When providers use different definitions for the same disease, confusion and chaos result. Trey La Charité, MD , discusses how coding and clinical documentation improvement specialists can clear up the situation.
Coders and clinical documentation specialists can use queries to improve physician documentation of a patient’s severity of illness and risk of mortality. Rhonda Peppers, RN, BS, CCDS, and Sara Baine, MSN-Ed, CCDS, walk through a case study to highlight query opportunities.
A hiatus from Recovery Auditor scrutiny may have allowed HIM professionals to focus on other issues, but Laura Legg, RHIT, CCS, explores why HIM departments need to gear up for Recovery Auditors’ return.
In the first part of a two-part series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, discusses the use of Z codes in ICD-10-CM.
Coders often talk about guidelines and coding conventions, but what about ethics? Robert S. Gold, MD , discusses the value of following ethical coding standards.
In part 2 of his series on medical necessity and coding, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, examines medical necessity and the 2-midnight rule using a case study.
The Official ICD-9-CM Guidelines for Coding and Reporting talk about the perinatal and newborn period as being the first 28 days of life. Robert S. Gold, MD, explains when neonatal really is—and isn’t—neonatal.
Coders now incorporate consideration of medical necessity when coding for inpatient admissions. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI , explains the importance of understanding the concept of medical necessity as it relates to coding.
The complexity of coding rules and the quality of documentation in facilities sometimes make correct DRG assignment a daunting task. Laura Legg, RHIT, CCS, highlights current DRGs that are subject to Recovery Auditor scrutiny and provides tips for accurate DRG assignment.
Healthcare facilities are subjected to a myriad of auditorswho scrutinize everything from how many units of a drug were billed to whether or not a patient actually needed to be admitted to the hospital. Trey La Charité, MD , explains how to turn every denial into a learning experience.
Plenty of uncertainty surrounds the ICD-10 implementation delay, but healthcare organizations shouldn’t put the brakes on their plans. Cheryl Ericson, MS, RN, CCDS, CDIP , William E. Haik, MD, FCCP, CDIP , Monica Lenahan, CCS , Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and James S. Kennedy, MD, CCS, CDIP, offer thoughts on how to keep moving forward with ICD-10.
Inpatient coders will have a new coding system on October 1, but they won’t have to learn new MS-DRGs. They aren’t changing. However, coders will see some shift in MS-DRG assignment in ICD-10. Donna M. Smith, RHIA, and Lori P. Jayne, RHIA, reveal why the MS-DRG shifts will occur.
Drug-resistant bugs are becoming more common as antibiotic use increases. Shelley C. Safian, PhD, CPC-H, CPC-I, CCS-P , AHIMA-approved ICD-10-CM/PCS trainer, explains why and how microbes become antibiotic resistant and compares ICD-9-CM and ICD-10-CM coding for these infections.
The audit landscape continues to change as Recovery Auditors expand prepayment reviews and CMS implements its new 2-midnight rule. Debbie Mackaman, RHIA, CPCO, Ralph Wuebker, MD, MBA, and Kimberly Hoy Baker, JD, review some of the recent changes to audit focus areas.
The ICD-10 implementation will result in a slowdown at every level of coding. Elaine O’Bleness, MBA, RHIA, CHP, Migdalia Hernandez, RHIT, Kimberly Carr, RHIT, CCS, CDIP, and Rachel Chebeleu, MBA, RHIA, provide suggestions on how to minimize that productivity decline.
The best way to decrease denials or increase overturn rates begins with a compliant concurrent review of documentation. Marilyn S. Palmer, DO, and Jonathan G. Wiik, MSHA, MBA, review common Recovery Audit targets and provide tips for successfully appealing denials.
No one is perfect, including coders. Mistakes aren’t necessarily a reflection on one’s abilities or attention to detail. James S. Kennedy, MD, CCS, and Laura Legg, RHIT, CCS, highlight some common problem areas and provide tips for compliance.
