With the added specificity available in ICD-10-CM, coders have many more options for reporting malignancies of the skin. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , compares ICD-9-CM codes with their ICD-10-CM counterparts and notes where more documentation may be needed to select the proper code.
Today’s rehearsal for the children’s Christmas play at Anytown Middle School was unforgettable for all of the wrong reasons. Just look at the waiting room at the Fix ‘Em Up Clinic. First in to see Dr...
Information that is not important for ICD-9-CM will take on new significance in ICD-10-CM. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, review areas when specificity comes into play in ICD-10-CM.
In ICD-10-PCS, coders will need to find details they currently don’t use. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, AHIMA-approved ICD-10-CM/PCS trainer, offers tips for locating the necessary information in the body of the operative report.
CMS released version 31 of the MS-DRG grouper for ICD-10 in November. Providers can use the grouper to identify MS-DRG shifts and payment changes under ICD-10. The Final ICD-10 MS-DRG v32 logic, which will be implemented on October 1, 2014, will be subject to rulema
ICD-10-PCS implementation is less than a year away, so the pressure is on coders to learn the new system and maintain productivity. Gerri Walk, RHIA, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer, discusses how to overcome some of the challenges inpatient coders will face in ICD-10-PCS.
Q: In ICD-10-PCS, which root operation would we report for an obstetrical delivery? Would it change for a cesarean section versus a manually assisted vaginal delivery?
Good King Wenceslas looked out on the feast of Stephen And what a festive occasion it was! Participants are suffering from: Functional dyspepsia (K30) Nausea (R11.0) Projectile vomiting (R11.12)...
Dashing through the snow, in a one-horse open sleigh … oh, wait, maybe that’s not such a good idea. Little Bobby came down with chilblains, while Suzie developed frostbite. ICD-10-CM only gives us...
Worried that your vendors won't be ready for ICD-10? CMS has a tip sheet for talking with your vendors on its website. In addition, CMS recently added five new resources: Introduction to ICD-10...
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, look at drug administration coding, beginning with documentation, in order to highlight the information coders need to ensure accuracy. They also review the hierarchy coders must follow when coding for injections and infusions.
In order to report accurate evaluation and management codes, coders need accurate, complete documentation. Coders can play a critical role in ensuring proper documentation. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, looks at methods coders can use to promote better documentation.
In its 2014 OPPS Final Rule , CMS finalized its proposal to replace existing evaluation and management CPT ® clinic visit codes with a single HCPCS G-code.
Codes for OB/GYN haven’t changed much recently, but some diagnoses still confuse coders. Glade B. Curtis, MD, MPH, FACOG, CPC, CPPM, CPC-I, COBGC , and Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, review some top areas of concern and walk through case studies to explain those problems.
Q: How does CPT ® define "final examination" for code 99238 (hospital discharge day management; 30 minutes or less)? Does the dictation have to include an actual detailed examination of the patient? We have been coding 99238 for discharges that include final diagnosis, history of present illness, and hospital course along with discharge labs, medicines, and home instructions. Very few contain an actual exam of the patient. Have we been miscoding all this time?
Why in the world is Mr. Grinch so mean? Maybe the problem is his health. Let’s see if we can diagnose the Grinch’s health woes. First, he is as cuddly as a cactus. What does that mean? He’s covered...
Everybody likes a shortcut. We want to get things done faster, arrive home sooner, finish tasks more quickly. Generally shortcuts are good. Unless you’re talking about physician documentation. Then...
The audit landscape continues to change as Recovery Auditors expand prepayment reviews and CMS implements its new 2-midnight rule. Debbie Mackaman, RHIA, CPCO, Ralph Wuebker, MD, MBA, and Kimberly Hoy Baker, JD, review some of the recent changes to audit focus areas.
Documentation and medical necessity continue to be scrutinized by payers and auditors. Debbie Mackaman, RHIA, CPCO, and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, explain how complete, accurate documentation of the entire patient encounter justifies the physician’s decision to admit.
Problems can occur anywhere along the alimentary canal or in any of the accessory organs. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, discusses some common diagnosis and procedure codes for digestive diseases and procedures.