The ICD-10-CM/PCS delay may give coders more time to learn the new system, but what does this mean for organizations that have already begun to prepare?
Coders play a crucial role in ensuring compliance, and the FY 2013 IPPS final rule , released August 1, gives them many reasons to showcase their skills.
ICD-10-CM coronary artery disease and myocardial infarction codes will undoubtedly differ from their ICD-9-CM counterparts in some ways, but some aspects will remain the same.
Coding isn't just about reading documentation and selecting codes based on certain words. It's about processing information and assessing whether the codes reported accurately depict the clinical picture and medical necessity for an admission.
Knowing when and how to query for all conditions is crucial; this couldn't be truer for CCs and MCCs, conditions that affect payment and help capture a patient's true clinical picture and complexity.
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
The Hospital Readmissions Reduction Program (HRRP) is a CMS pay-for-performance program that links the amount hospitals are paid to risk-adjusted readmission rates. Measures included in the program are claims based, which simply means that the ICD-10 codes we submit on our claims for payment are also used to assess our performance; our performance then impacts our payment.
