The clinical coding of “Underdosing” has some very specific guidelines which must be understood and followed. We see “underdosing” scenario’s occur in both outpatient and inpatient encounters. Several ICD-10-CM codes will need to be assigned in order to capture the underdosing patient encounter accurately.  The clinical coding of a condition or diagnosis of “Underdosing”...

The question is simple – What is anemia? However, the answer is not necessarily so simple. Anemia is a condition that is marked by a deficiency of red blood cells, or hemoglobin. Anemia can be linked to a variety of conditions and diseases, and can affect people of all ages, races, and ethnicities. The more common forms of anemia are noted below.  NUTRITIONAL-DEFICIENCY...

In March 2022, the U.S. Department of Health and Human Services released the updates for its Strategic Plan. All operating and staff divisions within the HHS and input from Congress, Tribes, Tribal, and Urban Indian Organizations, the Office of Management and Budget, and the public sector contributed to its development. For FY 2022 – 2026, HHS addresses and tracks five...

The Office of Inspector General (OIG) released in mid-March 2022 their annual report and statistics for 53 Medicare Fraud Control Units across the country. Significant investigative work and recoveries were obtained in 2021 totaling $1.7 billion recovered and 1,105 convictions. The 2021 annual Office of Inspector General (OIG) Medicaid Fraud Control Units (MFCUs) report...

Your next chart has the diagnosis “scleroderma.” Being familiar with medical terminology, you know “sclero” means “hard”. Derma, of course, means skin, so the diagnosis means hard/hardened skin. If you’re using coding books instead of an encoder, you’re probably thinking skin codes fall under Chapter 12 – Diseases of the Skin and Subcutaneous Tissue as you flip through...

The CPT code set for 2022 includes 249 new codes, 93 revisions, and 63 deleted codes that went into effect January 1st, 2022. Changes in codes and guidelines were made in all sections of CPT- so be sure to review the 2022 CPT code set in its entirety to ensure proper coding and reporting. Key changes in the Surgery section will be highlighted in this blog. Integumentary...

In 2021, CMS released the Official ICD-10-PCS Coding Guidelines for fiscal year 2022, which went into effect October 1st. The FY 2022 PCS guidelines include three guideline revisions in the Medical and Surgical section (B3.7, B4.1c, B4.8) and two guideline revisions from the New Technology section (E1.a, E1.b). Although key changes will be highlighted in this blog, be...

Over the past 20 years, Healthcare has seen an increased interest in the impact and influence of “Social Determinants of Health” or SDOH. Recent the Centers for Medicare and Medicaid Services (CMS). Health plans themselves have become more interested in SDOH and the associated cost of care present and future. Now we have CMS Medicare Part C raised attention to SDOH also. 

The CPT coding system was introduced in 1966, and was originally intended to simplify documenting procedures that physicians performed. By 1970, the system had changed to include lab procedures, and the codes had expanded to five digits. The concept of modifiers was introduced in the third edition of CPT in 1973. Modifiers provide additional information about a procedure...

The Office of Inspector General released in January 2022 an audit report on Medical Advantage for Healthfirst Health Plan, Inc. The identified errors were related to some specific diagnosis codes and Hierarchical Condition Categories (HCCs). Another Medicare Advantage Audit Report from the OIG! This particular audit report by the Health and Human Services (HHS) Office of...