Code EMR

12/01/2025

Weekly Coding Tip: Understanding MDM – Complexity of Problems

Accurately identifying the complexity of patient problems is essential for selecting the correct MDM level, which directly impacts E/M coding accuracy and reimbursement.

Misclassifying diagnoses - especially chronic conditions such as acne or hay fever - as “self-limited” can unintentionally lower the service level.

This week’s tip focuses on recognizing the different MDM problem complexity categories and correctly classifying conditions based on documentation.

Why It Matters?
1. Determines MDM level
2. Drives E/M code selection
3. Prevents downcoding and revenue loss
4. Supports accurate clinical representation of patient risk
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Problem Complexity Quick Reference
Self-Limited or Minor Problems
Short-term issues likely to resolve without intervention.
Examples: uncomplicated mosquito bite, diaper rash, viral cold, tinea corporis, minor abrasions.
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Stable Chronic Illness
Long-term conditions that are controlled and stable.
Examples: controlled asthma, controlled Type II DM, controlled HTN, hyperlipidemia, hypothyroidism, acne, osteoarthritis, hay fever.
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Acute, Uncomplicated Illness or Injury
New, short-term condition with low morbidity risk and expected full recovery.
Examples: viral URI, acute pharyngitis (antibiotics), acute sinusitis, AOM, sprains, first-degree burns, conjunctivitis, uncomplicated cystitis.
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Acute, Uncomplicated—Requiring Hospital or Observation Care
Short-term problem requiring treatment in an inpatient or observation setting.
Examples: uncomplicated appendicitis, kidney stones, severe gastroenteritis requiring fluids, pneumonia, pyelonephritis, allergic reaction.
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Stable, Acute Illness
Acute condition with treatment initiated and symptoms improving or stable.
Examples: pharyngitis, sinusitis, AOM, conjunctivitis, or cystitis—still symptomatic but treated.
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Chronic Illness With Exacerbation/Progression
Chronic condition that is worsening, uncontrolled, or showing progression.
Examples: COPD exacerbation, CHF exacerbation, uncontrolled diabetes, CKD progression, arthritis flare, Alzheimer’s with delirium.
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Undiagnosed New Problem With Uncertain Prognosis
New condition with unclear cause and requiring further evaluation; potential morbidity risk.
Examples: unexplained fatigue with weight loss, abdominal pain without source, new severe headaches, unexplained fever, atypical skin lesion.
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Acute Illness With Systemic Symptoms
Condition causing systemic effects and higher morbidity risk without treatment.
Examples: pyelonephritis, bacterial pneumonia, colitis, influenza, COVID-19, meningitis, acute hepatitis, sepsis.
https://medlineplus.gov/ency/article/002294.htm #:~:text=For%20example%2C%20systemic%20disorders%2C%20such,is%20called%20a%20localized%20infection.
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Acute, Complicated Injury
Injury requiring evaluation of additional body systems, extensive treatment, or involving multiple risks.
Examples: chest trauma, open fracture, third-degree burns, head injury with LOC, severe lacerations, crush injuries.
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Chronic Illness With Severe Exacerbation
Severe worsening or progression requiring escalated care.
Examples: severe COPD exacerbation, severe CHF flare, advanced CKD decline, cancer progression.
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Threat to Life or Bodily Function
Acute or chronic condition posing immediate risk without intervention.
Examples: MI, stroke, PE, severe sepsis, anaphylaxis, ARDS, severe burns, subarachnoid hemorrhage, metastatic cancer.

Contact us today for a free consultation - https://www.codeemr.com/request-information/

11/27/2025

🔍 Is Your Coding Audit Truly Working for You?

Every claim submitted impacts your bottom line. At CodeEMR, our Medical Coding Audit Services help uncover hidden errors, compliance risks, and missed revenue.

