As of October 1, approximately 1,080 cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S., according to the U.S. Centers for Disease Control and Prevention (CDC). Despite continued research into these cases by the CDC and the U.S. Food and Drug Administration (FDA), the specific cause of these illnesses remains unknown.
Every day, more than 130 people in the U.S. die after overdosing on opioids, according to the National Institute on Drug Abuse. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about accurate documentation and ICD-10-CM coding for opioid use, abuse, and dependence.
By selecting the most specific codes for cancer diagnoses, coders can help epidemiologists track disease trends and measure the efficacy of drug therapies and radiation oncology treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In part two of this two-part series, Sharme Brodie, RN, CCDS , reviews the recent guidance from Coding Clinic , Second Quarter 2019, including systemic inflammatory response syndrome, partial hip replacements, and more.
A wide range of diagnostic tests may be used by hospital providers to examine respiratory functioning. In this article, Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, CPC-I , interprets CPT guidance for reporting pulmonary functioning tests used to diagnose patients with asthma and chronic obstructive pulmonary disease.
In part one of this two-part series, Sharme Brodie, RN, CCDS , reviews the recent guidance from Coding Clinic , Second Quarter 2019, including cardiac conditions, transplants, and more.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews how to report the stage and type of various skin ulcers, the fiscal year (FY) 2020 guideline updates for pressure ulcers, and common terminology traps inpatient coders can get tripped up by.
Endometriosis is a condition where the tissue that usually grows in the lining of the uterus grows outside of the uterus. This typically happens in the neighboring sites of the uterus such as the ovaries, the fallopian tubes, the pelvic peritoneum, or even the intestines.
The fiscal year 2020 ICD-10-CM Official Guidelines for Coding and Reporting provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about significant guideline updates that will impact facilities starting October 1.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, HCS-D, reviews the 2020 ICD-10-CM code changes for atrial fibrillation, as well as the clinical background and ICD-10-PCS reporting for related procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC, writes that one of the most interesting aspects of the ICD-10-CM code update for fiscal year (FY) 2020 was CMS’ proposal to change the severity assignment for many of these codes. In this article, Blue compares the severity changes that were suggested in the FY 2020 IPPS proposed rule with the designations that were actually finalized.
Gastrointestinal cancer is the fourth most common cancer in the U.S., according to the National Cancer Institute. Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, COC , writes about ICD-10-CM coding for colon cancer screening and CPT coding for diagnostic colonoscopies.
ICD-10-CM/PCS coding for heart conditions such as aortic valve stenosis, heart failure, and atrial fibrillation requires an in-depth understanding of anatomical terminology and clinical indications. This article will review these three diagnoses to help ensure accurate reporting and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that the prevalence and complexity of prostate cancer is why it is so important for even inpatient coders to fully understand the diagnostic, treatment, and procedural aspects of this disease.
According to the Fourth Universal Definition of Myocardial Infarction (2018), “The clinical definition of myocardial infarction denotes the presence of acute myocardial injury detected by abnormal cardiac biomarkers in the setting of evidence of acute myocardial ischemia.”
Your heart may flutter when you’re nervous, but if this happens on a regular basis, it could be a sign of a serious heart condition. Atrial fibrillation (AF), a common and potentially fatal cardiovascular condition, is an irregular heartrate that can cause blood clots, stroke, and other heart-related complications.
Evolving diagnostic terminology and a general lack of awareness surrounding gender fluidity can cause confusion for healthcare providers and coders. Review key considerations for the ICD-10-CM reporting of biological sex, gender identity, and other gender-related diagnoses. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
It’s that time of year when coders eagerly await the release of the new ICD-10-CM/PCS codes and guideline updates for the upcoming year. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, tackles the fiscal year (FY) 2020 IPPS final rule to highlight 2020 code set and guideline changes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Atrial fibrillation (AF) is the most common type of heart arrhythmia, according to the Centers for Disease Control and Prevention. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , reviews outpatient coding for AF and surgical techniques used to treat the condition on a case-by-case basis.
Behavioral health is a highly specialized area of coding that many coders and billers are unfamiliar with. There are hundreds of ICD-10-CM codes for mental disorders with unique characters to specify symptoms and complications.
Adriane Martin, DO, FACOS, CCDS , describes key takeaways from Coding Clinic , Second Quarter 2019, including helpful advice on well-known coding challenges and their impact on severity and DRG assignment.
Sepsis and systemic inflammatory response syndrome (SIRS) have historically been difficult to report due to changing terminology and continuous updates to ICD-10-CM coding guidelines. Review clinical terminology and complex guidelines to select the most specific codes for both conditions.
The ICD-10-CM Manual lists hundreds of code options for mental disorders with unique characters to specify symptoms and complications. This article breaks down outpatient coding for commonly reported mental health conditions, psychiatric assessments, and psychotherapy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released the 2020 ICD-10-CM code set in May, adding 273 new codes effective for reporting beginning October 1. Shelley C. Safian, PhD, RHIA, CCS-P, COC , reviews new ICD-10-CM Z codes for factors influencing health status and Y codes for legal interventions.
