Acute respiratory distress syndrome presents a significant clinical challenge due to its rapid onset, high mortality rate, and complex management. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , delves into the comprehensive aspects of ARDS to show how coders, alongside healthcare providers and CDI specialists, play an essential role in reporting the complete picture of the condition.
Q: An elderly male patient has a rectal fistula with an abscess requiring complex packing of the wound. The most recent wound documentation reports “complex persistent rectal fistula with underlying abscess present, cultures show positive for E. coli and Klebsiella.” The patient will be administered daily IV antibiotics via a PICC line that has been placed. How would this encounter be reported in ICD-10-CM?
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , invites a deeper understanding for diagnosing and documenting acute renal failure and any other related diagnoses—before exploring the plethora of denial strategies medical staff may face. Not to worry as there are opportunities for successful appeals!
An upcoming audit reviewing Medicare inpatient hospital billing for sepsis underscores the critical importance of accurate coding and clinical validation. With guidance from Leigh Poland, RHIA, CCS, CDIP, CIC , coders can help prevent costly coding errors, reduce the risk of audits, and ensure hospitals are appropriately reimbursed for the care they provide. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS implemented modifier -FS (Split [or shared] E/M visit) as part of a major revision to its rules for split/shared services on January 1, 2022. This article provides tips for using modifier -FS from top reporters as it approaches its third year of active status. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With CMS publishing annual updated versions of its Medicare National Correct Coding Initiative (NCCI) Policy Manual, as well as quarterly updates to the individual NCCI edit files, it is often hard for facilities to keep up with the changes. This article details the latest updates, as well as provides insights on implementing NCCI-associated modifiers and tips for preventing and overriding common edits.
The concept of social determinants of health (SDOH) has transformed significantly, advancing from increased awareness to data integration and the development of tools and frameworks. This article explores the importance of integrating SDOH into the healthcare framework and the coding process, as well as best practices for leveraging this data to inform health interventions.
Review a recent OIG audit which found that Medicare payments for inpatient claims assigned with MS-DRGs 207 and 870 did not fully comply with Medicare requirements, resulting in $79.4 million being improperly paid to hospitals.
With guidance from three certified medical professionals, CDI specialists and coders can learn how to fight against the overwhelming tide of clinical validation denials by promoting strong documentation, capturing clinical pictures with appropriate codes, and justifying treatment plans.
Coding professionals are critical to the compliance initiatives of any healthcare organization, and the application of codes to a claim ignites the compliance ember. Discover how key initiatives not only ensure coders act ethically and responsibly but also enhance the accuracy of coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Patient presents with a chief complaint of persistent cough for 10 days with occasional mucus. She has a history of chronic asthmatic bronchitis for many years; is quite frail, reporting decline in energy and activity tolerance; was a smoker until about five years ago; and suffers chronic smokers’ cough and centrilobular emphysema. Past medical history includes heart failure, hypertension, and pulmonary hypertension. How would this diagnostic note be reported in ICD-10-CM?
To align subcategories for diagnosis coding with the DSM-5 classification subcategories for feeding and eating disorders, new ICD-10-CM codes were added in the FY 2025 update. Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , reviews the clinical criteria for affected disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, pica in adults, and rumination disorder.
Coding professionals are critical to the compliance initiatives of any healthcare organization, and the application of codes to a claim ignites the compliance ember. Discover how key initiatives not only ensure coders act ethically and responsibly but also enhance the accuracy of coding.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
Our experts answer questions on coding COPD, smokers’ cough, and rectal fistulas in ICD-10-CM as well as provide recommendations for addressing malnutrition denials depending on the diagnosis criteria used (GLIM or ASPEN).
Protect your practice by understanding the code level selection risks that could impact E/M office visit claims. Incorporate the guidance in this article into your compliance plan to make sure they stay on your risk radar.
Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP, explores common reasons for sepsis-related denials, offers strategies for effective documentation and coding, and presents approaches to successfully appeal these denials.
Take in the details of the 16 new telemedicine codes for real-time encounters in the CPT 2025 manual while you wait to see whether private payers adopt the services or CMS sways from proposed non-coverage of the codes.
