Organizations need to decide how to manage the clinical validation conundrum effectively and consistently. Trey La Charité, MD, FACP, SFHM, CCS, CCDS, explores one denial prevention tactic that has proved most effective for his organization.
Teresa Brown, RN, CCDS, CDIP, CCS, explores the significance of the Elixhauser Comorbidity Index in enhancing our understanding of patient health profiles and supporting informed decision-making across various facets of healthcare delivery.
The new ICD-10-PCS code set for fiscal year 2025, which includes 371 new codes, will be effective October 1, 2024. With highlights from Terry Tropin, MSHAI, RHIA, CCS-P , inpatient coders can make sense of each new term before they go into effect.
Q: A physician documented metabolic encephalopathy on a postoperative patient who was sedated on a vent, but because there were not documented responses while on the vent, I was unable to clinically validate the encephalopathy while the patient was sedated on the vent. How would a coder query this diagnosis for validity?
HIPAA has protocols for when patients’ protected health information can be used for research and marketing. This means you must understand privacy rule limitations and your organization’s policies and procedures before releasing any PHI in these situations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ fiscal year 2025 IPPS proposed rule and fact sheet proposes to upgrade certain codes describing social determinants of health (SDOH) to better capture the effect of housing instability on beneficiaries.
Sepsis is one of the most prevalent diagnoses necessitating hospital admissions in the United States, and unfortunately, sepsis denials are also prevalent and on the rise. John Williams, RN, BSN, CCDS, clarifies how to ensure all indicators and findings of sepsis are present and valid for each inpatient admission.
Without proof that services rendered were medically necessary, third-party payers are unlikely to approve claims for reimbursement. With tips from Shelley C. Safian, PhD, RHIA, CCS-P, COC, COC-I , medical coding professionals can use ICD-10-CM codes to prove medical necessity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The best technical security in the world cannot prevent breaches of protected health information if people are careless. Coders, billers, and HIM professionals should then learn to protect confidential health information by following proper security procedures and creating effective passwords.
Most facilities find acute respiratory failure to be a commonly denied diagnosis. Sharme Brodie, RN, CCDS, CCDS-O, explores when the circumstances of admission and the focus of care support the condition for coding.
A study published in the Journal of the American Medical Association found that administration of piperacillin-tazobactam among patients with suspected sepsis was associated with a higher mortality rate and increased duration of organ dysfunction compared with cefepime administration.
Q: A patient presents with a chief complaint of thoracic intrinsic spinal cord lesion causing back pain, left lower extremity sciatic-type pain, and foot drop. An MRI of the thoracic spine revealed a T11-T12 spinal cord lesion consistent with a cavernous malformation. Which ICD-10-CM codes would be reported?
The new ICD-10-PCS code set for fiscal year 2025, which includes 371 new codes, will be effective October 1, 2024. With highlights from Terry Tropin, MSHAI, RHIA, CCS-P , inpatient coders can make sense of each new term before they go into effect.
Without proof that services rendered were medically necessary, third-party payers are unlikely to approve claims for reimbursement. With tips from Shelley C. Safian, PhD, RHIA, CCS-P, COC, COC-I , medical coding professionals can use ICD-10-CM codes to prove medical necessity.
Q: A 64-year-old female patient who has a bilateral lung transplant presents with COVID-19 (reason for admission) with acute respiratory failure. She also has immunosuppression from drugs. How would this scenario be reported in ICD-10-CM?
Nancy Reading, RN, CPC, CPC-P, reviews the Phoenix Sepsis Score, a new set of clinical parameters to define and diagnose pediatric sepsis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published the fiscal year 2025 ICD-10-PCS code set and guidelines. Although CMS made no changes to the guidelines, the update includes 371 new codes, 61 deleted codes, and three new tables.
The success of coding and CDI departments depends on collaboration with multiple entities. Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , illuminates how to promote healthy partnership.
Shelley C. Safian, PhD, MAOM/HSM/HI, RHIA , explains ways administration can establish an organizational culture of legal and ethical responsibilities to maintain compliance and honor patients and staff.
A study published in the Journal of the American Medical Association found that four popular pretest risk assessment models for evaluating risk of hospital-acquired venous thromboembolism in inpatients did “not perform particularly well.”
Q: A 64-year-old female inpatient has hepatocellular cancer with an orthotropic liver transplant with bile duct obstruction and is immunosuppressed due to drugs. Which ICD-10-CM codes would be reported?
