As clinicians and coders invested in ICD-10-CM/PCS documentation and coding compliance, we’ve seen it all as it relates to the various approaches different hospital systems use to “optimize” or “maximize” their DRG-based case-mix index (CMI) or risk adjustment factor (RAF) scores based on Hierarchical Condition Categories (HCC).
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
Did you know there is a coding competition? The second annual ICD-10 Coding Contest, sponsored by Central Learning, took place last summer, recruiting coders from all over the nation to participate in coding a total of 1,636 real-life medical cases.
Bundled Payments for Care Improvement Advanced, a new voluntary bundled payment model launched by CMS in January, includes 32 clinical episodes encompassing both inpatient admissions and outpatient procedures. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , writes about participation criteria, payment calculations, and quality measures for this program.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about discussions at the AMA CPT Symposium that could impact coders, including the need for updates to CMS’ E/M Documentation Guidelines and how medical decision making is used as a key component for E/M reporting.
The skin is the largest organ in the human body and plays a vital role in protecting the body from injury and illness. This article reviews integumentary anatomy and provides guidance to aid in accurate ICD-10-CM and CPT code assignment for complex integumentary diagnoses and procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The World Health Organization is preparing for the official release of the 11th Revision of the International Classification of Diseases, or ICD-11, in June.
