Read the Case Carefully Skim the entire scenario once to understand the big picture (inpatient, outpatient, ED, surgical, etc.). Underline or highlight key clinical details: Primary diagnosis Secondary diagnoses/comorbidities Procedures performed Patient status (new...
Pro fee coding, short for professional fee coding, refers to the process of assigning medical codes to professional services provided by physicians and other qualified healthcare professionals. Pro fee coding focuses on capturing and billing for the provider’s...
What Is CMS in Medical Coding? The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services (HHS) that plays a critical role in healthcare administration and policy. In the context of medical...
What Is a Manifestation Code in Medical Coding? In medical coding, accuracy is crucial for proper diagnosis reporting, insurance reimbursement, and compliance. One specific type of diagnosis code that often confuses new coders is the manifestation code. Understanding...
Trauma Registry Coder Guidelines & Tips A trauma registry is a specialized database that collects, stores, and analyzes information on patients who sustain traumatic injuries. Accurate and complete medical coding of trauma registry is critical for quality...
Pneumonia Coding & Billing – Guidelines & Tips Pneumonia is a common and potentially serious respiratory infection that medical coders frequently encounter. Accurate coding and billing are essential to reflect the severity of illness, ensure compliance with...
What Is Medical Necessity in Medical Coding & Billing? Medical necessity is a cornerstone of accurate medical coding and billing. It determines whether a service, procedure, or supply is reasonable, necessary, and appropriate based on a patient’s medical...
What Is an Encoder in Medical Coding? An encoder is a specialized software tool used by medical coders to streamline the coding process by helping identify the correct diagnosis (ICD-10-CM), procedure (CPT/HCPCS), and modifier codes. Encoders often integrate official...
Medical Coding Audits: Guidelines & Tips for Compliance and Accuracy Medical coding audits are essential for maintaining compliance, ensuring accurate reimbursement, and reducing the risk of denials or legal penalties. Whether you're a coding professional,...
Medical Coding Compliance Guidelines & Tips for Medical Coding & Billing Maintaining billing and medical coding compliance is critical for preventing audits, avoiding penalties, and ensuring timely reimbursement. Healthcare organizations, providers, and coders...