Coding Clinic , Fourth Quarter 2017, which became effective October 1, has interesting morsels affecting ICD-10-CM/PCS documentation and coding compliance.
Crystal Stalter, CDIP, CCS-P, CPC, writes about the benefits of creating best practices at your facility and how they help avoid time lost and unnecessary delays in payment. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Yes, I’ll admit it: I used to be one of those people. Before finding a great fit on a CDI dream team, I worked as a medical review examiner for a Medicare Administrative Contractor (MAC). During that time, I reviewed Part A claims for inpatient stays, therapy reviews, medications, and Recovery Auditor (RA) appeals—to name a few. Not only did I gain experience working with Medicare hospital claims, but I also got to see a little bit of how different facilities approach their denials.
The newness and specificity of ICD-10 has ushered in a stronger focus on clinical coding audits. From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind.
According to the American Cancer Society, skin cancer is by far the most common type of cancer . Exposure to harmful ultraviolet (UV) rays from the sun without protection can cause skin cancer. UV rays can come from other sources as well, such as tanning beds and sun lamps. The number of skin cancer diagnoses has increased in the past few years.
Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) added a requirement that will dramatically revise the Medicare Clinical Laboratory Fee Schedule (CLFS) effective January 1, 2018.
In July, Utah pain doctor Jahan Imani, MD, and Intermountain Medical Management, P.C., entered into a nearly $400,000 settlement with the OIG to resolve allegations that Imani’s practice submitted false or fraudulent claims due to improper modifier use for payment by improperly using modifier -59 with HCPCS code G0431.
Patient care continues to move from the inpatient setting to outpatient. With this change, the challenge of securing comprehensive documentation that articulates the services rendered and the patient care provided now needs to extend across the care continuum.
Q: If you have an acute exacerbation of chronic right heart failure (CHF) with a preserved ejection fraction (EF) above 55%, can you code it as heart failure (HF) with preserved EF? All the clinical symptoms exemplify right-sided heart failure (e.g., ascites, pronounced neck vein distension, swelling of ankles and feet).
