Medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. This article describes how medical necessity impacts third-party payers and those who work in billing and reimbursement services.
Q: If a patient is admitted with a high blood alcohol level and the provider documents the blood alcohol level in his or her note, does the provider also need to specifically write “patient with intoxication?”
Allen Frady, RN-BSN, CCDS, CCS, CRC, explains the value of tracking and understanding key performance indicators (KPI), and gives advice on how facilities can improve on its practices.
Medical necessity denials are commonly encountered in facilities. Complete understanding and utilization of the ICD-10-CM/PCS coding guidelines is imperative for coders and coding mangers to recognize how to avoid these denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The cost for a hospital stay in 2014 involving acute renal failure (ARF) averaged $19,200, nearly twice the $9,900 average cost for stays not involving renal failure, according to the statistical brief published by The Healthcare Cost and Utilization Project (HCUP).
James S. Kennedy, MD, CCS, CCDS, CDIP, writes about potential coding compliance issues raised in the Office of Inspector General’s (OIG) Work Plan for providers to consider, including documentation and coding for severe malnutrition and bariatric surgery.
Did you know there is a coding competition? The second annual ICD-10 Coding Contest, sponsored by Central Learning, took place last summer, recruiting coders from all over the nation to participate in coding a total of 1,636 real-life medical cases.
In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
One of the most memorable sessions at the AMA CPT Symposium in November 2017 involved an impromptu open mic feedback session facilitated by CMS’ Marge Watchorn, deputy director of the Division of Practitioner Services. The focus of this session was the applicability of the current CMS documentation guidelines for E/M services.
As clinicians and coders invested in ICD-10-CM/PCS documentation and coding compliance, we’ve seen it all as it relates to the various approaches different hospital systems use to “optimize” or “maximize” their DRG-based case-mix index (CMI) or risk adjustment factor (RAF) scores based on Hierarchical Condition Categories (HCC).
The amount of energy it takes to stay up to date on all the relevant payment and coding updates can be overwhelming, taking valuable time away from daily record review duties and activities.
Review the provider documentation and operative report and consider the ICD-10-CM and ICD-10-PCS codes to be reported. See the answers and rationale to check your answers.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about discussions at the AMA CPT Symposium that could impact coders, including the need for updates to CMS’ E/M Documentation Guidelines and how medical decision making is used as a key component for E/M reporting.
The skin is the largest organ in the human body and plays a vital role in protecting the body from injury and illness. This article reviews integumentary anatomy and provides guidance to aid in accurate ICD-10-CM and CPT code assignment for complex integumentary diagnoses and procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
