We are uniquely positioned to experience both the backend of healthcare through billing and the future of the industry through our health IT work. We share our insight here.
By definition, modifier 53 is used to indicate a discontinued procedure and modifier 52 indicates reduced services. In both the cases, a modifier should be appended to the CPT code that represents the basic service performed during a procedure. Choosing between modifiers 53 and 52 can sometimes be confusing. A wrong modifier can lead to denials. The reason for this confusion is the ambiguity in its definitions.
There’s a lot of debate about government’s role in healthcare. Much of our attention is focused on fixing sickness not preventing disease. We obsess about availability of doctors, hospital beds, staff and infrastructure to treat sick people. We don’t debate enough about government’s role in maintaining health of its population.
Dr. John Noseworthy, chief executive of the world renowned Mayo Clinic, recently said in an internal meeting that they must “prioritize” commercial insurances over Medicaid (insurance for the poor). Commercial insurances pay better and contribute to better margins. Medicaid, a government insurance, pays much less and is possibly a loss-leader.
At HIMSS 2017, IBM’s chief Ginni Rometty reassured in a keynote that there will be “new collar jobs” because of advances in cloud computing, data, and AI. We are bravely marching towards cognitive computing in healthcare. However, the world of healthcare technology is dotted with isolated islands that make this march a huge challenge.
There are several procedures related to endoscopy coding for digestive system (code range from 40490-49999 in the CPT manual). These procedures include laparoscopic, endoscopic and general surgery procedures. Surgeries are further divided into incision, excision and repair categories and classified based on the organs examined and operated during the procedure.
Often, the healthcare system ignores the quarterback for whom it exists: the patient. We talk about patient engagement as if it’s a thing. That can be purchased in the market and implemented.
Before managed care became the dominant force that it is, patients and doctors had the opportunity to get to know each other well. Doctors treated multiple generations within families. This helped establish a strong bond among patients and their doctors.
With ICD-10, reporting for type, occurrence site, and complication has dramatically increased coding complexity. There are codes ranging from problems in relationship with in-laws (Z63.1) to being pecked by a chicken (W61.33) to being bitten by a sea lion (W56.11)!
It was in February 1968 that The Beatles stayed at an ashram in Rishikesh to learn Transcendental Meditation. The retreat is at the foothills of the Himalayas, across the river Ganges. Today it’s totally abandoned. In ruins. Part of a jungle.
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