Hospital inpatient

Medical necessity denials traditionally focus on high-dollar DRGs, such as those for hip and knee replacements; others may also soon become targets.

Unfortunately, ICD-10-PCS is not very comparable to the current ICD-9-CM volume 3 codes inpatient coders currently use. But coders shouldn’t despair, according to Sandy Nicholson, MA, RHIA, Jennifer Avery, CCS, CPC-H, CPC, CPC-I and Robert S. Gold, MD —ICD-10-PC coding may even be fun once coders get the hang of it.

Q: How have you handled situations when specialty physicians and hospitalists do not agree with diagnoses impacting core measures?

A wound is an injury to living tissue caused by a cut, blow, or other external or internal factor. Robert S. Gold, MD , and Gloria Miller, CPC, CPMA , review anatomy and documentation for wounds and explain how to code for wound care in ICD-9 and ICD-10.

CMS released its FY 2014 IPPS final rule in August, and with it comes a whole slew of changes for inpatient hospitals. Set aside a good amount of time to scroll through the 2,000-plus page document. Yes, that's right: There are more than 2,000 pages of information to absorb before the rule goes into effect on October 1, 2013.

Coding Clinic serves as the Supreme Court in interpreting ICD?9?CM or ICD?10?CM/PCS and their guidelines. James S. Kennedy, MD, CCS, CDIP, Kyra Brown, RHIA, CCS, and Nelly Leon-Chisen, RHIA, discuss the best ways to use this additional guidance.

Q: Can you explain how the recent updates to the three-day payment window pertain to self-administered drugs?

QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end. Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?

In February, AHIMA published an update to its 2010 query practice brief. The updated brief, Guidelines for Achieving a Compliant Query Practice, is the result of a joint effort between AHIMA and the Association for Clinical Documentation Improvement Specialists (ACDIS). ?

Facilities may be reluctant to charge for bedside services beyond the room rate because they fear double-dipping. Kimberly Anderwood Hoy, JC, CPC, and William L. Malm, ND, RN, CMAS, discuss what CMS does—and doesn’t—say about charging for ancillary services .