Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
All of us in ICD-10-CM/PCS coding compliance are facing a tsunami of denials from payers, Recovery Auditors, and Medicare quality improvement organizations. This is due to the auditors’ removal of ICD-10-CM codes based on provider documentation; auditors can perceive that a patient did not have clinical indicators supporting the presence of the documented condition.
CMS released the fiscal year 2018 IPPS proposed rule April 14, and with it came a bevy of new potential ICD-10-CM codes. Explore the new additions to the ophthalmologic, non-pressure chronic ulcer, maternity and external cause codes ahead of implementation October 1.
April marks sexually transmitted infections month, and Peggy S. Blue, MPH, CPC, CCS-P, CEMC , gets in the spirit by breaking down the staging, diagnosis, and treatment of syphilis before examining how to code the disease in ICD-10-CM. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When reporting multiple separate infusions of the same substance or drug provided through the same IV site during one visit, should we add up the total time and then report the appropriate codes?
CMS released four new resources in early April on the Merit-based Incentive Payment System, one of two new payment options under the Quality Payment Program initiative created by the Medicare Access and CHIP Reauthorization Act.
HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations, and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper, and that will hit reimbursement hard.
Coding Clinic for ICD-10-CM/PCS , First Quarter 2017, which became effective March 15, provides interesting perspectives that may be useful in our deliberations with payers or Recovery Auditors. Let’s process some of its guidance.
Query practices have changed a lot over the years. With so many shifts, coders and clinical documentation specialists may need to take a step back and take stock of the changes they’ve worked through, reassessing current practices against industry recommendations and shoring up policies to prevent well-known pitfalls.
On Friday, April 14, CMS released the fiscal year 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-PCS and ICD-10-CM code proposals.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, discusses the reporting of alcoholism, its key documentation details, and its effect on MS-DRGs in ICD-10. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Ghazal Irfan, RHIA, writes about healthcare’s shift from fee-for-service to pay-for-performance, volume-based care to value-based reimbursement, and case-mix index to outcome measures, and how your facility can achieve compliant coding practices among these changes.
Providers often document “global developmental delay” in pediatric charts. The phrase is used to describe when a child takes longer to reach certain development milestones than other children the same age, such as walking or talking. Children with conditions such as Down syndrome or cerebral palsy may also have a global developmental delay.
A benefit of the switch to ICD-10-CM is the ability to be as specific as possible about a patient’s condition, but the downside of this is that it can make coding fractures time-consuming and confusing. Knowledge of bone anatomy and how fracture codes work is therefore an invaluable asset in fracture coding.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, discusses the use of unspecified codes after the ICD-10-CM grace period and advises providers on how to decrease the use of those codes.
