When Lori Belanger, RN, BSN, RHIT, inpatient coder and CDI specialist at Northern Maine Medical Center in Fort Kent, Maine, began to practice coding charts using ICD-10-CM/PCS, she was a bit surprised by how much her productivity decreased.
DRGs for procedures unrelated to the principal diagnosis shouldn't occur frequently. If they do, coding managers should take a closer look at coding compliance efforts to ensure accuracy and avoid costly audits.
Q: Can you clarify the requirements surrounding the use of E codes? We have been working on documentation concerns related to patient safety indicator (PSI) 15 and wonder if E codes are required. Can a facility simply decide not to use them?
The OIG is taking a closer look at mechanical ventilation, according to its FY 2013 Work Plan. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explain why your facility should do the same.
Coders remain highly accurate when reporting present-on-admission (POA) indicators, but they need to maintain that accuracy. The OIG reiterates the importance of POA reporting in terms of monitoring hospital quality of care and the role that such reporting plays in CMS’ effort to align payment incentives with patient outcomes. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Nena Scott, MS, RHIA, CCS, CCS-P, offer tips to ensure complaint POA reporting.
Q: A patient with undiagnosed syncope is admitted to observation. Later that evening, the patient is diagnosed with syncope and develops complications that warrant an inpatient admission. Should the patient be considered an inpatient from the time inpatient criteria are met or from the time the inpatient order is written?
Everyone knows that CCs and MCCs are under scrutiny these days. However, that doesn't mean hospitals should err on the side of caution when reporting these conditions. William E. Haik, MD, FCCP, CDIP, director of DRG Review, Inc., in Fort Walton Beach, Fla., provides several tips that coders can employ to look for clinical evidence in the record before querying for these targeted conditions.
Q: A patient presents with a sore throat, and the physician states “Sore throat; differential diagnoses include streptococcal sore throat, tonsillitis, postnasal drip.” If the physician doesn’t rule out any of the differential diagnoses, should the coder query for clarification or simply choose one of the differential diagnoses?
According to the ICD-9-CM Official Guidelines for Coding and Reporting, it’s unusual for two or more diagnoses to meet the definition of principal diagnosis. Coders know the opposite is true. William E. Haik, MD, FCCP, CDIP, Donna Didier, MEd, RHIA, CCS, and Cheryl Ericson, MS, RN, CCDS, CDIP, offer tips for determining whether multiple conditions meet the criteria for principal diagnosis.
As more patients are being impacted by noncoverage of self-administered drugs, coders and billers need to know when and how to report drugs and drug administration services. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, discuss the differences in how drugs are paid under Medicare Part A and Part B.
ICD-10-PCS differs significantly from ICD-9-CM procedure coding, but fortunately, the Cooperating Parties are providing plenty of guidelines. Laura Legg, RHIT, CCS, discusses some of the key ICD-10-PCS guidelines and why coders should learn them.
In times of increased auditor scrutiny, it's important for coders to remind themselves of their strengths. Assigning the POA indicator is one of them, according to an OIG report released in November 2012.
The ICD-9-CM guidelines state that it's unusual for two or more diagnoses to meet the definition of principal diagnosis. However, coders know this isn't exactly true, as the scenario tends to occur frequently.
Coders should avoid reporting signs and symptoms as the principal diagnosis when possible. However, that’s not always possible. William E. Haik, MD, FCCP, CDIP, reviews the ICD-9-CM principal diagnosis selection guidelines and when coders should report signs and symptoms as the principal diagnosis.
Q: One of our orthopedic surgeons started to perform spinal fusions percutaneously. CPT ® provides instruction on how to code this procedure; however, these are inpatient surgeries, so we need an ICD-9-CM code. We’re leaning toward code 81.00 (spinal fusion unspecified). Do you think this is the correct code?
Physicians, especially ED physicians, need to start paying attention to how their documentation affects the facility. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Bernadette Larson, CPMA, discuss how documentation in the ED affects medical necessity and inpatient coding.
MLN Matters ® article SE1236, which discusses documenting medical necessity for major joint replacements, may be aimed at physicians, but Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, and Lynn Marlow, BS, RHIT, CCS, explain how it also applies to hospitals and coders.
Q: I’ve heard that queries differ between critical access and short-term acute care hospital settings. Is this true, and if so, where can I find more information?
