The complexity of coding rules and the quality of documentation in facilities sometimes make correct DRG assignment a daunting task. Laura Legg, RHIT, CCS, highlights current DRGs that are subject to Recovery Auditor scrutiny and provides tips for accurate DRG assignment.
CMS designates certain procedures as inpatient-only, meaning it will only reimburse the facility when the procedure is performed on an inpatient. However, CMS identifies these procedures using outpatient CPT ® codes. Beverly Cunningham, MS, RN, and Kimberly A.H. Baker, JD, CPC, discuss the process for identifying and coding inpatient-only procedures.
Chronic kidney disease (CKD) is a manifestation of many different chronic disease processes, including diabetes, hypertension, and immune complex diseases. Garry L. Huff, MD, CCS, CCDS , and William E. Haik, MD, FCCP, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, explain the clinical indicators of CKD as well as coding and documentation problem areas.
As part of the 2015 OPPS proposed rule , released July 3, CMS is considering eliminating the requirement for a signed physician certification for most short inpatient stays. CMS would still require a signed physician certification for stays that last 20 days or longer, as well as outlier cases.