News

Eli Global, LLC Charged With Public Corruption and Bribery

Ok, you might have read the title of this post and wondered why I’d even be writing about this. This is after all a medical coding blog right? Eli Global, LLC probably does not ring a bell. At least for me it didn’t when I first read about this. I was like Eli Global, LLC? Never heard of them. Moving on.

But here’s the thing. Eli Global, LLC is a huge company that has many companies under it’s umbrella, and one of those companies is AAPC. You’ve heard of AAPC right? AAPC is one of the main organizations that certifies coders and many of us (myself included) have gotten at least one coding certification through them over the years. So, the owner of Eli Global, LLC (and also AAPC) is under investigation now for different illegal things.

I don’t want this post to be about my opinion on this. I’ll go along with the whole innocent-until-proven-guilty-thing, but I have to admit, this is concerning to me. I’ll post links to some different articles and you can form your own conclusions:

Articles:

The United States Justice Department

Subpoena 

Insurance News 

The Hill

Triangle Business Journal

Well, maybe I’ll just put one of my opinions in this post and that’s it. So, in order to be a certified coder, it is just expected that we have high standards. AAPC even has a Code of Ethics. Here it is:

Code of Ethics

AAPC has a code of ethics which addresses coding professionalism and compliance integrity. The eight components of AAPC’s Code of Ethics are:

  • Maintain and enhance the dignity, status, integrity, competence, and standards of our profession.
  • Respect the privacy of others and honor confidentiality.
  • Strive to achieve the highest quality, effectiveness, and dignity in both the process and products of professional work.
  • Advance the profession through continued professional development and education by acquiring and maintaining professional competence.
  • Know and respect existing federal, state, and local laws, regulations, certifications, and licensing requirements applicable to professional work.
  • Use only legal and ethical principles that reflect the profession’s core values, and report activity that is perceived to violate this Code of Ethics to the AAPC Ethics Committee.
  • Accurately represent the credential(s) earned and the status of AAPC membership.
  • Avoid actions and circumstances that may appear to compromise good business judgment or create a conflict between personal and professional interests.

Hopefully it’s not too much of a stretch for the owner of AAPC to follow it’s own Code of Ethics. I’ll leave it at that.

Thanks for reading.

-Lindsay Della Vella BS, COC

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15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

 

 

 

 

 

 

 

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Coding Guidelines

Can You Code Symptoms And A Definitive Diagnosis Together?

If you’ve been an outpatient coder for a while, you may know the answer to this off the top of your head. However, if you’re new to coding, you may not, so I thought it would be helpful to go over this guideline real quick. Before we even get started, I just wanted to say that as a general rule, in outpatient coding, you would not code the symptoms and the findings together. For example, let’s take a radiology coding example because I admit I’m biased and it’s my favorite. Say if a patient goes to get an x-ray of their elbow for pain, and it turns out, they have a fracture, you would code the fracture and not the pain, since the fracture is the finding. Pretty easy, right? But there is a guideline that I admit, I didn’t really even think about until not that long ago. You can turn to it in your ICD-10-CM book. It is in the front of the book in the guidelines, for chapter 18, b. Here is a pic just to make it easier:

 

So basically what this guideline is saying is that sometimes you can assign symptoms when it’s not associated with the definitive diagnosis. You would code the diagnosis first, then the symptoms. This is something I don’t see too often in radiology coding. Is this something you’ve coded before? Does anyone have an example they can share? Anyway, then it goes on to say that signs and symptoms associated with a definitive diagnosis are not coded with the diagnosis. This is the part that most coders seem to know.

Anyone have any comments on this? Examples? Please share in the comments below.

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

 

15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

 

 

 

 

 

 

 

 

 

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Questions

Diagnostic Radiology Coding Questions?

Hey Everyone,

For this weeks blog post, I thought I’d have you guys ask me questions. What questions do YOU have about diagnostic radiology coding? It can be about CPT, ICD-10, guidelines etc. Is there anything you’d want me to answer? Please post in the comments below or send me an email at midnightmedicalcoding@gmail.com.

I’ll post the questions and the answer in the blog post for next week.

 

Thanks!

