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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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Report unlisted procedure codes appropriately to ensure accurate reimbursement
Meera Mohanakrishnan, CPC, CPC-H, explains why it’s important for coders and billers to understand that they should only report an unlisted HCPCS code for rarely performed, unusual, or new procedures when a more appropriate code is not available.
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It happens every day in every kind of healthcare facility: Claims denials. Large and small physician offices, hospitals, specialties, and family practices lose thousands of dollars per year as a result of denied claims. Studies indicate that some hospitals lose $1,000 per day, and some outpatient facilities lose as much as $1,200 per day. Unfortunately, some facilities and practices try to mitigate the loss by passing the debt to the patient or guarantor. Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, provides helpful advice that you can use to successfully overcome denials.
How do you define “chronic”? Many medical dictionaries and Web sites describe chronic diseases as long lasting or recurrent. The Agency for Healthcare Research and Quality prefers a more substantial definition; it says that chronic conditions are “expected to last one year and result in limitations in self-care, independent living, and social interactions or in the need for ongoing medical intervention.” Leatrice Ford, RN, BSN, CCS, and Shannon McCall, RHIA, CCS, CPC, debate the importance of assigning a Y indicator to chronic conditions as well as the need for a universal chronic conditions reference list.
The query process is an effective way to improve clinical detail and coding accuracy. More specific and detailed documentation improves future continuity of care and can potentially lead to improved quality of care. Colleen Garry, RN, BS, offers advice on how your facility can develop compliant physician queries to enhance its clinical documentation improvement program.
Most health information management (HIM) directors think a disaster will never occur at their hospitals. And although channeling positive thoughts is generally laudable, it isn’t a realistic approach when disaster can strike at any moment. A disaster doesn’t necessarily need to take the form of a hurricane, tornado, or pandemic to severely incapacitate an HIM department. What happens when the power goes out? Or how about when the computer system crashes? Glennda Gore, RHIA, and Chris Apgar, CISSP, help prepare your facility for future obstacles.
Earlier this year, CMS advised during an Open Door Forum that the medically unlikely edit (MUE) value for units with CPT infusion codes 90766 or 90761, which providers bill to fiscal intermediaries, would increase on April 1, retroactive to the original date of January 1. However, it wasn’t until the end of April that providers begin to notice that CMS was accepting infusion and injection claims for values that it had previously rejected. Andrea Clark, RHIA, CCS, CPC-H, and Jugna Shah, MPH, explain recent MUE changes.
Coding wound closures is fairly straightforward, and the CPT Manual does a good job providing definitions. But there are hundreds of procedures involving wound closure, and many are included in more extensive procedures. As of July 1, there are more than 500 active National Correct Coding Initiative (NCCI) edits just for wound closure codes. CMS developed the NCCI edits to promote correct coding methodologies nationwide and control improper coding. You can find the NCCI edits on the CMS Web site. CMS updates the NCCI edits every quarter.
Healthcare happenings: CMS seeks cosponsors for educational conference on e-prescribing incentive payment program
August 20, 2008
In an August 8 press release, CMS announced a special conference to educate physicians and other stakeholders about a newly-enacted federal program that offers incentive payments for physicians who use e-prescribing. CMS requests that interested public and private sector organizations join the agency as cosponsors of the conference that will be held October 6-7 in Boston.
Healthcare happenings: ICD-9-CM official guidelines for coding and reporting
August 13, 2008
CMS and the National Center for Health Statistics (NCHS) released the following guidelines for coding and reporting using ICD-9-CM. Coders should use these guidelines as a companion document to the official version of the ICD-9-CM.
Healthcare happenings: CMS releases FY 2009 IPPS final rule
August 13, 2008
CMS released its inpatient prospective payment system (IPPS) final rule for fiscal year (FY) 2009 on July 31, updating Medicare payments to hospitals and providing added incentives for hospitals to improve their quality of care. Changes take effect October 1. CMS will publish the final rule in the August 18 Federal Register.
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August 28, 2008
The Impact of the New and Revised 2009 ICD-9-CM Codes
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