Laura Legg, RHIT, CCS, CDIP, writes that coders will benefit from digging deeper into the meanings of the new fiscal year 2018 ICD-10-PCS cardiovascular code descriptions to be able to fully comprehend and use them.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , takes a look at scleroderma diagnoses and helps coders to breakdown the disease components and treatment to better identify it in documentation and improve coding. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Beginning and sustaining a remote CDI program can be a challenge for even seasoned professionals. Traditionally, CDI specialists put in varying amounts of face-to-face time with the physicians. Ideally, that in-person interaction makes the physicians more open to CDI efforts. However, many remote CDI programs and individual specialists have found creative ways around this face-to-face time.
James S. Kennedy, MD, CCS, CDIP , writes that if a payer has criteria that differs from that of the provider or the facility, Recovery Auditors can deny ICD-10-CM/PCS codes they deem not to fit these criteria. Kennedy gives solutions for coding compliance for conditions such as sepsis, coma, and encephalopathy.
Sharme Brodie, RN, CCDS, reviews 2017 First and Second Quarter Coding Clinic advice, which includes sequencing chronic obstructive pulmonary disease with other respiratory diagnoses and body mass index reporting instructions.
In today’s virtual environment, with its focus on flexible schedules, organizing an inpatient coding team requires consideration of time zones, team member skills, volume of work, and claim-processing schedules. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
A recent Coding Clinic has garnered a lot of questions on inpatient obstetrics coding. While coders were originally taught to use multiple codes for the repair of a third- or fourth-degree perineal laceration, Coding Clinic , First Quarter 2016, states that you don’t use multiple codes for third- and fourth-degree tears, because you need to code to the “deepest layer.”
While you thought that we’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the compliance risks and opportunities with a new risk-adjustment method applicable to MACRA, Hierarchical Condition Categories (HCC).
Turning the microscope to critically examine the program you painstakingly created is no easy task. It is a challenging process that requires a fair amount of humility and humbleness. It’s hard to accept that your program, your staff, and you (the physician advisor) might suddenly not be as effective as you previously believed. Believe me, I speak from experience.
Most healthcare systems already have a proven process in place to monitor revenue integrity and ensure correct reimbursement. Beyond the day-to-day revenue cycle staff involved in revenue integrity, more than 60% of hospital executives believe revenue integrity is essential to their organization’s financial stability and sustainability, according to a survey by Craneware, Inc .
Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But Jugna Shah, MPH , writes that, increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
James S. Kennedy, MD, CCS, CDIP, helps coders and CDI specialists process important aspects of Coding Clinic’s First Quarter 2017 guidance such as the sequencing of pneumonia in the setting of chronic obstructive pulmonary disease.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes about how understanding the different forms of viral hepatitis and alcoholic hepatitis, as well as their effects on the liver, help to clarify coding assignment. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Cheryl Ericson, MS, RN, CCDS, CDIP, explains why so many CDI departments are expanding their review processes to include consideration of how CMS quality measures are affected by claims data.
Joel Moorhead, MD, PhD, CPC , explains that a patient with an atypical presentation, by definition, may have the disease but might not meet typical criteria for diagnosis; thus, the patient needs to be at the center of clinical validation.
With new data feeding into DRGs, facilities can finally start to see the impact of coders reporting new ICD-10 specificity and if cases are going to the same DRG groups that they did in ICD-9-CM. One MS-DRG group falling into question this year is for acute ischemic stroke with use of thrombolytic agent. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Ghazal Irfan, RHIA, writes that it’s pivotal that coders have a thorough and in-depth understanding of complex surgeries such as excisional debridements, along with comprehensive knowledge of relevant Coding Clinics and guidelines.
Alcohol, as a legal substance for those 21 and older, is commonly seen as more benign than illicit drugs such as heroin and cocaine. However, alcohol can also physically harm the body in many ways. In ICD-10-CM, the categories related to alcohol fall under category F10.- (alcohol-related disorders).
Clinical documentation improvement (CDI) specialists, in theory, bridge the gap between physicians and coders. However, CDI and coding teams are often educated separately and work apart from each other.
One of the primary difficulties in achieving uniformity of code assignment is that, in some circumstances, selecting the principal diagnosis is believed to be up to the individual coder or CDI specialist. Let’s take a closer look at the 2017 ICD-10-CM Official Guidelines for Coding and Reporting to understand whether this is really the case.
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.
The incidence of stroke and transient ischemic attack is increasing as the baby-boomer population ages. James S. Kennedy, MD, CCS, CDIP , writes that understanding and embracing clinical and coding fundamentals for these conditions is essential in the joint effort to promote providers’ complete documentation and the coder’s assignment of clinically valid codes.
Laura Legg, RHIT, CCS, CDIP , explains how external coding audits are an important part of shining a light into all coding operations and turning risk into security and peace of mind. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The selection of the principal diagnosis is one of the most important steps when coding an inpatient record. The diagnosis reflects the reason the patient sought medical care, and the principal diagnosis can drive reimbursement.
The human eye may be small, but it’s one of the most complex organ systems in the body. Review the anatomy of the eye and how to code for conditions affecting the system, including new details for 2017.
In today’s ever-changing healthcare landscape, emphasis is shifting away from fee-for-service to pay-for-performance, from volume-based care to value-based reimbursement, and from case-mix index to outcome measures.
Red letter days in coding compliance occurred in December 2016 and January 2017 with the Office of Inspector General’s (OIG) release of two audit reports. These reports asserted that Northside Medical Center of Youngstown, Ohio, and Vidant Medical Center of Greenville, North Carolina, improperly submitted ICD-9-CM codes for marasmus and severe malnutrition.
Erica E. Remer, MD, FACEP, CCDS , explains what clinical validation denials are, how they are determined, and how a coder can help to limit these rebuffs.
Amber Sterling, RN, BSN, CCDS , and Jana Armstrong, RHIA, CPC , discuss revenue integrity and how it focuses on three operational pillars: clinical coding, clinical documentation improvement, and physician education.
