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Selecting an EHR vendor

Specific critical technological features exist to assure the overall practice success when choosing the right EHR.

Here are those features every small physician practice should seek when selecting an EHR vendor:

  • Affordability
  • Flexibility
  • Vendor Stability
  • Usability
  • Customization for Specialty Workflow
  • Clinical Decision Support
  • Ability to Meet Meaningful Use Requirements
  • Cloud-based Technology
  • Customer Service

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Modifier Codes Instructions


When desiring to indicate a distinct procedural service the physician may need to indicate a procedure or service was distinct or independent from other services performed on the same day.

This may represent a different session or patient encounter, different procedure or surgery, different site, or organ system, separate incision/excision, or separate injury (or area of injury in extensive injuries).

Multiple services provided to a patient on one day by the same provider may appear to be incorrectly coded, when in fact the services may have been performed as reported.

Because these circumstances cannot be easily identified, a modifier was established to permit claims of such a nature to bypass correct coding edits.

The addition of this modifier to a procedure code indicates that the procedure represents a distinct procedure or service from others billed on the same date of service representing a different session, different surgery, different anatomical site or organ system, separate incision/excision, different agent, different lesion, or different injury or area of injury (in extensive injuries).

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Coder/Biller Wages


Here are  salary statistics for a medical coder and biller:

  • Top Earned $60,919
  • Median Wage $54,880
  • Lowest Earned $40,196

What is the job outlook for medical coding and billing?

According to the Bureau of Labor Statistics, medical coders and billers are expected to have a 22% job growth through the year 2022. 

The healthcare services are increasing so the demand for qualified medical coders and billers will continue to grow. 

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ICD Procedure Codes


ICD procedure codes are required for inpatient hospital Part A claims only.

Healthcare Common Procedure Code System (HCPCS) codes are used for reporting procedures on other claim types.

Inpatient hospital claims require reporting the principal procedure if a significant procedure occurred during the hospitalization.

For information of the selection of the principal procedure, see the posted Official ICD-10-PCS  coding guidelines.

The principal procedure code and other procedure codes shown on the bill must contain the full ICD-10-PCS procedure code, including all applicable digits, up to seven digits.

Up to twenty four significant procedures other than the principal procedure may be reported.

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Choosing The Right EHR


Choosing the right Electronic Health Records (EHR) for your practice can be a daunting task.  

There is enough research documenting improved productivity levels and efficiency gained by EHR Software implementation. 

Large physician practices may have financial flexibility to implement an EHR with bells and whistles driving up the price point,.

Small practices often lack this luxury.

In times of decreasing reimbursement and increasing regulatory demands, small practices must partner with an EHR vendor offering the biggest “bang for buck.”

This allows physicians ttheo focus on what they do best: Generate revenue by providing top-notch clinical care to patients.

Small practices lag behind struggling with EHR implementation.

Sixty-seven percent of small practices (i.e., those with 2-3 physicians) have adopted an EHR. 

Meaningful us (MU) drives adoption.

As MU continues evolving and becoming more complex, practices of all sizes are realizing to implement certified EHR technology will avoid financial penalties. 

MU is likely driving both new EHR implementations and replacements as Stage 3,  focusing on patient outcomes and population health management, forces smaller practices to partner with those offering more advanced clinical monitoring and data analysis.

EHRs have come a long way, and continue to evolve since the dawn of the HITECH Act, passed in 2009.

Many EHR features only available to large hospitals and practices in the past are now accessable to smaller practices. 

These small practices must choose carefully when investing in a cost effective and user-friendly solution.   

The perfect EHR is unavailable.

However, the specific critical technological features exist to assure the overall practice success.


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Surgical Modifiers #2


Surgical Modifiers

  • Bilateral
  • Multiple
  • Reduced
  • Discounted
  • Co Surgery
  • Team Surgery
  • Assistant Surgery
  • Bilateral Surgery
  • Performed on both sides of body at the same operative session to the same organ or structure


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2018 Practice Priorities


Protect confidentiality

  • Core tenet
  • Number one priority

Assess financial health

  • Review and understand financial statements
  • Outsource expertise to evaluate practice viability and health

Stay ahead of the curve

  • Increase quality of services
  • Introduce new technologies

Charting and Billing practice reevaluation

  •  Review documentation habits
  •  Translates to increased revenue

Manage the revenue cycle

  • Analyze renewal contracts
  • Remain up to date on insurance changes

Make innovation profitable

  • Allows better decision making
  • Evaluate downstream implications
  • Link the business to creative ideas

Increase Efficiency

  • Implement real-time performance analysis
  • Make staff accountable for the quality control

Create a shared perspective

  • Optimize reliability
  • Collective staff perspective

Improve patient services

  • Directly tied to overall satisfaction  

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Rules for Outpatient Diagnostic Codes

Outpatient Claim Diagnosis

For outpatient claims, providers report the full diagnosis code for the diagnosis shown to be chiefly responsible for the outpatient services.

For instance, if a patient is seen on an outpatient basis for an evaluation of a symptom (e.g., cough) for which a definitive diagnosis is not made, the symptom is reported.

If, during the course of the outpatient evaluation and treatment, a definitive diagnosis is made (e.g., acute bronchitis), the definitive diagnosis is reported.

If the patient arrives at the hospital for examination or testing without a referring diagnosis and cannot provide a complaint, symptom, or diagnosis, the hospital reports the encounter code that most accurately reflects the reason for the encounter.

Examples include:

    • Encounter for general adult medical examination without abnormal findings 

    • Encounter for general adult medical examination with abnormal findings

    •  Encounter for examination of ears and hearing without abnormal findings

    • Encounter for examination of ears and hearing with other abnormal findings

For outpatient claims, providers report the full diagnosis codes for diagnoses that coexisted in addition to the diagnosis reported as the principal diagnosis.

For instance, if the patient is referred to a hospital for evaluation hypertension and the medical record also documents diabetes, diabetes is reported as another diagnosis.

Additional information and training is available on the CMS  website.

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Medical Biller Salaries


Sixty percent of medical billers earn between $30,000-$60,000.  

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Podiatry Revenue Modifier


Your patient is readmitted to the hospital with cellulitis at the incisional site during the postoperative global period after a transmetatarsal amputation.   

You follow the patient for multiple daily visits.  No surgery performed. 

The only allowable coding option available refers to an "unrelated evaluation and management (E/M) service by the same physician or other qualified health care professional during a postoperative period."

Any diagnosis associated to the amputation will not qualify, only an "unrelated" one will. 


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