The anatomical definition of a body part may not be the same as the ICD-10-PCS identification of a body part. Jennifer Avery, CCS, CPC-H, CPC, CPC-I, Nena Scott, MSEd, RHIA, CCS, CCS-P, and Gretchen Young-Charles, RHIA, explain the guidelines for selecting the appropriate body part and how body parts can affect root operation selection.
When a provider notes a diagnosis on the hospital-acquired condition (HAC) list, coders must be diligent about looking throughout the rest of the chart to ensure documentation clearly indicates the presence of a HAC. For example, if the condition is a pressure ulcer, the condition may have been present on admission. Shelia Bullock, RN, BSN, MBA, CCM, CCDS, and Beverly Cunningham, MS, RN, address the importance of coder participation as members of hospital HAC committees and the development of best practices to ensure accurate HAC and HCAC reporting.
Under a new ruling, CMS allows full Part B payment for inpatient stays that a contractor denies because it deems them to be not reasonable and necessary. David Danek and Ann Marshall, both from CMS, explain how the rebilling works under the ruling and what will be different under a simultaneously released proposed rule.
Coding tells a patient's story, based on the narrative the physician provides in his or her documentation. Accurately painting a picture of the patient's severity of illness (SOI) and risk of mortality (ROM) is essential for good patient care, and it is becoming increasingly important for quality measures and payment.
Although ICD-10-CM resolves some problematic areas of coding, it isn't a panacea. Respiratory insufficiency is one diagnosis that will continue to challenge coders.
