Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRD, CCDS, writes that while the fiscal year (FY) 2019 IPPS proposed rule is considering the downgrade of ICD-10-CM code B20 (human immunodeficiency virus [HIV] disease) from an MCC to a CC, it does not mean that diagnosing and coding for HIV has lessened in complexity.
It is well known that ICD-10-CM/PCS code assignment impacts hospital reimbursement and compliance; however, there is an additional code that often flies under the radar for inpatient coders—the discharge status code. Inaccurate discharge status code assignment for Medicare post-acute care transfers (PACT) can lead to under reimbursement and compliance risks for hospitals.
The thyroid gland, included in the endocrine system, is a small gland located at the base of the neck. Although small when compared to the other components of the endocrine system, the thyroid gland plays a significant role in overall body function, influencing the performance of the heart, brain, liver, kidneys, and skin.
Allen Frady, RN-BSN, CCDS, CCS, CRC, writes about guidance related to documenting acute respiratory insufficiency and gives tips to coders and CDI teams on what to do when the conditions are over-documented postoperatively.
A diagnosis of autism spectrum disorder (ASD) now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified, and Asperger’s syndrome. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews these terms to aid accurate coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP, CCDS, writes that the various approaches hospital systems use to optimize their DRG-based case-mix index or HCC-based risk adjustment factor scores will likely conflict with how an accountability agent will see those measurements.
I was recently reviewing Coding Clinic , First Quarter 2018, and felt that the question regarding physeal fractures needed more clarification and explanation than was provided in the official answer.
Coders often seek definitions for realistic productivity benchmarks, and standards depend on how a given facility establishes the responsibilities and expectations of its team. Therefore, before assessing a coder’s success, a facility must set goals that define that success. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CCDS, CDIP, writes that clinical validity, documentation, and ICD-10-CM coding applicable to liver disease remains a great challenge to those invested in severity and risk-adjustment coding compliance. In this article, he reviews several pitfalls that could await facilities.
Danielle Richmond says that while inpatient coder shortages are nowhere near what they were with ICD-9-CM, new challenges have emerged. This article shares important advice for any managers trying to improve their coder recruitment and hiring process.
Yvette M. DeVay, MHA, CPC, CPMA, CIC, CPC-I , reviews the anatomy of the brain and details treatments and surgeries associated with the brain and how to report them in ICD-10-CM/PCS.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, writes that even though CDI specialists are not coders, it’s important to learn the rules and guidelines that coders follow. CDI teams need to reference guidance and guidelines in their daily work to ensure documentation is clear, concise, and supportive of accurate code assignment true to the patient’s story.
Laura Legg RHIT, CCS, CDIP, looks at the results of Central Learning’s second annual ICD-10 Coding Contest and highlights ways facilities can use the data to improve coding performance and accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In 2015, I wrote 44 appeal letters challenging DRG validation/coding denials. In 2016, I wrote 88 appeal letters. Last year, I penned 159. We already received more than 40 DRG validation denials in January of this year. Does this trend sound familiar?
The implementation of an EHR is a multifaceted, comprehensive project for healthcare organizations. Though it affects every department and function in some way, the impact on medical record coding may be the most profound and complicated, with some organizations reporting a 20% decrease in coding productivity after EHR implementation.
Traditionally, the Office of Inspector General (OIG) Work Plan is released annually with focus areas identified for the upcoming year. However, as of June 2017, the decision was made to update the plan on a monthly basis to promote transparency by demonstrating a continuous effort to ensure compliance.
The fiscal year (FY) 2018 ICD-10-CM changes have now been active for several months. Though the volume of new codes is relatively small compared to previous updates, the impact on reimbursement has the potential to be quite large.
James S. Kennedy, MD, CCS, CDIP, CCDS , reviews readmission rates and writes that if physicians learn the foundations of readmission measurement and implement some basic principles and workflows for reporting clinically accurate ICD-10-CM/PCS coding, hospitals can succeed with readmission measures.
Osteoarthritis is the most common joint disorder in the United States and one of the leading causes of chronic pain and disability, according to the National Institutes of Health. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, examines ICD-10-CM/PCS coding and associated guidance for this condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Paul Evans, RHIA, CCDS, CCS, CCS-P, tackles the various characteristics of creating a query and says that while all portions of any program, such as education and metrics, are important, the proper formulation of a query represents the most important task for a CDI professional.
James S. Kennedy, MD, CCS, CCDS, CDIP, writes about potential coding compliance issues raised in the Office of Inspector General’s (OIG) Work Plan for providers to consider, including documentation and coding for severe malnutrition and bariatric surgery.
