Internal Medicine – Coding Best Practices Guide
What is Internal Medicine?
Internal medicine is a medical specialty dedicated to the diagnosis, treatment, and prevention of diseases in adults. Physicians specializing in internal medicine, known as internists, manage a wide range of conditions affecting internal organs and systems. They provide comprehensive adult healthcare, focusing on complex illnesses and coordinating care among specialists.
Subspecialties of Internal Medicine
Internal medicine includes various subspecialties such as:
Allergy and immunology
Cardiology
Endocrinology
Hematology
Infectious diseases
Gastroenterology
Nephrology
Oncology
Pulmonology
Rheumatology
Internal Medicine vs. General Medicine
Internal Medicine: Focuses on diagnosing and managing diseases and chronic conditions in adults. Internists handle complex diseases affecting internal organs.
General Medicine: General practitioners treat patients of all ages and genders, providing a broad range of healthcare services.
Common Denials in Internal Medicine Coding
Hospice Denials
When a patient gets enrolled in hospice for treatment, the claims submitted to Medicare HMOs will be denied as “Service not Covered” because Medicare does not cover a patient enrolled in Hospice.
In such a scenario, the patient's eligibility will be checked in Medicare online, and the patient's hospice dates will be verified. Once it has been confirmed that the patient had enrolled in Hospice for the submitted dates, the GW modifier will be added, and the claims will be submitted directly to Medicare.Medical Records Related Denials:
Humana insurance mostly denies the claims if the Medical records are unavailable. We check the claims' status in the Availity online and fax the Medical Records for the claims to get processed. Similarly, we reach out to the facility and request the Medical Records if it is not available in the EMR.POS Denials:
In superbills, doctors mostly mark the observation code with the follow-up codes. In this scenario, the MR will be reviewed to determine if the patient has been admitted to the hospital, and based on the findings, the appropriate observation codes will be billed under the POS 22.
If the patient has been admitted to the hospital, it will be billed as the inpatient codes under the POS 21.
Internal Medicine Billing
Internal medicine billing involves managing financial transactions related to services provided by internists.
Professionals use codes like Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) to document and bill healthcare services.
Advance Care Planning in Internal Medicine
Advance Care Planning (ACP) involves discussions about future medical preferences. ACP ensures that medical care aligns with individual preferences, emphasizing personalized, future-oriented healthcare decisions.
Conclusion
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