✅ Pre-bill & retrospective audits
✅ E/M, ICD-10, HCPCS reviews
✅ Targeted focus audits for high-risk areas
✅ Certified auditors guiding your team with clarity

Don’t leave your revenue cycle to chance. With audits tailored for accuracy and efficiency, you gain the confidence to improve documentation, reduce denials, and optimize reimbursement.

📌 Explore how we partner with providers and payers to elevate coding integrity → CodeEMR Medical Coding Audit Services - https://www.codeemr.com/services/medical-coding-audit-services/

Enhance coding accuracy and compliance with CodeEMR’s Medical Coding Audit Services. Reduce claim denials and improve reimbursement with expert auditor support.

11/24/2025

Prepare for Medicaid Cuts: Strengthen Coding, Reduce Denials & Protect Revenue with CodeEMR

Did you know that nearly 30% of coding denials are never reworked?

That’s revenue left uncollected. We walk through key questions every practice should ask:

1) Are your denials tracked properly in your EHR?
2) Are you coding to the highest specificity?
3) Are certified coders reviewing claims?
4) Do you have a backlog of unresolved denials?

Significant Medicaid cuts are expected next year, and many practices are at risk of losing revenue if they don’t optimize their coding and denial management workflows.

In this video, CodeEMR explains why improving coding accuracy, tracking denials effectively, and strengthening reimbursement strategies have never been more important.

Know more - https://youtu.be/BzvLaoM3EWY

Significant Medicaid cuts are expected next year, and many practices are at risk of losing revenue if they don’t optimize their coding and denial management ...

11/20/2025

🎉 That’s a wrap on the 2025 NACHC Partner Conference!

📍 Booth #609 | November 17–18 | Hyatt Regency Minneapolis, MN

It was an incredible two days connecting with community health leaders, administrators, and care teams dedicated to strengthening access and delivering high-quality care.

Our ScribeEMR & CodeEMR team had the opportunity to share how our:
✅ Virtual Medical Scribing
✅ AI-powered ScribeRyte solutions
✅ Medical Coding & Audit Services
✅ Revenue Cycle Management
✅ Virtual Medical Office Support

are helping CHCs and FQHCs reduce documentation burden, streamline workflows, improve compliance, and enhance patient care.

We’re grateful for the meaningful conversations, collaborative discussions, and the enthusiasm around innovation in community health.

📸 Here are some highlights from the event! -

A big thank-you to everyone who stopped by Booth #609 - we look forward to continuing the conversations and supporting your teams long after the conference.

11/17/2025

Coding Tip:

Understanding Excludes 1 Notes - Why You May Still Get a Denial
Even though your ICD-10 codes are valid, you might still receive a denial - and the reason could be hidden in the Excludes 1 note.

What Does “Excludes 1” Mean?
1. An Excludes 1 note means two conditions cannot be coded together.
If you see an Excludes 1 note under a diagnosis code, it means the condition listed is completely separate and should never be reported at the same time as the main code.
2. Think of it as the “Do Not Code Together” rule.
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Example 1: Type 1 vs. Type 2 Diabetes
1. If you look up a code for Type 1 diabetes, you might see an Excludes 1 note for Type 2 diabetes.
2. That means you cannot bill both Type 1 and Type 2 diabetes on the same patient at the same time - because a person can only have one type of diabetes.
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Example 2: Flu vs. Common Cold
1. If you pick a code for influenza (J10–J11), you might see an Excludes 1 note for common cold (J00) or acute nasopharyngitis.
2. You can’t code both the flu and the common cold together for the same visit.
Choose the diagnosis that best fits what the provider documented.
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Example 3: COVID-19 and Flu-Like Symptoms
1. If the patient is diagnosed with COVID-19 (U07.1) and the provider also lists flu-like symptoms, you don’t add a separate flu or viral infection code.
2. The Excludes 1 note under U07.1 tells you COVID already covers the viral infection.
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Example 4: Sore Throat
1. If you look up chronic pharyngitis (J31.2), you’ll see an Excludes 1 note for acute pharyngitis (J02.9).
2. If the provider documents an acute sore throat, you cannot also code chronic pharyngitis - choose one based on documentation.
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Key Takeaway
1. An Excludes 1 note is your clue that certain conditions cannot be billed together, even if both seem correct.
2. Before finalizing your codes, always scan for any Excludes 1 notes in the ICD-10 book or encoder - it can save you from unnecessary denials and rework.

