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00:00:00 – 00:33:11
The video, presented by Dr. Marty Cotler, provides a comprehensive guide on accurately pairing CPT and ICD-10 codes for medical and chiropractic documentation. Dr. Cotler emphasizes the importance of precision in coding procedural services (CPT) and diagnoses (ICD-10) to ensure proper patient record-keeping and compliance, thereby averting legal and insurance issues. Specific conditions and therapeutic interventions are discussed in detail, with examples like mechanical traction for cervical radiculopathy and therapeutic exercises for sciatica. The speaker advises against making assumptions without diagnostic tests and highlights the need for clear documentation using acronyms like SURF (Strength, Endurance, Range of motion, Flexibility). The video also covers code pairing strategies, the rationale behind therapeutic procedures, and the importance of staying informed via resources such as Target Coding and compliance manuals, particularly for Medicare patients. Additionally, services offered for compliance assurance, including personalized policy development, self-audit tools, and HIPAA support, are detailed, along with membership options and continuous educational support.
00:00:00
In this segment of the video, the presenter, Dr. Marty Cotler, introduces a program on CPT and ICD-10 code pairing, stressing its educational purpose and the illegality of unauthorized reproduction. Dr. Cotler, who is certified in CPT coding and professional compliance, discusses the importance of accuracy in coding to ensure proper documentation and avoid legal issues. He explains that CPT codes represent procedural services such as chiropractic adjustments and therapies, while ICD-10 codes are for diagnoses. The pairing of these codes must be justified in patient records and care plans, even for cash patients, to mitigate risks such as malpractice and state board issues. Dr. Cotler emphasizes that procedure and diagnosis codes must be accurate and specific to protect the practice.
00:05:00
In this part of the video, the speaker advises medical professionals against making assumptions about diagnoses without proper diagnostic tests. They emphasize the difference between “disc disorder” and “disc displacement,” explaining that a disc disorder involves disc pathology with radiating pain (radiculopathy), while disc displacement involves disc pathology without radiating pain or nerve compression. The speaker underscores the importance of coding diagnoses with specificity and understanding medical terms like radiculitis, radiculopathy, and myopathy. They also discuss justifying CPT codes, differentiating between supervised and constant attendance modalities, using mechanical traction (97012) as an example of a modality that does not require continuous one-on-one contact.
00:10:00
In this segment, the speaker discusses how to properly justify and document various therapeutic procedures and diagnoses in patient care. They highlight the importance of explaining the use of mechanical traction, emphasizing that practitioners should clearly articulate the purpose, such as promoting spinal segment mobility and joint hydration, instead of giving vague reasons. The speaker then moves on to therapeutic procedures, like therapeutic exercises, stressing the need to justify their use for developing strength, endurance, range of motion, and flexibility. They introduce the acronym SURF (Strength, Endurance, Range of motion, Flexibility) to aid in documentation. Finally, the speaker covers the importance of clear rationale when diagnosing conditions, using an example of sacroiliac sprain, and advises using specific orthopedic tests and detailed clinical findings to support the diagnosis, especially in cases of insurance review or malpractice inquiries.
00:15:00
In this segment, the speaker discusses the diagnosis process for cervical radiculopathy and highlights the importance of justifying diagnoses through clinical findings such as pain radiating into the upper extremity, numbness, positive orthopedic tests, reflex changes, and palpatory tenderness. They emphasize the significance of understanding and justifying coding decisions to avoid issues. The speaker then shifts to the topic of ‘code pairing’, likening it to food and wine pairing, and provides examples of how different therapeutic interventions align with specific diagnosis codes. Mechanical traction is paired with cervical radiculopathy and lumbar degeneration, therapeutic exercises with sciatica, low back pain, and shoulder stiffness, and neuromuscular re-education with conditions affecting balance, coordination, or proprioception. Various example codes are provided, highlighting the necessity to check specific insurance policies for billing purposes.
00:20:00
In this part of the video, the speaker discusses the clinical rationale for applying manual therapy, which includes stretching shortened connective tissue, facilitating fluid exchange, and addressing conditions such as myofascial pain syndrome. They proceed to explain various therapeutic activities aimed at improving functional performance, such as exercises for patients with a frozen shoulder to aid in activities like tennis or baseball. The video also covers how to report these treatments using diagnosis codes and CPT codes with specific examples. For instance, a chiropractic adjustment (9894) is linked with lumbar disc problems and back spasms. The importance of pairing diagnosis codes with therapeutic procedures for accurate reporting is highlighted, using both general and Medicare-specific examples.
00:25:00
In this segment, the speaker discusses specific chiropractic adjustments and their corresponding diagnosis codes, highlighting thoracic, cervical, and lumbar regions. Thoracic traction (97012) is paired with thoracic stenosis codes (M992, M484), while chiropractic adjustments (97530, 97124) target lumbo sacral disc displacement (M5127), sacroiliac joint sprain (S33.6), thoracic pain (M54.6), and back spasms. Massage therapy addresses a left rotator cuff sprain (S43.4) and left shoulder pain (M25.512). The speaker emphasizes the importance of checking with carriers before submitting claims, staying updated with changes, and using resources like Target Coding’s book on chiropractic ICD-10 and CPT codes. They also mention compliance manuals, particularly for Medicare patients, and encourage staying informed through seminars and professional associations. Contact information for Target Coding and additional resources are provided.
00:30:00
In this part of the video, the speaker discusses various services offered to ensure compliance and prevent issues in chiropractic and medical offices. Key features include personalized policies, procedures, and a chart audit tool to help with self-audits. The importance of HIPAA compliance is highlighted due to increasing cybercriminal activity, with their program offering extensive support and $100,000 in cyber liability insurance. They provide different membership levels—base, gold, and platinum—each with varying levels of service and support, including staff training and customizable forms. They also offer seminars, webinars, and continuous support throughout the year. Contact information is provided for further inquiries.