What You Need to Know About Coding

• Learn some coding basics as well as more specific information about correct coding in these articles by TMA.
  

   

  Avoid These Coding and Documentation Errors   

  Back to Basics — Documentation 101 and Self-Auditing  

  Bill Medicare Correctly for Prolonged Services — Part 1   

  Bill Medicare Correctly for Prolonged Services — Part 2  

  Blue Cross Targeting Modifier 50 Misuse  

  CMS Eliminates Consultation Payments 

  Correct Code for Billing a Routine Venipuncture  

  E&M Coding Advice  

  Emergency Diagnosis Codes Related to Pregnancy  

  Modifiers 22, 52, and 53 for Medicare Claims  

  Unraveling Modifier 25  

  Why Was the Code I Submitted Returned as Truncated? 

   

Consulting for Your Practice

• Do you need assistance with coding and documentation procedures in your office? Look over the options TMA has available to physicians.
  

   

  Coding and Documentation Review: A comprehensive analysis of a physician’s coding and documentation techniques presented in a written report with specific findings and opportunities for improvement.  Audits are performed by a TMA Practice Management Consultant who is certified as a professional coder and a professional medical auditor.  Audits are a review of claims, coding, and medical record documentation to determine whether the practice is following the coding guidelines for appropriate billing.  Audits may be performed on annual or quarterly basis.  (Approved for 20 AMA PRA Category 1 Credits™)

  Coding and Documentation Check-ups:  An abbreviated review of claims coding and medical record documentation performed by a professional coder and auditor to provide a glimpse into a physician’s coding techniques.  Simplified reporting of the check-up findings allow physicians to step-back from the details and realize the underlying trends that directly affect practice revenue through visual illustration.

  Coding and Documentation Training: On-site training for physicians and staff on the coding and documentation guidelines, customized to the practice’s specialty.  Training also includes education on how to identify inappropriate coding practices and weaknesses in the medical record that may expose the practice to problems with payers or third-party audits. (Approved for up to 2 AMA PRA Category 1 Credits™)  

  TMA Mini-Consultation Program: Having problems with coding, billing, reimbursement, denial of services, or filing of claims? TMA staff travel to county medical societies across the state and conduct free 30-minute sessions with individual practices on these topics. Each physician or office staff member who attends receives a free handbook full of helpful articles and reference materials, and a packet of TMA resources on managed care, practice management, and more. Contact your county medical society to schedule a mini-consultation. Free to TMA members.

Products & Services

• View the various products and vendors related to coding.
  

   

  TMA Endorsed Services
  Available only to TMA members, endorsed vendor programs are an excellent value that can help you succeed in the ever changing medical practice environment.

  InGauge Healthcare Solutions
  As a member of Texas Medical Association, you receive a group purchasing discount on Medical Coding & Billing products through an arrangement with InGauge Healthcare Solutions, Inc. If you need medical billing and coding books for CPT®, ICD-9, HCPCS, physician’s fee guides, coding guides, look no further than www.CodersCentral.com.

  Coding Courses 

Tools

• Utilize the tools below to assist with your coding questions.
  

   

  Evaluation and Management (E/M) Services: Overview Fact Sheet  - CMS (PDF)

  Medicare Fee Schedules  

  Sample Letter (SB 418): Appeal Letter for Services Incorrectly Denied    

  Sample Letter: Getting to Know a Carrier's Surgical Billing Principles 

ICD-10/5010

• *Please note: ICD-10 implementation deadline has been delayed to 2014. Many of the documents and links below do not reflect the new implementation date.
  

   

  What’s the Main Difference Between ICD-9 and ICD-10? (E-Tips, Apr. 24, 2013)

   ICD-10: What Should I Do Now? (Action, Jan. 15, 2013)

   ICD-10 Prep May Take Longer Than You Think (Action, Jan. 4, 2013) 

  ICD-10 Nightmare Coming, TMA, AMA Warn (Action, Dec. 17, 2012)

   It's Official: ICD-10 Starts in 2014 (Action, Sept. 5, 2012)

   TMA Wants ICD-10 Canned (Action, May 15, 2012) 

  5010 Deadline Extended (Action, Mar. 19, 2012)

  Notify TrailBlazer of Your 5010 Vendor  

  TrailBlazer 5010 Tech Support Line Hours Extended  

  Change to HHS Proposes One-Year Delay of ICD-10 Compliance Date 

  CMS AAPC ICD-10 Code-a-thon - CMS and the American Academy of Professional Coders (AAPC) collaborated on an ICD-10 Code-a-thon on April 26, 2011. Coding experts from AAPC responded to nearly 250 questions from the more than 1,200 participants who joined online or by phone. These materials should be helpful in getting informed and learning about the transitions to Version 5010 and ICD-10.

  Presentations from AAPC and CMS on ICD-10 and Version 5010

  A transcript and audio of the presentations given during the webinar

  ANSI 5010 and ICD-10 - The means by which Blue Cross and Blue Shield of Texas (BCBSTX) exchanges member data with providers will change dramatically over the next several years. The changes – upgrading ANSI 4010 to ANSI 5010 and ICD-9 to ICD-10 – are required by a new directive from the U.S. Department of Health and Human Services (HHS). That directive makes the same requirement of providers.

  ANSI Version 5010/ICD-10 - 2011 Webinars   

  ICD-10 Basics for Medical Practices - CMS  (PDF)

  Talking to Your Vendors About ICD-10 and Version 5010: Tips for Medical Practices - CMS  (PDF)

  Talking to Your Customers About ICD-10 and Version 5010: Tips for Software Vendors - CMS  (PDF)

Links

• Use these links to get to more coding resources.
  

   

  AMA CPT®: Current Procedural Terminology  

  Centers for Medicaid & Medicare Services 

  TMA Knowledge Center  

  Trailblazer Health Enterprises­ ­provides services to Medicare beneficiaries and health care professional

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