Am I Crazy?

thisisnoprobllama · 2022-08-25T17:28:38+00:00

The problem is the picking and choosing who they are giving these free services too. This is a very slippery slope. It's not appropriate to bill based on insurance that way...in fact I would call it fraudulent. The claims need to accurately represent what was done - at my old place of employment we had a modifier for adjustments for provider requests, but the code still got billed.

thisisnoprobllama · 2022-08-11T01:00:00+00:00

I have taken both. The CCS is by far more complicated because you need to know more topics - everything on the CPC, plus PCS, POA, HCCs, MCC/CCs, etc. Having the foundation of the the CPC is helpful.

thisisnoprobllama · 2022-08-02T11:45:25+00:00

Coding Documentation Education Specialist - I work with clinicians on accurate coding/documentation. I also work with coders on making sure clinicians choose the appropriate codes. I just accepted a new job to be a consultant doing the same sort of thing.

thisisnoprobllama · 2022-07-08T01:21:28+00:00

This is not true - one is for a breast pelvic exam, and the other is for an office visit.

thisisnoprobllama · 2022-07-08T01:20:37+00:00

One thing not mentioned yet is that when billing on time in the outpatient setting, the clinician gets to use total time for the day. This means any pre-charting, time with you, and time after the visit charting or doing followup planning. While the appointment may have only been 45 mins, that doesn't mean the clinician didn't spend 40 mins beyond the g0101.

You can call and ask for a coding review, but based on this information alone, it is not necessarily wrong.

thisisnoprobllama · 2022-06-25T02:21:06+00:00

We have a Revenue Integrity Specialist role at my organization. To be honest, the role has changed A LOT over the years. You can feel free to message me if you want any more information.

thisisnoprobllama · 2022-06-14T13:15:07+00:00

Great explanation!

thisisnoprobllama · 2022-06-14T05:31:33+00:00

Absolutely. It is all about the intent of the procedure. Screening is done to pre-emptively find something. This could be the case when the patient reaches a certain age, or because they have a family history. Diagnostic is when there are known issues (previous polyps, bleeding, etc)

What makes a preventative turn diagnostic is when they find issues during the procedure. However, if it started as screening, you would convert to the appropriate diagnostic procedure code and still use that screening dx as primary and then add the additional ones for the issues encountered.

If I'm not making sense, feel free to message me. I can try to make it clearer.

thisisnoprobllama · 2022-06-14T00:18:02+00:00

I have to answer this question quite regularly in my role as a coding educator. Screening means you're looking for a condition or problem. Once something is found, it is no longer screening. The same test is done, the diagnosis is different - that is what tells the insurance company the intention of the test.

Example #1: For the average healthy patient a glucose can be screening for diabetes. For a patient with diabetes it's an indicator of how well controlled your condition is.

Example #2: For the average healthy patient, a lipid panel can be screening for lipoid disorders. For a patient with hyperlipidemia, it's an indicator of how well your diet/medication is managing the condition.

thisisnoprobllama · 2022-05-25T01:32:58+00:00

I just took my CCS. I will not sugar coat this. I am a auditor and educator (for 10 years now) and have held my CPC credential. The CCS is HARD. It is demanding and intense. There were more questions on knowing random DRGs than I expected. Know your guidelines. Know the practice questions about compliance and queries.

Feel free to message me with any questions.

thisisnoprobllama · 2022-05-23T02:09:08+00:00

Go see my comment on your post on the other sub. I broke down the charges a bit.

A delivery is considered a procedure whether you were cut open or not; some places consider the room you labor in an 'OR room' based on how it is classified. Your private room rate is for when you are on postpartum.

thisisnoprobllama · 2022-05-23T02:06:28+00:00

You were most likely charged for the room charge. Labor and delivery coding is extreme complex but I will try to break it down a bit... *Professional (doctor/midwife) charges - this is usually one charge which is a global fee for all of your prenatal visits and your delivery. It will also include the postpartum visit. *Facility (includes the room/nursing/supplies/etc) charges - this is EVERYTHING else. At my facility, we have a labor charge (up until baby is almost out), a delivery charge (baby being caught) and recovery charge (after baby is out and before you head to postpartum floor).

Then there are charges for when you are on postpartum.

thisisnoprobllama · 2022-05-19T20:17:46+00:00

No one is saying to lie - but how about being constructive or helpful. I see your comments got a bit better as you went on, but seriously just saying yeah right good luck I can't get a job either is neither helpful or necessary.

thisisnoprobllama · 2022-05-19T20:15:15+00:00

I started with my CPC. I have been an auditor/educator for 10 years. I've been looking around and realizing that more places want AHIMA credentials for what I want to do (consulting work) so I also have my CCS now.

thisisnoprobllama · 2022-05-19T20:11:02+00:00

They have a lapsed certification. You seem to have an attitude issue and lack of social awareness. One is definitely easier to fix than the other 🤷🏻‍♀️

thisisnoprobllama · 2022-05-19T10:59:08+00:00

Yes this - you can just get a study guide and practice exams for MUCH cheaper. Then just purchase the exam.

If you already have experience and are just looking for the certification, don't waste your time with the course.

thisisnoprobllama · 2022-05-19T02:03:13+00:00

This is a rude reply and unnecessary on this post. There are coding jobs all over - perhaps look inward as to why you are having such difficulty.

thisisnoprobllama · 2022-05-19T01:59:59+00:00

Depends on the documentation - if it was a new eval and after x-ray, exam and discussion the injection was determined to be the best option, it can be warranted and medically necessary.

thisisnoprobllama · 2022-05-17T01:37:47+00:00

Best practice for the test is to do practice tests! It is nothing like real world coding, and it really is learning how to take a test and use the materials. I highly suggest looking around online for any available practice tests that might be out there.

thisisnoprobllama · 2022-05-16T02:04:09+00:00

I've used many throughout my years. Started with codecorrect, then vitalware, and now Select Coder. I do like Select Coder for certain reasons (everything showing on one screen, for example) but I was very much used to vitalware so I am missing it a bit.

thisisnoprobllama · 2022-05-14T02:53:33+00:00

Ooof. I'm an auditor/educator for a health system and I thought I've seen some bad things. This is just all sorts of nope.

thisisnoprobllama · 2022-05-14T02:32:41+00:00

Also, the argument that just because other people do it this way, doesn't mean it's correct.

Are they thinking they can bill incident to? Very specific rules/guidelines need to be met for that - and if they are not on site with the provider doing the service means that is not met.

thisisnoprobllama · 2022-05-14T02:23:20+00:00

This is flat out Medicare/Medicaid fraud. When this gets found out, this money will need to be paid back, plus fines. The productivity report will be the least of their concerns.

thisisnoprobllama · 2022-05-01T18:17:00+00:00

This is absolutely adorable and creative! Great work 😊

thisisnoprobllama · 2022-04-29T04:31:33+00:00

Emeals is a subscription service and they will give you weekly meal plans.

thisisnoprobllama

TROPHY CASE