PTSD is marked by persistent mental and emotional stress that occurs as a result of severe psychological shock. Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews symptoms of and ICD-10-CM coding for PTSD, as well as barriers to psychosocial treatment for the condition.
Adriane Martin, DO, FACOS, CCDS , writes about how to accurately capture and report social determinants of health to improve patient outcomes and decrease costs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In 2013, “Guidelines for Achieving a Compliant Query Practice,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. The 2019 update reinforces the information set forth in the preceding practice briefs while also introducing some newer guidelines reflective of today’s healthcare environment.
Keeping up with coding changes in the circulatory system chapter in the ICD-10-CM manual is an ongoing process. Almost every fiscal year coders are met with new codes for myocardial infarctions (MI), changes to congestive heart failure codes, and updates to the guidelines for reporting cerebrovascular diseases.
This summary, organized by major diagnostic category (MDC), highlights some of the changes to the IPPS proposed rule affecting MS-DRG and ICD-10-CM/PCS code assignment.
Acute kidney injury (AKI) and acute tubular necrosis (ATN) remain targets for both coding and clinical validation. Over the years, we’ve gleaned valuable insights from appealing hundreds of coding and clinical validation denials for AKI and ATN.
The use of ultrasound at the bedside, or within the office practice, has become more common in provider-based clinic settings. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , details documentation requirements and CPT and ICD-10-CM coding for diagnostic ultrasound services.
Diagnosis coding for neoplasms can be particularly challenging, as neoplasms are classified by site, behavior, and morphology. Review ICD-10-CM coding and guidelines for reporting solid organ tumors and cancers affecting the bone marrow and lymphatic system. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A May report from the Office of Inspector General (OIG) found that some physician practices were at the root of basic coding errors that caused federal overpayments. Although the Essence audit was small, the findings have significant implications for physician coders.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that accurate ICD-10-CM/PCS coding for the heart improves data quality, which in turn is used for statistics and tracking trends, so it is imperative to ensure the disease process is captured correctly.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, presents a review of MS-DRG basics to ensure that inpatient coders have a thorough understanding of MS-DRGs’ intricacies, thus perfecting assignment and reimbursement accuracy.
Diagnosis coding for skin ulcers can be particularly confusing as different kinds of ulcers have their own etiology and associated ICD-10-CM code. Review ICD-10-CM coding and reporting for venous, pressure, and diabetic skin ulcers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, CCS, CCDS, says that from the inpatient coding and CDI perspective, sepsis can be one of the trickiest diagnoses. In this article, she reviews 10 things coders wish physicians knew about sepsis documentation and coding.
Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that due to the frequency of diagnoses and treatments for breast cancer, it’s more important than ever for inpatient coders to make sure they are reporting these diagnoses and procedures with the utmost accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The spread of acute flaccid myelitis (AFM), a serious, paralysis-inducing syndrome, is beginning to alarm epidemiologists who have yet to identify its cause. Recognize the first signs of AFM and learn how to report the condition using ICD-10-CM codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
The endocrine system is an intricate collection of hormone-producing glands that help to control mood, metabolism, tissue function, and sexual development. This article breaks down endocrine anatomy and ICD-10-CM guidelines for reporting diabetes mellitus and Cushing’s disease. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Kay Piper, RHIA, CDIP, CCS, details the process of submitting ICD-10-CM codes to the ICD-10 Coordination and Maintenance Committee meeting by sharing the experience a medical coding educator and a CDI physician adviser had when submitting a proposal for the March 2018 meeting.
A transcatheter aortic valve replacement (TAVR) is an interventional cardiology procedure that has proven to be an important life-saving cardiac intervention frequently seen by inpatient coders. In this article, Stephen Houlahan, RN, MSN, MBA, CCDS, reviews TAVR history, clinical background, and documentation and reimbursement methodologies to ensure proper education and compliance for facilities.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, writes that proper reporting and documentation of chronic obstructive pulmonary disease (COPD) will help ensure accurate MS-DRG assignment and strengthen cases during inpatient audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Anemia is the most common blood disorder, affecting more than 3 million Americans per year, according to the National Heart, Lung, and Blood Institute. In this article, Joel Moorhead, MD, PhD, CPC , reviews documentation and ICD-10-CM coding for anemia.
With March declared National Endometriosis Awareness Month, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, details endometriosis-related procedure reporting for inpatient coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to the U.S. Department of Health and Human Services, endometriosis affects 11% of women between the ages of 15 and 44. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about diagnosing and treating endometriosis as well as ICD-10-CM and CPT coding for the condition.
Laurie L. Prescott, MSN, RN, CCDS, CDIP , details the basics of ICD-10-CM/PCS for newer inpatient coders including a review of the ICD-10-CM seventh-character extension, placeholder use, and ICD-10-PCS root operations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