 

 

 

 

 

 

 

 

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

 

 

 

 

 

 

 

 

 

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Diagnostic Radiology Coding Basics

10 Things You Need To Know Before Coding Diagnostic Radiology

For this week’s post, I thought I’d talk about just some general things relating to diagnostic radiology coding.  Bear in mind, this isn’t the be-all-end-all, everything-you-need-to-know guide. This is just what I would tell a new coder who had limited experience with this specialty in a nutshell.

  1. First things first–radiologists can be vague in their documentation. They like to use words like “consistent with,” “probable,” “rule-out” etc.  In the outpatient setting–you do not code uncertain diagnoses. So if you come across a report with these terms, do not code it. A common phrase I see in the impression on chest x-rays is “consistent with pneumonia.” Since it is not definitive, you would not code the pneumonia–you would code whatever the symptoms are. There is a coding clinic however that states that the use of the words “Evidence of” is not a vague term–so you can code the condition.
  2.  When you’re coding, refer to the impression. If there is a finding, it will be listed here, and this is where you code from. If there are no findings, you would code the history/symptoms stated on the report.
  3. When you’re coding x-rays, you count up the number of views to get the CPT. Sometimes the radiologists may mention images–do not count images. It is not the same thing as views. (If you want to learn more about x-ray coding, don’t miss the boat on our online class).
  4. Another thing to keep in mind is to always follow all client specific guidelines. For example, do you code an addendum? Do you need to add a modifier 26? All of these types of questions will be answered in your client guidelines. (A good rule of thumb is to review your client guidelines before reaching out to the lead coder for questions).
  5. Know the difference between limited and complete ultrasounds (refer to the CPT book).
  6. Know the difference between all the different OB ultrasounds (refer to the CPT book).
  7.  CTA’s must state 3D in the documentation.
  8. Know whether or not you need to code the contrast for MRI and CT scans. Do you code contrast waste? Again, review client guidelines on these types of questions.
  9. Know whether or not you need to code incidentals. The answer to this is generally no, but this is another client guideline type question.
  10. Last but not least, know how to code fractures. If this is new to you, see this previous blog post.

So there you have it. Hopefully this list helped you figure out a little more about diagnostic radiology coding.

Thanks for reading-

 

 

 

 

 

 

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Join the Midnight Medical Coding Stars- A membership only area where one HIPAA compliant diagnostic radiology report is added each week for you to code the ICD-10-CM and CPT codes. Answers provided.

 

Join the Midnight Medical Coding Stars

 

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

 

 

 

 

 

 

 

 

 

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modifiers

Difference Between Modifiers 76 and 77

For this week, I thought I’d talk about 2 common modifiers used in diagnostic radiology–modifier 76 and 77. Let’s be honest though–talking about modifiers is probably not the most exciting coding thing to talk about–but it’s important. I’ll do my best to explain it in such a way that you actually read the whole article without getting bored– 🙂

So–modifier 76. If you look at the CPT book it says-

Ok, so the keywords here are ‘Repeat Procedure’ and ‘Same Physician.”

 

Now let’s look at modifier 77:

 

The keywords to look at here are ‘Repeat Procedure‘ by “Another Physician.’

So the difference between these modifiers is that modifier 76 is for a repeat procedure by the same physician on the same day, and modifier 77 is for a repeat procedure by a different physician on the same day.

In diagnostic radiology, I would say these modifiers are most commonly used on x-rays. Sometimes the same patient might need the same x-ray taken a few times during the course of the day. It could be x-rays for broken bones or chest x-rays to monitor different issues over time.

 

Le’ts look at a very common code- 71045. This is the CPT code for a 1 view chest x-ray.

 

Say if a patient had:

A 71045 was done at 8 am- read by Dr Smith, then later the same day

A 71045- done at 2 pm- read by Dr Smith

So basically this patient had 71045 done twice the same day. To bill these out, you have to add a modifier. In this case, this is the same procedure, read by the same physician. What modifier would you use?

You would add a modifier 76 to show that it’s a repeat CPT read by same radiologist. The 76 would go on the 71045 billed at 2 pm.