Contact us today for a free consultation - https://www.codeemr.com/request-information/

11/13/2025

🎉 We’re at the 2025 NACHC Partner Conference!

📍 Booth #609 | November 17–18 | Hyatt Regency Minneapolis, MN

ScribeEMR and CodeEMR are proud to be part of this year’s NACHC Partner Conference, connecting with community health leaders who are driving innovation and advancing access to care.

We’re showcasing how our Virtual Medical Scribing, AI-powered Scribing solutions (ScribeRyte AI), and Revenue Cycle Management Solutions help Community Health Centers (CHCs) and FQHCs:
✅ Reduce documentation burden
✅ Streamline workflows
✅ Enhance patient experience
✅ Strengthen financial performance

It’s inspiring to engage with organizations that share our mission - empowering healthcare teams to focus on what truly matters: patient care.

If you’re attending, stop by Booth #609 to meet our team and explore how ScribeEMR and CodeEMR can support your operational goals.

11/11/2025

Struggling with delayed payments, rising denials, or growing AR backlogs?

You’re not alone - and the solution starts with understanding Accounts Receivable (AR) Management.

We just released a new video that breaks down how effective AR processes can transform cash flow and strengthen the financial health of your practice.

✅ Monitor aging reports
✅ Follow up on unpaid or underpaid claims
✅ Work denials and rejections
✅ Resubmit corrected claims
✅ Coordinate patient balances
✅ Reduce Days in AR
✅ Prevent write-offs

At CodeEMR, our AR specialists help healthcare organizations improve reimbursement speed, uncover systemic issues like coding errors or payer delays, and maintain a healthier, more predictable revenue cycle.

🎥 Watch the full video here: https://youtu.be/duN1SocoQLI

Accounts Receivable (AR) management is one of the most important components of a healthy revenue cycle. In this video, CodeEMR breaks down how AR management ...

11/06/2025

Did you know?

The DOJ recovered $2.7 billion under the False Claims Act in FY2023, with over $1.8 billion linked to healthcare fraud alone.

As enforcement tightens in FY2024, certified medical coders are more critical than ever in ensuring compliance and preventing costly claim denials.

✅ Accurate coding
✅ Regulatory compliance
✅ Reduced risk of FCA violations

At CodeEMR, we deliver precision-driven medical coding services backed by certified professionals and specialty-specific expertise.

💡 Discover how certified coders can protect your practice from legal and financial risks:

👉 Read the full blog - https://www.codeemr.com/fy2024-false-claims-act-certified-medical-coders/

False Claims Act settlements exceeded $2.9B in FY2024. Learn why certified medical coders are essential for accurate billing, compliance, and fraud prevention.

11/03/2025

Why Code Linkage (Diagnosis Pointer) Matters?

Each CPT (procedure) code that you bill must be linked to the correct diagnosis code that explains why the service was performed. This connection is called code linkage or sometimes a diagnosis pointer on the claim form.

Think of it this way:

• The CPT code tells the insurance company what you did (the service).
• The ICD-10 diagnosis code tells them why you did it (the reason or medical necessity).
• The linkage is what connects those two pieces of information together.

If they don’t match up correctly, the insurance company may deny the claim because they don’t see a medical reason for that service.

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Example:

Let’s say a patient comes in with a sore throat.

• Diagnosis code: J02.9 (Acute pharyngitis, unspecified)
• CPT code: 87880 (Rapid strep test)

If you link 87880 to J02.9, it makes sense - the sore throat supports the need for a strep test.

*Claim likely pays.

But if by mistake, you link 87880 to a diagnosis like E11.9 (Diabetes), it doesn’t make sense to the payer.

