CMS has instructed MACs to reprocess claims and providers to reimburse beneficiaries due to a miscalculated copayment for stereotactic radiosurgery, according to the October update to the OPPS and Integrated Outpatient Code Editor (I/OCE).
In this issue, we review coding for sprains, strains, and dislocations in ICD-10-CM, exmine how to audit for denials of inpatient only procedures, and offer tips for identify documentation shortcomings. Robert S. Gold, MD, discusses how to handle situations when what the physician says he or she did is not what the physician actually did.
Q: A patient was in a hyperbaric oxygen chamber for eight minutes and the physician had to abort the treatment because the patient was feeling anxious. Which HCPCS/CPT ® code should the hospital bill: HCPCS code C1300 (hyperbaric oxygen under pressure, full body chamber, per 30 minute interval) or an E/M code? Which code should the supervising physician bill: CPT code 99183 (physician or other qualified healthcare professional attendance and supervision of hyperbaric oxygen therapy, per session) or an E/M code?
Changes to the codes for musculoskeletal injuries goes beyond just increased codes for fractures. Find out how to code for sprains, strains, and disclocations in ICD-10-CM.
Coding for endovascular revascularization requires following a unique hierarchy and specific guidelines. Caren J. Swartz, CPC-I, CPC-H, CPMA, CPB , and Denise Williams, RN, CPC-H , look at the anatomy of the lower body and the necessary documentation to report these services.
In its latest survey of the healthcare industry's ICD-10 readiness, the Workgroup for Electronic Data Interchange (WEDI) found that this year's delay negatively impacted provider progress, with two-thirds reporting slowing down or putting implementation initiatives on hold as a result.
CMS officially declared October 1, 2015, the new ICD-10 implementation date with the publication of a final rule, "Administrative Simplification: Change to the Compliance Date for the ICD-10-CM and ICD-10-PCS Medical Data Code Sets," in the August 4 Federal Register .
Coders and clinical documentation improvement (CDI) specialists have different perspectives and priorities even on common diagnoses. HCPro boot camp instructors Shannon E. McCall, RHIA, CCS, CCS-P,...
With flu season just around the corner (hey, where did summer go?), Melissa took her 4-year-old son Andrew to Dr. Spock, the pediatrician, for his flu shot Wednesday. With a minimum of fuss (and a...
If coders choose the wrong root operation in ICD-10-PCS, they will arrive at an incorrect code. Nena Scott, MSEd, RHIA, CCS, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer, Gretchen Young-Charles, RHIA, Anita Rapier, RHIT, CCS, and Nelly Leon-Chisen, RHIA, discuss some of the root operation clarifications offered by Coding Clinic .
Q: Is it okay to code a diagnosis if the physician documents two diagnoses using the phrase “versus” between them? For example, the patient arrives with abdominal pain and the physician orders labs and other tests, but they all come back normal. In the discharge note, the physician documents “abdominal pain, gastroenteritis versus irritable bowel syndrome (IBS).” When I first started as a CDI specialist I was told we could not use diagnoses when "versus” was stated, and that we had to query for clarification.
Not feeling well? The problem could be in your small intestine. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, reviews common conditions related to the small intestine.
Recovery Auditors have uncovered incorrect secondary diagnoses in patients who underwent amputations for musculoskeletal and circulatory system disorders. CMS revealed the findings in its Quarterly Compliance Newsletter .
ICD-10 implementation and coding present plenty of challenges, especially when it comes to ICD-10-PCS. Sue Bowman, RHIA, CCS, and Donna Smith, RHIA, clear up some misconceptions about ICD-10 implementation and use.
Some days I swear I have the attention span of a hyperactive hummingbird or Dug the talking dog from the movie “Up.” Maybe what I really have is attention deficit disorder (ADD). How would you code...
ICD-10-CM readiness goes beyond training coders on the new code set. Rhonda Buckholtz , Wendy Aiken, and Sid Hebert, look at the impact of implementation on physicians and payers, and how providers can ease the transition.
Most diabetes codes in ICD-10-CM include more details than ICD-9-CM codes, but coders also need to consider additional codes. Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, MHP , and Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, review key aspects for coding diabetes in ICD-10-CM.
Q: What if the provider states that diabetes is due to the adverse effects of a drug, but doesn't tell us which drug? How do we report that in ICD-10-CM?
