The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
DRGs for procedures unrelated to the principal diagnosis should occur rarely. Robert S. Gold, MD, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain when it is appropriate to report an unrelated DRG.
Three out of four providers have completed only 25% or less of their ICD-10-CM/PCS conversion process, according to an ICD-10 snapshot survey conducted by the Aloft Group in February. However, CMS and others are busy helping to ensure that providers and payers are ready for the transition to ICD-10-CM/PCS.
Change is consistently a part of HIM and coding. Rules, regulations, and codes change yearly and sometimes quarterly. Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, reveals why the switch to ICD-10 is different from the annual changes coders are used to and how coders and organizations can prepare.
Choosing the correct root operation may be one of the most challenging aspects of ICD-10-PCS. Sandra Macica, MS, RHIA, CCS, and Kristi Stanton, RHIT, CCS, CPC, define some of the root operations in the surgical section of ICD-10-PCS and explain when to report them.
Q: Using the ICD-10-CM guidelines for the seventh character extensions for fracture codes, how should I identify each of the following? Avascular necrosis following fracture Cast change or removal Emergency treatment Evaluation and management by a new physician Follow-up visits following fracture treatment Infection on open fracture site Malunion of fracture Nonunion of fracture Medication adjustment Patient delayed seeking treatment for the fracture or nonunion Removal of external of internal fixation device Surgical treatment
Many organizations are concerned about the expected drop in coder productivity after the transition to ICD-10. Angie Comfort, RHIT, CDIP, CCS, discusses the pros and cons of using computer-assisted coding to help offset those productivity losses.
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.
Coded data is incredibly important to a wide range of people. Bill Rudman, PhD, RHIA, Roxanne Andrews, PhD, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Susan Beever, RHIT, CCS, reveal how accurate coding aids research and law enforcement and improves quality of care.
Office politics are a fact of life, but can lead to poor or unjust outcomes. Lois Mazza, CPC, offers tips to help coders navigate the political waters in the office.
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?
Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the four Recovery Auditors in FY 2013 first quarter (October 2012–December 2012), according to the most recent release of improper payment statistics .
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?
Recovery Auditors are currently performing prepayment MS-DRG validation and coding reviews of MS-DRG 312 (syncope and collapse). Ralph Wuebker, MD, MBA, and Stacey Levitt, RN, MSN, CPC, discuss the scope of the new reviews and what coders need to look for in documentation of syncope.
More than 450 healthcare organizations will participate in CMS’ Bundled Payments for Care Improvement Initiative . CMS announced the specific organizations in January, and some participants will begin receiving bundled payments as early as April. The program will be in effect for three years.
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.
Obstetric coding has always been challenging for coders and coding multiple births is particularly difficult. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA COBGC, reviews how coding for multiple births differs between ICD-9-CM and ICD-10-CM.
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.
Physician documentation must reflect severity of illness and risk of mortality for all patients. Robert S. Gold, MD, and Valerie Bica, BSN, RN, CPN, explain why pediatric patients require special attention in terms of clinical documentation improvement specialists.
Coders are under constant stress and pressure. They must remain incredibly focused and pay attention to detail regularly. Lois E. Mazza, CPC, discusses why coders need to think about their health.