*Claim likely denies - no medical necessity.

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Key Points to Remember

• Each CPT must be linked to the correct diagnosis that justifies the test or procedure.
• Some visits may have multiple diagnoses and multiple CPT codes - make sure each one is linked to the proper “why.”
• Accurate linkage helps reduce denials and supports compliance.
• “If it wasn’t medically necessary, the insurance won’t pay - and if it was necessary, the linkage must show it.”

Contact us today - https://www.codeemr.com/request-information/

10/30/2025

🔍 Understanding HCC Coding: A Key to Accurate Reimbursement and Quality Care

In the era of value-based care, accurate documentation and coding are paramount. Hierarchical Condition Category (HCC) coding plays a crucial role in determining reimbursement rates by assessing the severity of a patient's health conditions.

Why HCC Coding Matters:

1. Fair Reimbursement: Ensures providers are compensated appropriately for managing complex patients.

2. Regulatory Compliance: Adherence to CMS guidelines reduces audit risks and penalties.

3. Quality of Care: Accurate coding supports effective care coordination and population health management.

The Risks of Inaccurate HCC Coding:

1. Revenue leakage from underreported chronic conditions.
2. Audit risks due to unsupported or suspect codes.
3. Gaps in care when patient risk isn't fully understood.
4. Increased administrative workload to correct coding errors.

How CodeEMR Supports HCC Coding:

1. Annual Recapture: Ensuring chronic conditions are coded every year to protect Risk Adjustment Factor (RAF) scores.
2. Provider Education: Collaborating with providers to improve documentation practices.
3. Compliance-First Process: Regular audits and adherence to CMS guidelines to mitigate risks.
4. Scalable Support: Tailored solutions for practices of all sizes.

Accurate HCC coding is more than just a coding task; it's a strategic approach to ensuring fair reimbursement and delivering high-quality patient care.

🔗 Read the full blog here - https://www.codeemr.com/an-introduction-to-hcc-coding-and-why-it-matters/

HCC coding is essential for accurate risk adjustment and reimbursement. Learn how proper documentation and ICD-10 coding impact healthcare revenue and compliance.

10/27/2025

📊 Why Accurate HCC Coding Matters More Than Ever

In today’s value-based care environment, Hierarchical Condition Category (HCC) coding isn't just about checking boxes - it's about capturing a patient's full clinical picture to ensure accurate risk adjustment and maximum reimbursement.

⛔ Inaccurate coding can lead to:
• Revenue loss
• Audit risks
• Skewed patient risk scores

✅ In this blog, we break down how accurate HCC coding helps healthcare organizations:
• Optimize reimbursements
• Improve care quality
• Stay compliant with CMS guidelines

💡 Whether you're a provider, coder, or administrator, this guide is a must-read: https://www.codeemr.com/hcc-medical-coding-accuracy-risk-adjustment/

Enhance HCC medical coding accuracy and risk adjustment outcomes with proven strategies that improve compliance, patient care, and value-based healthcare success.

10/23/2025

💡 Did you know?

Community Health Centers (CHCs) and Federally Qualified Health Centers (FQHCs) face some of the most complex coding and reimbursement challenges in healthcare.

From encounter-based PPS billing and preventive care visits to behavioral health and telehealth coding - accuracy isn’t just important, it’s essential for financial sustainability.

In our latest blog, we explore how CodeEMR’s specialized CHC & FQHC coding support helps centers:

✅ Reduce denials and accelerate reimbursements
✅ Maintain PPS and compliance accuracy
✅ Scale operations without increasing overhead
✅ Refocus staff time on patient care, not paperwork

Read how expert coding can strengthen mission-driven healthcare ⬇️

👉 https://www.codeemr.com/coding-support-for-chcs-and-fqhcs/

Improve coding accuracy and compliance for CHCs and FQHCs with CodeEMR’s experts. Streamline workflows, reduce claim denials, and maximize healthcare revenue.