Q: Which ICD-10-CM external cause code should we report if a patient falls while on an escalator? This is the first time that the patient has been seen for such a fall.
Problems can occur anywhere along the alimentary canal or in any of the accessory organs. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, discusses some common diagnosis and procedure codes for digestive diseases and procedures.
CMS' introduction of the 2-midnight rule in the 2014 IPPS final rule makes properly identifying inpatient-only procedures even more important for hospitals.
Clinical auditors are often not able to translate from ICD-9 to CPT ® to determine a procedure is inpatient-only, which leads to denials. Kimberly A.H. Baker, JD, CPC, and Beverly Cunningham, MS, RN, reveal common causes of denials and what hospitals can do to overturn incorrect denials.
Even through ICD-9-CM and ICD-10-CM/PCS are currently under a code freeze, c oders and CDI specialists still need to pay attention to what conditions are considered CCs and MCCs, as well as sequencing rules which could affect MS-DRGs.
PSI 15 measures the hospital's risk-adjusted rate of accidental punctures and lacerations. PSI 15 has the highest weight in the PSI 90 composite under both the Hospital-Acquired Condition Program and the Hospital Value Based Purchasing Program. Coders and CDI specialists can improve performance for PSI 15 by ensuring complete documentation and correct ICD-9-CM code assignment for PSI 15?pertinent inclusions, exclusions, and risk adjustment variables.
QUESTION: A patient was exposed to shingles, for which a coder reported ICD-9-CM code V01.79 (exposure to other viral diseases, including HIV). This poses a problem for billing as code V01.79 is a confidential diagnosis, requiring special release of information from the patient and would remain on the insurance record. As an RN and certified coder, I believed code V01.71 (exposure to varicella) is the correct code because the varicella virus causes both chicken pox and shingles. However, I am being overridden by the chief business office. Which code is correct?
QUESTION: Can a patient have encephalopathy after surgery? For example, a patient becomes confused post-surgery and is transferred from the medical-surgical floor to the intensive care unit, where he or she receives high doses of pain medication via IV. However, the patient recovers well and the confusion disappears after the IV fluids and reduction in pain medication and oxygen. Would it be appropriate to query the physician regarding encephalopathy and its possible cause, or would this be a red flag for auditors? The situation did extend the patient’s length of stay by one day.