Medical necessity denials are commonly encountered in facilities. Complete understanding and utilization of the ICD-10-CM/PCS coding guidelines is imperative for coders and coding mangers to recognize how to avoid these denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Allen Frady, RN-BSN, CCDS, CCS, CRC, explains the value of tracking and understanding key performance indicators (KPI), and gives advice on how facilities can improve on its practices.
The amount of energy it takes to stay up to date on all the relevant payment and coding updates can be overwhelming, taking valuable time away from daily record review duties and activities.
As clinicians and coders invested in ICD-10-CM/PCS documentation and coding compliance, we’ve seen it all as it relates to the various approaches different hospital systems use to “optimize” or “maximize” their DRG-based case-mix index (CMI) or risk adjustment factor (RAF) scores based on Hierarchical Condition Categories (HCC).
Review the provider documentation and operative report and consider the ICD-10-CM and ICD-10-PCS codes to be reported. See the answers and rationale to check your answers.
Did you know there is a coding competition? The second annual ICD-10 Coding Contest, sponsored by Central Learning, took place last summer, recruiting coders from all over the nation to participate in coding a total of 1,636 real-life medical cases.
Clinical validity, documentation, and ICD-10-CM coding applicable to liver disease remains a great challenge to those invested in severity and risk-adjustment coding compliance.
Emergency departments at designated trauma centers encounter some of the most complex patients—and with them, a complicated documentation web that’s difficult to untangle, making trauma case review essential for hospitals.
Because Hierarchical Condition Categories (HCC) and similar risk-adjustment methodologies impact physician and hospital practices, James S. Kennedy, MD, CCS, CDIP, CCDS , reviews CMS’ Risk-Adjustment Data Validators (RADV) instructions to improve HCC compliance.
According to the American Cancer Society, in 2017 there were an estimated 1,688,780 new cancer cases diagnosed and 600,920 cancer deaths in the U.S. In this article, Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , breaks down the usage of the ICD-10-CM neoplasm table and reviews coding for neoplasm admissions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Outsourced coding audits for ICD-10-CM and ICD-10-PCS code sets are a common practice in inpatient facilities, and from national healthcare systems to physician practices, outside coding experts are engaged to audit coding accuracy, quality, and performance.
In November 2017, HCPro asked healthcare professionals about ICD-10 coding productivity. Based on respondent feedback, respondents were asked to report productivity based on records per hour or records per day. In previous years, respondents were asked to report productivity based only on records per hour.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that since there is such a prevalence for obesity in our nation, it’s a no brainer that correctly assigning and fully understanding the ICD-10-CM/PCS codes for obesity-related conditions is imperative for coders in any facility.
Creating a query and knowing when to query can be complicated, and there are a number of training tactics that can prove successful for coders when trying to improve upon physician query practices. For this article, let’s take a look at when coders should query and when it’s appropriate for them to cite clinical evidence. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP, CCDS, reviews some ICD fundamentals and to help facilities develop a strategy that will ease the transition to the new administrative language as the federal government moves toward deployment of the International Classification of Diseases, 11th Edition, for Mortality and Morbidity Statistics (ICD-11-MMS).
Congestive heart failure (CHF) is a commonly diagnosed condition where the ventricles or the lower chambers of the heart do not work effectively. The heart serves as a pump to get blood in and then out of the heart to circulate to the rest of the body. When any type of pump doesn’t work efficiently, backups can occur.
Lynelle A. Clausen, RN, BSN, writes about the struggles she faces as a CDI specialist when dealing with vague documentation, lack of criteria, and the reporting of malnutrition.
Surprisingly, thyroid disease is more common than diabetes or heart disease, with an estimated 20 million Americans having some form of the disease. In this article, Yvette M. DeVay, MHA, CPC, CPMA, CIC, CPC-I gives readers a background on thyroid cancer and reviews ICD-10-CM/PCS coding for the disease.
With yearly ICD-10 code and guideline updates to the respiratory system, it’s important for coders to stay abreast of changes to ensure documentation and coding integrity. This article takes a closer look at the ICD-10-CM code updates as well as recent Coding Clinic guidance on the respiratory system. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In perusing the United States Department of Health and Human Services Office of Inspector General’s (OIG) Work Plan , there are many clinical issues that we in ICD-10-CM/PCS coding compliance must address.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, writes about the Office of the Inspector General’s (OIG) recent audit findings regarding the ICD-9-CM diagnosis code for kwashiorkor, and discusses what coders can do to stay compliant when coding guidance is lacking. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
While a facility’s case–mix index is an important metric to measure, program managers and directors warn that metrics mean different things to different stakeholders and that CDI programs need to work diligently to present their data within the context of a host of other important measures.