Verbal conversations with providers regarding reportable conditions and procedures are considered verbal queries. Refresh how they should be memorialized within the record to maintain compliance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Kathy Dorich, MSN, RN, CCDS, CPHQ , explains two types of DRG reconciliation processes that she has implemented to alleviate conflict between coding and CDI departments.
JoAnn Baker, CCS, CPC, COC , defines sepsis and septic shock, and delves into the emerging initiative to integrate AI into the diagnosis and treatment process.
Our experts answer questions about querying a metabolic encephalopathy diagnosis and documenting the start of mechanical ventilation if a patient is intubated in another ED.
JoAnn Baker, CCS, CPC, COC , defines sepsis and septic shock, and delves into the emerging initiative to integrate AI into the diagnosis and treatment process.
A Journal of the American Medical Association study found that ICD-10-CM influenza codes accurately represented cases of positive diagnoses in pediatric patients, but their sensitivity was modest.
Managing chronic conditions requires involvement from many parties, making documentation challenging. Assess how to improve documentation and reimbursement for chronic conditions with tips provided by Arta Kelmendi-Doko, MD, PhD . Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Brandi Hutcheson, RN, MSN, CCM, CCDS, CCA , examines the coding and clinical literature on malnutrition and obesity to see how coders can reconcile these seemingly disparate diagnoses.
Q: A patient has acute renal failure due to dehydration, a history of Type 1 diabetes mellitus causing end-stage renal disease, a kidney transplant two years ago, and chronic kidney disease stage 3a, immunosuppressed by their drugs. How would this be reported in ICD-10-CM?
Despite the expansion of codes that came with the transition from ICD-9 to ICD-10-CM, the majority of codes for inflammatory arthritis were not frequently used in 2015 through 2021, researchers found.
Merle Zuel, RN, CCDS , explains how healthcare leaders can improve in their roles by understanding all coding and clinical data available and knowing how to analyze it.
Pressure injuries, which can lead to a patient safety indicator (PSI), require clear documentation and coordination among coding, CDI, and clinical departments. Katherine Siemens, RN, BSN, CMSRN, CCDS , evaluates how poor coordination could result in a PSI being incorrectly reported.
Q: A 64-year-old female bilateral lung transplant recipient presents with aspiration pneumonia, hypoxia, and has immunosuppression from the drugs. How would this scenario be reported in ICD-10-CM?
Sarah McDonald, CPC , reviews ICD-10-CM and ICD-10-PCS coding guidelines for the U.S.’ most common orthopedic surgeries: hip and knee replacements. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Pressure injuries, which can lead to a patient safety indicator (PSI), require clear documentation and coordination among coding, CDI, and clinical departments. Katherine Siemens, RN, BSN, CMSRN, CCDS , evaluates how poor coordination could result in a PSI being incorrectly reported.
by Jess Fluegel It is a truth universally acknowledged that a CDI department, in possession of a part-time physician advisor who is already stretched too thin, may be in want of provider engagement...
This article reviews malware basics and covers tips that healthcare employees can implement to avoid cyberattacks that could put protected health information (PHI) at risk.
Sarah McDonald, CPC , examines the ICD-10-CM/PCS coding conventions for symptoms, stages, and treatment of gastroesophageal reflux disease—a commonly diagnosed digestive disorder in the U.S. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ fiscal year 2025 IPPS proposed rule and fact sheet, published April 10, includes proposals for a 2.6% payment increase, a new bundled payment program, code updates, and other policy changes.
Educating clinical staff on proper documentation of mechanical ventilation can avoid compliance issues and support accurate reimbursement. This article clarifies the complications of reporting mechanical ventilation in ICD-10-PCS.
This article reviews malware basics and covers tips that healthcare employees can implement to avoid cyberattacks that could put protected health information (PHI) at risk.
Q: How would the scenario of a previous kidney transplant patient presented with sepsis due to acute pyelonephritis (E. coli), CKD, and immunosuppression be reported in ICD-10-CM?
Sarah McDonald, CPC , explains the spinal fusion process and overviews the process of constructing ICD-10-PCS procedure codes character by character. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Aside from Coding Clinic , Third Quarter 2005, pp. 19–20, is there any more up-to-date advice on reporting ICD-10-CM diagnoses from physician orders?