 

Let’s look at another example:

Say if a patient had:

71045 done at 9 am, read by Dr Smith, then later the same day

71045 done at 2 pm ready by Dr Jones

Now which modifier would you use? You would use a modifier 77 to show that this patient had 2 separate 71045’s done the same day, but NOT read by the same dr. You would add a modifier 77 on the 71045 from 2 pm. Does this make sense? You would use these modifiers to bill out 2 separate 71045’s the same day. You’re just trying to tell the insurance company if the same radiologist read the films or not. If you forget to add these modifiers, the insurance company most likely will think you made a mistake and billed out the same exam twice and deny one.

**Just a reminder–always follow client specific guidelines and insurance specific guidelines.

Questions? Feel free to comment below or email me at mightmedicalcoding@gmail.com.

 

Thanks for reading-

Lindsay

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Questions Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Join the Midnight Medical Coding Stars- A membership only area where one HIPAA compliant diagnostic radiology report is added each week for you to code the ICD-10-CM and CPT codes. Answers provided.

 

Join the Midnight Medical Coding Stars

 

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs.

 

 

 

 

 

 

 

 

 

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ICD-10 Coding Tips

Beginners Guide To Coding Fractures Using ICD-10-CM- Part 1

I have to admit, I was a little disturbed this week after reading through comments on a Facebook post. The post was about the different 7th characters and what they mean and when to add them. This is something that can be confusing for sure. The question was fine–it was the answers that scared me a little. I realized after reading that post, that many coders (not even new coders–I’m talking about experienced coders–do not understand seventh character A.

If you have your ICD-10-CM book around, please look in the beginning section of Chapter 19. Or just to make it easier–here is a pic from my book:

 

 

Please see what I’ve underlined above. “The 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” The key is active treatment. That is what the A means. It has nothing to do with the provider seeing the patient. For example, if someone goes to the ER and it turns out he/she has a broken wrist–that encounter will be coded with 7th character A. Say this same person now follows up with their regular doctor the following day–the fracture is still coded with an A. It doesn’t change based on the provider or anything like that. It has to do with whether or not the patient is receiving active treatment. This patient is still receiving active treatment, so it’s still coded with seventh character A.

I can write many more posts about fracture coding (and I will if that’s something you guys are interested in) but I felt like I had to post about this. It is all here in the guidelines.

Are any of you looking for practice reports to code? There are some available. There are 15 x-ray reports and for each one you code the ICD-10-CM and CPT. Rationales are included at the end. Click the button below for more info.

Questions? Please feel free to comment below or email me at midnightmedicalcoding@gmail.com.

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CAC

Will CAC (Computer Assisted Coding) Replace Medical Coders?

So, here’s a question I see posted in different FB groups every once in a while–Will CAC (Computer Assisted Coding) ever replace medical coders? There is a long and short answer. The short answer is No. The longer answer–still No, but there’s more to it than meets the eye.

We all know there are some computer programs out there that make coding easier. These programs pick up on key words in documentation and for lack of better word–the computer ‘codes’ it. But here’s the thing-computers may be good at picking up on key words, but they can’t think. Computers are not aware of coding rules and guidelines, modifiers, excludes 1 notes…etc. So what happens is, the CAC just codes whatever keywords it picks up on, but it may be all wrong because it doesn’t know the rules. Here is what I mean:

Sometimes, it codes the reason for the exam plus the findings. According to ICD-10-CM coding guidelines, that is incorrect. When there are findings that explain the reason for the exam, the report is coded to the finding. Another thing I’ve seen CAC software do is put about 5 or 6 diagnosis codes on a simple report, like an abdominal ultrasound. It’s not wrong per se, but really? Do we need to code every single incidental diagnosis? No. Incidentals don’t need to be coded, but I’ll save that for another post.

Here is another common mistake that I’ve seen on audits done by CAC software. If you’ve coded radiology, you know how radiologists love to say “consistent with.” So, say you’re coding a chest x-ray and the report says, “findings consistent with pneumonia.” According to ICD-10-CM Coding Guidelines, you would not code the pneumonia because it is not definitive (this is outpatient coding, by the way. Inpatient coding has different rules on this). Many times the CAC software picks up on the word “pneumonia” and codes it. That is not how that report should have been coded because of the “consistent with.” It would be coded to the symptoms or a definite finding in the report. So, like I said earlier, CAC does not think. Does not know coding rules.

