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Coding & Compliance- Launch Your Career® for Residents and Fellows

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.
Read more…

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?
Read more…

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
Read more…

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.
Read more…

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)
Read more…

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.
Read more…

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.
Read more…

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:
Read more…

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:
Read more…

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.
Read more…

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  • Executive
    Search


    • Our Process
    • Child Health Practice
    • Adult Health Practice
    • Our Results
      • Chiefs, Chairs & C-Suite Results
      • Subspecialty Results
    • Testimonials


  • Leadership
    Development


    • Core Leadership Competencies
      • Business of Medicine
      • Healthy Cultures
      • Clinical Excellence
      • Diversity
      • Education
      • Leadership
      • Advocacy & Mentorship
      • Philanthropy
      • Recruitment & Retention
      • Research
    • Launch Your Career® for Trainees
    • Search-based Reviews
    • New Leader Engagement Program
    • Department & Division Strategy
    • Succession Planning


  • Pediatric
    Insight


    • Insight Conversations
    • Insight Webinars
    • Insight Articles


  • Child Health
    Advisory Council


    • Child Health Advisory Council
    • Council Leadership
      • Bruder Stapleton, MD
      • Christine Gleason, MD
      • Craig Hillemeier, MD
      • Renée Jenkins, MD
      • Danielle Laraque-Arena, MD
      • Valerie Opipari, MD
      • Bruce Rubin, MD
      • Robert S. Sawin, MD
      • Arnold Strauss, MD


  • Our
    Company


    • About Us
    • Our Team
    • News
    • Testimonials