Recovery Auditors audit the MS-DRG, principle diagnosis, any secondary diagnoses, and any procedures that affect—or could affect—DRGs. Christina Benjamin, MA, RHIA, CCS, CCS-P, reveals the most important documentation pitfalls and coding guidelines challenges related to MS-DRGs under auditor scrutiny.
Healthcare data continues to become the industry’s newest hot commodity. Ralph Wuebker, MD, MBA, and Yvonne Focke, RN, BSN, MBA, explain what information facilities can extract from PEPPER reports.
These days, the healthcare industry is all about the numbers, especially as pay-for-performance becomes more common. Lawrence L. Sanders, Jr., MD, MBA, and Simone R. Gravesande, RN, BSN , review how APR-DRGs work and why all coders should understand them.
The accuracy and completeness of coded data can potentially affect physicians more as the healthcare industry becomes increasingly transparent to consumers. William E. Haik, MD, FCCP, CDIP, Timothy Brundage, MD, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Cathy Testerman, CCS, EMT, and Donna Walker-Thomas, MBA, RHIA, CPC, CMA, review how coded data relates to physician profiling and offer tips for engaging physicians in documentation improvement.
Although coders and billers don’t play a role in determining whether condition code 44 is appropriate, they certainly ensure correct billing of the code. Deborah K. Hale, CCS, CCDS, and John Zelem, MD, FACS, review the requirements for condition code 44 and when coders should report it.
Distinguishing between clinical and coding significance is often confusing. Joel Moorhead, MD, PhD, CPC, discusses how coders should differentiate between the two.
The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
Many organizations are concerned about the expected drop in coder productivity after the transition to ICD-10. Angie Comfort, RHIT, CDIP, CCS, discusses the pros and cons of using computer-assisted coding to help offset those productivity losses.
Coded data is incredibly important to a wide range of people. Bill Rudman, PhD, RHIA, Roxanne Andrews, PhD, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Susan Beever, RHIT, CCS, reveal how accurate coding aids research and law enforcement and improves quality of care.
Office politics are a fact of life, but can lead to poor or unjust outcomes. Lois Mazza, CPC, offers tips to help coders navigate the political waters in the office.
Recovery Auditors are currently performing prepayment MS-DRG validation and coding reviews of MS-DRG 312 (syncope and collapse). Ralph Wuebker, MD, MBA, and Stacey Levitt, RN, MSN, CPC, discuss the scope of the new reviews and what coders need to look for in documentation of syncope.
Coders are under constant stress and pressure. They must remain incredibly focused and pay attention to detail regularly. Lois E. Mazza, CPC, discusses why coders need to think about their health.
MS-DRGs won’t change much in the first year after the transition to ICD-10, but hospitals still need to understand the details of the transition. Janice Bonazelli and Dwan Thomas Flowers, MBA, RHIA, CCS, explain how to use the draft ICD-10 MS-DRG Definitions Manual to prepare for MS-DRGs in ICD-10.
Electronic health records (EHR) provide opportunities for more efficient and effective care, yet they also provide coding and documentation challenges. Jill M. Young, CPC, CEDC, CIMC, explains what coders need to be wary of when coding from an EHR.
Hospitals are approximately two months into the Fiscal Year (FY) 2013 Value-Based Purchasing (VBP) Program that began with Medicare fee-for-service discharges on or after October 1, 2012. The Hospital Readmission Reduction Program is also well underway. Deborah K. Hale, CCS, CCDS, and Susan Wallace, Med, RHIA, CCS, CDIP, CCDS, explain the important role coded data plays in these and many other quality-of-care-related initiatives.
Recovery Auditors have already begun prepayment audits of MS-DRG 312 (syncope and collapse). Laura Legg, RHIT, CCS, details how hospitals can ensure the appropriate assignment of MS-DRG 312.
So many coding topics to audit, yet so few staff members to perform those audits. Julie Daube, BS, RHIT, CCS, CCS-P, reveals steps you can take to resolve this dilemma and determine which areas to audit in 2013.
