Wednesday, February 28, 2018

6 ICD-10 Tips for OB/GYN Specialists

Like many specialties, OB/GYN includes a variety of changes related to diagnosis codes (CPT & E/M codes remain the same) with the transition to ICD-10. Lori-Lynne Webb, CHDA, COBGC, CPC, CCS-P, CCP, an AHIMA ICD-10-accredited trainer and regular blogger at Lori Lynne's Coding Coach Blog, provides tips to ensure that physicians incorporate ICD-10-CM information into their documentation as well as avoid common compliance traps.

Tip #1: Document the specific trimester. Many of the codes in Chapter 15 of the ICD-10-CM Manual require coders to report the specific trimester of the patient’s pregnancy. For example, ICD-10-CM code O09.01 denotes supervision of pregnancy with history of infertility, first trimester. ICD-10-CM code O60.02 denotes preterm labor without delivery, second trimester.

Trimesters are counted from the first day of the last menstrual period and are defined as follows:
1st trimester: Fewer than 14 weeks 0 days
2nd trimester: 14 weeks 0 days to fewer than 28 weeks 0 days
3rd trimester: 28 weeks 0 days until delivery

Physicians can also simply document the specific number of weeks and days (rather than the trimester). Even this information is helpful because coders can calculate the trimester themselves. What physicians don’t want to do is force coders to report an unspecified trimester. This reflects poorly on the physician and his or her attention to detail and clinical care.

Tip #2: Be careful when reporting an annual GYN exam. In ICD-10-CM, the code for an annual GYN exam is not included in Chapter 15. Instead, it’s located in Chapter 21. Code Z01.4- denotes an encounter for a routine GYN exam, including the following:
Encounter for general GYN exam with or without cervical smear
Encounter for GYN exam (general) (routine), not otherwise specified
Encounter for pelvic exam (annual) (periodic)

Physicians must document whether the exam is with or without abnormal findings, as this affects code assignment. Physicians can bill an E/M code in conjunction with the appropriate ICD-10-CM code for this visit; however, only the lab can bill for the cervical smear test itself.

Tip #3: Document the cause of pelvic pain, if known. As in ICD-9-CM, if OB/GYN specialists can identify the cause of any abdominal and pelvic pain associated with menstruation, they should document this information. Causes of pain include—but aren’t limited to—adhesions, a history of endometriosis, cystic ovaries, or menorrhagia. It’s important to paint the most comprehensive picture of the patient’s clinical presentation so coders can capture all of the appropriate codes in addition to the code for pelvic and abdominal pain (ICD-10-CM code I10.-).

Tip #4: Pay attention to detail when documenting migraines. When a patient presents complaining of chronic migraines related to menstrual cramps, be sure to specify that the patient has menstrual migraines. ICD-10-CM includes codes for a variety of migraines, including those that are neurologic, abdominal, and ophthalmologic based. Also specify whether the menstrual migraine (ICD-10-CM codes G43.82- and G43.83-) is intractable vs. not intractable as well as whether it is with or without status migrainosus.

Tip #5: Document the reason for any fetus viability scans performed. Is the scan performed for routine screening for viability, or are there signs and symptoms (e.g., decreased fetal movement or fetal anemia and thrombocytopenia) that indicate that the patient may have a miscarriage? This information affects code assignment.

Tip #6: Specify whether advanced maternal age (elderly primigravida) complicates a patient’s pregnancy. If a patient is over the age of 35, specify whether her advanced maternal age is a factor in the delivery, and if so, what specific problem it caused. For example, during delivery, these patients may have pre/post eclampsia, an increased likelihood of postpartum hemorrhage, or placenta accretes. During the antepartum care, they may have an increased genetic risk factor for fetal abnormalities.

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Mississippi city sued over denial of pride parade permit

Two women sued [complaint, PDF] the college town of Starkville, Mississippi, Monday after it denied a permit for a gay pride parade.


