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Avoid losing revenue and patients through poor customer service. The insurance verification process confirms patient eligibility and benefits and must be done before the patient is seen by the provider. Failure to perform this step or allowing untrained staff to perform this step can cause a medical practice to lose revenue and patients. An Example […]
The post The Right Way to Conduct Insurance Verification appeared first on AAPC Knowledge Center.
Picking the right coding vendor can be challenging. There so many options and they all tell you they offer accurate coding to ensure revenue optimization and compliance risk minimization. To help you select the right coding vendor, we have compiled some considerations to help narrow down your decision.
Always ask if the codes that they use are specialty specific. Generalist coders are unable to provide the most accurate coding possible and some multi-specialty coding vendors have coders working across multiple unrelated specialties. The best multispecialty coding vendors only utilize specialty specific coders and will not let their coders handle materials they are not only unfamiliar with but also do not have the requisite experience in. It is also important to make sure that specific coders will be assigned to your account, this helps ensure that if there are disputes or disagreements coders can be held accountable for their work.
Additionally, it is wise to ask about their hiring criteria. Look for answers that stress single specialty experience. Just as important is whether or not the vendor is validating the caliber of the coder. This is primarily done in two ways: 1) prior to the engagement of the coder by the vendor, testing them up front to see that they have the requisite skills to code in a particular specialty irrespective of their job experience coding in that discipline, and 2) ongoing coding audits of the coders to validate that they are maintaining their proficiency in that specialty.
Of great import is to ensure that there is a contractual guarantee that all coding work is performed in the USA. Offshore coding opens the group up to both accuracy and privacy/security issues. We have also seen companies pull a bait and switch on their clients for vendors that operate a mixed model of possessing both onshore and offshore coders. They have US based coders to handle dispute, questions, and customer service, but they will send the bulk of their day-to-day work offshore. Getting a contractual agreement stating that all coding work is US based provides you as the client with more control and greater sense of security that the coders performing work for you are the ones you wanted when you selected the vendor.
These considerations are not all inclusive but should allow for a solid foundation for your coding vendor search.
The post Picking the Right Coding Vendor appeared first on The Coding Network.
Step #1 – Hold an officers’ meeting right away: Get acquainted with one another. The most successful chapters have leaders who work as a team and communicate openly. Together, review the responsibilities and general expectations of each officer as outlined in the 2020 AAPC Local Chapter Handbook. Allow each person to fulfill his or her […]
The post Here’s What Wise Officers Will Do Right Away appeared first on AAPC Knowledge Center.
Timing is everything when defining and capturing the 7th character in an ICD-10-CM code. ICD-10-CM brought about new concepts for diagnosis coding, with some being straightforward and others being a bit confusing when interpreting the guidelines. One concept that is often debated is how to select the correct seventh character, representing the episode of care. […]
The post Select the Right Episode of Care Every Time appeared first on AAPC Knowledge Center.
Intraoperative findings:
TEE showed severe left ventricular dysfunction with global hypokinesis. Aortic valve was a trileaflet valve with no insufficiency or stenosis. Limited TEE was performed for the purposes of placement of the ventricular assist device. After placement of the device, the device was positioned appropriately across the aortic valve.
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On fluoroscopy, the final resting position of the percutaneous left ventricular assist device had the elbow of the device positioned at the level of the aortic valve. Device was functioning appropriately.
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Procedure in detail:
The patient had his history and physical updated prior to the procedure. He was transferred to the operating suite and placed on the operating table where he underwent general anesthesia. The patient was already endotracheally intubated.the right shoulder and chest were prepped and draped in usual sterile fashion using DuraPrep solution after TEE probe was inserted by anesthesia. Timeout was used confirm patient identity as well as the surgery to be performed. Antibiotics given prior the incision. Next
The right axillary artery cutdown was performed by Dr. X. Once this was completed, the right actually artery was exposed and proximal distal vessel loops were placed. I then took over the operation. The patient was anticoagulated with ACT greater than 250 seconds after giving heparin. Proximal distal control of the axillary artery was performed. A longitudinal arteriotomy was then made and extended with angled scissors. A 6 mm Dacron graft was then beveled and anastomosed using 6-0 Prolene. Once this was completed, the graft was de-aired.
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The introducer sheath was then placed within the 6 mm graft and secured. The dilator was removed. The graft was de-aired and then carefully flushed with hep saline. J-wire was then introduced and advanced into the Aortic arch under fluoroscopic guidance. The pigtail catheter was inserted over the wire and positioned within the aortic arch, then used to manipulate the wire into the aortic root. The pigtail catheter was then positioned within the aortic root and the wire was carefully advanced across the aortic valve under fluoroscopic and TEE guidance. Pigtail catheter was advanced into the left ventricle. The J-wire was removed and the 018 guidewire was then placed within the left ventricle. Next
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The ventricular assist device then placed over wire and advanced in position within the left ventricle using fluoroscopic and TEE guidance. The wire was removed. The device was started, with excellent flows, improvement in the mean arterial pressure,as well as good motor current. The 6 mm graft was then trimmed to just above the level of the skin. The peel-away sheath was removed. The positioning sheath was then inserted and secured with 0 Ethibond and 0 silk. The Impala device was then secured with final fluoroscopic Evaluation used to pull the Impala back slightly as it had advanced during these maneuvers. Once this was completed, the soft tissues reapproximated with 0 Vicryl. The skin was closed with 4-0 Monocryl in running subcuticular manner. Dermabond was placed over the wound. The patient tolerated procedure well was transferred to CVRU in critical condition.
