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JustCoding.com provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals. To learn about the different levels of access to this site, click here.
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Simplify the complexities of urodynamics coding
Urodynamic studies are a coding challenge. Differing physician terminology, unique documentation requirements, and new combination codes make for complicated reporting of these diagnostic procedures. Abraham Morse, MD, MBA, and Cynthia A. Trapp, CHFP, CMPE, CPC, CPC-I, CCS-P, CHC, discuss how to code different types of urodynamic studies. 
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Querying when physician documentation seems sparse may be tempting. However, coders and clinical documentation improvement specialists should only initiate a query when clinical evidence in the medical record supports doing so. Margi Brown, RHIA, CCS, CCS-P, CPC, CCDS, and Lynne Spryszak, RN, CCDS, CPC-A, discuss specific clinical clues that provide clinical support for a congestive heart failure query.
If you’ve attended any audio conferences or trainings related to ICD-10, then you’ve probably heard from numerous experts that there simply isn’t a cookie cutter solution for ICD-10 planning and implementation. But Margaret Skurka, MS, RHIA, CCS, FAHIMA, highlights some universal steps that you should incorporate into your timeline for preparation and implementation of this new code set.
Despite increased scrutiny from CMS and private payers, many provider organizations continue to make costly mistakes in coding, documentation, and often in both. There’s no shortage of educational resources, of course. So what’s the problem? Jeannie Cagle, RN, BSN, CPC, Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, and Adel Miles, CPC, share what they’ve seen and offer some advice.
Your provider has performed a procedure, but the documentation indicates that he or she did not meet all of the components of the procedure. You read your 2010 CPT® Manual and pore over the guidelines, but you are still uncertain about which modifier to use. The answer to your dilemma may be modifier -52. Dawson Ballard Jr., CCS-P, CPC, CEMC, shares tips to help you correctly assign this modifier.
Have you started talking with your vendors?
July 30, 2010
October 1, 2013 is not the only deadline to be concerned with. If you submit electronic claims, you should complete internal testing with Version 5010 by January 1, 2011 so that you are prepared for external testing with payers, clearinghouses, billing services, and other business partners. And by January 1, 2012, providers need to be fully [...] 
Recognize the value and purpose of GEMs
July 28, 2010
The network of relationships between the ICD-9-CM and the ICD-10-CM code sets is named the General Equivalence Mappings (GEMs). It's like trying to translate from one language to another. Sometimes there is an exact word match, and sometimes there isn't. For example, the Eskimo has 52 names for snow. In English, [...] 
A word about external cause codes
July 22, 2010
Many of the changes to the 2010 ICD-9-CM codes were additions to the external causes of injury and poisoning E codes (E800-E999). Activity codes were added to give context as to what the person was doing when they sustained the injury. Another subcategory, the Activity Status codes, were also new additions. With ICD-10, you [...] 
Healthcare News: Hospital groups cite studies concerned with CMS’ DCA methodology
July 28, 2010
In a letter to CMS, the American Hospital Association, Federation of American Hospitals, and Association of American Medical Colleges cited two independent studies that underscore their concerns about CMS’ methodology for determining the effect changes in documentation and coding (i.e., documentation and coding adjustment [DCA]) have had on the Medicare patient case mix index.
Healthcare News: CMS issues special MLN Matters article addressing provider vulnerabilities identified in RAC demonstration
July 21, 2010
On July 12, CMS released Special Edition MLN Matters article SE0124 that is “the first in a series of articles that will disseminate information on Recovery Audit Contractor (RAC) high-dollar improper payment vulnerabilities.” The purpose of the article is to provide education regarding RAC demonstration-identified vulnerabilities in an effort to prevent these same problems from happening in the future, according to CMS.
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Check out what you're missing on JustCoding Platinum!
A new course in the in the E-learning library:
Continuing education credits: To receive a 0.5 CE credit, take the quiz after reading the following articles:
- Simplify the complexities of urodynamics coding
- Coding examples illustrate appropriate reporting of modifier -52 for reduced services
- Know what is included in the global surgical package for each procedure
- Healthcare News: Hospital groups cite studies concerned with CMS’ DCA methodology
- Q&A: Bundling guidelines when procedures involve right and left sides of the body
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August 5, 2010
Inpatient Wound Debridement and RACs: Documentation and Coding Improvement Strategies
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