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MEDICAL BLOG

Intersegmental Traction — What’s Happening with Roller Tables?

Wyn Staheli, Director of Research
2021-05-20

Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?

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Since When did Dental Claims Require Diagnosis Codes?

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-05-12

The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...

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Coding Lesions and Soft Tissue Excisions

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-04-29

There are several considerations to be aware of before assigning a code for lesions and soft tissue excisions. The code selection will be determined upon the following: Check the pathology reports, if any, to confirm Morphology (whether the neoplasm is benign, in-situ, malignant, or uncertain) Technique Topography (anatomic location) The size Tissue Level Type of closure required Layers ...

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58% of Improper Payments due to Medical Necessity for Ventilators

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-04-29

Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...

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ICD-11 — What’s Happening?

Wyn Staheli, Director of Research
2021-04-20

ICD-11 is officially released, but what does that mean for diagnosis coding in the United States? What's really different? This article discusses what has been happening with ICD-11, some interesting things to note about it, as well as links to other important information.

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Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K

Wyn Staheli, Director of Research
2021-04-12

Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.

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Properly Reporting Imaging Overreads (Including X-Rays)

Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
2021-04-08

hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.

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Understanding Skin Biopsy Codes

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-03-23

A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...

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COVID-19 Vaccines

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2021-03-10

To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...

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Common Medical to Dental Procedures and Where to Find Them

Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
2020-12-08

With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ...

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