Medical Coding Rights

Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing. Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible.  In addition, thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries must receive coverage of COVID-19 vaccines and their administration, without cost-sharing. COVID-19 vaccines and their administration, including boosters, will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market.  CMS continues to explore wa

 Immunization Administration  0001A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; first dose. 0002A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; second dose. 0003A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose. 0004A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])

The overall will protect patients of the 50,000 providers and over 17 million health care workers in Medicare and Medicaid certified facilities for COVID-19 Vaccines. The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include, Hospitals,  Dialysis facilities,  Ambulatory surgical settings,  Home health agencies. Nursing homes with an overall staff vaccination rate of 75% or lower experience higher rates of preventable COVID infection.  In CMS’s review of available data, the agency is seeing lower staff vaccination rates among hospital and End Stage Renal Disease (ESRD) facilities.  To combat this issue, CMS is using its authority to establish vaccine requirements for all providers and suppliers that participate in the Medicare and Medicaid programs.  Vaccinations have proven to reduce the risk of severe

Continuation of PART 2 Etiology/Manifestation Convention Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the  ICD-10-CM  has a  coding convention that requires the underlying condition to be sequenced first , if applicable, followed by the manifestation.  Wherever such a  combination exists,  there is a “use additional code” note at the etiology code,  and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes,  etiology followed by manifestation.  In  most cases, the manifestation codes will have in  the code  title,  “in  diseases classified elsewhere.”  Codes with this title are components of the etiology/ manifestation convention.  There are manifestation codes that do not have  “in diseases classified elsewhere” in the title. For such codes,  there is a  “use additional code” note at the etiology code and a “code fi

Continuation of PART 1  Includes Notes  This note appears immediately under a three-character code title to further define, or give examples of,  the content of the category.  Inclusion Terms A list of terms is included under some codes. These terms are the conditions for which that code is to be used.  The terms may be synonyms of the code title, or, in the case of “other specified” codes,  the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the  Alphabetic Index may also be assigned to a code.  Excludes Notes  The  ICD-10-CM  has two types of excludes notes. Each type of note has a  different definition for use,  but they are all similar in that they indicate that codes excluded from each other are independent of each other.  Excludes1  A type1 Excludes note is pure excludes note. It means “NOT  CODED HERE!”  An  Excludes1 note indicates that the code excluded should never be used a

Format and Structure The Tabular List contains are Categories Subcategories codes.   All categories are 3 characters. A three-character category that has no further subdivision. The Subcategories are either 4 or 5 characters. The Codes maybe 3,  4, 5,  6, or  7 characters. That is, each level of subdivision after a category is a subcategory. The final level of subdivision is a  code.  Placeholder Character The ICD-10-CM utilizes a placeholder character  “X”.  The “X” is used as a placeholder at certain codes to allow for future expansion.  An example of this is at the poisoning, adverse effect, and underdosing codes, categories  T36-T50.  Where a placeholder exists, the X  must be used in order for the code to be considered a valid code NEC - Not  Elsewhere Classifiable NEC - This  abbreviation  in the  Alphabetic  Index & Tabular List represents “other  specified.” When a  specific code is not available for a  condition,  the  Alphabetic Index directs the coder to the “other spec

Alphabetic Index and Tabular List The ICD-10-CM is divided into the Alphabetic Index and Tabular List Alphabetic Index - An alphabetical list of terms and their corresponding code and contains the following parts. Diseases Injury External Causes of Injury Neoplasms Table Drugs and Chemicals Tables Tabular List - A structured list of codes divided into chapters based on body system or condition. Drive the Codes To select a code in the classification that corresponds to a diagnosis or reason for visit documented in a medical record. First, locate the term in the Alphabetic Index, and then verify the code in the Tabular List. Read thoroughly and be guided by instructional notations that appear in both the Alphabetic Index and the Tabular List. It is essential to use both the Alphabetic Index and Tabular List when driving and assigning a code. The Alphabetic Index does not always provide the full code. Selection of the full code, including laterality and any applic

Medicare Deductible, Coinsurance  Rates'2021 The Centers for Medicare & Medicaid Services (CMS) issued for the 2021 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program.  The 2021 deductible, coinsurance, and base premium rates are below and effective from 01/01/2021 2021 Part B - Supplementary Medical Insurance (SMI) Based on Part B, the Medicare Supplementary Medical Insurance (SMI) program, enrollees are subject to a monthly premium.  Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute. Standard premium: $148.50 a month Deductible: $203.00 a year Pro-Rata  Data  Amount  $145.31  for  the  1st  month  $57.69  for  the  2nd  month Coinsurance: 20% 2021 Part A - Hospital insurance Deductible: $1,484.00 Coinsurance $371.00 a day for days 61 through 90 $742.00 a day for days 91 through150 (lifetime reserve days) $185.50 a day for

The alphabetic index is not a substitute for the main text of the CPT codebook. Even if only one code is present, the coder must refer to the main term to ensure that the code is selected accurately and correctly to identify the services rendered. Main Terms The index is organized by main terms. Each main term can stand alone or can be followed by up to three modifying terms. There are four primary classes of main entries, Procedures or Services - E.g, Scopic, Anastomosis, Splint, Opening Organ or Other Anatomical Site - E.g, Knee, Arm, Ear, Tibia, Colon Conditions - E.g, Abscess, Entropion, Tetralogy of Fallot. Synonyms, Eponyms, and Abbreviations. - ECG, EEG, PET, Brock Operations, Clagett Procdures Modifying Terms The main term may be followed by up to three indented terms that modify the terms they follow. EG. The main term "Endoscopy" is subdivided by the anatomical sites in which the procedure is used. And within these anatomical sites, the specific purpose of the pr