All of us in ICD-10-CM/PCS coding compliance are facing a tsunami of denials from payers, Recovery Auditors, and Medicare quality improvement organizations. This is due to the auditors’ removal of ICD-10-CM codes based on provider documentation; auditors can perceive that a patient did not have clinical indicators supporting the presence of the documented condition.
CMS released the fiscal year 2018 IPPS proposed rule April 14, and with it came a bevy of new potential ICD-10-CM codes. Explore the new additions to the ophthalmologic, non-pressure chronic ulcer, maternity and external cause codes ahead of implementation October 1.
Coding Clinic for ICD-10-CM/PCS , First Quarter 2017, which became effective March 15, provides interesting perspectives that may be useful in our deliberations with payers or Recovery Auditors. Let’s process some of its guidance.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, discusses the reporting of alcoholism, its key documentation details, and its effect on MS-DRGs in ICD-10. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Ghazal Irfan, RHIA, writes about healthcare’s shift from fee-for-service to pay-for-performance, volume-based care to value-based reimbursement, and case-mix index to outcome measures, and how your facility can achieve compliant coding practices among these changes.
Query practices have changed a lot over the years. With so many shifts, coders and clinical documentation specialists may need to take a step back and take stock of the changes they’ve worked through, reassessing current practices against industry recommendations and shoring up policies to prevent well-known pitfalls.
Providers often document “global developmental delay” in pediatric charts. The phrase is used to describe when a child takes longer to reach certain development milestones than other children the same age, such as walking or talking. Children with conditions such as Down syndrome or cerebral palsy may also have a global developmental delay.
Queries are definitely not what they used to be. When I first started as a CDI specialist, back when dinosaurs roamed the earth, the query process was a muddy exercise in creative writing. CDI specialists wrote all kinds of crazy things in order to get physicians to answer a query. Then in 2001 came the first AHIMA practice brief, “Developing a Physician Query Process,” which gave order and standards to the query process.
Clinical documentation improvement (CDI) specialists bridge the gap between physicians and coders. This article takes a look at the benefits of CDI and coding collaboration, and how CDI specialists can address coding hot topics at their own facilities.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , writes about hemophilia and how this condition is important for inpatient coders to understand since incorrect reporting can affect MS-DRG assignment.
Erica E. Remer, MD, FACEP, CCDS , comments on a recent Coding Clinic that has garnered a lot of questions on inpatient obstetrics coding and gives advice on how she thinks this new guidance is flawed. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Long before ICD-10 became a focus, working as a clinical documentation improvement manager with physicians to improve their progress and/or operative notes was a challenge—doctors either got it or they didn’t. But as the transition from paper charts to an electronic medical record began, providers started to understand how to better document their visits, since they had to choose from drop-down menus and multiple options to complete their notes.
Since the physician doesn't need to document a specific root operation, coders cannot rely solely on the terms the physician uses; thus it is important for each coder to fully understand each definition. This article takes a look at the root operations Drainage, Extirpation, and Fragmentation. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, discusses the importance of monitoring your facility’s case-mix index, and how evaluating each component of a case-mix index allows you to narrow your focus and to hone in on all of the factors that might be affecting them.
James S. Kennedy, MD, CCS, CDIP , reviews recent coding audits at that Northside Medical Center of Youngstown, Ohio, and Vidant Medical Center of Greenville, North Carolina, and gives readers tips on how to better prepare their facilities through these examples.
