Amanda Vincent, MBA, CCS, CPC, CCDS, CRC, explains the differing definitions of “complication” for providers vs. coders, reviews types of complications, and codes an intraoperative laceration case study.
A recent ProPublica article found that nearly 30,000 Medicare patients may have received atherectomy procedures prematurely or unnecessarily, resulting in millions of dollars in reimbursement.
The 2024 ICD-10-CM update added 36 codes to the now nearly 400 codes in category M80.- (osteoporosis with current pathological fracture). The additional codes add further specificity for pelvis fractures due to age-related osteoporosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a broad federal law that establishes the basic privacy and security protections that coders are required to follow.
Medical necessity is the foundation for justifying the need for services. It provides the reason for the diagnostic test or therapeutic services. Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI , reviews the fundamentals of medical necessity and explains its importance.
Anemia describes a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient. Review the types of anemia, diagnostic criteria, treatment, and ICD-10-CM coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The healthcare setting can feel like a courtroom in the denials and appeals arena. By assessing the effort that goes into an appeal and the difference that comes out of them, coders and CDI specialists may find that the chasm between clarifying a patient record and defending it isn’t as wide as they think.
Spinal surgery for hospital coders can be very challenging if they do not know the rules for assigning the correct ICD-10-PCS codes. Nancy Reading, RN, CPC, CPC-P , reviews spinal anatomy and surgical approaches, and offers tips on how to select the most appropriate characters in ICD-10-PCS.
Anemia describes a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient. Review the types of anemia, diagnostic criteria, treatment, and ICD-10-CM coding.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a broad federal law that establishes the basic privacy and security protections that coders are required to follow.
After years of working to engage providers and get them on board with CDI efforts, every seasoned CDI professional knows there’s no one-size-fits-all solution.
The Journal of the American Medical Association recently released a study that analyzed social determinants of health and other conditions associated with lower-limb amputation in the U.S.’ most populated areas. The study found that several factors corresponded with an increased risk of amputation.
Q: I’ve heard some facilities are beginning to incorporate ICD-11, even though it is not yet implemented in the U.S. How can coders help their providers transition to ICD-11?
Debbie Jones, CPC, CCA , examines the cause, prognosis, and treatment options for desmoid tumors, in addition to reviewing the ICD-10-CM codes designed to identify them with specificity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medical coding practices can vary widely between countries, with different code sets, regulations, and policies governing the process. However, there are some commonalities when comparing medical coding in the U.S. to other countries, which this article explores.
As more health systems have been forced to reckon with the undeniable impacts of socioeconomic status on health outcomes, CDI and coding practices have followed in kind. Analyze recent developments with reimbursement and ICD-10-CM coding for social determinants of health (SDOH).
Colder weather is approaching, which brings an increase in respiratory infections. Shelley C. Safian, PhD, RHIA, CCS-P, COC, COC-I, clarifies the pathogenic causes of pneumonia, specifically those with recent additions to ICD-10-CM, and those with antibiotic resistance. She also reviews how to report treatment methods in ICD-10-PCS.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews the clinical definition and types of postpartum hemorrhage, the intrauterine treatment devices used to treat it, and relevant ICD-10-PCS coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM, delves into the ethical standards, best practices, and importance of accurate health record documentation in regard to heart failure by drawing insights from authoritative sources within the industry.
Children diagnosed with acute respiratory distress syndrome (ARDS) had a readmission rate of 27.8% in the first year after discharge, with half of those readmissions occurring within two months, according to a recent study in JAMA Network Open.
Q: How would a coder report a coronary artery bypass graft complicated by ineffective external cardiac device insertion, subsequent removal, and intra-aortic balloon pump placement?
Medical coding practices can vary widely between countries, with different code sets, regulations, and policies governing the process. However, there are some commonalities when comparing medical coding in the U.S. to other countries, which this article explores.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews the clinical definition and types of postpartum hemorrhage, the intrauterine treatment devices used to treat it, and relevant ICD-10-PCS coding.
Does the data collected by your healthcare system truly represent the patient you are caring for? Andrew B. Maigur, MD, CHCQM-PHYADV, CMPC, writes about how documentation is critical to capturing data for accurate coding and quality metric reporting.
