Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
Q Addendum B of the APC updates for 2012 indicates the new molecular pathology codes have status indicator E (noncovered service, not paid under OPPS). Our laboratory director said we should report these new codes in addition to the codes that are payable. Can you explain why?
ICD-10 will allow coders to report nonspecific, unspecified, or not otherwise specified (NOS) codes, but experts say doing so will be counterproductive because of the specificity inherent in the new system.
Even if you didn’t make a personal New Year's resolution, you should make a professional one: to be more conscientious when scrutinizing physician documentation. Experts say every coder should scrutinize physician documentation, especially with ICD-10-CM/PCS looming on the horizon. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Dinh Nguyen examine the role coders play in determining diagnosis quality and accuracy.
In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, offer some tips and suggestions for reporting self-administered drugs and determining when the drug is integral to the service.
The American Hospital Association does not plan to “convert” past issues of Coding Clinic for ICD-10-CM/PCS. Lynne Spryszak, RN, CCDS, CPC, discusses why this decision has caused concern among coders and clinical documentation improvement specialists, who for years have relied on the guidance published in Coding Clinic to assist with coding complicated diagnoses or procedures.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, JustCoding will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. In this month’s column, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, addresses the anatomy of the respiratory system.
Q We're struggling with nursing documentation of stop times for IV infusions (e.g., piggybacks and hydration). The nurses also inconsistently document a patient's return to the unit from diagnostics. We know that CMS now allows us to use average times for common services, and we're interested in considering this approach at my organization. Can you share additional specifics?
A coder can be misled when coding directly from an encoder, and heavy dependence on one can ultimately affect a coder’s skill set. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, CCDS, explains that a critical limitation of encoders is that they cannot physically reason. This inability to deduce often contributes to inaccurate ICD-9-CM code assignment at the expense of clinical accuracy in the reporting of disease processes, not to mention potential reimbursement and measures of continuity of care post-hospitalization.
As hospitals develop more intensive training programs for ICD-10-CM/PCS, coordinators may want to consider how different learning styles will impact the effectiveness of these training sessions. Education has to work for everyone and one size does not necessarily fit all. Victoria Weinert, RHIT, CCS and Lora Ma explain how to get everyone moving in the same direction and prevent coders from going rogue.
