOT of medical reports each year! In fact according to the CDC over 1.4 billion patients visit were recorded last year alone! With 1.4 billion patient visits a year ranging from your average strep throat to Medically complex conditions the amount of data can quickly grow out of control. Medical coding allows this massive amounts of data to be conveyed in a simple and efficient way to Insurance companies . This is also important because it allows the transfer of your medical history between doctors to be efficient too. For example: the Code for Strep throat in Kentucky is the same code for strep in Florida! CPT codes, HCPCS, and ICD-10 codes Types Healthcare Common Procedure Coding System HCPCS HCPCS is the second of the two procedure codes which are based directly off of CPT codes. In fact, these codes were created by the same organization that developed CPT codes however they are maintained by the AMA. HCPCS codes represent services, procedures and equipment that aren't already included in CPT codes like prosthetics, ambulance rides and medical equipment. Fun Fact HCPCS are the offical code for Medicare, Medicaid and outpatient hospital care International classification of diseases ICD-10 or International Classification of Diseases are uniform DIAGNOSTIC codes that create a set vocabulary for different causes of the injury, illness or even death ICD-10 We use these codes to represent a doctors diagnosis which is essential in the billing process because they help determine the medical necessity. Fun Fact The "10" at the end of ICD is because we are currently on the tenth generation Current Procedure Terminology CPT CODES CPT Codes are one of two types of procedure codes. They are managed by the American Medical Association and are updated annually. CPT codes are divided up into three different categories: Category I (used most often) Category II (optional codes) Category III (emerging medical technology) The first category is the most common is divided into six ranges: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. The second category also corresponds in some cases to laboratory and radiology but is based on performance measurement. The third is the least likely used category and pertains to new medical technology. Resources Writers, S. (2019, March 22). What is Medical Billing and Coding? MedicalBillingandCoding.Org.

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