Laureen shows you her proprietary “Bubbling and Highlighting Technique”
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Guidelines and auditing tools help with the decision-making process involved in coding E/M services. Selecting evaluation and management (E/M) service levels in the emergency department (ED) can be a challenge, and the medical decision making (MDM) component is particularly difficult to score. E/M service guidelines are defined separately in the CPT® code book, by the […]
The post Evaluate Medical Decision Making in the Emergency Department appeared first on AAPC Knowledge Center.
JustCoding’s Emergency Department Coding, by Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, is a quick reference guide for coders in emergency department (ED) settings. It guides coders through assigning visit levels and documentation requirements for a variety of common ED services. The handbook also includes anatomical illustrations for fractures.
For more information or to order, call 800-650-6787 and mention Source Code EZINEAD or visit the HCPro Healthcare Marketplace.
In April, the Government released last year’s accomplishments for their work in Healthcare Fraud and Abuse. In 2017 $ 2.6 billion was returned to the Federal Government or paid to private persons. Specifically; $ 1.4 billion was returned to the Medicare Trust Funds and $ 406.7 million was returned to Medicaid programs. Yes, that means that over $ 1 million dollars was paid to Qui Tam relators or put into resources to continue to fight fraud and abuse.
A staggering 967 investigations were opened in 2017 resulting in criminal charges filed for 439 cases involving 720 defendants. This resulted in 639 convictions which is an impressive 88.7% conviction rate. In addition 818 civil actions were filed.
Another interesting statistic was the high number of healthcare exclusions that were published. There were a total of 1,281 healthcare exclusions. They stated that 309 of those exclusions were related to patient abuse or neglect and 972 were a result of licensure revocations.
The post Report from the Department of Justice Fraud & Abuse Control for 2017 sheds light upon the importance of compliance appeared first on The Coding Network.
I code for 6 clinics in Oregon that primarily deal with worker’s comp insurance and I deal with a lot of WC insurance such SAIF, Sedgwick, Gallagher Bassett, Travelers, Broadspire, Corvel, Matrix, etc. We also bill to US Department of Labor as well but I’ve been having a difficult time getting paid by them. Can anyone who has dealt with them give me some pointers on how to deal with them/get paid or at least how I submit appeals or disputes to get paid? I know they are a federal WC insurance so they are not under the state’s jurisdiction. I even have trouble getting a claim/case file number from USDL as they state they cannot give out that information/refuse to give that info out. Any help would be great!
Thank you very much for any advise and recommendation. 
If it is the provider’s responsibility to document that a pregnancy is incidental to the Emergency Room encounter, I assume that all encounters that are not documented as such are to be coded from Chapter 15 of the ICD 10.
If the patient is 38 years old, would it be appropriate to use Supervision of High Risk Pregnancy – Elderly Primigravida or Multigravida on the ED encounter, or is "Supervision" for use by OB/GYN?
Thanks you,
Sue
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