How to research coding questions

June 1st, 2015 - Christina Benjamin
Categories:   Billing   CPT® Coding   Diagnosis Coding   Evaluation & Management (E/M)   HCPCS Coding  
0 Votes - Sign in to vote or comment.

How to Research Answers to Coding Questions

  1. Perform a search of the discussion board or listserv website prior to posting a new question.  For your search terms, include specific words such as the diagnostic statement or procedure statement or the specific code number or the words “ICD-9 code” or “CPT® code.” Use quotation marks as necessary to limit your search further.  This same searching technique can be applied to general Google searches as well.  For Codapedia, the search box is clearly visible and oftentimes articles that are pertinent to hot topics are already posted and may have the answer that you are looking for.  If you want to see an extensive list of the available articles in Codapedia, use the search term "Codapedia Editor."  This brings up all the articles written by the original codapedia editors.  Articles contributed by other specified individuals will not show up from this search.
     
  2. If a search fails to reveal the specific information you are seeking, try posting a new question.  Here are some tips for posting or asking a question.
    1. Always remember that per HIPAA laws, no personally identifying patient information should be submitted via any forum or website.  Also, be sure to read the terms or guidelines for the usage of the listserv or forum prior to posting your question.  These guidelines also give you information on how to unsubscribe to the forum or listserv or discussion board if you wish negating the need to post a request to the whole forum to be unsubscribed.  Also, the directions to unsubscribe are almost always at the bottom of every email that you receive from any listserv including Codapedia’s listserv.
    2. It is also easy to make this mistake; you are in the middle of coding or billing and you have your CAPs lock on because the system requires it and then you run out to a forum and start typing in all caps without realizing it…it only takes a second to hit the caps lock button before typing the message and to hit it again when you are done and are back to your system that you were working in.
    3. Subject line note: for a discussion board or listserv, be sure to post a descriptive subject line for your question and be sure to identify the most appropriate area of the board for the nature of your question.  Don’t tag your question onto and older post that had nothing to do with your topic; change the subject line if the discussion topic changes within a thread or better yet start a new thread if possible.  Keep all replies to any answers you receive on that same discussion thread instead of starting a new one so that others can follow the discussion.  Often the discussion groups are divided by coding specialty or organized in some other way.  Otherwise a descriptive subject line describes the nature of your question such as “coding knee arthroscopy.”  Non-descriptive subject line examples include just listing  “your name” or  putting the term “coding question”  or “CPT® coding help” or “Help” etc. You may have to repost your question or directly email one of the experts on the board who answers many of the questions if you don’t get a response after a few days.
    4. It is recommended that you ask only one question at a time; multiple questions can be confusing and all of them may not be recognized by the colleague responding to you
    5. It is recommended that you provide as much detail about the medical record documentation that you have when submitting your inquiry without providing any personally identifying patient information, of course.  Such as an extensive excerpt of the operative note for a CPT® or ICD-9 procedure code. 
    1. It is recommended that you list the kind of payer involved, if possible or applicable
    2. It is recommended that you list the state in which the provider and payer are located as each this can have an effect on the billing and coding rules and reporting requirements
    3. It is recommended that you specify the setting for which you are coding or billing for (facility fees on the UB-04 or professional fees on the CMS 1500; inpatient—acute care or emergency department or skilled nursing facility, etc.)
    4. It is recommended that you specify the type of coding guidance that you need (ICD-9 diagnosis code, ICD-9 procedure code, CPT® procedure code, both ICD-9 and CPT® procedure code, ICD-9 diagnosis code and CPT® procedure code, etc.)
  1. Remember that the advice given by anyone other than by an official source is not to be considered authoritative or legal.  It is given only as a professional opinion and you are solely responsible for final code assignment and other reimbursement-related decisions.  Here are some tips on how to evaluate answers you may be given.
    1. Don’t just take the answer; think it through and carefully evaluate it!
    2. Note whether the response included official references or is consistent with basic coding rules/guidelines or whether it was simply an opinion, from experience, insurance specific, facility policy specific answer
    3. If necessary, do further research and ask other sources.  Nothing is wrong with getting a second or more opinion.  As you gain experience with different sources, you will be able to determine what the best sources are.  Don’t be afraid to professionally (not critically) challenge any advice given with further questions.
    4. Use your gut! Learn to fine tune your personal judgment skills and to constantly reevaluate advice you have received on confusing coding issues.  This is a sort of safety measure to catch anything inaccurate or faulty that you may have inadvertently picked up along the way and it will help to improve confidence in your own judgment.  
    5. It is my personal practice to make computerized notes of many of the answers I have received along with any references given for these answers.  It is important to have a separate electronic personal file that you can keep with you so that you can readily search the file in the future if the question comes up again.  You can also review the entire file periodically for errors and to update it with any new information as it comes available.  This electronic file will also help you to apply previous answers given to future questions when appropriate.  The goal is to detect patterns and principles so that you can apply them for new situations.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

​​Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association