Insufficient documentation led to approximately 97% of improper payments for kyphoplasty and vertebroplasty claims reviewed during a recent Comprehensive Error Rate Testing (CERT) study, according to the Medicare Quarterly Provider Compliance Newsletter.
Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details correct coding for spinal injuries in both ICD-9-CM and ICD-10-CM, along with the documentation requirements for choosing the most accurate code.
Injuries to the elbow and forearm are common as a result of many everyday activities, and ICD-10-CM allows more specificity for reporting these conditions. Review the anatomy of the elbow joint and forearm to prepare for ICD-10-CM.
The July quarterly I/OCE update from CMS brought few new APCs or edit updates, but did deliver a new modifier. Debbie Mackaman, RHIA, CHCO, Jugna Shah, MPH , and Denise Williams, RN, CPC-H , explain how to use the modifier, as well as the impact of APC changes.
Julie comes into the Fix ‘Em Up Clinic with a seriously broken arm. Her son Jay left his toy fire engine on the stairs and Julie tripped over it. She threw her arms out to brace her fall. And then...
Have you started dual coding for ICD-9 and ICD-10? Two facilities shared their experiences today during the AHA’s webinar, Lessons Learned on Dual Coding–A Provider’s View. The first thing you need...
As part of the 2015 OPPS proposed rule , released July 3, CMS is considering eliminating the requirement for a signed physician certification for most short inpatient stays. CMS would still require a signed physician certification for stays that last 20 days or longer, as well as outlier cases.
Chronic kidney disease (CKD) is a manifestation of many different chronic disease processes, including diabetes, hypertension, and immune complex diseases. Garry L. Huff, MD, CCS, CCDS , and William E. Haik, MD, FCCP, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, explain the clinical indicators of CKD as well as coding and documentation problem areas.
CMS designates certain procedures as inpatient-only, meaning it will only reimburse the facility when the procedure is performed on an inpatient. However, CMS identifies these procedures using outpatient CPT ® codes. Beverly Cunningham, MS, RN, and Kimberly A.H. Baker, JD, CPC, discuss the process for identifying and coding inpatient-only procedures.
The complexity of coding rules and the quality of documentation in facilities sometimes make correct DRG assignment a daunting task. Laura Legg, RHIT, CCS, highlights current DRGs that are subject to Recovery Auditor scrutiny and provides tips for accurate DRG assignment.
It turns out that not all eponyms are going away in ICD-10-PCS. The Alphabetic Index still includes an entry for a Roux-en-Y operation. The entry directs you to see bypass of the gastrointestinal...
Body mass index (BMI) reporting is becoming more important as a diagnostic tool for providers, and ICD-10-CM will expand the ability to accurately report it. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , looks at documentation concerns and coding concepts for BMI in both ICD-9-CM and ICD-10-CM.
The 2015 OPPS proposed rule , released July 3 by CMS, is relatively short at less than 700 pages, but contains refinements to the previously introduced Comprehensive APC policy and significant packaging of ancillary services.
Q: We are coding for pain management procedures and have been doing dual coding in ICD-9-CM and CPT ®. With a medial branch block ablation at two levels for L3-L4 and L4-L5 for a bilateral injection, we are coding: ICD-9-CM procedure code 04.2 (destruction of cranial and peripheral nerves) CPT codes 64635 (destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint) and 64636 (destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure]), each with modifier -50 (bilateral procedure) appended. What would be your recommendation for the ICD-10-PCS code? Currently we are coding 015B3ZZ (destruction, lumbar nerve, percutaneous) twice. We are not sure if we should be picking this code up twice or only once.
Coders will find many more options for fractures in ICD-10-CM. Review the anatomy of the foot and the specificity providers will need to document to code accurately with the new code set.
ICD-10-CM expands the coding options for phobias, eating disorders, and pervasive developmental disorders. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , reviews these disorders and how to report them in ICD-10-CM.
Holly spent the weekend hanging out at the beach, enjoying the sun. The sand was so warm that she slipped off her shoes to stroll near the water. And disturbed a crab in the process. The crustacean,...
A lot of people are starting their Fourth of July celebrations early. At least it seems that way at the Fix ‘Em Up Clinic. Shannon took her dog Damian to the park to watch some fireworks last night...
Go to your local bookstore, pick up a copy of Gray’s Anatomy (the book, not the television show), and flip though the illustrations. Alternately, you can Google “Gray’s anatomy illustrations.” They...
