Optimal ICD-10 accuracy cannot be achieved by simply looking up a code in an encoder or book. Knowing the rationale for what you are coding, why you are applying one code versus another, and having the knowledge base to correctly apply the 2017 Official Guidelines for Coding and Reporting are the ingredients necessary for accurate clinical coding.
Clinical validation denials (CVD) result from a review by a clinician, such as a registered nurse, contractor medical director, or therapist, who concludes retrospectively that a patient was not really afflicted by a condition that was documented in the medical record and coded by the coder.
James S. Kennedy, MD, CCS, CDIP, reviews important coding recommendations mentioned in various Medicare Quarterly Provider Compliance Newsletters, covering the MS-DRG postacute discharge policy, readmissions to the same hospital on the day of discharge, and postoperative respiratory failure.
Laura Legg, RHIT, CCS, CDIP, writes about the new round of Recovery Auditor (RA) contracts, and how even the most experienced RA response team will need to understand the new challenges providers face with CMS’ 2017 changes. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
The advent of the electronic record changed (EHR) how clinical documentation improvement specialists work with providers and coders. As more healthcare organizations take on the arduous process of implementing an EHR, new challenges and considerations arise.
One of my favorite sayings when teaching clinical documentation integrity, as well as coding, is that a good lawyer knows the law, but a better lawyer knows the law, the judge, and the jury. In learning the judge and the jury, one of my favorite references is the Medicare Quarterly Provider Compliance Newsletter , an official CMS publication written in plain language that serves as a summary of how Medicare and its contractors interpret the Medicare rules, regulations, and policy statements.
Shannon Newell, RHIA, CCS, explains that pneumonia discharges impact hospital payments under the Hospital Value-Based Purchasing Program, as well as the Hospital Readmission Reduction Program, and conveys what CDI teams can do to help.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , writes about how one of the many coder obligations is to report noncompliant activities and provides information on how to do this anonymously. Note: To access this free article, make sure you first register here if you do not have a paid subscription. Once you have set up your free registration, you can log in and access this article by clicking here.
James S. Kennedy, MD, CCS, CDIP, says that since the clinical intent and language of physicians does not translate into the administrative language of ICD-10-CM, understanding and embracing both their clinical foundations is essential to accurately measure outcomes and ensure coding compliance.
Pneumonia discharges impact hospital payments under the Hospital Value-Based Purchasing Program, as well as the Hospital Readmission Reduction Program.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes about how the selection of the code and a principal diagnosis seems fairly straightforward, but there are multiple factors that must be considered and reviewed before a coder can assign a certain diagnosis as principal.
Trey La Charité, MD, FACP, CCDS , notes that getting a handle on a facilities’ case-mix index (CMI) fluctuations can be difficult, and shares insights to how CDI teams can handle these CMI difficulties.
The 30-day all cause acute myocardial infarction (AMI) mortality outcome measure has been linked to hospital payments since the inception of the Hospital Value-Based Purchasing Program (HVBP) in fiscal year 2013. In February 2016, CMS announced that 70% of commercial payers have agreed to use this measure as one of the cardiology outcomes linked to payment.
The world didn’t end on October 1, 2015. After years of postponement, the proverbial “deal with the devil” made between CMS and the AMA to push ahead with ICD-10-CM/PCS implementation was a year’s grace period during which physician practices could continue using unspecified codes without worrying about Medicare denials or auditor reviews.
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 Inspection, Map, Dilation, and Bypass. Note: To access this free article, make sure you first register for the free content if you do not have a paid subscription.
After a year full of numerous coding changes, Laurie L. Prescott, RN, MSN, CCDS, CDIP , takes a closer look at 12 new guidelines that will affect CDI and helps coders better understand these recommendations.
CMS announced that 70% of commercial payers have agreed to use the 30-day all cause acute myocardial infarction mortality outcome measure as one of the cardiology outcomes linked to payment. Shannon Newell, RHIA, CCS , writes about how CDI teams can best prepare for these upcoming changes.