CMS released Transmittal 836 on October 19, clarified language in Chapter 6 of the Medicare Program Integrity Manual regarding medical review of diagnostic laboratory tests.
Coding and documentation teams can replicate an organization’s overall denial avoidance and management program by scaling it to the scope of denials for which they are responsible. Lynette Kramer, MA, RHIA , outlines a four-step process that coding teams can use to monitor claim data and establish accountability for denials.
According to the National Center for Chronic Diseases Prevention and Health Promotion, an estimated 5.7 million adults throughout the U.S. have heart failure. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, writes about ICD-10-CM coding for heart failure diagnoses and CPT coding for procedures used to treat the disease.
The FY 2019 ICD-10-CM update includes 54 code additions, three deletions, and 87 revisions to Chapter 19 of the ICD-10-CM Manual , “Injuries, Poisonings, and Certain Other Consequences of External Causes.” Review updated codes and guidelines for reporting burns, infections and sepsis following a procedure, drug abuse, and human trafficking. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We have a patient admitted with a history of chronic heart failure (CHF) and end-stage renal disease (ESRD) who was admitted with volume overload due to acute kidney injury and dialysis noncompliance. How should we report this in ICD-10-CM?
The rate of most hospital-acquired conditions (HAC) continued to decline from 2014 to 2016, according to the latest national scorecard released by the Agency for Healthcare Research and Quality.
Cheryl Manchenton, RN, BSN, CCDS , details the recent updates to patient safety indicator (PSI) 90 and says that these changes are the reason why it’s more important than ever to ensure that PSI metrics are complete and accurate.
Chris Simons, MS, RHIA , outlines tasks that generally fall within the CDI department’s realm and writes that to ensure that inpatient CDI specialists can thoroughly complete these tasks, they must have strong clinical skills and a working knowledge of ICD-10-CM and MS-DRG assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Adriane Martin, DO, FACOS, CCDS , reviews some of the ICD-10-CM/PCS code and CC/MCC updates that made the final cut in the fiscal year 2019 IPPS final rule.
Patients determined to have a tubo-ovarian abscess (TOA) require immediate and aggressive surgical therapy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews clinical documentation and ICD-10-CM coding for TOAs as well as CPT coding for surgical interventions used to treat them.
Before radiation therapy can be administered, several steps must be taken prepare the patient for treatment. Review CPT coding and documentation for the first two steps in the process: the initial consultation and preparation for radiation treatment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A retrospective study recently published in the Journal of Pediatric Surgery found that 59% of reviewed cases across four institutions contained discrepancies between operative dictation and CPT coding for pediatric abdominal surgeries.
Modifier -25 is frequently a target of payer and Office of Inspector General audits. Susan E. Garrison, CHCA, CPC, CPC-H, reviews CMS and NCCI guidance for reporting modifier -25.
Creating a query and knowing when to query can be complicated, and there are a number of continued training tactics that prove successful for the coder when trying to improve upon physician query practices. This article looks at a few of the official sources that offer query guidance for coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We recently had a patient admitted for syncope workup. The workups were negative except for incidental findings of acute kidney injury (AKI). The physician documented “AKI likely 2/2 hypovolemia. Treatment focus is to trend creatinine levels and hydration.” Would the AKI or hypovolemia be sequenced as the principal diagnosis?
Cesar M. Limjoco, MD, writes that although different literature has become available on principal diagnosis selection through the years, questions and disputes keep popping up. In this article, he revisits the issue and provides additional insight to code selection for conditions such as acute respiratory failure and congestive heart failure.
Acute heart failure patients in an emergency department's clinical pathway program had a 13.1% lower readmission rate, according to a report published in the American Journal of Emergency Medicine.
Adriane Martin, DO, FACOS, CCDS, reviews Coding Clinic guidance published in the first and second quarters of this year as it pertains to coding guidelines, severity of illness, and MS-DRG assignment for the inpatient setting.
As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption.
Developing an outpatient CDI program isn't just about metrics--departments needs to consider how to engage providers and interact with other teams to be truly effective.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
CMS recently released updated guidance on billing intensity-modulated radiation therapy (IMRT) after an OIG audit found a 100% error rate in billing certain IMRT planning services.
This month we are pleased to introduce Roger Hettinger , RHIA, CCS, CCS-P, COC, CPC, CPCO, CPB, CPMA, CRC, CEDC, CGSC, CHONC, CIMC, CUC, CGIC, CHC, CRCR, Senior Revenue Cycle Advisor for Axea Solutions, Inc. in Cumming, Georgia.
