James S. Kennedy, MD, CCS, CDIP, CCDS, writes that the various approaches hospital systems use to optimize their DRG-based case-mix index or HCC-based risk adjustment factor scores will likely conflict with how an accountability agent will see those measurements.
To help bring JustCoding members together and let them learn more about their colleagues, JustCoding created a monthly member spotlight to appear in upcoming issues. The JustCoding team loves hearing members’ stories, including major triumphs and challenges, and sharing them with the larger JustCoding membership.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), it is estimated that more than half a million people in the U.S. have Crohn’s disease. For unknown reasons, the disease has become more widespread in both the U.S. and other parts of the world.
A coding audit may be conducted by internal staff or external entities, typically representing the insurers paying for the care. When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration.
I was recently reviewing Coding Clinic , First Quarter 2018, and felt that the question regarding physeal fractures needed more clarification and explanation than was provided in the official answer.
CMS recently released MLN Matters SE18001 to provide healthcare practitioners with instructions and coding guidance for specimen validity when performed and billed in combination with drug testing. The article was issued to remind laboratories and other providers performing urine drug testing that specimen validity testing (SVT) is not separately billable.
Coders and clinical documentation improvement specialists play a key role in the success of quality payment programs such as MIPS. This article describes the financial impact that hierarchical condition category coding has on provider reimbursement and the coder’s role in ensuring complete, accurate, and timely documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If a patient is seen for a pressure ulcer on the foot related to diabetes, would you report a diabetes diagnosis code? If surgical debridement is performed and the patient receives treatment for their diabetes, can you charge for both an office visit and debridement?
While oral arguments in the American Hospital Association’s (AHA) lawsuit against CMS for its cuts to 340B drug payments in the 2018 OPPS final rule don’t begin until May 4, providers may want to take steps now to preserve their appeal rights if the AHA’s lawsuit is successful.