My guess is though (and this is only a guess) is that maybe in the future, most coders will be just checking the codes that CAC software came up with, and having more of an auditing role. Many places use CAC and have success with it, but there are also people checking the codes before it goes out. At the end of the day, there will always be a need for coders. Coders do way more than assign codes based on keywords. We think and have an in depth knowledge that just can’t be replaced by a computer. Besides, would any doctor out there want their billing/coding not even checked by a qualified person before it goes out? Probably not.

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Coding Course

Intro To X-Ray CPT Coding Class Is On Sale!

 

Intro To X-Ray CPT Coding- Learn The 50 Most Common X-Ray CPT Codes is on sale. Today only! There are literally hundreds of CPT codes used in diagnostic radiology coding. Trouble is, these codes are not focused on in many general coding classes. This leaves new coders barely scraping by once they’re on the job, especially if they’re expected to know these codes already. If you’re a newbie or a coder in another specialty who wants to learn the basics of X-Ray CPT coding-this is the class to sign up for! It is all online and self-paced. You can email the instructor (that’s me-Lindsay Della Vella BS, COC) anytime if you have questions. This class is backed up by great reviews from former and current students. I hope you’ll join us! Price is $39.99. Today Only. Payment plan available.

Go HERE to see what exactly is include in the class, read reviews and sign up!

Coding Course

My First Day Working As A Medical Coder

On the first day of my first coding job, I didn’t know what I was doing. I really didn’t. I never coded a real radiology report before. I guess I read a few in my coding classes, but it was something that wasn’t focused on.

Everything I knew about radiology was just based on my life experiences up to that point. I knew what a wrist x-ray was because I needed one before (broke my wrist rollerblading). I knew what an ultrasound was because I have kids and had my fair share of prenatal ultrasounds.

I kind of knew what an MRI was because the machine looked scary to me and I couldn’t see myself ever being brave enough to go in one if needed. I didn’t know what a CT was. Never heard of a CTA or MRA. Didn’t know what spectral doppler was. Needless to say I was confused at my first coding job. I didn’t know what any of this stuff was. I was fortunate enough to have an awesome mentor who helped me with CPT coding and even some diagnosis coding here and there.

But I know not everyone is as lucky as I was. Not everyone has a mentor. Or maybe you don’t feel comfortable asking a coworker for help. Even though I’m not a new coder anymore, I didn’t forget what it was like being new. How I was afraid of coding everything wrong. How I was afraid that I really did not know what I was doing and was not going to make it as a coder.

 

Some of you may know this already–but I’ve put together a new diagnostic radiology coding course. It is geared towards new radiology coders or coders in another specialty who want to learn more about it. It focuses on the CPT coding of x-rays. By the time you finish the course, you will know how to code the CPT for a variety of x-rays. You will be familiar with 50 of the most common ones used and will be prepared for ‘real life’ diagnostic radiology coding. It is all online and self-paced.

Please see the link below for a full description of the course. You’ll see the exact format and what is included. Scroll down the page and you will see a FAQ section and what my students are saying about the class. I hope you’ll join us!

 

Click Here for more info, to see class reviews and to sign up!

 

Click HERE for more info, to see class reviews and to sign up.

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Coding Course

On Sale Now!

Are you a medical coder or medical coding student who wants to learn more about diagnostic radiology coding?

There are A LOT of codes in the CPT book and you’re probably only familiar with the ones you use everyday.

So, if you’re a coder in another specialty, or a coding student, you might not know that much about the CPT coding of x-ray’s just because you haven’t had the opportunity to code them yet, or maybe it’s something that really wasn’t focused on in your regular coding classes.

Our new online coding class is available now! It focuses on the CPT coding of x-rays. You will code HIPAA compliant reports after each lesson and do coding practice exercises, take quizzes (your score is available immediately after submitting it) and there is test at the end. Supplemental info/sources/links are also provided. It is all online and self-paced.

The instructor (me- Lindsay Della Vella!) is available 24/7 through email for questions.

This class is getting excellent reviews from fellow coders who have already completed it. I hope you join us!

It is on sale NOW for $39.99! Offer expires Sunday at 5 pm EST.

Click the link to sign up and for more info.
https://bit.ly/2wSf6hF

Still have questions? Feel free to email me at midnightmedicalcoding@gmail.com