Beginning in 2018, total knee arthroplasty (TKA) was removed from the Inpatient Only List and assigned a comprehensive APC payment. Outpatient coders need to ensure they are assigning the correct CPT codes for TKA to reduce their hospital’s risk of audits.
Findings from an Office of Inspector General (OIG) audit show that Novitas Solutions Inc. overpaid hospitals for intensity-modulated radiation therapy (IMRT) services provided to nearly all sampled Medicare beneficiaries over a 30-month period, resulting in overpayments of at least $7.2 million.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
Outpatient procedures involving anesthesia should be reported using five-digit CPT codes as well as applicable hospital modifiers. Review types of anesthesia administration and documentation elements required for accurate code assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
When pneumonia documentation is questioned, CDI specialists or coders should always query the provider. But reviewing the following clinical elements involving aspiration and pneumonias with your physician staff may help improve the documentation of complex pneumonias and avoid adverse determinations by external reviewers.
Q: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
A new risk model provides a simple way to determine whether acute myocardial infarction (AMI) patients are at a high risk for hospital readmissions, says a study published in the Journal of the American Heart Association.
Sharme Brodie, RN, CCDS, reviews recent guidance published in Coding Clinic , Third Quarter 2018, including advice on diabetes, acute myocardial infarctions (AMI), pressure ulcers, and more.
Crystal R. Stalter, CPC, CCS-P, CDIP, says that there is still confusion around documenting patient stays to show quality, especially in the inpatient realm. Is it really as simple as documenting conditions to their fullest specificity or does it involve a more complex approach?
