The root operation identifies the intent of the procedure. It is identified in the third character of the ICD-10-PCS code. ICD-10-PCS guideline A.11 states that the coder is responsible for selecting the root operation that most closely matches the intent of the procedure.
Since the dinosaurs roamed the earth (OK, since 1983), coding professionals have been tasked with ensuring that bills for Medicare patients included the proper elements of the diagnosis-related group (DRG) system so that the hospital got as much money as possible from Medicare.
Remember, the hierarchy applies to all IV injection and infusion services. Chemotherapy services are primary and should be selected as initial when provided in conjunction with therapeutic, prophylactic, or diagnostic services.
The 2016 CPT® code update may have been relatively small compared to previous years, but the urinary and genital system sections did receive numerous changes to align them with other sections of the code book.
This month's column is all about data--the importance of providers reporting accurate and complete data, as well as CMS having complete, accurate, and consistent data to compute future payment rates.
CMS administers the Medicare program and it is currently the single largest payer for healthcare in the United States. Medicare Part A, B, C, and D, all encompass a wide variety of services, all of which providers need to understand to determine which services are covered for patients.
The mosquito-borne illness known as Zika virus still has unanswered questions surrounding the illness its self, but thanks to the Centers for Disease Control and Prevention, an official ICD-10-CM diagnosis code has been assigned to the virus.
Allen Frady, RN, BSN, CCS, CCDS , and Gwen S. Regenwether, BSN, RN , combat coders’ and clinical documentation improvement (CDI) specialists’ querying bad habits, and show how to support productivity and revenue flow for the facility.
For years, coding professionals have been tasked with ensuring that bills for Medicare patients include the proper elements of the diagnosis-related group (DRG) in order to try to accurately show a patient’s severity, but, as Robert S. Gold, MD , writes, there is much more to coding than DRG maximization.
Q: In the past few weeks, we noticed physicians are documenting acute congestive heart failure with preserved ejection fraction instead of diastolic or systolic. They say the heart failure is not diastolic or systolic. What is the best way to approach this issue?
CMS recently announced a delay in the anticipated system release of outpatient and inpatient quality reporting data due to the relocation of the Health Care Quality Information System Data Center responsible for the Hospital Quality Reporting programs.
Specialty groups are often able to move faster on creating guidelines for new procedures and codes than other ruling bodies. But sometimes this guidance can create conflicts between physician and facility coders. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, writes about how to avoid these scenarios and come to the best resolution for providers, payers, and patients.
Q: If a physician orders a consultation for a patient who is experiencing a headache due to hypertension, which ICD-10-CM codes would be assigned? Would hypertension be coded since headache is a common sign and symptom of hypertension, or would both the headache and hypertension be coded?
Accurate coding and billing data is important for both providers and CMS. Jugna Shah, MPH, writes about challenges providers have faced with providing that data to CMS and what the agency can do to ease provider burden.
CPT codes for drug administration follow a hierarchy that is unique to those procedures. Review the hierarchy in order to understand how to apply codes for any type of scenario.
Root operations are the fundamental building block of ICD-10-PCS codes, but providers may not use the same terminology coders are familiar with. Review these root operations that involve taking out all or some of a body part.
Q: Our facility is developing clinical definitions regarding types of atrial fibrillation (afib) given the specificity changes in ICD-10. Could you provide suggestions for these definitions? Do you think it is appropriate to query for persistent atrial fibrillation for the period of more than seven days and chronic afib sustained for more than 12 months Are you aware of any strategies other institutions are using when querying regarding afib?
CMS is reporting that the Quality Improvement and Evaluation System (QIES) will be down for five days in March due to extended systems maintenance. The QIES will be unavailable starting at 8 p.m. Eastern on March 16, and returning March 21 at 11:59 p.m., according to CMS.
