Are You Well Acquainted with the New ICD-9 Codes?

October 1 brought many changes and we hope that you have made yourself well acquainted with the latest ICD-9 changes . Pediatric diagnosis code changes aren't plentiful this year, but there are still quite a few that could result in denied claims if you don't update your forms.

The quiz below is on the new, revised, and deleted codes and will certainly help you decide whether you're on the right track or if you require reviewing your ICD-9 coding skills.

Pin down Flu Codes

Question 1: A 12-year-old patient come with influenza because of recognized novel influenza A virus along with pneumonia. Which code are you supposed to report?

A. 487.0

B. 488.01

C. 488.81

D. 488.82

Answer: C. From Oct. 1, you'll have advantage from novel code 488.81 (Influenza due to identified novel influenza A virus with pneumonia) to define this condition. Earlier, you most probably would have used 487.0 (Influenza with pneumonia), however that code didn't identify the nature of influenza A.

The ICD-9 Committee has reviewed the influenza codes many years in a row now, which may make coding these particular conditions a bit challenging, however the most significant element to remember while reporting these illnesses is to study the documentation for validation of the kind of influenza that the patient has. When uncertain, check any lab reports or inquire the physician to explain.

Remember: You'll also see revised diagnosis code descriptors for the H1N1 codes, as following:

488.11 - i.e. Influenza because of identified 2009 H1N1 influenza virus along with pneumonia

488.12 - i.e. Influenza because of identified 2009 H1N1 influenza virus along with further respiratory manifestations

488.19 -- i.e. Influenza because of identified 2009 H1N1 influenza virus along with further manifestations

Curb TB Test Confusion

Question 2: A patient comes for a tuberculosis skin test. The consequences come back presentating that the patient went through a reaction to the test, though does not have active tuberculosis. Which code are you supposed to report?

A. 795.51

B. 795.5

C. 795.4

D. 795.52

Answer: A. From Oct. 1, the ICD-9 code listing will remove nonspecific code 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis) and substitute it with two more definite codes, one of which is the correct answer to the above question, 795.51 (Nonspecific reaction to tuberculin skin test without active tuberculosis).

ICD-9 will also present code 795.52 (Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis) to distinct out the former 795.5 category.

Migrate To 5010 form before Hopping into ICD-10 Bandwagon

As ICD-10 goes into effect on October 1, 2013, you will need to start your transition with a piece of health insurance reform legislation called 'Version 5010'. This form lays out the technical electronic transaction standards mandated for Health Insurance Portability & Accountability Act of 1996 (HIPAA) transactions and includes requirements for transmission of claims and payment data using the soon-to-go-into effect ICD-10 code set. This form will affect almost everyone involved in healthcare transactions.

Why 5010 form?

The present system version 4010/4010A1 lacks functionality for some transactions; more importantly, it does not accommodate the ICD-10 code set. This system will therefore be replaced by version 5010 for eligibility enquiries and remittance advices. The new version will take up various problems and complexities found in the earlier version. Additionally, the just-in form also comes with other diagnosis reporting advantages.

When: Although Centers for Medicare & Medicaid (CMS) has started accepting 5010 forms from January 1, 2011, the deadline for you to start using this form is January 1, 2012.

Need of the hour: However, it's being seen that too many billers and providers are taking this deadline casually. What happens in case you fail to submit the 5010 form by the set deadline? When that happens, you will no longer be able to submit electronic transactions to Medicare; you will also receive delayed or reduced payments, audits will frequent you and your practice and there are chances your relationship with your vendors and payers will turn sour. What's more, your practice is also likely to witness a dip in productivity in case of a failure to use this form.

Communicate with your vendors immediately: So if you want to switch to 5010 format successfully, you need to communicate with your vendors first.

Four additional ways to help EPs duck E-prescribing Penalty

According to a new proposal, EPs would be eligible to request for hardship exemption till October 1, 2011.

Next year, you may be subject to a one percent payment adjustment on your Part B payments if you don't get onboard the e-prescribing bandwagon in 2011. This payment adjustment will keep going up with each year - 1.5 percent in 2013 and 2 percent in 2014.

Exemption criteria too limited? Although the agency had laid down that practitioners could evade the penalty, practitioners were not too happy as they found the exemptions were too limited and did not include realistic situations. Taking this into consideration, the agency has come up with four more ways eligible professionals can avoid the penalty:

New proposal aims to exempt those who have just got their technology in place or are getting it in position

The agency's new proposal will offer exemption to those practitioners who have just got their technology in place or are in the process of doing so as they may not have e-prescribed ten times within the first half of the current year.

