Codebusters Quick Guide to Coding and Billing Compliance for Medical Practices

Preface v What Are the Rules? 1(4) Provider responsibility for accuracy of coding Official coding guidelines for physician services Diagnosis coding Procedure coding Coding rules for non-HCFA payers Why you need written policies and procedures Patient Records---The Basis of Coding 5(5) Improving the record Organization/format Forms Improving the documentation Content Legibility Other improvements Translating the Record into Codes---Diagnosis 10(5) Primary diagnosis Rule/out V codes Payable diagnoses Cheat sheets/superbills Diagnoses for procedures Translating the Record into Codes---Procedures 15(5) Nonbillable procedures Bundled procedures Global package Modifiers Translating the Record into Codes---Evaluation and Management 20(10) Definitions Counseling and coordination of care Newborns/critical care/discharge day Prolonged services/preventive medicine/care oversight Decision-making documentation Audit tool for E&M services What Went Wrong? 30(4) Clean claims Payment denials Prior approvals How to appeal denials Resources for You and Your Staff 34(4) Training/credentialing References/software Payer newsletters and manuals Internet resources Consultants Professional organizations Appendix A. Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital-Based and Physician Office) 38(3) Appendix B. Data Elements for Adequate Documentation 41(7) Appendix C. Bibliography 48