CMS recently released the 2018 IPPS final rule, with updates to various quality initiatives, annual payment updates for inpatient services, and an extensive amount of now-annual ICD-10-PCS code additions, deletions, and revisions. This article reviews guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement. 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, details how Coding Clinic , Second Quarter 2017, did not disappoint in addressing clinical issues affecting those in coding compliance and instructing how to properly use the ICD-10-CM Index and Table .
The fiscal year (FY) 2018 IPPS final rule includes updates to payment rates and quality initiatives, but some of the most extensive changes pertain to MS-DRG classifications and relative weights.
You may be thinking that you’ve never heard of scleroderma. As a coder, we know to look at these big fancy words and break them down by their root words in order to get a clue of what we’re talking about.
CMS recently released the fiscal year (FY) 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
One of the reasons that we all read Briefings in Coding Compliance Strategies is to maintain our competence and quality in coding and risk-adjustment principles as to anticipate how recovery auditors and accountability agents view our coded data. While a good compliance officer and attorney knows the law, the better one knows the law, the judge, and the jury.
In Major Diagnostic Category 1, Diseases and Disorders of the Nervous System, which covers MS-DRGs 020-103, CMS made changes to the classification of the diagnoses of functional quadriplegia and precerebral occlusion or transient ischemic attack with the use of a thrombolytic, as well as for the insertion of a responsive neurostimulator system. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Hammerman, RHIA, CPHQ , and Sam Champagnie , explain how the newness and specificity of ICD-10 ushered in a stronger focus on clinical coding audits and how coding audit best practices shifted following implementation.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about congestive heart failure and covers symptoms, coding best practices, and treatment for the disease using new ICD-10 for 2018.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews coding guidelines, signs, and symptoms of gastroparesis and helps coders avoid tricky guidance that can lead to reporting errors. 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, says that with the news codes available October 1, coders will face significant changes in documentation and coding practices. He discusses some of the additional new codes, including type 2 diabetes mellitus with ketoacidosis and pulmonary hypertension.
Crystal Stalter, CDIP, CCS-P, CPC, writes that with the release of the 2018 IPPS final rule, hospitals around the country are poring over it to see what impact the changes might bring to their case-mix index, quality initiatives, and overall reimbursement. In the midst of this are coders and CDI specialists who need to be kept abreast of these changes.
It’s that time of year again – when HIM directors, hospital administrators, and coding managers begin to wonder just how they will be affected come October 1.
Now that the fiscal year 2018 ICD-10-CM/PCS codes have been released , let’s consider some of the compliance pitfalls, booby traps, and opportunities that await coders when these new codes are implemented on October 1.
CDI professionals recognize the effect comprehensive CDI programs have on both payment and profiling outcomes in all healthcare settings. As a result, many organizations are forging ahead to apply CDI beyond the walls of the traditional acute care setting.
The Medicare Outpatient Observation Notice (MOON) finally went into effect after a bumpy start. The MOON was originally set to go into effect August 2016, but the draft version was only released for comment at the beginning of that month.
James S. Kennedy, MD, CCS, CDIP , explains how ICD-10-CM addresses kidney illness and advises on how to ensure documentation and coding integrity through certain challenges including risk-adjustment methodologies and functional versus anatomic diagnoses.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that coding for skin cancers requires understanding the guidelines as well as knowledge of how the conditions are classified in 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.
Starting October 1, the new and revised ICD-10-CM and ICD-10-PCS codes go into effect along with proposed DRG changes. Coders will benefit from digging deeper into the meanings of the new cardiovascular code descriptions to be able to fully understand and use them.
With the increased focus on clinical documentation improvement in the outpatient arena, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, shares her tips for proving medical necessity on claims.
Coding Clinic , Second Quarter 2017, which became effective May 17, did not disappoint in addressing clinical issues affecting us in coding compliance and instructing us in how to properly use the ICD-10-CM Index and Table. Let’s review several of Coding Clinic’s changes.
James S. Kennedy, MD, CCS, CDIP, writes that while you might have thought you’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: Hierarchical Condition Categories.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , explains that as a coding manager, whether your inpatient team is on-site, off-site, or remote, creating the appropriate environment and selecting proper locations are key to any successful team. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Daniel E. Catalano, MD, FACOG, says that from the CDI perspective, the ability to communicate pediatric severity of illness is complicated by the fact that pediatricians have a lexicon that is not well captured in ICD-10-CM. This, he writes, is especially true for pediatric cardiology.
Many national organizations, such as the Centers for Disease Control, the American Liver Foundation, the Department of Health and Human Services, and the Food and Drug Administration have information and resources available to provide education and promote testing for viral hepatitis.
When someone decides to enter the world of medical coding, they usually start off coding for obstetric and newborn charts. After coding for a month or two, the newbie coder is transitioned to low-dollar queues; usually encompassing charts $10,000 and less. Gradually, he or she works toward the medium-dollar and moderate-procedure queues between $20,000-$39,000.
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.
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.
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.
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.
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.
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.”
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 .
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.
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).
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.
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.
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.
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.
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.
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.
