Spinal fusion procedures are reported using two different ICD-10-PCS tables, depending on the location of the vertebrae fused. Sarah Nehring, RHIT, CCS, CCDS , breaks down ICD-10-PCS coding for spinal fusions based on details in the operative note.
Susan Belley, RHIA, CPHQ , and Audrey Howard, RHIA , analyze the frequently changing ICD-10-CM guidelines for reporting COVID-19 and related respiratory complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laura Evans, CPC , and Julia Kyles, CPC , break down potentially confusing updates to the 2021 E/M guidelines, including new definitions for technical terms and revised guidance for reporting diagnostic laboratory testing with interpretation.
CMS’ recently released fiscal year (FY) 2022 IPPS proposed rule includes 153 proposed ICD-10-CM code additions, mainly affecting reporting for immune effector cell-associated neurotoxicity syndrome, gastric intestinal metaplasia, and poisonings by cannabis and synthetic cannabinoids.
Q: A patient receives Apligraf® (44 sq. cm) after subcutaneous wound debridement. Ten sq. cm is applied to a diabetic foot ulcer on the patient’s left heel and 20 sq. cm to an ulcer on the patient’s right ankle. What CPT codes would the facility use to report these services?
Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how facilities can create internal guidelines and point systems for determining E/M level section. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Monica Tyiska, MBA-PM, RHIA, CCS, CPC, CPMA, CHA, OHCC, CCP-P, offers advice for how organizations can improve hiring practices to ensure candidates from diverse backgrounds that represents the community are brought in.
It’s always been easy to show financial return on investment for inpatient CDI endeavors, but the monetary value of outpatient programs is increasing dramatically year after year, making outpatient CDI reviews more attractive to many healthcare organizations.
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how facilities can create internal guidelines and point systems for determining E/M level section.
Hierarchical Condition Categories (HCC) are used to represent risk scores for patients on Medicare Advantage plans. Learn why it’s important for organizations to understand how HCCs are used across settings.
Review quality reporting metrics such as length of stay and mortality indexes that you can use to assess patient outcomes and improve revenue cycle processes.
A Humana health plan in Florida collected nearly $200 million in Medicare overpayments in 2015 by improperly coding for high-severity Hierarchical Condition Category conditions, according to a recent audit from the Office of Inspector General (OIG).
Encephalopathy is a general term used to describe any disease of the brain that alters its function or structure. Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , analyzes ICD-10-CM coding for toxic, metabolic, and hepatic encephalopathies.
Q: I’m having trouble determining how to report an acute myocardial infarction (MI) for subsequent admissions occurring within four weeks of the initial MI in ICD-10-CM. Can you walk me through the process?
Vaginal cuff dehiscence is a severe complication of a total hysterectomy. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about ICD-10-CM coding for vaginal cuff dehiscence and ICD-10-PCS coding for dehiscence repairs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A patient is diagnosed with Type 2 diabetes mellitus and arteriosclerotic peripheral artery disease (PAD). Can we report ICD-10-CM code E11.51 with a code from subcategory I70.2- to describe affected vessels?
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
Essential newborn care includes services provided at the time of birth and over the first hours of life. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about E/M coding for these routine obstetric services.
CMS recently added 24 audiology and speech-language pathology services to its list of telehealth services covered under Medicare during the COVID-19 public health emergency (PHE). These services include speech, hearing, and swallowing assessments, and cognitive interventions.
Viral hemorrhagic fevers (VHF) are infectious diseases that pose a great public health risk due to their epidemic potential. Debbie Jones, CPC, CCA , breaks down ICD-10-CM coding for four VHFs: Crimean-Congo hemorrhagic fever, Ebola virus disease, Lassa fever, and Marburg virus disease. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Cheryl Manchenton, RN, BSN, Beth Wolf, MD, CCDS, CPC, and Audrey Howard, RHIA, review ICD-10-CM coding for cytokine release syndrome, sepsis, and multisystem inflammatory syndrome. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
About 1% of children in the U.S. suffer from chronic malnutrition, according to John Hopkin’s Medicine. In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, breaks down ICD-10-CM coding and documentation requirements for malnutrition.
Allen Frady, RN, BSN, CCS, CRC, CCDS, describes steps that coding and clinical documentation integrity managers can take to improve quality metrics and hold staff accountable for reporting errors.
Billing for high-level inpatient stays increased over a six-year period sparking concerns by the government about upcoding, according to a recent report from the Office of Inspector General (OIG).
Approximately 34.2 million Americans, or 10.5% of the U.S. population, were diagnosed with diabetes in 2018, according to the Centers for Disease Control and Prevention. Review signs and symptoms of diabetes mellitus types 1 and 2 and ICD-10-CM coding for these conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Corneal dystrophies are a group of genetic, often progressive, eye disorders that alter functioning of the cornea. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for corneal dystrophies and CPT coding for procedures used to treat them.
Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2x4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)?
Physician and non-physician practitioners may benefit from reviewing documentation requirements and HCPCS Level II codes for knee orthoses, according to a recent Medicare Quarterly Compliance Newsletter .
Medicare auditors have identified failure to document time as a key flaw in claims for advance care planning (ACP), and the Office of Inspector General plans to conduct an audit of these services. Read up on documentation requirements and CPT coding for ACP to prevent claim denials.
Regular monitoring and internal auditing are critical to ensure compliance throughout the revenue cycle and protect revenue integrity. Consider the different strategies that can be applied to documentation and chart audits, coding audits, and more.
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures.
Strokes are complicated, which is why it is important for inpatient coders to be familiar with the brain’s anatomy and the clinical concepts of a stroke in order to report the most accurate ICD-10-CM codes.
The most impactful overhaul to the E/M coding and documentation guidelines in 25 years went live January 1. The updated guidelines eliminate medical history and physical examination as required elements for reporting E/M codes 99202-99215. E/M coding for outpatient visits is now based on documentation of medical decision-making (MDM) or time spent on the encounter.
Let’s face it: Our organizations are under tremendous scrutiny. As the healthcare dollar shrinks, all payers strive to minimize patient care expenses to maintain profit margins.
It’s common to see CDI job listings that require applicants to be registered nurses. Often an RN credential is not listed as being “preferred,” but required. There are risks, however, with only seeking candidates from this one background.
Ischemic heart disease has a multifactorial etiology and can be prevented from developing in populations primordially and in individuals at high risk by primary prevention.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, CCDS-O , analyzes complex E/M coding guidance for selecting an outpatient visit level on the basis of medical decision-making (MDM).
The American Medical Association’s (AMA) CPT Editorial Panel at its February meeting approved technical corrections to the E/M coding guidelines for outpatient visits. The corrections were uploaded to the AMA website on March 9 and go into effect retroactively from January 1.
The mid-revenue cycle is rife with possibilities to lose earned, appropriate revenue. Learn how to identify common weaknesses and deploy coding and technology to avoid revenue loss.
Refresh your knowledge of dysphagia, esophagitis, gastroesophageal reflux disease, and Barrett’s esophagus, and review guidance for reporting these conditions in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM codes for immunodeficiencies are CCs for inpatient admissions and can impact severity of illness and risk of mortality calculations, which is why they are important for coders to frequently review. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and the rules governing their assignment in order to ensure proper reimbursement. Part two of this two-part series will review HACs in particular as part one focused on present on admission indicators.
In part one of this two-part series, Allen Frady, RN, BSN, CCS, CRC, CCDS, gives tips to CDI and coding teams on how to help improve healthcare quality scores by reviewing CMS star rating calculations, department challenges, physician education, and more.
COVID-19 patients who were hospitalized as inpatients cost significantly more than those treated in an outpatient setting, according to data from the Blue Cross and Blue Shield Association.
Q: We have a patient admitted for COVID-19 who is now showing signs of cytokine release syndrome (CRS). Can you give our team more information on symptoms or clinical indicators for CRS as well as any ICD-10-CM coding advice?
CMS recently added six codes to the list of services that may be reported with HCPCS modifier -CS (cost-sharing), which requires Medicare to cover beneficiary cost-sharing during office visits and other encounters for the duration of the COVID-19 public health emergency.
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, CCDS-O, analyzes confusing E/M guidelines for time-based visits and prolonged services provided before or after a face-to face encounter.
Supporting accurate Hierarchical Condition Category (HCC) capture is essential to success under the growing number of risk-adjusted payment models. With their strong knowledge of coding and documentation guidelines and insight into emerging trends, coders are a key part of that strategy.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, says with recent audit activity and the Office of Inspector General’s continued scrutiny of malnutrition diagnoses, it’s important to dig into the coding and documentation requirements for this tricky diagnosis, particularly in the case of COVID-19 patients.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and present on admission (POA) indicators and the rules governing their assignment in order to ensure proper reimbursement. Part one of a two-part series will review POA indicators in particular.
Q: We had a patient admitted with a negative COVID-19 test, but after being retested the patient had a positive COVID-19 result. Should we query the provider whether COVID-19 was POA?
Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ , write that since acute respiratory distress syndrome (ARDS) is included as a common respiratory manifestation of COVID-19 in the ICD-10-CM Official Guidelines for Coding and Reporting , it is essential to understand the syndrome for accurate and complete inpatient reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to a study recently published in the Journal of Clinical Endocrinology & Metabolism , 55% of Black patients with both COVID-19 and Type 1 diabetes also presented with diabetic ketoacidosis.
In 2005, the International Pediatric Sepsis Consensus Conference published definitions for sepsis, severe sepsis, and septic shock. Sepsis among children is defined as systemic inflammatory response syndrome (SIRS) associated with suspected or proven infection.
