Hospitals earned a big win with drug payments this year in the 2013 OPPS final rule, released November 1. CMS decided to finalize its proposal to follow the statute and reimburse facilities at the average sales price (ASP) plus 6%.
In this month's issue, we review the major changes to OPPS for 2013, discuss the potential impact of CMS' packaging clarification, examine therapy, molecular pathology changes, offer suggestions on how to begin teaching providers to speak ICD-10, and answer your coding questions.
Providers and coders seem to speak two different languages-clinical and coding. Providers already have issues parsing ICD-9-CM "coder speak," so how can you get them to understand ICD-10?
The holiday presents have all been unwrapped, and while the children were (mostly) thrilled by their gifts, their parents aren’t as pleased with what happened once the kids started playing with them...
Q: Is nursing documentation of completion of physician-ordered procedures, such as splinting/strapping, Foley catheter insertion, etc., sufficient to assign a CPT ® code for billing the procedure on the facility side in the ED?
The AMA added new CPT ® codes to report transcatheter aortic valve replacement for 2013. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details these and other code changes for cardiology.
Coders will find significant changes in the medicine section of the 2013 CPT® Manual . Denise Williams, RN, CPC-H, and Georgeann Edford, RN, MBA, CCS-P, review the changes to nerve conduction studies, vaccine administration, ophthalmology, and allergy testing.
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) concerning packaged services. Jugna Shah, MPH, and Valerie Rinkle, MPA, explain how this clarification could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates.
CMS recently posted an updated version of the National Correct Coding Initiative (NCCI) manual to the CMS NCCI website . The manual includes changes identified in red text and will be effective with dates of service January 1, 2013.
‘Tis the day before Christmas and all are not well at North Pole Industries. Ernie the head elf has lost his grip, literally. Ernie, it seems, can’t hold on to the toys he’s building. When he goes to...
It’s the end of the world as we know it and the people in the Fix ‘Em Up Clinic waiting room don’t feel fine. Apparently some people really believed that today would be the end of the world and their...
Moderation is not a term usually associated with the holiday season, as you can see from the waiting room at Fix ‘Em Up Clinic. Clark spent two days stringing holiday lights over everything: his tree...
ICD-10-PCS introduces plenty of new concepts. One that could cause coder confusion involves how to report a procedure when the physician changes the approach. The ICD-10-PCS guidelines state: If...
Q: A patient has unintentionally failed to take a prescribed dosage of insulin due to his Alzheimer’s dementia (age-related debility), and is admitted for initial care with inadequately controlled Type 1 diabetes mellitus. Which ICD-10-CM code(s) should we assign?
In order to assign the correct ICD-10-PCS code, coders will need to determine the correct root operation. Christina Benjamin, MA, RHIA, CCS, CCS-P, discusses the various root operations found in the medical and surgical section of ICD-10-PCS.
Nervous or worried about the upcoming transition to ICD-10-PCS? Don’t be. Charlotte Lane, RHIA, CCS, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, offer up tips to reduce your anxiety about the new coding system.
ICD-10-CM Chapter 19 codes for injury, poisoning, and certain other consequences of external causes (S00-T88) demonstrate the specificity inherent in the new coding system. Betsy Nicoletti, MS, CPC, and Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, dig into the details of codes for injuries and underdosing.
In a recent CMS email to providers, the agency reminded hospitals that any department, form, template, or other information that uses ICD-9-CM codes today will need to accommodate ICD-10-CM/PCS codes as of October 1, 2014.
When you search the 2013 ICD-10-CM Official Guidelines for Coding and Reporting you will find chapter-specific guidelines for each chapter except for Chapters 3, 8, and 12. Chapter 1: Certain...