Physicians who prescribe narcotics or medications that cannot be transmitted electronically will get a breather

Secondly, there are many physicians who prescribe narcotics. Practices that prescribe large quantities of these drugs may find that they cannot take the electronic way even if they wanted to participate in it.

Patients who do not need to prescribe medications for several reasons are likely to get hardship exemption

Some practitioners seem like they're eligible for the penalty because they carry out enough visits; however that may not be the reality because chances are they may not prescribe medications for several reasons. Keeping this in mind, the agency is proposing that the physicians and other EPs be allowed to send a request for a hardship exemption.

Not enough opportunities to report the e-prescribing measure owing to limitations in the measure's denominator

Sometimes it may so happen that a surgeon may prescribe electronically but the prescriptions may not be associated with the kind of visits that the e-prescribing measure's denominators include. The new proposal comes to rescue of these physician.

Stay tuned to CPT 2010 & other changes

CPT 2010 is just round the corner. Are you ready for the sea of changes it will bring with it this time round?


American Medical Association (AMA) is planning to come up with lots of changes. They have said that they will work to reduce the confusion that has been created in the past when a new code is added in a section that has run out of numbers. AMA is naming the new process ‘resequencing’, which can be used in rare occasions.


AMA has also released some information relating to H1N1 codes and data structure. In reply to an urgent request from the Department of Health and Human Services, the CPT Editorial panel voted to create a new code and to revise another to use for reporting for H1N1 virus. These changes were approved by the panel on September 25, 2009. Since these changes were made so late in the year, you will not find them in the 2010 CPT code book. But chances are you’ll find these codes in the 2011 CPT code book.


How do you keep yourself informed of the latest CPT and other changes if they are not to be found anywhere in the CPT code book? You can go for CPT coding online information. For this, you can sign up for a one-stop medical coding website and have access to the entire gamut of CPT changes and information.

Stay informed of 2010 CPT codes and avoid claim errors

The average salary for an entry-level coder was around $30,000 in 2003, with some facilities offering higher salaries to well-trained individuals with experience and certification. As per the prediction of the US Department of Labor, the overall numbers of careers in medical information technology will have increased by almost 50 per cent between 2003 and 2010. Current Procedural Terminology (CPT) coders are one of the key components of this ever-growing job market.


Come January 1, 2010, and CPT code set will include several changes of interest to Ob-Gyns, including guideline clarifications in addition to new, revised and deleted codes. Owing to the HIPAA requirements, insurers must accept new codes starting January 1, 2010.


And with more than 500 CPT code changes likely for the year 2010, it’s important that you keep yourself update with what’s new, what’s been revised and what’s been done away with to keep your payments intact.


For all the 2010 AMA CPT codes, there are various one-stop medical coding websites where you can head to. When you sign up at http://www.SuperCoder.com , you’ll know what to stop using, what to start using, what you might have to use differently, and the like. In other words, such websites will certainly help you prepare to avoid claim errors and lost reimbursement.

Specialty-specific medical coding survival guides to your rescue

Thousands of people have made coding their lifelong career path, got certified and started their own medical services from the comforts of their homes. But it’s not that easy to survive the tough challenges that a medical coder has to put up with. Making sure your coding is compliant is a never-ending task.


To stay on top of your coding game, there are various medical coding survival guides, which are easy to read and tailored specifically to select the appropriate code every time. So whether you’re coding for cardiology, orthopedic, Ob-Gyn, or any other specialty, there are medical coding survival guides to help you sail through.


You can get specialty-specific medical coding survival guides both in print and online formats. For the online version, there are one-stop coding websites which come loaded with survival guides. Evaluation and management survival guide, ICD-9 update guide, modifier coding survival guide, Pediatric coders survival guide, et al - All you need to do is register for a one-stop coding website and take your pick.


These guides are sure shot ways to brush up the coding essentials for your specialty. They come packed with practical tips, strategies and every trick of the trade to help you wriggle out of your coding woes. In other words they just teach you to survive difficult coding situations so that you don’t miss out on your rightful reimbursements.


So whether you’re coding for cardiology, orthopedic or any other specialty, medical coding survival guides will certainly help you survive the toughest coding challenges.