IMPELLA 33990
axillary cutdown by DR X?
axillary graft?
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PRE-OP DX: ischemic ULCER RIGHT LATERAL FOOT
post-op dx: osteomyelitis WITH ISCHEMIC ULCERATION OF RIGHT LATERAL FOOT INVOLVING 4TH AND 5TH METATARSAL AND CUBOID BON
Performed:
1) debridement of right foot to include skin & soft tissue and cuboid bone right foot.
2)Right 5th metatarsal resection, partial
3) right 4th metatarsal resection, partial
Description: (extraction of pertinent verbiage). Ischemic ulceration was then debrided over the lateral foot. This clearly involve the 5th metartarsal bone.
Wound did extend more medially w/involvement of the cuboid bone as well as the 4th metatarsal. These were all sharply debrided back with a rongeur and
the 5th metatarsal was resected along with a portion of the 4th metatarsal. Would was packed w/saline-good bleeding was appreciated from wound bed.
My efforts: I see a debridement here in #1, but not sure about the two codes for #2 and #3. I’m thinking 28122, 28122. (The 5th metatarsal was resected, with a portion
of 4th?), so not sure about choosing the same code for both procedures when one was a partial.
Can anyone offer guidance?
Please any ones help would be greatly appreciated.
…curvilinear incision was made over the mass and this was made with an 15 blade and carried down through subcutaneous tissue with a curved iris scissor. There was evidence of a cystic capsule…no fluid. Capsule appeared to be within the auricular cartilage. This was dissected out removing the entire capsule, leaving a defect within the cartilage. Skin remained uninvolved. Bleeding controlled with bipolar cautery. Deep dermis was closed with 4-0 monocryl and the skin was closed with 4-0 prolene in a running fashion. A bolster was applied using Xeroform gauze placed inot the anterior and posterior aspects of the pinna to prevent hematoma. This was sutured in place with 2-0 silk.
TIA
KM
PROCEDURE: Open repair of incarcerated right inguinal hernia with mesh (3 x 6 inch polypropylene onlay) incidental appendectomy.
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SPECIMENS: 1. Incidental appendectomy 2. Hernia sac
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A right inguinal incision was performed in a standard fashion and carried down to the superior aspect of the scrotum. Subcutaneous tissue was incised through Scarpa’s layer to the external oblique fascia. A large sac was identified communicating with the cantaloupe sized scrotal hernia. The external oblique fascia was incised from the external to the internal ring. Attenuated internal oblique musculature overlying the sac was divided with the electrocautery. The sac was then incised. This allowed for manipulation of the sac contents away from the edges of the sac so that it could be dissected free from the spermatic cord. The spermatic cord structures were identified and protected throughout the case as were the sensory nerves of the inguinal canal. 1/4 inch Penrose drain was placed about the spermatic cord. The enlarged sac was dissected back to the dilated internal ring. At this point the patient was placed in Trendelenburg position and sac contents were reduced. Prior to reduction of the cecum, an elongated normal-appearing appendix was removed by first ligating the mesoappendix and tying off the vessels with interrupted 2-0 silk. The base of this appendix was clamped and the appendix was excised. The base of the appendix was tied off with 0 silk suture and the tip of the base was electrocauterized. Following reduction of the sac contents, it was identified that there was a large internal ring that required support.
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A 3 x 6 inch polypropylene mesh was then placed within the inguinal canal. It was sutured in place with interrupted 2-0 Vicryl, to the Cooper’s ligament medially and along the reflected edge of the inguinal ligament inferiorly. The mesh was split laterally allowing the cord to lie anterior to the mesh. The mesh was sutured superior medially to the conjoined tendon. The tails were brought together laterally, recreating an internal ring. The tails were tucked under the external oblique fascia.
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The dead space within the scrotum was inspected. The edges of the peritoneal sac were cauterized. 1/2 inch Penrose drain was placed in the dead space and brought out through the inferior aspect of the scrotum via a stab incision and sutured in place with 3-0 nylon. The drain was left within the scrotum and the soft tissue surrounding the drain, superiorly was closed off from the inguinal canal using a pursestring suture of 2-0 chromic, to prevent communication of the drain with the mesh. Prior to this, the wound and the scrotum were irrigated thoroughly with warm saline and hemostasis was obtained. The closure was with a running 2-0 Polysorb and the external oblique fascia. Scarpa’s layer was closed with interrupted 2-0 chromic. The skin was closed with staples. A sterile gauze dressing was applied and secured with Medipore tape. The wound was infiltrated with 0.25% Marcaine with epinephrine, 30 mL. A scrotal support was placed with gauze. The patient tolerated the procedure well and was taken to the recovery room stable.
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