Billing Code 99212

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

The E/M code's is a big important part in this process. Being a health care professional, using the medical code's. like medicare, medicaid, other private insurance to be reimbursement. If not using the right code, the doctor office, hospital, and urgent care. Will lose a lot of money. So using the right cpt code's insurance companies, office, hospital, and urgent care can be reimbursement correct. Cause CPT code's are formed with 5 digits.

S- 3671 dispatched to a m pt C/O of abdominal pain and black stool. Pt is a 49 y/o m whose C/C is abdominal and lower back pain. Pt also states that he is experiencing cramping around his left ribcage. Pt states that he has been experiencing N/V/D for the past four days. Pt also states that his bm's have produced black, watery stool since the monday prior to the incident date. Pt is able to provide EMS personnel with a detailed medical Hx that includes HIV, acid reflux, and recently diagnosed COPD. Pt also states that he recently stopped smoking cigarettes. Pt is also able to provide EMS personnel with a list of medications that he is currently taking that includes Duloxetine, Stribild, Ranitidine, Aripiprazole, oxycodone, and proair. Pt states that he has not taken any of his prescribed medications for the past four days prior to the incident date. Pt states that he has allergies to Kaletra and gabapentin. Pt states that his primary

Medical coding, on the other hand, deals more closely with patient medical records. Medical coders work in the billing office, or “back office” of medical practices or hospitals. Alphanumeric codes are assigned to all illnesses, injuries and treatments. Medical procedures are coded for the purpose of classifying diseases in numerical sequences for identification and data collection purposes, similar to the Dewey Decimal System in libraries. Coding specialists review medical records and assign numeric codes for the diagnoses identified and procedures performed. Each medical procedure and patient encounter has a number (CPT code) associated with it which corresponds to an ICD code. These

The Current Procedural Terminology (CPT) codes, are codes a medical biller uses to report healthcare procedures and services. Both medical billers and providers use CPT codes as a way to communicate with insurance companies. Proper coding and documentaition is essential for reimbursement. Proper coding and documentation also makes the difference between full reimbursement and reduced reimbursement or even a denial. Each code that is sent to a payer on a claim, has to have supporting documentation. For example, if a patient is seen for a urianary tract infection and during the visit the patient receives a urianalysis, you would expect to see an order, the correct CPT code, and the results for a urinalysis in the patients chart. I have always

The Centers for Medicare and Medicaid Services (CMS) requires all providers to implement ICD-10 coding system begin on October 1st, 2015 so the U.S. healthcare system can communicate in the same language as with other countries’ systems. The transition from ICD-9 to ICD-10 had big changes from 14,000 diagnostic codes to more than 68,000 and 4,000 procedure codes to 87,000. The transition affected the reimbursements of hospitals. Medicare requires all patients’ procedures and services to be coded using ICD-10 system while they are charged in CDM using CPT codes. However, there is no direct link between ICD and CPT codes (Jensen, Ward, & Starbuck, 2016). The CDM committee had to work together to prepare for this event. Switching from numerical

Many people get confused when they hear the terms inpatient and outpatient. An inpatient is a patient hospitalized for more than 24 hours, but the stay can be less, depending on doctor’s orders. An outpatient is a patient that does not stay overnight in a medical facility and goes home. ICD-9-CM diagnosis codes are 3 to 5 digits long (numeric) or can be a letter followed by up to 4 digits (alphanumeric). For example, the code for Hypertension is (401.9), examination of the breast is (V76.10), and struck accidentally by a falling object is (E916). ICD-10-CM diagnosis codes are three to seven digits or characters long. The first character is a letter, and the second to seventh characters are letters or numbers. For example, sprain of unspecified

She or he also needs to be familiar with how to use the International Classification of Disease (ICD) codes, the Current Procedural Terminology (CPT) codes, and the Diagnosis Related Group (DRG), which is used to reimburse hospitals for inpatient stays. These stays are for patients who may have severe injuries, might need more extensive care, or may require admission for twenty four hours, or longer depending on how severe the severity of his or her diagnosis. The in-patient coder will then assign the accurate codes to the medical diagnoses and treatment plans for the in-patient facilities. Next, the coder will then continue to monitor the inpatient stay and must perform coding services for every day that the patient is in the hospital until being

Up-Coding Services: Billing of government and private insurance programs is done using a complex series of numerical codes that identify the specific procedure or service being performed. These code sets can include: the American Medical Association’s Current Procedural Terminology (“CPT”) codes; Evaluation and Management (“E&M”) codes; Healthcare Common Procedure Coding System (“HCPCS”) codes; and International Classification of Disease (“ICD-9”) codes. Government health care programs assign a dollar amount it will pay for each procedure code. Up coding occurs when a health care provider submits of a claim for health care services, treatments, diagnostic tests or items that represent a more serious and more expensive procedure than that which actually was performed. Up coding can be a violation of the Federal False Claims Act.

CPT coding is to make sure the patient is getting billed for the correct services that was rendered. The Tabular list is a compilation of codes divided in different categories: Category I, II, III. Category I is the basis of CPT codes. Category II is used for tracing information. Category III is short term codes for collection of services rendered and procedures. There are 15 appendices that are used as guides. Modifiers help report situations. Locating codes are done by finding the main term. Assess information provided such as notes and terms. Locate the code. Guidelines are presented in the front of the sections. Special instructions help point out rules on how to use codes. Instructional notes are located in parentheses

The key elements to a healthy and successful medical practice are a reliable and properly trained staff and a sound revenue cycle that produces satisfactory reimbursement. Revenue cycle management starts at the front-end with pre-registration of the patient. Complete and accurate recording of patient insurance and billing information is imperative. Insurance verification plays a major role in the assurance of reimbursement. The front desk should counsel and confirm financial responsibility with the patient during the registration process. Patient encounter is equally as important. Correct coding of patient diagnosis and procedures minimizes the likelihood of claim rejection. The next step in the revenue cycle is claim submission. The claims process begins with the provider treating the patient then sending a bill to the designated payer. Before the bill is sent, a certified coding specialist or medical billing specialist prepares and reviews the claim for any inaccuracies. There are a few ways the claim is submitted, either manually or electronically. Once the claim is submitted, follow-up with third party payers is a necessary step in the

Cost is a huge factor for Trevor due to he recently was dismissed from his employer, as a result his health insurance was discontinued. However, Trevor could set an appointment with his Primary Care Physician (PCP), which would cost $150.00 out of pocket due to his lapse in insurance. Alternatively, Trevor could go to an Urgent Care (UC) facility which would be $50.00 for a basic visit, if he needed labs or diagnostic testing this would simply drive the out-of-pocket cost up. Trevor has no choice but to go to the Emergency Room.

The outmoded coding professional’s role was to describe and apportion diagnosis, procedure, and other medicinal service codes using ICD-9-CM and HCPCS/CPT coding classifications while referencing the Coding Clinic for ICD-9-CM, Coding Clinic for HCPCS,

specialist determine the ICD, CPT or HPCS coding. The coder or biller may have to communicate with the healthcare provider if there are any questions on any of the diagnoses, treatments or duration of the office visit (Dietsch, 2011). Because insurance companies are very strict on correct medical billing and coding, a small mistake can cause the insurance company to deny the claim and will then require the doctor to fix the error and the claim will need to be resubmitted (Cocchi & White, n.d.).