The FY 2017 IPPS proposed rule released April 27 is replete with modifications and expansions to claims-based quality and cost outcome measures. Although many of these proposed changes are for future fiscal years, ICD-10 codes reported for current discharges will impact the future financial performance for our organizations.
The FY 2017 IPPS proposed rule includes updates to payment rates and quality initiatives, but some of the most extensive changes pertain to proposals for certain MS-DRG classifications and relative weights.
Katy Good, RN, BSN, CCDS, CCS, Paul Evans, RHIA, CCS, CCS-P, CCDS, Laurie Prescott, MSN, RN, CCDS, and Gloryanne Bryant, BS, RHIA, CDIP, CCS, CCDS, all comment on how over-querying is a common concern in clinical document improvement, and how over-querying can cause delays in documentation and coding processes.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP, reviews scenarios for initial, subsequent, and sequela encounters, and helps coders better understand how to assign seventh characters for each type of encounter. Note: To access this free article, make sure you first register if you do not have a paid subscription.
Kimberly Anderwood Hoy Baker, JD, writes about the many changes in the 2017 IPPS proposed rule, and explains how almost everyone could be affected by CMS’ proposals.
The FY 2017 IPPS proposed rule addresses MS-DRG classifications and relative weights pertaining to the categories of other cardiothoracic procedures without MCC, and injuries, poisonings and toxic effects of drugs.
Robert S. Gold, MD, writes about important changes made in hypertension since ICD-9-CM, and helps coders better understand the relatively complex diagnosis.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , AHIMA-approved ICD-10-CM/PCS trainer, discusses strategies for reporting, and better understanding, pyeloplasty in ICD-10-PCS. Note: To access this free article, make sure you first register if you do not have a paid subscription.
With a widespread lack of awareness of national best practice guidelines for malnutrition, Joannie Crotts, RN, BSN, CPC , and Szilvia Kovacs, MS, RD, LDN , explain how identifying and diagnosing the condition is often still difficult, and how important changes can be made to improve a facility’s malnutrition program.
Robert S. Gold, MD, writes about the significant changes in documentation needs for diseases of the brain and how this can affect patient data, as well as the treatment needs of the patients both during a hospital stay and afterward.
ICD-10-PCS defines the root operations in very specific ways and coders need to know the definitions and the nuances of the root operations. Learn more about root operations that involve the physician looking at a patient, Inspection and Map.
Anny Pang Yuen, RHIA, CCS, CCDS, CDIP and Laurie Prescott, MSN, RN, CCDS, CDIP discuss how for the past few years, healthcare professionals have focused on ICD-10 preparation, and while prep work paid off and the transition has been largely successful, facilities are experiencing a few bumps as their focus shifts from preparation to improvement of clinical documentation and coding.
When the Quality Improvement Organizations (QIO) took over the role of education and enforcement for the 2-midnight rule on October 1, 2015, many anticipated that their reviews would only look at records from that date forward, but some hospitals have reported QIO record requests zeroing in on cases as far back as May 2015 and requesting charts for inpatient-only surgeries.
Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS trainer, explains how under the Comprehensive Care for Joint Replacement, acute care hospitals in selected geographic areas assume quality and payment accountability for retrospectively calculated bundled payments for lower extremity joint replacement episodes, and how this now requires a CDI evolution.
Richard D. Pinson, MD, FACP, CCS , describes the Third International Consensus Definitions for sepsis and septic shock as published on February 23 in the Journal of the American Medical Association , and what the impact will be for both clinicians and coders.
There have been some significant changes in documentation needs for diseases of the brain since October 2015. These can affect accurate patient data as well as providing information for the treatment needs of the patients both during a hospital stay and afterwards. They will enable patient information to be available to all providers and ensure that you get paid appropriately for the complexity of the patients under your care.
Under the CJR, which began April 1, acute care hospitals in selected geographic areas assume quality and payment accountability for retrospectively calculated bundled payments for lower extremity joint replacement (LEJR) episodes. Episodes begin with admission to an acute care hospital for an LEJR procedure that is paid under the IPPS through MS-DRGs 469 or 470 (Major joint replacement or reattachment of lower extremity with or without MCC, respectively) and end 90 days after the date of discharge from the hospital.
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)¹ as published on February 23 in the Journal of the American Medical Association represents a radical departure from the prior sepsis definitions in 1991² (identified as Sepsis-1) and 2001³ (identified as Sepsis-2) and subsequent Surviving Sepsis Campaign (SSC) guidelines through 2015.
Barbara A. Anderson, RN, MSM, says that in 2014, 66% of 318 hospitals surveyed by AHIMA had a CDI program in place. Anderson explains how CDI programs can be a valuable bridge between clinical care and coding at hospitals, and gives examples on how to improve upon a facility’s program.
