Disease processes and their relationships impact diagnoses coding and prove medical necessity to ensure proper reimbursement of provider services. This webinar teaches you about coding guidelines for reporting definitive diagnoses and disease processes, interaction, and symptoms.

Understand the Driving Force Behind Medical Necessity and Proper Reimbursement

Disease processes and their relationships impact diagnoses coding and are the driving force behind proving medical necessity and ensuring proper reimbursement of provider services. This webinar teaches you about coding guidelines for reporting definitive diagnoses and the disease processes, interaction, and symptoms to capture medical necessity when coding.
Symptoms and disease processes often relate to each other or have an assumed relationship, and some do not. This is why coding professionals must be able to identify those circumstances when there is a relationship and to query the provider when more documentation is needed to code diagnoses correctly. This webinar will help you to identify those circumstances.
You’ll take a comprehensive look at some of the most common disease interactions, why symptoms can sometimes be hard to identify, and how to query a provider compliantly and effectively when uncertain. This webinar will also discuss Excludes 1 and Excludes 2 notes and how they assist in guidance on conditions that don’t normally occur together. Medical coders need to understand how the ICD-10 Excludes notes work, their differences, and what they mean.
Because disease processes and their relationships determine medical necessity and reimbursement, it all affects risk adjustment and providers’ MIPS quality reporting scores. Accurate and compliant diagnoses coding is necessary for all organizations — both inpatient and outpatient — and this webinar will help you bolster that accuracy.

Learning Objectives/Agenda

• Gain a broad understanding of the impact assumed relationships have on diagnoses coding
• Learn common coding guidelines around disease interaction and symptoms of definitive conditions
• Know how disease relationships and diagnosis coding impact reimbursement
• Identify when it is necessary and effective to query providers and implement a query process
• Better understand ICD-10 Excludes notes and their significance

Why is this topic important?

Learning coding guidelines for disease interactions and symptoms is important because they paint an accurate representation of all medical conditions a patient has, which fosters correct medical coding. This is crucial for understanding the patient’s health status and for planning appropriate treatment strategies. Capturing accurate patient representation through appropriate diagnoses coding also helps to facilitate clear communication among healthcare providers, which reduces the risk of misinterpretations. Other important benefits are to help promote legal compliance, quality of care, and better patient outcomes.
Capturing disease processes, their relationships, and symptoms will bolster your healthcare organization’s financial reimbursement when billing insurance companies by ensuring you are compensated appropriately for the medical services provided. Research companies and public health organizations also benefit from coding and reporting all disease interactions and symptoms because they allow for proper tracking of disease trends to better inform public health interventions.

Who would benefit from this topic?

• Medical coders in all settings
• Medical staff who places orders for diagnostic services
• Office managers and practice managers
• Hierarchical Condition Category (HCC) coders
• Risk adjustment coders
• Clinical documentation integrity specialists

What’s the presenter's background/expertise on this topic?

Swindle has more than 20 years of experience in the healthcare industry. In her role as vice president of coding and compliance for Pivot Health, she is responsible for identifying and mitigating client risk by assessing, designing, and implementing proven compliance protocol. Swindle is highly credentialed as an auditor, but also has vast expertise as an educator and facilitator for both large and one-on-one sessions. She has written numerous articles on coding practice in AAPC the Magazine (formerly Coding Edge and Healthcare Business Monthly) and Healthcare Financial Management Association’s Revenue Cycle Strategist.

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