The women had submitted an application for a parade permit to the city of Starkville, following the city's guidelines. Most of the time, the applications are addressed without publicity through a standard yes or no vote. However, in this case, the plaintiffs' application was put through an irregular procedure that involved a closed-session meeting of the board as well as subsequent public comment. The only objections raised had nothing to do with logistics, security, or cost. Rather, plaintiffs claim, they were anti-LGBT religious comments directed towards the pro-LGBT view that would be expressed by the parade. After these discussions, the board denied the permit application.


The plaintiffs argue that the city had denied [legal memorandum, PDF] their constitutional rights to free expression because the First Amendment "strictly limits the grounds on which they can deny permits." In addition, under the Equal Protection Clause, "the Supreme Court has made clear that governmental acts based solely on animus against LGBT individuals are constitutionally impermissible."

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Sunday, February 25, 2018

4 Ways to Grow Your Practice Like a Startup

For any enterprising and entrepreneurial doctor, it is important to make your presence known. That process should eventually involve a concerted marketing effort, but first you need shift your initial focus to "growth hacking". The goal is having a strong patient panel to market your services to.



"Growth hacking" does not imply any sort of negative connotations that hacking may generally carry; it actually refers to a concentrated, online presence that will build the first few steps to any modern success story.

Here are some powerful, yet simple steps to growth hack your practice:

Identify a Niche: This will take some time, but knowing who to specifically target and developing a USP (unique selling point) will clearly define where and what to post across all Internet forums. Attaining that clairvoyance can yield astounding results. This video by Ramit Sethi and Chase Jarvis describes how to develop a deeper understanding if your market niche.If you are a plastic surgeon who specializes in rhinoplasty, you need to know what ages and gender you typically serve. This will help you better segment who to gear your services towards.


Target Market Interaction: This aspect is as straightforward as it gets. Being attentive to what people are posting and commenting about across all relevant Internet forums is essential to properly tuning the communication with the proper target markets.Take it from one of the most trusted sites for reviews, Yelp: “Responding to reviews is a great way to learn from and build goodwill with one of your most vocal customers.” Your goal is to nurture a healthy, symbiotic relationship between your practice and your patients.

Start Small, Work Your Way Up: Rome wasn’t built in a day, and neither was Facebook; Facebook started out small and grew with increasing interest. That is the best approach to starting an informative and entertaining blog for your medical practice. It also applies to the amount and style of content shared on social media; start slow and gauge interest through likes and comments, then expand accordingly.

Search Engine Optimization: After setting up a website, blog, Facebook and Twitter page for any private practice, it’s time to get down to the nitty-gritty of what to write in those various media. Communication on Facebook, Twitter, and the like is mostly habit formation. Whatever you read on a daily basis that is pertinent to your practice can be easily shared through social media buttons.Blog posting can get lost in the haze of the Internet unless you know how to attract viewers. Using keywords consistently throughout all of your digital media can make your online brand, marketing campaign and overall image consistent. Learn how to use keywords in this post.Using specific keywords are used will help drive the right users to your site and help reinforce your expertise throughout the web.

Medicine is changing rapidly with new policies, regulations, and technologies. To stay competitive in a marketplace where many small practices are being acquired by large groups, it’s vital to find ways to grow your practice. Use these creative strategies for achieving consistent organic growth of your patient panel.

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Thursday, February 22, 2018

7 Key Metrics for Producing Highly Effective PPC Ads

No matter your niche, pay-per-click (PPC) advertising can likely serve to provide your business with far-reaching gains.


If your brand seeks to drive increased traffic, downloads, conversions, or sales, PPC advertising should be on your radar as a profitable marketing tactic.


As the number of businesses investing their marketing dollars in paid search begins to reach critical mass, it is imperative that you understand how to properly dissect your paid adverts to maximize the gains your business can receive.


With the wealth of content online showing how to measure PPC success, it can be challenging to decipher which metrics are most impactful, and which are less relevant to your campaign’s interests.