Ethical dilemmas can creep in at any time during a coder’s average workday. However, one might be hard pressed to find a coder who will openly acknowledge this. Brad Hart, MBA, MS, CMPE, CPC, COBGC, and Kathy DeVault, RHIA, CCS, CCS-P, explore how coders can and should handle ethical dilemmas.
Coders are the backbone of an organization’s fiscal health. Timely coding leads to timely revenue collection. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, discusses why coders must be willing to look beyond their traditional roles to help ensure the continued financial viability and success of the organization.
Do you audit records before sending them to your Recovery Auditor? If not, your hospital may be one of many that simply doesn't have the resources to do so. Lori Brocato, Cathie Eikermann, MSN, RN, CNL, CHC, and Laura Legg, RHIT, CCS, reveal why hospitals should consider auditing records before sending them to the Recovery Auditor.
Many of us are perfectly content with our present jobs. As coders, we may be thrilled to have secured a coding position that’s both challenging and satisfying. Others may feel differently about their work. Lois Mazza, CPC , discusses how to decide when to look for a new job and how to secure it.
Program for Evaluating Payment Patterns Electronic Report compares hospital data regarding a variety of benchmarks. John Zelem, MD, FACS, and Brenda Hogan, RN, BS, explain how hospitals can use PEPPER to identify risk areas and create a plan for self-auditing.
Retain. Train. Assess. Investigate. Analyze. HIM professionals have undoubtedly come across action verbs like these since HHS announced the replacement of the ICD-9-CM code set with the more advanced ICD-10-CM code set currently used in other nations. Mark Jahn, Luisa Dileso, RHIA, MS, CCS, and James S. Kennedy, MD, CCS, CDIP, explain what HIM professionals need to do over the next two years to be ready for the final implementation date of October 1, 2014.
What do cubism and coding have in common? Both can be viewed as art forms. Joel Moorhead, MD, PhD, CPC, details the three steps that the coding artist performs in reassembling medical record elements into abstracted form.
There is nothing new about stress; humans have felt stress since the beginning of time, and coders are certainly no exception. Lois Mazza, CPC, discusses how coders can mitigate the many effects of stress while they handle the pressures of their jobs and lives.
A lack of funding shouldn't prevent you from getting creative in your morale-boosting celebrations, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, and Nicolet Araujo, RHIA. So when your staff members are around, this time of year can be a great time to boost their morale with summer outings and special staff recognition for jobs well done.
The thought of learning ICD-10 is intimidating for many coders, but does it need to be? Robert S. Gold, MD, and Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explain why coders may not need to fear the transition quite as much as they think.
Many HIM directors and coding managers are aware of the decrease in productivity that is anticipated with the implementation of ICD-10. The concern is a valid one, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, who explains what’s ahead and how HIM professionals should prepare.
Do not view the proposed rule extending the ICD-10 implementation date from October 1, 2013, to October 1, 2014, as a year-long break from ICD-10 preparations. Rather, focus on using the additional time allotted to your advantage. This includes conducting documentation and coding assessments to gauge ICD-10 readiness. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, explains why—and how—facilities should start assessing the readiness of their coding staff and documentation procedures in relation to ICD-10 requirements and create strategies to manage any deficiencies.
While we know the implementation date of ICD-10 may change to the proposed 2014 deadline, healthcare organizations must keep moving forward with preparations. Annie Boynton, BS, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, CPhT, explains how organizations can use the additional time to better handle the change process associated with ICD-10, especially planning for education and training.
Each year the number of quality measures being used for public reporting across provider settings increases. Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, and Linda Hyde, RHIA, explain why organizations that have not started to evaluate the impact ICD-10 will have on their quality measure data should start now.
As you run down your mental to-do list for the rest of the afternoon, you realize you're double-booked for multiple meetings, and you're having trouble prioritizing because your phone keeps buzzing with new e-mail notifications. If you're a health information management (HIM) director, this scenario likely repeats day in and day out. Luckily Monica Pappas, RHIA, Patti Reisinger, RHIT, CCS, and Tesa Topley, RHIA, provide tips and strategies for HIM directors to help manage all that they juggle, and prevent stress from getting out of control.