Ready or not, ICD-10 is here. Sam Antonios, MD, FACP, FHM, CCDS, writes about how to talk to physicians about the transition in order to make it as seamless as possible.
The updated guidelines in ICD-10-CM will impact how coders report certain diagnoses. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, highlights important changes in each section for coders to review before implementation.
A Recovery Auditor review of claims from September 25, 2012, to August 30, 2013, found providers billing hydration therapy with diagnosis codes not considered reasonable and medically necessary, according to the July 2015 Medicare Quarterly Compliance Newsletter .
Combination codes in ICD-10-CM will allow coders to report pressure ulcer location and severity in a single code. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, review the stages of pressure ulcers and which information coders will have to look for in documentation.
Q: I have been told by our billers that infusion codes reported in the ED along with an E/M code that has modifier -25 (significant, separately identifiable evaluation and management service on the same day of the procedure or other service) require another modifier. I thought that -25 is the only modifier that should be submitted, unless the provider started a second infusion at a second site on the body. This is the first time I’ve been told the infusion coder need a modifier if the E/M has modifier -25 appended. All of my educational articles tell me that the two can be reported together. Have I missed an update somewhere along the way?
Sue Bowman, MJ, RHIA, CCS, FAHIMA, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, provide strategies for coders and coding department managers to speak with physicians regarding ICD-10 in order to allay physicians’ fears.
The expanded code set available in ICD-10-CM will give providers the chance to better tell the story of each patient’s care. Glenn Krauss , RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM, explains how coders can assist physicians in telling that story .
Q: I have a question regarding facility coding for evaluation and management (E/M) levels, not for an ED physician, but for facility-level nursing in the ED. If a specialist is called to evaluate or consult on a patient, the nursing intervention is what the facility-level criteria is based on. For example, a patient has difficulty walking, a nurse assists the patient to get an x-ray, takes vitals, does an initial assessment, then provides discharge instructions of moderate complexity. I would code this scenario as a level 3.
ICD-10 implementation is almost here, but coders are still facing resistance from physicians. W. Jeff Terry, MD, highlights ICD-10 challenges from the physician perspective, while Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, responds from a coder’s point of view.
CMS is proposing a new status indicator to be assigned to laboratory tests so when the tests are the only service on a claim, CMS will pay for them separately under the Clinical Laboratory Fee Schedule without providers having to do anything additional from a reporting perspective.
The 2016 OPPS proposed rule introduces APC restructuring, new comprehensive APCs, and many other potential changes for next year. Jugna Shah, MPH, and Debbie Mackaman, RHIA, CPCO, CCDS, review the proposals and what they could mean for providers.
Organizations have their hands full with ICD-10-CM implementation finally on the horizon. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, and AHIMA-approved ICD-10-CM/PCS trainer, examines how coding departments can clean up their processes now so they are ready for the new code set.
CMS has repeatedly tweaked its logic regarding comprehensive APCs since inception. Dave Fee, MBA, reviews the latest changes regarding complexity adjustments, as well as new and deleted codes.
Coders may need to review the anatomy of the gastrointestinal system and disease processes for gallstones, hemorrhoids, and ulcerative colitis to choose the most specific ICD-10-CM code. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, explain aspects of anatomy and what coders will need to look for in the documentation.
CMS has released a document to clarify questions providers raised about its recent guidance on ICD-10-CM, including answers on how the agency is defining a family of codes.
Q: We had a patient come into our ED with a severe head injury. To protect his airway, we intubated the patient. Can we report an emergency endotracheal intubation (CPT ® code 31500) and CPR (92950) together if only bagging happens and no chest compressions?
The gastrointestinal system is subject to many diseases and conditions that ICD-10-CM allows coders to report in more detail. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Annie Boynton, BS, RHIT, CPCO, CCS, CPC, CCS-P, COC, CPC-P, CPC-I, describe the changes for reporting hernias and Crohn’s disease in ICD-10-CM.
Physician office coders are likely familiar with coding for x-ray procedures, but may not have much experience coding ultrasound. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, and ICD-10-CM/PCS trainer, reviews how ultrasound procedure codes are categorized and offers tips on reporting them in office settings.
The 2015 CPT ® Manual included big changes to drug test reporting. Denise Williams, RN, CPC-H, AHIMA-approved ICD-10-CM/PCS trainer and AHIMA ICD-10 ambassador, and Steven Espinosa, CCS, AHIMA-approved ICD-10-CM/PCS trainer, explain the changes and how they will impact documentation and coding.
Q: I am a coder in a hospital outpatient setting. Our physicians document drug use in social history. For example, marijuana use is documented as just "marijuana use" without any further information regarding a pattern of use or abuse. Based on that information, can I report ICD-9-CM code 305.20 (cannabis abuse, unspecified)? How would this be reported in ICD-10-CM?