To help you sift through the noise and develop the most profitable PPC campaign possible, here are 7 key metrics to producing highly effective paid adverts.

1. Impressions



Impressions indicates how many individuals have seen your advert. It helps to provide a measure on the search volume a given campaign or keyword receives.


This is vital for determining which keywords are prosperous and which are holding your campaign back.


For instance, if a term you are using only generated 10 impressions over the course of a month, you know that it is a dud. If you have a different keyword that garners 1,000 impressions a month, you will likely want to optimize your campaign around this phrase.

2. Cost Per Click (CPC)



Your cost-per-click, or CPC, is the average amount that your brand spends on a single click to its website. This data can be analyzed at an account level, but it will likely serve a greater purpose by viewing the CPC for various keywords.


A good benchmark for these metrics will greatly differ from industry to industry. For example, in 2017, the term “bail bonds” was one of the most expensive keywords, with an average CPC of roughly $58. Most terms you target will come in well below this, but be aware that your industry may have a sizable impact on pricing.


This metric will not only tell you how much it costs to gain a click to your site, but also provides business owners with an estimated budget to reach specific goals.

3. Click-Through-Rate (CTR)



While your CTR is a vital metric to monitor, this one comes with a bit of baggage as it is found by leveraging two other metrics.


The first is clicks.


Clicks are essentially the entire goal of PPC advertising; to get folks to click on something you want them to see. Clicks indicates the number of people who clicked your ad and landed on your site or optimized landing page.


To get your CTR, take the number of clicks your campaign generated and divide that by the number of impressions received. Doing this will provide you with the number of people who saw your ad andclicked on it.


This number indicates the quality of your advert or targeted keywords. If you have a low CTR, it could be due to poor copy or irrelevant keywords. Conducting a bit of A/B testing can help you determine the underperforming element.

4. Conversions



Conversions are the outcome you aim for a user to take. Depending on the goals you have established in Google Analytics, this could be engendering a phone call, gaining a download, acquiring an email address, driving a sale, or any number of other objectives.


While this number is vital to monitor and measure as it indicates how many people are taking the desired action, it tells a much larger (and more informative) story when analyzing conversion rates.

5. Conversion Rate



Your conversion rate is the number of conversions your campaign received, divided by the number of clicks it generated. The outcome is the percentage of individuals who clicked on your ad and proceeded to convert.


This number indicates how well-optimized your campaign or landing page is. If folks are clicking through to your website, but quickly bouncing off, you might be targeting irrelevant keywords. If users land on your site, stay for a good while, and then leave, the next step(s) you want them to take may not be clear.


Look at where and when you are losing your potential customers as this will give you an indication of where your campaign could use a little TLC.

6. Cost-Per-Conversion



No matter your company’s definition of what a conversion is (based on your goal), this metric tells you how much it costs to gain each conversion.


To determine your cost-per-conversion, divide the number of conversions generated by your campaign by the amount of money spent.


While many consider this to be the single most important metric to monitor during a PPC campaign, there is one (depending on your goal) that will always trump all others.

7. Return on Investment



To determine your campaign’s actual return on investment (ROI), you need to be able to track a lead all the way from click to close. Additionally, you’ll want to measure the amount of revenue you earned per lead.


While this may sound complex and daunting, it’s rather simple in practice.


To track consumers through their entire journey, you will need a good customer relationship management system like Nimble or HubSpot. Many CRM systems like these integrate with nearly any PPC platform; this enables you to determine which campaign brought a customer to you.


To establish your campaign’s ROI, just compare the sales data to the amount spent.


No matter how you cut it, PPC advertising is a complex beast with lots of ins and outs. Running a prosperous campaign and improving your brand’s efforts moving forward requires a keen understanding of the most important metrics to monitor, how they work together, and lots of practice.


Start getting some PPC experience by crafting compelling ads, avoiding the most common PPC pitfalls, and continually aiming to improve each of the above metrics and you can become a PPC superstar in no time.

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