JoAnn Baker, CCS, CPC, COC , defines sepsis and septic shock, and delves into the emerging initiative to integrate AI into the diagnosis and treatment process.
Managing chronic conditions requires involvement from many parties, making documentation challenging. Assess how to improve documentation and reimbursement for chronic conditions with tips provided by Arta Kelmendi-Doko, MD, PhD . Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A Journal of the American Medical Association study found that ICD-10-CM influenza codes accurately represented cases of positive diagnoses in pediatric patients, but their sensitivity was modest.
Q: A patient has acute renal failure due to dehydration, a history of Type 1 diabetes mellitus causing end-stage renal disease, a kidney transplant two years ago, and chronic kidney disease stage 3a, immunosuppressed by their drugs. How would this be reported in ICD-10-CM?
Brandi Hutcheson, RN, MSN, CCM, CCDS, CCA , examines the coding and clinical literature on malnutrition and obesity to see how coders can reconcile these seemingly disparate diagnoses.
Despite the expansion of codes that came with the transition from ICD-9 to ICD-10-CM, the majority of codes for inflammatory arthritis were not frequently used in 2015 through 2021, researchers found.
Q: A 64-year-old female bilateral lung transplant recipient presents with aspiration pneumonia, hypoxia, and has immunosuppression from the drugs. How would this scenario be reported in ICD-10-CM?
Merle Zuel, RN, CCDS , explains how healthcare leaders can improve in their roles by understanding all coding and clinical data available and knowing how to analyze it.
Sarah McDonald, CPC , reviews ICD-10-CM and ICD-10-PCS coding guidelines for the U.S.’ most common orthopedic surgeries: hip and knee replacements. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pressure injuries, which can lead to a patient safety indicator (PSI), require clear documentation and coordination among coding, CDI, and clinical departments. Katherine Siemens, RN, BSN, CMSRN, CCDS , evaluates how poor coordination could result in a PSI being incorrectly reported.
Pressure injuries, which can lead to a patient safety indicator (PSI), require clear documentation and coordination among coding, CDI, and clinical departments. Katherine Siemens, RN, BSN, CMSRN, CCDS , evaluates how poor coordination could result in a PSI being incorrectly reported.
This article reviews malware basics and covers tips that healthcare employees can implement to avoid cyberattacks that could put protected health information (PHI) at risk.
by Jess Fluegel It is a truth universally acknowledged that a CDI department, in possession of a part-time physician advisor who is already stretched too thin, may be in want of provider engagement...
This article reviews malware basics and covers tips that healthcare employees can implement to avoid cyberattacks that could put protected health information (PHI) at risk.
Educating clinical staff on proper documentation of mechanical ventilation can avoid compliance issues and support accurate reimbursement. This article clarifies the complications of reporting mechanical ventilation in ICD-10-PCS.
CMS’ fiscal year 2025 IPPS proposed rule and fact sheet, published April 10, includes proposals for a 2.6% payment increase, a new bundled payment program, code updates, and other policy changes.
Q: How would the scenario of a previous kidney transplant patient presented with sepsis due to acute pyelonephritis (E. coli), CKD, and immunosuppression be reported in ICD-10-CM?
Sarah McDonald, CPC , examines the ICD-10-CM/PCS coding conventions for symptoms, stages, and treatment of gastroesophageal reflux disease—a commonly diagnosed digestive disorder in the U.S. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah McDonald, CPC , explains the spinal fusion process and overviews the process of constructing ICD-10-PCS procedure codes character by character. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The pediatric population is smaller and involves different clinical and nuances, but this often-underdeveloped area of coding can be a source of missed revenue if left uninvestigated.
The Journal of the American Medical Association (JAMA) published a study that found that high-flow nasal cannula protocols were associated with a 6.1% reduction in ICU admissions among children.
Kate Siemens, RN, BSN, CMSRN, CCDS , offers tips on how coders and CDI can assess patient safety indicators to improve reporting accuracy and increase quality of care.
Q: Aside from Coding Clinic , Third Quarter 2005, pp. 19–20, is there any more up-to-date advice on reporting ICD-10-CM diagnoses from physician orders?
Many CDI professionals are familiar with the saying that, since CDI is “already in the chart,” they can easily pick up a new review lens. The reality, however, is that each new responsibility can put a damper on staff bandwidth and productivity.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, analyzes the challenges that both inpatient and outpatient CDI specialists encounter and offers advice to lessen provider opposition to participating in outpatient CDI.
Educating clinical staff on proper documentation of mechanical ventilation can avoid compliance issues and support accurate reimbursement. This article clarifies the complications of reporting mechanical ventilation in ICD-10-PCS.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes guidance from the 2024 first quarterly release of Coding Clinic , including reporting for postoperative complications, non-traumatic kidney injuries, and vertebral artery dissection.
This article explains the quality metrics of hospital-acquired infections and accidental punctures and lacerations, and details how collaborative efforts can reduce these risks.
Sarah McDonald, CPC , analyzes the process of reporting traumatic brain and spinal cord injuries ICD-10-CM, notably the cause of injury, reason for the encounter, and aftereffects. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon Oitker, MSN, RN , reviews the nine MS-DRGs for ventilator use, explains how DRGs are designed, and assesses whether hospitals are receiving adequate reimbursement for ventilation services.
Terry Tropin, MSHAI, RHIA, CCS-P , continues her exploration of ICD-10-PCS April updates with added options for intracranial brachytherapy, electroporation, sinus dilation, pedicled omentoplasty, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS will be holding its next ICD-10 Coordination and Maintenance Committee meeting March 19-20. The committee will deliberate applications for new ICD-10-PCS and ICD-10-CM code assignments. If approved, the codes will become effective October 1, 2024.
Susan G. Michael, MSN, RN, CPHQ, CCDS , examines social determinants of health through a historical perspective and explains how they evolved into the codes that coders and researchers use today.
This article explains the quality metrics of hospital-acquired infections and accidental punctures and lacerations, and details how collaborative efforts can reduce these risks.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes guidance from the 2024 first quarterly release of Coding Clinic , including reporting for postoperative complications, non-traumatic kidney injuries, and vertebral artery dissection.
Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, and Karla VonEschen, MS, CPC, CPMA, CCDS-O, look back at the progression of diagnosis and mortality coding before looking ahead to ICD-11 and how coding departments can prepare for it.
Shannon Oitker, MSN, RN , reviews the nine MS-DRGs for ventilator use, explains how DRGs are designed, and assesses whether hospitals are receiving adequate reimbursement for ventilation services.
Although every professional may be different, there are a few tricks of the trade to building the right garden and letting your CDI department show off some of that natural talent.
Terry Tropin, MSHAI, RHIA, CCS-P , explores the 2024 ICD-10-PCS updates that will become effective April 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent study has suggested that COVID-19 patients who have a history of inflammatory bowel disease (IBD) are at an increased risk of sepsis, shock, and acute kidney injury.
TaraJo Vaught, MSN, RN, CCDS , shines a light on the crucial roles played by coding and CDI specialists, compares their respective realms, and offers insights for transitioning between them.