Can’t I justify a service with a fourth-digit diagnosis code instead of the carrier’s fifth-digit code to describe the patient’s condition?

You can’t justify a service with a fourth-digit diagnosis code when carriers require a more specific fifth-digit code to describe the patient’s condition.
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Coding is confusing and time consuming. Can’t I leave coding entirely in staff’s hands?

You will probably never like coding. But you’ll need to know the basics and be able to speak the language of coding. Why?
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How can I evaluate potential miscoding of evaluation and management procedures in a practice?

By comparing the procedures that doctors perform to the largest national database describing patient care, a practice can evaluate potential miscoding of evaluation
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How can I motivate my staff to better select diagnosis codes for claims?

Only you, not a staffer, should select diagnosis codes for claims. An exception is if you have a certified professional coder on staff, and you’ve given him or her the responsibility to abstract the records.
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How many different coding systems do I need to use when submitting reimbursement claims?

Reimbursement claims actually require the use of two coding systems: one that identifies the patient’s disease or physical state (the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM, codes)
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I could skip a lot of the coding hassle by billing for services at a level higher than the documentation supports, right?

Billing for services at a level higher than the documentation supports is considered up coding. Being accused of up coding is mortifying, especially when it is not intended.
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I was under the impression that only egregious coding errors can result in fraud charges, is that the case?

Even if you are meticulous in your coding, you still might miss the one Medicare document that says you can’t do a particular thing,” says Pittsburgh attorney William Maruca, chair of the American Health Lawyers Association’s group on fraud and abuse.
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I’m aware that modifiers are used to indicate a procedure has been altered, etc., but how else are they used?

Modifiers may be used to indicate to the recipient of a report that:
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I’m aware that modifiers are used to indicate a procedure has been altered, etc., but how else are they used?

Modifiers may be used to indicate to the recipient of a report that:
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We have certified professional coders on staff. Why can’t they assume a diagnosis based on my specific treatment or prescription?

If you have certified professional coders on staff, and you’ve given them the responsibility to abstract the records, make sure they don’t assume a diagnosis based on your specific treatment or prescription.
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Coding & Compliance- Launch Your Career® for Residents and Fellows