Q: Facilities often have two charges for services performed in an operating room (OR) suite. For example, a facility performs a colonoscopy and an esophagogastroduodenoscopy, which took a total of 20 minutes in the procedure room. The facility charged two set-up fees plus an additional five minutes of OR time. Would this be considered a duplicate charge?
The ICD-10 Coordination and Maintenance Committee will meet March 7-8 to discuss new conditions, procedures, and expanded details that could appear in a future update of the code set.
The intersection of CMS’ packaged payment policy and the increasing volume of Medically Unlikely Edits (MUE) can be likened to a car crash waiting to happen. Hospitals are having valid, medically necessary claim lines denied – including charges and units below MUE limits. Providers can help stop the crash by ensuring their claims, CPT coding, medical necessity, and the units are all correct.
With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
Red letter days in coding compliance occurred in December 2016 and January 2017 with the Office of Inspector General’s (OIG) release of two audit reports. These reports asserted that Northside Medical Center of Youngstown, Ohio, and Vidant Medical Center of Greenville, North Carolina, improperly submitted ICD-9-CM codes for marasmus and severe malnutrition.
Q: If a patient is admitted to the hospital with diabetic ketoacidosis (DKA) and cholelithiasis, and is treated for both, would you code the cholelithiasis as the principal diagnosis because the patient had his or her gallbladder removed?
Erica E. Remer, MD, FACEP, CCDS , explains what clinical validation denials are, how they are determined, and how a coder can help to limit these rebuffs.
CMS pushed the February 15 submission deadlines for select inpatient clinical and healthcare-associated infection measure data, citing system glitches and inaccessibility to QualityNet reports.
Amber Sterling, RN, BSN, CCDS , and Jana Armstrong, RHIA, CPC , discuss revenue integrity and how it focuses on three operational pillars: clinical coding, clinical documentation improvement, and physician education.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about the transition of the CPT code for reporting ablation of uterine fibroid tumors from a Category III to Category I code and the impact that could have on coding and billing.
Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly paying $137 million for these services, according to a study reported in the January 2016 Medicare Quarterly Compliance Newsletter .
Q: We have claims that are hitting an edit between a procedure HCPCS code and the new codes for moderate sedation (99151–99153). Since moderate sedation is no longer inherent in any procedure beginning January 1, why are these scenarios hitting an edit?
Inpatient coding departments are likely familiar with integrating clinical documentation improvement (CDI) specialists into their processes. Crystal Stalter, CPC, CCS-P, CDIP, looks at how CDI techniques can benefit outpatient settings and what services and codes facilities should target.
The codes in ICD-10-CM Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, cover diagnoses for conditions throughout the body. Due to the wide scope of conditions in the chapter, it had extensive updates for 2017. Review some of the most significant changes and the details required to accurately report the codes.
Crystal R. Stalter, CPC, CCS-P, CDIP, writes about how fully specified documentation is the key to quality care, compliance, and eventual reimbursement, and how documentation software can help to streamline these processes.
Q: My hospital’s coding team keeps having trouble distinguishing between J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) and J44.1 (chronic obstructive pulmonary disease with [acute] exacerbation. Is there any guidance out there that can help clarify their differences? We would appreciate any help.
In January, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine released the 2016 Surviving Sepsis guidelines, adopting the new consensus definitions for sepsis and septic shock (Sepsis-3) established last year.
Clinical documentation improvement managers discuss their management duties and program priorities and how they strive for the best possible results at their facility.
James S. Kennedy, MD, CCS, CDIP, discusses bundled payments and the importance of applying proper ICD-10-CM/PCS-pertinent documentation and coding principles to remain compliant.