CDI departments have long been involved with the denials management process. As with any expansion of CDI responsibility, those looking to venture into a new area can glean valuable knowledge from those already on the cutting edge.
Despite sepsis being the leading cause of hospital readmissions and in-hospital deaths in the U.S., its extensive history of clinical definitions and criteria can cause confusion for even the most experienced coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Kate Siemens, RN, CMSRN, CCDS , discusses the clinical indicators for malnutrition during end-of-life care with Taylor Kuykendall, MS, RD, LD . She covers relevant ICD-10-CM codes and proper reporting methodologies for the condition.
Q: A patient’s previously implanted Impella, a small, catheter-based ventricular assist device, was removed and replaced due to an emergency. How would we report this in ICD-10-PCS and which DRG would it lead to?
Gastroparesis is a condition that affects stomach motility. Sarah Gould, CPC , explains how to report the condition and its complications in ICD-10-CM, in addition to treatment methods in ICD-10-PCS. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews coding, CDI, and clinical validation challenges associated with acute kidney injury cases and gives insight into how coders and physicians can work together to increase accuracy.
Despite its benefits, remote work has created obstacles for employees and managers. Healthcare leaders and educators share hard-earned knowledge used to keep their staff and providers’ attention during educational sessions.
A recent Office of Inspector General report found that CMS paid $41.4 million in improper payments to acute care hospitals for claims that were assigned incorrect discharge status codes.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews coding, CDI, and clinical validation challenges associated with acute kidney injury cases and gives insight into how coders and physicians can work together to increase accuracy.
Despite sepsis being the leading cause of hospital readmissions and in-hospital deaths in the U.S., its extensive history of clinical definitions and criteria can cause confusion for even the most experienced coders.
Clinical validation has become one of the hottest targets in payer auditing. Denise Wilson, MS, RN, RRT, writes about strategies facilities can use to appeal clinical validation denials.
Reporting malnutrition correctly is a constant challenge that faces increasing payer scrutiny. Kate Siemens, RN, CMSRN, CCDS, defines malnutrition and its unique applicability to end-of-life care, documentation tips, and how to report associated conditions in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published an infographic that defines social determinants of health (SDOH), explains the significance of capturing them, and lists which SDOH codes will go into effect October 1.
There is one tell-tale sign that fall is here: the October implementation of the ICD-10 coding updates. Courtney Crozier, MA, RHIA, CCS, CDIP , explains the highlights of the update for fiscal year 2024, including 395 new codes, 25 deletions, 22 revisions, and 131 new headers.
Kellie Halsted, MSN/MHA, RN, CCDS, CCM , writes about how her experience as a hospital case manager has given her additional insight into writing clinical validation appeal letters as a CDI specialist.
A Journal of Hospital Medicine study published online in August found that decreases in readmission associated with CMS’ Hospital Readmission Reduction Program (HRRP) correlated with an increase in patient mortality for certain conditions.
Building ICD-10-PCS codes for cardiovascular surgery can be tricky given the number of root operations that may apply. Sarah Gould, CPC , reviews cardiac anatomy and ICD-10-PCS guidelines for reporting cardiac insertion and bypass procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
It can be advantageous for patients and facilities to capture social determinants of health (SDOH) alongside medical conditions. Joscelyn Thomas, RHIT , explains how incorporating screening tools into facilities can help providers and coders promote better health outcomes, reduce disparities, and increase patient engagement.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes the highlights from the newest installment of Coding Clinic, which includes guidance on reporting pancytopenia, inherent conditions, ORIF, and neurally adjusted ventilatory assist devices.
There is one tell-tale sign that fall is here: the October implementation of the ICD-10 coding updates. Courtney Crozier, MA, RHIA, CCS, CDIP , explains the highlights of the update for fiscal year 2024, including 395 new codes, 25 deletions, 22 revisions, and 131 new headers.
Coders should take note of hundreds of updates to the tabular addenda that serves as an instruction guide to the 2024 ICD-10-CM code set. Both take effect October 1.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes the highlights from the newest installment of Coding Clinic, which includes guidance on reporting pancytopenia, inherent conditions, ORIF, and neurally adjusted ventilatory assist devices.
