The transition to ICD-10-CM is coming. The only question is when. Despite the possible delay, coders and other HIM professionals must continue to prepare for the transition. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Sandy Nicholson, MA, RHIA, Robert S. Gold, MD, Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and Kim Felix, RHIA, CCS, provide information on how ICD-10-CM will—and will not—differ from ICD-9-CM.
Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
The January update to the Integrated Outpatient Code editor generally includes a large number of changes and the January 2012 update is no exception. Dave Fee, MBA, highlights the most significant changes including the addition of modifier –PD, which he calls one of the real sleepers in this release.
In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, offer some tips and suggestions for reporting self-administered drugs and determining when the drug is integral to the service.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, JustCoding will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. In this month’s column, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, addresses the anatomy of the respiratory system.
As hospitals develop more intensive training programs for ICD-10-CM/PCS, coordinators may want to consider how different learning styles will impact the effectiveness of these training sessions. Education has to work for everyone and one size does not necessarily fit all. Victoria Weinert, RHIT, CCS and Lora Ma explain how to get everyone moving in the same direction and prevent coders from going rogue.
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator procedures at the standardized inpatient rate as part of the calendar year 2012 Outpatient Prospective Payment System final rule. In addition, CMS finalized several changes regarding payments for 11 cancer centers, drug payment calculations, and physician supervision. Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, explain the changes facilities will see in 2012.
Q: How many times should Glasgow Coma Scale information be captured? If you have the ambulance, ED physician, and attending physician all recording the score, should each be reported?
Q: A patient fractured all metatarsals last year and had open reduction and internal fixation. The patient now has a nonunion of the fracture sites and is going back to the OR for an amputation. What would be the appropriate ICD-10-CM seventh character to report?
Q: We are an independent outpatient end-stage renal disease clinic. When we administer a blood transfusion (we do not bill for the blood) can we bill HCPCS code A4750 (blood tubing, arterial or venous, for hemodialysis, each) for the tubing used in the procedure and also A4913 (miscellaneous dialysis supplies, not otherwise specified) for miscellaneous supplies pertaining to administering the blood?
