First we saw the new ICD-10-PCS codes and guidelines in May, followed by the new ICD-10-CM codes in June and the ICD-10-CM guidelines in July. Now we have updated general equivalence mappings (GEMs)...
Medical necessity is as simple as it sounds and it isn’t important just for inpatients. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the importance of establishing medical necessity for outpatient services.
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable), but instituted a six-month trial period. That grace period ended July 1. Denise Williams, RN, CPC-H, Dave Fee, MBA, and Debbie Mackaman, RHIA, CHCO, explain how to report these G codes and their related functional modifiers.
Q: A clinician goes to a patient's home and does not perform an evaluation and management, but performs a catheter replacement. How should we code this encounter?
The AMA significantly changed how coders report cervicocerebral imaging in 2013. Andrea Clark, RHIA, CCS, CPC-H, and David Zielske, MD, CIRCC, CPC?H, CCC, CCS, RCC, discuss the changes and provide tips for coding these services.
CMS has been gathering information about the use of observation services and short inpatient hospital stays because hospitals have been placing patients in observation for longer periods of time. CMS recently finalized a change that will substantially affect how hospitals bill for observation stays, long outpatient stays, and short inpatient stays.
Wile E. Coyote presented to the ACME ED this morning with more injuries suffered in his quest to catch the Roadrunner. You won’t believe what he tried this time. Wile E.’s plan involved dropping an...
Providers setting charges based on an understanding of their costs is not a new concept, says Jugna Shah, MPH, president and founder of Nimitt Consulting. However, providers struggle with this or fail to do it correctly, and then stand to deteriorate their future payment rates since CMS relies on provider data to set payment rates not only for inpatient and outpatient services, but also for laboratory services.
It took some time to break down the wall between coders and CDI specialists at New Hanover Regional Medical Center in Wilmington, N.C. However, that wall eventually crumbled. Linda Rhodes, RN, BSN, CCDS, manager of CDI, says an increased emphasis on communication and respect is what did the trick.
Joint replacement surgery is nothing short of a miracle for those experiencing pain due to an arthritic or damaged joint. The surgery is performed not only on the hip and knee, but also on the ankle, foot, shoulder, elbow, or finger. Patients who have undergone this surgery often regain mobility and are able to live pain free.
BCCS recently spoke with advisory board member Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, about the role of state HIM associations in ICD-10-CM/PCS coder education. The following is a summary of that conversation. Bryant serves as the president of the California Health Information Association (CHIA), which has approximately 5,000 members to date. For more information, visit http://californiahia.org .
Although ICD-10-CM resolves some problematic areas of coding, it isn't a panacea. Respiratory insufficiency is one diagnosis that will continue to challenge coders.
In this month’s issue, we examine how coders can use General Equivalence Maps to find codes in ICD-10, explain the new therapy G-codes, review CMS’ updates to the I/OCE, discuss the importance of proper rate setting, and answer your coding questions.
Eight CPT ® codes for multianalyte assays with algorithmic analyses (MAAA) procedures are now classified as not covered under OPPS (status indicator E), retroactive to January 1, 2013. These codes are now subject to I/OCE edit 9.
When Paul Belton, RHIA, MBA, JD, LLM, speaks about the culture at Sharp HealthCare in San Diego, you can hear the pride and enthusiasm swelling in his voice. Having served as the vice president of corporate compliance for the past 15 years, Belton has led the ongoing effort to ensure that all employees "do the right thing" at all times.
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable). These G codes are to be reported in conjunction with therapy services (physical, occupational, and speech). CMS also introduced seven complexity/severity modifiers to be used with these G codes.
Recovery Auditors audit the MS-DRG, principle diagnosis, any secondary diagnoses, and any procedures that affect—or could affect—DRGs. Christina Benjamin, MA, RHIA, CCS, CCS-P, reveals the most important documentation pitfalls and coding guidelines challenges related to MS-DRGs under auditor scrutiny.