The official version of the fiscal year (FY) 2019 IPPS final rule was recently published in the Federal Register . This rule, which became effective on the first of October, contains key financial information, including certain payment factors, based upon the government’s best estimate at the time of publication.
The verdict is in. CMS’ fiscal year (FY) 2019 IPPS final rule took effect on October 1 and impacts 3,300 hospitals. CMS made changes to several of its inpatient quality programs: Hospital Value-Based Purchasing Program, Hospital-Acquired Condition Reduction Program, and Hospital Readmission Reduction Program, in addition to the changes made to ICD-10 CM/PCS codes.
CMS recently released the fiscal year (FY) 2019 IPPS final rule with significant reductions to reporting requirements for quality initiatives, changes to CC/MCC designations, and revisions to various MS-DRGs.
The most recent quarterly update to the influenza virus vaccine code set includes a new HCPCS influenza virus vaccine code approved for use in 2019, according to CMS Transmittal 4127.
Medicare guidelines for reporting arthroscopic shoulder surgeries have changed significantly over the past decade. Review updated guidance and CPT coding for SLAP repairs as well as biceps tenotomy and tenodesis procedures to reduce audit risk. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: I received confusing guidance regarding CPT coding for a segmental spinal fusion with pedicle screws placed at L3 and L4 vertebrae. Would it be appropriate to report CPT code 22612 with add-on code 22614 for this procedure?
Coding leadership can assist the chargemaster team by providing input, preparing appeals, and tracking coding-related denials. Rose T. Dunn, MBA, RHIA, CPA/CGMA, FACHE, FHFMA, CHPS , describes how to effectively work with a team of coders to combat continued denials.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews the key characteristics of physician visits administered to patients in skilled nursing facilities and E/M coding for these services.
Q: Our team is having a hard time determining a principal diagnosis for a patient with a history of stage 5 chronic kidney disease (CKD) who is receiving chronic hemodialysis and is in acute renal failure (ARF) with volume overload. Which ICD-10-CM code should be the principal diagnosis?
Allen Frady, RN-BSN, CCDS, CCS, CRC, says that defending code assignment against denials requires more than reviewing the denial to determine if the condition was coded and reported according to the coding guidelines; it requires an understanding of payer requirements as well.
Inpatient coding audits need to be tailored to the type of record being reviewed, the time it may take to complete the audit, and any compliance-related issues that may crop up. This article focuses on how coding managers can streamline these aspects to ensure a successful audit. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Early readmissions were more likely to be preventable and amenable to hospital-based interventions, according to a recent study published in the Annals of Internal Medicine.
William E. Haik, MD, FCCP, CDIP, writes that complex pneumonias can segregate to a higher-weighted MS-DRG than other pneumonia types, so reviewing clinical elements with your physician staff may help improve documentation and avoid adverse determinations by external reviewers for these conditions.
Age-related macular degeneration (AMD) is a leading cause of vision loss among people age 50 and older, according to the National Eye Institute. Debbie Jones, CPC, CCA , reviews ICD-10-CM coding for AMD and CPT coding for treatments used to slow the disease’s progression.
The American Medical Association recently released the 2019 CPT code set, which includes 335 code changes, primarily for skin biopsies, fine needle aspirations, and central nervous system assessments. All changes take effect January 1.
A nine-month audit conducted by a CDI specialist at a family practice and internal medicine clinic revealed 1,353 coding errors on physician-coded claims for outpatient office visits. Tammy Trombley, RHIT, CDIP, CCDS , reviews findings from this 2017 audit and discusses implications for risk-adjustment coding.
According to the American Academy of Orthopedic Surgeons, in 2013, 2 million people in the U.S. saw a physician for a rotator cuff problem. Review shoulder anatomy and CPT coding for rotator cuff repairs to improve coding accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If a CDI specialist doesn’t enter the queried diagnosis in his or her working DRG, but the physician responds favorably to the queried diagnosis at the time of coding (or during the retrospective query process), would you consider this in the reconciliation process? If yes, how would we capture this type of data?
The European Heart Journal recently published the fourth universal definition of myocardial infarction (MI). The newest definition, which supersedes all previous versions, includes new and updated clinical concepts as well as new sections of guidance.
Cathy Farraher, RN, BSN, MBA, CCCM, CCDS , details the basics of the All Patient Refined Diagnosis Related Groups (APR-DRG), the system developed to allow for a more specific analysis of outcomes in the non-Medicare population, and shows coders and CDI teams how to better capture quality metrics through documentation.