With these survival guides around, medical coding has never been easier!

What you need is a one-stop medical codes look up system

The online world has a number of medical codes look up system, but most of them are difficult to use and is tough on the pocket of the average physician practice. What you really need here is a tool that is affordable, easy to use, and packed with top-notch information.


There are a few one-stop online shops for medical coders which are however simple, providing you with instant connection to official medical code descriptors and guidelines.


Such websites also provide you with how-to-articles, discussion forums, CMS references, CCI bundles and a host of other tools to help the medical coder in you perform your every day duty and excel in it too. All you need to do is insert a keyword or code and the website does the rest of the work for you.


What’s more when you sign up for such a website, you’ll get opportunities to get CEUs which in turn will keep your certifications current.


The medical coding and billing world is changing at a fast pace and to keep pace with it, you need a one-stop shop which will provide you with just the right tools to keep you on track – one place which will provide you with all the important news, updates and insurance changes needed to keep your practice compliant and profitable.

Evaluation and management coding: A low down

Evaluation and Management (E&M) services are those services provided by physicians and non-physician practitioners to weigh up patients and manage their care. The important components of evaluation and management services are history, examination and medical decision-making. When it comes to history, you need to be careful of over documentation; every office visit does not require a detailed history.


Evaluation and Management coding is an important part of the hospital’s revenue cycle; therefore it’s essential that these codes are reported accurately. It’s also on the Office of Inspector General’s (OIG) radar. As such, it’s all the more important now than ever to accurately report these codes. Conducting an Evaluation & Management audit will help your practice boost its revenue.


Challenges of Evaluation and Management Coding:


• Well-trained E&M coding coders are not found easily and demand high salaries

• Few E&M coders are certified

• Coding guidelines for E/M services are complex, change often and errors can be costly to the practice


Advanced management strategies: You need to understand the E/M guidelines for accurate and appropriate coding no doubt, but understanding how to benchmark E/M utilization is the key to developing advanced management strategies. This is inclusive of compliance risk assessments, financial impact analyses, etc.


Evaluation and management services guide: There are one-stop shops where you can get expert solutions to all your evaluation and management coding queries. So go for one and enhance compliance and recognize areas of risk at your practice, identify patterns of undercoding and upcoding, spot revenue opportunities and of course improve your documentation!

CPT codes: How to get started

In order to use Current Procedural Terminology (CPT) coding, you’ll need to have sound knowledge in the general medical parlance. This is inclusive of medical terminology basics as well as a good understanding of human anatomy and physiology. CPT is segmented into three categories of codes:


• Category I: These are procedures that are consistent with contemporary medical practice and are used extensively.


• Category II: These are supplementing tracking codes that can be used for performance measures.


• Category III: These are temporary codes for emerging technology, services and procedures.


There are several sources of access for the CPT codes, both online and offline. You can check out a CPT coding website, which offers free study guides, tutorials and assessments that can help you in your understanding of specific CPT codes and the overall coding process.


Instead of looking at CPT coding as one big picture, it makes more sense to break it down into smaller ones that are easier to comprehend. You need to spend a fair amount of time learning about Category I codes before moving on to the others. This will give you a solid foundation and the confidence to go further. You’ll also get more insight by visiting the websites of different insurance companies, CMS, and others.

Tips to fill health insurance claim forms

Filling a health insurance claim form is not too difficult a task, but some people do run into troubled waters while doing so. Keeping a few things in mind will certainly help you file your claim better so that you don’t land in any spot.



Before you get your health insurance claim form, the first thing that you need to procure is an itemized bill from your doctor, listing all the services that he has provided you with along with the cost of each of those services. This is something that you will need to attach to your health insurance claim form.



After this, reach out to your health insurance company to procure a health insurance claim form. If you have any query, get them clarified then and there before filling up the form. It will question you on things such as insurance information, what was the visit for, among other things.




After you’re done with filling up the claim form, make sure you keep duplicate copies of the filled out form as well as of the itemized bill obtained from your doctor. This will do away with any error that may be made in the claim process and make your task easier in case your health insurance claim gets lost. In fact make copies of everything that is going to be involved in the process.



Last but not the least, a very important part of the process is to review it. See to it that everything’s in place before you send it off because you wouldn’t want even a small mistake to throw things out of gear. Find out how long it’s going to take it get backs to you.



Following these tips while filling up health insurance claim forms is certainly the way to go!