In the outpatient setting, we have a different set of rules to follow in regard to the ICD-10-CM Official Guidelines for Coding and Reporting compared to those that follow the guidelines for inpatient care. The ICD-10-CM guidelines for outpatient coding are used by hospitals and providers for coding and reporting hospital-based outpatient services and provider-based office visits.
Billing correctly for observation hours is a challenge for many organizations. Getting it right requires knowing how to calculate observation hours for each patient, which is far from straightforward.
If your hospital resides in one of the 67 metropolitan statistical areas (MSA) required to participate in the Comprehensive Joint Replacement Model (CJR), you will also be required to participate in a new orthopedic payment model called SHFFT (surgical hip and femur fracture treatment) if an August 2 proposed rule is finalized.
As providers prepare for the thousands of new codes and updated guidelines to be implemented October 1, the ICD-10 Coordination and Maintenance Committee recently met to discuss the next batch of updates to be implemented October 1, 2017.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, continues her review of the updated 2017 ICD-10-CM guidelines by explaining how changes to sections for laterality and non-provider documentation will impact coders and physicians. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, delves into chapter-specific guidance included in the updated 2017 ICD-10-CM guidelines, including changes for diabetes, hypertension, pressure ulcers, and more.
Q: We have a new pharmacy director and he wants to monitor all separately payable drugs to ensure that we receive appropriate reimbursement. We’re trying to figure out how to do this because the payment is subject to change each quarter. Do you have any suggestions?
Billing correctly for observation hours is a challenge for many organizations. Getting it right requires knowing how to calculate observation hours for each patient, which is far from straightforward. Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW, writes about how to properly calculate hours and report observation services properly.
Q: I am with a CDI program that is starting to explore severity of illness/risk of mortality (SOI/ROM). I personally have been reviewing for SOI/ROM for quite a while. I usually designate the impact (MCC/CC/SOI/ROM) after the billing is done and see if what I queried for made a final impact, and only take credit for those that do. I was told that regardless of the actual final impact on SOI/ROM, we should be taking credit for any SOI/ROM clarification as SOI/ROM impact. Which is the most accurate, “correct” way to capture the CDI impact for these types of clarifications?
After an almost five-month deferment, the Beneficiary and Family Centered Care Quality Improvement Organizations resumed initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities, CMS announced on their website.
