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.
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.
James S. Kennedy, MD, CCS, CDIP, discusses bundled payments and the importance of applying proper ICD-10-CM/PCS-pertinent documentation and coding principles to remain compliant.
Clinical documentation improvement managers discuss their management duties and program priorities and how they strive for the best possible results at their facility.
Crystal R. Stalter, CPC, CCS-P, CDIP, writes about how fully specified documentation is the key to quality care, compliance, and eventual reimbursement, and how documentation software can help to streamline these processes.
In promoting ICD-10-CM coding integrity and compliance, cerebrovascular disease represents one of the greatest challenges for providers and coders alike. It seems that clinicians, ICD-10-CM, and risk-adjusters (those who create the DRG system), do not sing the same tune.
The 2017 ICD-10-CM Official Guidelines for Coding and Reporting brought many changes and updates for coders, and present-on-admission (POA) reporting was not excluded. Completely understanding POA guidelines is necessary for any inpatient coder.
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.
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.
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.
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.
