Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC , gives guidance to CDI teams working on clinical validation, denials prevention, and appeals processes to help ensure proper reimbursement for their hospitals.
Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , reviews Coding Clinic , First Quarter 2020, guidance, which includes topics such as reporting vaping-related disorders, malnutrition, and bariatric procedures.
Sarah A. Nehring, CCS, CCDS, writes that an inpatient coder’s first concern regarding the reporting of novel coronavirus (COVID-19) is to code all confirmed cases and only confirmed cases. In this article, Nehring details guidelines on how to accomplish this.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, details coding guidelines and instructional notes in Chapter 9 of the ICD-10-CM manual, which contains codes for diseases of the circulatory system, including rheumatic fever, hypertension, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary or excessive services, contributing to rising healthcare costs and the possibility of depleting Medicare funds.
On May 11, CMS issued its inpatient prospective payment system (IPPS) proposed rule and policy changes for fiscal year (FY) 2021. The proposed rule includes ambitious policy changes showcasing CMS’ commitment to “transform the healthcare delivery system through competition and innovation while providing patients with better value and results.”
For FY 2021, CMS projects the rate increase, together with other proposed changes to IPPS payment policies, will increase IPPS operating payments by approximately 2.5%. Proposed changes in uncompensated care payments, new technology add-on payments, and capital payments will decrease IPPS payments by approximately 0.4%, according to the proposed rule. Therefore, CMS estimates a total increase in overall IPPS payments of approximately 1.6%.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, details MS-DRG updates found in the fiscal year (FY) 2021 IPPS proposed rule, including the proposed creation of MS-DRG 521 (Hip Replacement with Principal Diagnosis of Hip Fracture with MCC) and MS-DRG 522 (Hip Replacement with Principal Diagnosis of Hip Fracture without MCC). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Clinical validation reviews and queries ensure that the documented diagnoses and clinical indicators hold up to inspection. This article gives an overview on processes and templates, top queried diagnoses, and physician engagement to help CDI teams perfect their clinical validation efforts.
Pulmonary hypertension is a complex, progressive disease that affects both children and adults, and leads to significant morbidity and mortality. In this article, Amy Sanderson, MD , reviews this disease to help ensure proper inpatient reporting and more precise queries.
Sarah Nehring, CCS, CCDS, says that strokes are complicated, which is why it is important for inpatient coders to be familiar with the brain’s anatomy and the clinical concepts of a stroke in order to report the most accurate ICD-10-CM codes.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that attention must be paid to coding guidelines and instructional notes for blindness, low vision, and laterality when reporting diseases of the eye and adnexa in Chapter 7 of the ICD-10-CM manual. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes that one area of risk unique to CDI and coding staff is the physician query. While the creation of the individual physician query usually garners most of the attention, maintenance of query compliance is equally important and frequently overlooked.
Sarah A. Nehring, CCS, CCDS, details ICD-10-PCS reporting for extracorporeal membranous oxygenation (ECMO) procedures and says basic knowledge of what an ECMO procedure is, how it is established in a patient, and why it is used can have a large impact on proper reporting and hospital reimbursement.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julian Everett, RN, BSN, CDIP , details the updated pediatric sepsis recommendations presented by the Surviving Sepsis Campaign which provides insight for clinical documentation specialists and inpatient coders on current clinical practices for the treatment of pediatric severe sepsis and septic shock.
Amy Sanderson, MD , writes that cerebral edema and brain compression are the result of significant brain abnormalities that can be life-threatening, and it’s important for clinicians to recognize and treat these conditions promptly. Properly documenting these diagnoses in the medical record is important to accurately reflect just how sick these patients are.