Adriane Martin, DO, FACOS, CCDS , writes that abdominal aortic aneurysms (AAA) are the most common type of aortic aneurysm, and the complexities surrounding AAAs make reporting procedures related to them difficult for even the most skilled inpatient coder.
The fiscal year (FY) 2019 IPPS final rule contains extensive changes pertaining to MS-DRGs. This article details some of the most notable MS-DRG updates including revisions to epilepsy with neurostimulators and pacemaker insertion classifications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To effectively report opioid use, abuse, and dependence, coding and billing professionals must be able to recognize symptoms of these disorders and interpret detailed ICD-10-CM guidelines. Additionally, they must be able to identify complications associated with opioid misuse and overdose.
Modifiers -25 and -27 are used in the outpatient facility setting on E/M services. Learn more about how these modifiers should be applied in accordance with coding and Medicare guidelines.
Summer has ended. For some, that marks the start of school, the beginning of football season, and the return of the pumpkin spice latte. If you are an inpatient coder or CDI specialist, it marks two full quarters worth of Coding Clinic advice.
This month we are pleased to introduce Mary Ann Polantz, RHIT, CCS, CCDS, who has 34 years of experience in coding and 45 years of experience in the healthcare industry. Mary Ann is currently a consultant at CBIZ KA Consulting Services, LLC, located in East Windsor, N.J.
Risk is the new buzzword in healthcare, right up there with denial. In fact, CDI programs often deploy physician advisors to assist with shared risk payment models, denial prevention, and improved outcome performance.
Working remotely can be either totally fulfilling or a bit difficult. If you’re a people person, you will miss the camaraderie of working in the hospital setting, the ability to problem solve by bouncing ideas off your coworkers, the gossip, and the potlucks. On the other hand, if you’re organized and self-motivated enough, enjoy peace and quiet, and prefer wearing your pajamas to work, remote might be right up your alley.
Cancer is so prevalent that it is virtually impossible to find anyone who hasn’t personally been affected by or known someone who has this disease. According to the American Cancer Society , in 2017, there were an estimated 1,688,780 new cancer cases diagnosed and 600,920 cancer deaths in the United States.
E/M code assignment for hospital admissions based solely on the provider’s documentation of face-to-face-time spent with a patient can be confusing and requires a detailed understanding of CPT guidelines. Lori-Lynne A. Webb , CPC, CCS-P, CCP, CHDA, COBGC , reviews reporting requirements for E/M visit levels based on the provider’s documentation of time and CPT coding for hospital admissions.
The October 2018 OPPS quarterly update introduced two new HCPCS codes and granted passthrough payment status to eight separately payable drugs and biologicals.
In 2017, the U.S. Department of Health and Human Services (HHS) declared a nationwide public health emergency to address the opioid crisis, investing almost $900 million in opioid-specific funding to support treatment and recovery services. Learn about the epidemic and review ICD-10-CM coding and guidelines for reporting opioid use, abuse, dependence, and overdoses.
Continuing with numerous requests for comment in last year’s OPPS proposed rule, CMS is once again asking stakeholders for feedback on a variety of issues for potential future rulemaking. Review OPPS proposals for quality measure changes and policies aimed at improving interoperability and the electronic exchange of information between providers.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , provides background on vaccinations and writes that coding for vaccine administration isn’t relegated to the outpatient coder; inpatient coders also have codes to report for vaccine administration. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Jennifer Cayce, RHIT, CCS, CCS-P, CPC , explores the conundrums of reporting acute kidney disorders due to confusing clinical terminology and addresses some of the problematic areas of nephrology diagnoses.
Q: We have a patient who is diagnosed as having acute renal insufficiency due to dehydration with decreased urinary output and was admitted for IV hydration. What diagnosis codes should we assign?
CMS recently released the fiscal year (FY) 2019 IPPS final rule with significant reductions to reporting requirements for quality initiatives, updates to payment rates, changes to CC/MCC designations, and revisions to various MS-DRGs.
Q: In what instance would septic shock not be coded as a principal diagnosis (PDX)? I’ve been under the impression that septic shock should always be reported as a PDX.
CMS and the National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting. Changes include clarification on the usage of “with,” updated sepsis guidance, and added guidelines for subsequent myocardial infarction.
Adriane Martin, DO, FACOS, CCDS, says that knowledge of coding guidelines and Coding Clinic advice, as well as an understanding of the spine anatomy and the spinal fusion procedure itself, can go a long way toward helping put together the pieces of the fusion puzzle.