Facilities that are not leveraging CDI efforts for denials management and tracking denials as a key performance indicator (KPI) should consider doing so. Denials are the framework for identifying gaps in provider documentation and are a surefire approach to tailoring physician education that is meaningful.
Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. It’s more important than ever as the COVID-19 pandemic continues to drain hospital resources, but with HIM departments already stretched thin, it’s also more difficult than ever.
Our coding experts answer questions about CPT documentation and coding for psychotherapy services, ICD-10-CM reporting for knee injuries, conducting chargemaster audits, and more.
CPT neurology codes describe advanced techniques to evaluate and treat conditions of the brain, spinal cord, and nerves. This article details CPT coding for three procedural services used to assess neurological symptoms: electroencephalogram, electromyography, and auditory-evoked potentials testing.
Though the adoption of outpatient CDI has been growing steadily over the years, it’s not always easy to prove the return on investment for such efforts.
Arthroscopic surgical procedures involve the insertion of a small scope into the interior of a joint, allowing the physician to view the joint without making a large incision through the skin. Review CPT coding for arthroscopic procedures of the hip and knee joints.
Coding managers use risk assessments to measure their level of compliance with laws, regulations, and internal policies and procedures. Learn about the steps involved in E/M risk assessments and practices used to address E/M coding and billing errors.
Arthroscopic surgical procedures involve the insertion of a small scope into the interior of a joint, allowing the physician to view the joint without making a large incision through the skin. Review CPT coding for arthroscopic procedures of the hip and knee joints. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Food and Drug Administration (FDA) recently issued an emergency use authorization (EUA) for the combination treatment of bamlanivimab and etesevimab for COVID-19 patients at high risk for severe infection.
A vaginal cuff tear, also known as vaginal cuff dehiscence, is a severe complication of a hysterectomy . Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about CPT coding for transvaginal and laparoscopic vaginal cuff repairs.
Q: We are confused about which body part value in ICD-10-PCS should be captured for an incision and drainage (I&D) of a perianal abscess of the left buttocks because the physician documented both “perianal” and “left buttocks.”
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, RHIA, says inpatient coding professionals need to look for signs and symptoms supportive of sepsis in order to report the most accurate codes, which is why staying up to date on the ever-changing clinical criteria for sepsis is so important.
CMS is modifying its approach for presenting new technology add-on-payment-related ICD-10-PCS code requests that involve the administration of therapeutic agents for its March 9-10, 2021 ICD-10 Coordination and Maintenance Committee meeting.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM reporting of sequelae generally requires two codes, but the codes assigned and the sequencing depend on whether the sequela is from a cerebrovascular accident, a traumatic injury, or an infection such as COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
ICD-10-CM reporting for genitourinary conditions requires careful attention to detail as many codes in this section of the manual are for conditions that involve multiple body structures and that present with a variety of symptoms.
In its February MLN Connects newsletter, CMS reminds providers that HCPCS add-on code G2211 for visit complexity is a bundled service under the Medicare Physician Fee Schedule, meaning the application of this code will not result in additional payment for a billed E/M visit service.
CPT® neurology codes describe advanced techniques to evaluate and treat conditions of the brain, spinal cord, and nerves. This article details CPT coding for three procedural services used to assess neurological symptoms: electroencephalogram, electromyography, and auditory-evoked potentials testing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Podiatrists are doctors devoted to the health and wellbeing of the feet, ankles, and lower extremities. Review common ICD-10-CM and CPT codes reported by podiatrists in facility settings.
Hospitals across the country marked the start of the new year by posting new and more detailed price information online. With the Hospital Price Transparency final rule, which became effective January 1, 2021, CMS completed the most ambitious chapter in its ongoing price transparency efforts.
Howard Rodenberg, MD, MPH, CCDS , writes that ensuring the social determinants of health are appropriately documented within the medical record allows CDI and coding teams to capture the hard data needed to demonstrate the interactions among race, gender, ethnicity, and other key socioeconomic indicators with healthcare costs, utilization, and outcomes.
Q: When two conditions are both present on admission, both meet definition to be the principal diagnosis (PDX), and are “equally treated,” my understanding is that the condition does not have to be "equally treated" in the sense of duration/frequency. Can you provide the actual verbiage of the coding rule and explain?
Review clinical indicators and query opportunities for acute respiratory failure, respiratory failure due to surgical procedures, and ventilator MS-DRGs. Frequently reviewing clinical indicators for these complicated diagnoses will ensure both proper coding and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Inpatient coding professionals must have a clinical understanding of COVID-19 and the disease process in order to accurately sequence diagnoses, code etiology and manifestations, and assign present on admission (POA) indicators. In this article, Audrey Howard, RHIA , and Susan Belley, RHIA, CPHQ, focus on coding issues related to POA indicators for the hospitalized, inpatient COVID-19 population.
