Internal Medicine – Coding Best Practices Guide
Internal medicine can be defined as the medical specialty dedicated to the diagnosis and medical treatment of adults. A physician who specializes in internal medicine is referred to as an internist. Subspecialties of internal medicine include:
Allergy and immunology
Cardiology
Endocrinology
Hematology
Infectious diseases
Gastroenterology
Nephrology
Oncology
Pulmonology
Rheumatology
Difference between Internal Medicine and General Medicine
Internal Medicine – Internal medicine physicians treat adults and specialize in preventing, diagnosing, and managing disease and chronic conditions. They are trained to diagnose complex diseases occurring only in adults.
General Medicine – General Practice physicians can treat patients of any gender or age, including children & adolescents.
Common Denials
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
