JustCoding.com: Special Reports and News

Five Q&A's about outpatient care

Read the questions and answers to five questions about outpatient care in this week’s Just Coding Platinum!

Executive summary of ACDIS survey results

HCPro distributed its clinical documentation improvement (CDI) survey in January 2008. This overwhelming response rate demonstrates the importance of this subject to health information management (HIM) managers and CDI specialists and managers, according to Colleen Garry, RN author of HCPro’s soon-to-be released book, The Clinical Documentation Improvement Specialists Handbook.

Treatment of new and deleted laboratory codes

CMS changes payment allowance for two influenza vaccines

Physician Presence Policy now applies to renal dialysis monthly capitation payment

CMS releases new instructions for observation vs. inpatient admission and discharge codes

Reporting subsequent hospital visits and hospital dicharge day management services

CMS has modified the 2005 National Coverage Determination for a treatment of obstructive sleep apnea (OSA) to cover continuous positive airway pressure (CPAP). Coverage is limited to a 12-week evaluation period. If patients experience improvement during this 12-week period, they may have use of the machine covered for a longer period of time.

Productivity benchmarks for the POA indicator: An executive summary

Has the present-on-admission (POA) indicator affected coder productivity at your facility? Find out what your fellow coders have to say about their coding experiences since the implementation of POA reporting. Also learn about the benefits that coder/physician education and system preparation had on the transition to Medicare Severity DRGs.

ASCRI's quarterly benchmarking report

In this new Ambulatory Surgery Coding & Reimbursement Insider (ASCRI) quarterly benchmarking report, we take a look at ASC coder compensation. This report is based on the results of a survey in which we asked coders to provide information about their salaries and discuss the importance of coder compensation in ASCs. To view the report click

Pass on the humble pie and admit your own value: Coders should recognize their worth

Although coders are among those most responsible for a hospital's financial health and data quality, fewer than one-third feel very respected in their organization, according to a JustCoding.com survey of 226 readers. The survey also found that fewer than half of respondents feel only somewhat respected, while one in five feel that they are not respected at all.

Understanding and applying the 2008 ICD-9-CM codes

This special report provides coders with a detailed explanation of the new 2008 ICD-9 codes that took effect October 1, as well as the clinical rationale for each new code to ensure proper code assignment, appropriate reimbursement, and accurate data reporting.

Revenue codes: Compliance risks and reimbursement pitfalls

2007 CMS-DRG CC and 2008 MS-DRG CC/MCC Table

Complete list of 2008 ICD-9-CM diagnosis and V codes

What do you do when physicians use the wrong terms?

There are several scenarios that can make DRG assignment difficult. For example, when a physician uses a word in his or her documentation that has two meanings, a coder may assume the wrong one. Faulty reporting also occurs as a result of clinical misunderstanding. In this case, a coder might take a code that is inherent to one body system and inadvertently apply it to surgery in another body system. Robert S. Gold, MD, provides coders with advice on how to avoid incorrect documentation pitfalls.

CMS proposes policy, payment changes for physician services in 2008

CMS proposes policy, payment changes for physician services in 2008: MPFS revisions add new quality measures, boost value of anesthesia work by 32%

Take note of Medicare foot care coverage guidelines

Survey shows mixed approach to documentation improvement

CMS corrects DRG relative weights for FY 2008

CMS recently corrected an error made in the calculation of the DRG relative weights in the Fiscal Year (FY) 2008 Inpatient Prospective Payment System (IPPS) proposed rule. CMS revised the relative weights and recalculated the IPPS amounts. The result of the correction is that CMS will increase the DRG relative weight amounts by $0.18.

CMS reminds providers to submit all paper claims on the UB-04 as of May 23

As of May 23, providers who submit paper claims must do so using the UB-04, CMS said in a reminder.

CMS releases new instructions for payment of astigmatism-correcting intraocular lenses

On April 27, CMS issued a new ruling concerning the insertion of astigmatism-correcting intraocular lenses (IOL) following cataract surgeries. This type of IOL imparts improved near, intermediate, and distance vision.

New transmittal outlines bariatric surgery billing requirements

On April 28, 2006, CMS issued change request CR 5013 to provide coverage for certain bariatric surgeries. The change request was necessary because the national coverage determination (NCD) was not uniformly implemented. Many claims that did not involve bariatric surgery were denied while other covered bariatric procedure claims were held. The new CR was meant to clarify claims processing instructions. Now, CMS issued CR 5477 to further explain these instructions.