Chris Simons, MS, RHIA, details way to improve querying across health information management (HIM), coding, and CDI departments since querying providers is a key strategy for improving documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Continuing with numerous specific requests for comment in last year’s OPPS proposed rule, CMS is once again asking stakeholders for feedback on a variety of issues for the 2019 OPPS proposed rule for future potential rulemaking. You may submit comments to the agency until September 24, 2018.
Along with quality measure removals in the 2018 OPPS and MPFS final rules, CMS has continued to propose additional removals in the 2019 proposed rules. In addition, the agency is proposing to add to its ability to remove quality measures in the future.
Back in January, I wrote an article regarding E/M codes and the need for changes to the 1995 and 1997 E/M documentation guidelines. In that article, I suggested making E/M codes for office visits solely time-based to simplify the reporting of these very subjective codes. Little did I know that this is what CMS would propose months later.
CMS’ 2019 OPPS proposed rule, released in late July, continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments.
Numerous Briefings on Coding Compliance Strategies (BCCS) advisory board members will be presenting at the 2018 AHIMA Convention and Exhibit in Miami, Florida, from September 22–26. The advisory board members will cover topics including ICD-10-PCS accuracy basics, surgical complications, and HIM leadership.
According to the National Heart, Lung, and Blood Institute, approximately 13,000 Americans die each year from aortic aneurysms , with most of the deaths attributable to an aneurysmal rupture or dissection.
As I sit down to summarize the proposed fiscal year (FY) 2019 ICD-10-CM update, the number of changes proposed are significantly less than the prior two years. This makes me think we’re getting back to the norm of expected yearly changes.
As with many diagnoses in the inpatient setting, acute kidney disorders can be confusing for coders to report due to multiple abbreviations and varying clinical criteria. Although the ICD-10-CM codes for the genitourinary system may seem straightforward, they don’t always line up precisely with the provider’s documentation in the medical record.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
A common error and audit finding affecting providers is the lack of a physician order or physician signatures on medical documentation. Kimberly A. H. Baker, JD, CPC , reviews CMS guidance for physician signatures on medical documentation.
Q: When is it appropriate to bill CPT code 77470 (special treatment procedure [e.g. total body irradiation, hemibody radiation, per oral or endocavitary irradiation]) for a special treatment procedure?
To help bring JustCoding members together and let them learn more about their colleagues, JustCoding created a monthly member spotlight to appear in upcoming issues. The JustCoding team loves hearing members’ stories, including major triumphs and challenges, and sharing them with the larger JustCoding membership.
The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule includes significant potential updates to E/M coding and reporting. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS , reviews the proposed changes and their potential impact on coding and billing for office visits and other outpatient services in 2019.
ICD-10-CM and CPT coding for glaucoma and retinal detachment requires a detailed understanding of coding guidelines as well as ocular anatomy and terminology. Explore the anatomy of the eye and review coding guidance for conditions that affect our view of the outside world. Note : To access this article, you must first register here if you do not have a paid subscription.
Q: Our coding team is currently debating how to report acute tubular necrosis (ATN) in ICD-10-CM for a patient after a renal transplant. Can you provide any guidance?
Amy Sanderson, MD, says that the term “dysphagia” has many synonyms used by providers in medical documentation. However, not all of these symptoms are able to describe the diagnosis with enough specificity so that it can be translated into its corresponding code assignment.
Adriane Martin, DO, FACOS, CCDS, summarizes the proposed changes found in the fiscal year (FY) 2019 IPPS proposed rule, broken down by Major Diagnostic Category (MDC), that would impact ICD-10-CM/PCS codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In June, an article detailing the upcoming release of the fourth edition of the universal definition of myocardial infarction (MI) was published in the American Journal of Medicine .
William E. Haik, MD, FCCP, CDIP , AHIMA-approved ICD-10-CM/PCS trainer, Jonathan Besler, CPA, MA , and Mary Devine, RN , write that while it is well-known that ICD-10-CM/PCS code assignment impacts hospital reimbursement and compliance, there is an additional code that often flies under the radar for inpatient coders and has a huge impact on reimbursement: the discharge status code.
Emergency departments (ED) at designated trauma centers encounter some of the most complex patients—and with them, a complicated documentation web that’s difficult for even the most experienced CDI specialists and coders to untangle.
To succeed in a modern health information management (HIM) environment, coding departments need efficient coding specialists and knowledgeable management to monitor coder performance and provide feedback. Review expert guidance on hiring staff and determining work flow to improve the organizational structure of your coding department.
Hypertension, or high blood pressure, is not easily diagnosed and brings added risk factors to pregnancy oversight. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, reviews ICD-10-CM coding for hypertension during pregnancy and related complications.
