Medical Billing Q&A Forum

Does Code 173.61 Include Hand or Fingers for Medical Billing?

173.61 is the ICD-9-CM diagnosis code for basal cell carcinoma of skin of upper limb, including shoulder—one of the new dermatology codes that took effect on October 1, 2011.  (Please see our blog article, "Updated Dermatology Codes For Medical Billing.")

The answer to the question is yes, this diagnosis would include hand or finger.

To answer this question, we referred to ICD-9-CM For Physicians, Volumes 1&2 2012 Expert Edition from Ingenix/Optum Insight.  When you look under neoplasm, skin, hand or finger, note that it states (Neoplasm, skin, upper limb) and because it is a basal cell carcinoma, you would code with the 1 at the end.

Thanks for your question.  We hope this helps.

What Are The CMS Requirements For Physician Signatures On Patient Records?

Want to avoid unnecessary audits and compliance headaches? Then make sure your signature is present on all your patients' charts. CMS has strict guidelines for what constitutes a legal identifier on services provided/ordered.  If the signature is handwritten, acceptable forms include:  A legible first and last name, a legible first initial with last name, or even an illegible signature over a printed or typed name.  Basically, as long as an illegible signature is on the same page as other information identifying the signer, CMS will accept the documentation.  WARNING:  Stamped signatures do not meet the CMS requirements.  This is because a signature stamp can be used by anyone who has access to the stamp, in essence making the signature impossible to authenticate.

What Is Medical Billing?

Medical billing is the process through which medical, psychological and other healthcare providers submit claims for payment of services to insurance companies and patients.  Claims are prepared using a set of diagnosis (ICD-9-CM—International Classification of Diseases, 9^th Revision, Clinical Modification) and procedure (CPT—Correct Procedural Terminology) codes specified by the American Medical Association.  Claims are generally transmitted to insurance carriers on a special form (HCFA 1500) or electronically, and insurance carriers use the claims to reimburse (pay) the provider or facility for services rendered to the patient on the date specified.  These payments are issued to the providers or facilities according to a contracted fee schedule, which includes reimbursement according to terms set forth in a provider agreement entered into by both the provider or facility, and the insurance carrier.  These rates vary from insurance carrier to insurance carrier, but are generally based on the rates of payment set forth in the WPS Medicare fee schedule, the list of rates paid by the Centers for Medicare and Medicaid Services (CMS) department of the US Government.

Codes are filled out on this form based on what procedures are done and codes can be found in procedure books put out by the AMA.  The process of determining what codes to use for procedures and diagnoses is complicated and exacting, and generally requires specialized training.