CMS clarifies coding requirements for inpatient psychiatric facilities that furnish hemophilia clotting factors

On April 27, CMS released Transmittal 1234 to clarify coding requirements applicable to inpatient psychiatric facilities that furnish hemophilia clotting factor. The implementation date is October 2, 2007. Transmittal 1234 replaces Transmittal 1222.

CMS offers instruction on billing for brachytherapy sources in Q&A

According to a question and answer published on the CMS Web site, hospitals may report and charge Medicare and the Medicare beneficiary for all brachytherapy sources that are ordered by the physician for a particular patient and used in the care of that patient.

2007 Coder Salary Survey: A Special Report

As coders, you understand the important role your work plays in the revenue cycle and in ensuring that a facility or practice receives the reimbursement it deserves. But does administration recognize this? And are you paid accordingly? In the wake of added responsibilities and higher productivity standards, this question has been at the forefront of many coders' minds. Check out this special report that is based on a 2007 JustCoding.com coder salary survey. It provides a detailed breakdown of coder salaries, age, education level, gender, experience, and work hours according to geographic region. It will also take a glance into the future and address how technological and other changes may affect salary.

Drug administration: Master the 2007 coding, billing changes

Learn the injection and infusion changes for 2007 to ensure compliant coding.

Billing and Coding Audits Made Easy

Learn the top 10 reasons why performing billing and coding audits will increase your organization's effectiveness. Get an 11-step plan to audit one-day stays to verify that your organization admits patients under the appropriate status. Read this a nine-step plan for ensuring that your hospital is billing appropriately for patients who are discharged and readmitted on the same day. And more!

Pay attention to details when documenting diabetes

Robert S. Gold, MD, of DCBA, Inc., and Larry C. Deeb, MD, president of the American Diabetes Association, co-authored this special supplement to HCPro's Medical Records Briefings.

Medicare beneficiaries have new copayment for colorectal cancer screenings in non-OPPS hospitals

When providers perform one of the three colorectal cancer screenings in a non-OPPS hospital setting, they can expect to collect a higher copayment (25%) from Medicare beneficiaries, according to Medlearn Matters article number MM5387.

Medicare introduces new secondary payer modifier

Physicians who participate in the Competitive Acquisition Program (CAP) should note that when they procure a CAP drug from a source other than a CAP vendor, they should append new modifier -M2, according to Medlearn Matters article number SE0703.

50 Tips Every HIM Director Should Know

This goldmine of tips will help both the beginning HIM director or the experienced one. Read more of our special report to improve your department.

To the End of the Paper Trail

Those who are on their way to the end of the paper trail and those who have already reached it agree: The first step to a successful EHR project is planning. Read our special report for more information.

CMS establishes IRF-PPS edit to enforce proper transfer coding and payment

Inpatient rehabilitation facilities (IRF) are now subject to edits that the Centers for Medicare & Medicaid Services (CMS) will implement effective April 1, 2007. These edits will match beneficiary dates with admission dates to other providers to identify potentially miscoded claims, according to Medlearn Matters (MM) article number 5354 dated November 2.

CMS issues clarification of billing protocol for modifier -FB

CMS has provided additional information on how providers should bill no-cost and reduced cost devices under the outpatient prospective payment system (OPPS) in Medlearn Matters (MM) article number 5263, effective January 1, 2007. This Medlearn Matters article supplements Transmittal 1103, dated November 3, which outlines application of modifier -FB that providers should use for such devices.

OPPS final rule brings few surprises for ASCs: Industry focused on proposed changes for 2008

The Centers for Medicare & Medicaid Services (CMS) issued its final rule for the 2007 outpatient prospective payment system (OPPS) on November 1, and providers should expect reimbursement cuts and revisions to the ambulatory surgery center (ASC) list of Medicare-approved procedures effective January 1, 2007.

CMS declares post-operative drug administration a packaged service during a Sept. 21 Open Door Forum call

In terms of hotly debated OPPS coding/billing topics, there are few subjects that approach the level of post-operative drug administration-i.e., pain medication injections. The questions come up again and again-which injections/infusions can you bill separately from an associated procedure? Which are considered integral to the procedure and therefore not separately billable? Until recently providers have found guidance supporting both sides of the argument, leading to nationwide confusion. However, in the CMS Open Door Forum call of Sept. 21, Medicare appeared to deliver the definitive word when a representative stated that an injection for pain relief following an outpatient surgery is packaged into the surgery, and it is not proper to append modifier -59 to get the injection paid.

Compliance Benchmarking Report

To gain a better understanding of which topics healthcare organizations plan to audit this year, HCPro conducted a survey of 309 compliance and audit personnel. In this special report, we share the results of our survey and provide analysis by industry experts.