Coding for diabetes used to present challenges because unclear documentation or poorly stated manifestation relationships prevented capturing the type of diabetes and its complications. ICD-10 has further delineated diabetes into five code categories and even greater specificity is necessary to code accurately.
Salud Revenue Partners collaborated with senior healthcare leaders on a series of four articles exploring revenue cycle challenges affecting community and safety net providers. The series was published by Becker’s Hospital Review, a major trade journal, and tells how many community providers, including safety net hospitals, haven’t adequately addressed fundamental challenges in the revenue cycle created by health payment reforms, vast changes in the insurance markets and the rise of healthcare consumerism.
Coauthors of articles in this series include Alan H. Channing, Principal, Channing Consulting Group , former President and CEO, Sinai Health System, Chicago; Jesse Ford, CEO, Salud Revenue Partners; Michael Karpf, MD, Executive Vice President for Health Affairs, UK HealthCare, Lexington, Ky.; Dennis Price, CFO, The Polyclinic, Seattle; José R. Sánchez, CEO, Norwegian American Hospital, Chicago; and Jennifer Swindle, Vice President of Coding Solutions, Salud Revenue Partners.
Defining medical necessity for evaluation and management services is difficult. Clinicians and coders should be careful to include only those things that are necessary for patient treatments to determine the appropriate levels of E&M services.
Modifier 59 is used when procedures normally bundled together should be reported as distinct and separate procedures. The determining factor for using X modifiers is if a service that is usually part of a bundle should not be in a particular instance, for a particular patient, on a particular day.
A high-risk colonoscopy is covered every 24 months and a low-risk colonoscopy is covered once every 10 years, so using the right code for each is important. Without a diagnosis to support high-risk patients, the service will not be paid.