An Office of Inspector General (OIG) audit of the University of Michigan Health System revealed noncompliance with four types of inpatient claims, including those associated with the billing of high-severity-level MS-DRGs.
CMS released Transmittal 3997 March 8, outlining HCPCS drug and biological code updates. These changes include updates to specific biosimilar biological product HCPCS codes, modifiers used with these biosimilar biologic products, and an autologous cellular immunotherapy treatment.
Medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. This article describes how medical necessity impacts third-party payers and those who work in billing and reimbursement services.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about discussions at the 2017 AMA CPT Symposium that could impact coders, including issues with the Table of Risk for E/M office visit codes and suggestions for E/M guideline revisions. This article is part two in a series.
Wound care coding can be challenging as wound size, depth, and severity must be properly documented to report the most accurate codes. Review coding for pressure ulcers in ICD-10-CM and wound debridement in CPT to avoid common documentation and reporting errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CCDS, CDIP, writes about potential coding compliance issues raised in the Office of Inspector General’s (OIG) Work Plan for providers to consider, including documentation and coding for severe malnutrition and bariatric surgery.
Q: If a patient is admitted with a high blood alcohol level and the provider documents the blood alcohol level in his or her note, does the provider also need to specifically write “patient with intoxication?”
Allen Frady, RN-BSN, CCDS, CCS, CRC, explains the value of tracking and understanding key performance indicators (KPI), and gives advice on how facilities can improve on its practices.
Medical necessity denials are commonly encountered in facilities. Complete understanding and utilization of the ICD-10-CM/PCS coding guidelines is imperative for coders and coding mangers to recognize how to avoid these denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
