Code EMR

12/15/2025

Coding Tip of the Week: Understanding “Code First” Rules in Behavioral Health

When coding behavioral health conditions, certain ICD-10-CM codes include a “code first” instruction. This means the underlying medical condition must be sequenced before the behavioral health manifestation.

Failing to follow this rule can lead to inaccurate risk capture, sequencing errors, and claim denials.

Why It Matters
“Code first” notes appear when the behavioral condition is caused by or is a manifestation of another illness. ICD-10-CM requires the etiology (cause) to be coded before the behavioral diagnosis.
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Common Behavioral Health Categories With “Code First” Requirements
1. Dementia in Other Diseases Classified Elsewhere (F02.80–F02.81x)
These codes are never used alone.
Sequence first: the underlying neurological or medical disease.
Example:
• G20.(XX) Parkinson’s disease
• F02.80 Dementia in other diseases classified elsewhere
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2. Mood Disorders Due to a Medical Condition (F06.31–F06.34)
These represent manifestation codes.
Example:
• I63.9 Cerebral infarction
• F06.31 Mood disorder due to known physiological condition with depressive features
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3. Psychotic Disorders Due to a Medical Condition (F06.2)
Used when psychosis results from an identified illness.
Example:
• E05.90 Hyperthyroidism
• F06.2 Psychotic disorder due to known physiological condition
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4. Anxiety Disorders Due to a Medical Condition (F06.4–F06.42)
Example:
• J44.9 COPD
• F06.4 Anxiety disorder due to known physiological condition
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5. Behavioral or Cognitive Changes Due to Physiological Conditions (F07.*)
Includes post-concussion syndrome, personality change after brain injury, and other cognitive disturbances.
Example:
• S06.2X9A Traumatic brain injury
• F07.81 Postconcussional syndrome
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Key Takeaway

If a behavioral health condition is secondary to another medical condition, check the Tabular List for a “code first” note.

Always code:
1. Underlying medical etiology
2. Behavioral/mental health manifestation

Proper sequencing ensures accurate clinical reporting and reimbursement.

Schedule a free consultation today - https://www.codeemr.com/request-information/

12/11/2025

🔍 Maximizing CHC Reimbursements Through Specialized Medical Coding

Community Health Centers (CHCs) and Federally Qualified Health Centers (FQHCs) are pivotal in providing accessible healthcare to underserved populations. However, without precise medical coding, these centers risk underpayments, claim denials, and compliance challenges.

At CodeEMR, we specialize in CHC and FQHC coding, ensuring accurate coding, full compliance, and reduced claim denials. Our team of certified coders has helped numerous centers achieve significant improvements in their reimbursement processes.

Discover how specialized coding expertise can enhance your CHC's financial health and operational efficiency.

🔗 Read the full blog here - https://www.codeemr.com/chc-reimbursements-medical-coding-expertise/

Boost CHC reimbursements with CodeEMR’s specialized medical coding experts, ensuring accurate coding, full compliance, fewer claim denials, and maximum revenue.

12/08/2025

🩺 Is paperwork silently capping your practice’s growth - even before patients walk in?

In 2024-25, many independent clinics told us: “It’s not patients, it’s claims, denials, and documentation that’s burning us out.”

That’s why we built a service layer that combines pro-fee coding + revenue-cycle management (RCM) with clinical-grade documentation support - to turn charts from burden to fuel for your practice.

📊 Here’s what practices see when they get it right:
- 30–40% reduction in documentation-linked denials 🛡️
- 98%+ note-accuracy and audit-ready claims 📄
- Faster claim cycles, cleaner cash flow, less admin friction 💰

Because behind every patient visit is paperwork - and behind every claim is cashflow waiting to be protected.

If you manage a small/independent practice and you’re tired of chasing denials or delayed reimbursements, this is for you.

👉 Read more on how a unified RCM + scribing-aware model makes a difference: https://www.codeemr.com/pro-fee-coding-services-revenue-cycle/

Pro-fee coding services that strengthen your revenue cycle. CodeEMR ensures accurate coding, reduced denials, and improved reimbursement performance today now.!

12/04/2025

🔎 Why many denied claims never see the light of day - and how to change that?

Healthcare billing denials often stem not from coding mistakes, but from weak documentation and appeal-evidence stacks.

At CodeEMR, we dug into what differentiates a “lost claim” from a “win.” Our new article - “The Anatomy of a Win” - outlines a proven appeal-evidence framework that:

🧾 Builds airtight documentation around patient risk and medical decision-making,

📂 Compiles claim history, clinical context & payer requirements clearly,

🚀 Helps reduce denials and reclaim lost revenue with transparency and compliance.

In real use cases we support, this approach has helped practices significantly improve appeal success - because documentation becomes more than a formality.

If you handle medical billing, coding, or RCM for your practice, this read will give you a structured, easy-to-follow evidence stack blueprint.

👉 Read the full article here: https://www.codeemr.com/articles/the-anatomy-of-a-win-how-codeemr-builds-a-strong-appeal-evidence-stack/

Discover how CodeEMR’s appeal evidence stack strengthens documentation, reduces claim denials, and speeds up reimbursement with a clear, evidence-driven process.

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.