Documentation and billing for observation stays has come under increased scrutiny from the OIG, though many hospitals have struggled with changing regulations and frequently updated guidance.
ICD-10-PCS will be a big change for inpatient coders. The best way to learn the new coding system is to practice, practice, practice. See how well you know ICD-10-PCS by assigning all applicable ICD-10-PCS codes for the following case.
CMS' introduction of the 2-midnight rule in the 2014 IPPS final rule makes properly identifying inpatient-only procedures even more important for hospitals.
Editor's note: With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, we will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. This month's column addresses the anatomy of the feet.
CMS and Obamacare have increasingly been moving healthcare toward a more value-based model. They want to pay physicians for how well they treat patients and not by the volume of services they provide...
More healthcare providers would have been ready for an October 1, 2014 ICD-10 implementation date than people may have realized, according to a survey by Edifecs, eHealth Initiative (eHI) and AHIMA...
Composers lead pretty safe lives, right? They compose music, conduct the symphony, and hang out at post-show parties. And we’re not talking rock star parties. Sometimes, though, that job isn’t so...
Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS , and Susan E. Garrison, CHCA, CHCAS, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, examine a pair of case studies to determine whether the right codes were applied and whether it's appropriate to append a modifier.
The increased specificity required for ICD-10 coding requires a solid foundation in anatomy and physiology for coders. Review the anatomy of the kidney, as well as the essential coding concepts to properly report kidney conditions in ICD-10-CM.
Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , examines common orthotic procedures, including fracture reduction, total knee replacement, and total hip replacement, to determine how to choose the correct CPT ® code and key terms that should be documented.
Q: I work for general surgeons. Here is a common scenario: The surgeon is called in to see patient in the ED for trauma or consult. The patient is admitted, but our physician is not the admitting physician. I would tend to bill the ED code set, but do I have to use the subsequent hospital care codes instead?
Poor Finn is having a rough week. It started out well as he spent Sunday with his folks and older brother at an amusement park being as amused as a 6-month-old can be. Things started going downhill...
Jeff comes in to the Fix ‘Em Up Clinic complaining of shortness of breath, a persistent cough, tightness in his chest, and frequent respiratory infections. He tells Nurse Nosey that he smokes a pack...
CMS focused on quality measures in the 2015 IPPS proposed rule, released April 30. Kimberly A.H. Baker, JD, Cheryl Ericson, MS, RN, CCDS, CDIP, James S. Kennedy, MD, CCS, CDIP ,and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, highlight the most significant proposed changes.
Q: A few days into the patient’s stay, an order for a Foley catheter was placed for incontinence and around the same time the physician documented a urinary tract infection (UTI). Would it be appropriate to query the physician regarding the relationship of the UTI to the Foley? Our infection control department caught this but we did not. I am concerned about this for two reasons; first, I worry about writing a leading query and second, whether the UTI could be considered a hospital-acquired condition (HAC) if additional documentation isn’t provided.
Sequela, or late effect, is the remaining or lasting condition produced after the acute stage of a condition or injury has ended. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the correct way to code for sequelae in ICD-9-CM and ICD-10-CM.
Learning to code in ICD-10-PCS is in some respects like learning a language, you need a strong foundation in the rules. Sue Bowman, MJ, RHIA, CCS, FAHIMA , Gerri Walk, CCS-P , Nena Scott, MSEd, RHIA, CCS, CCS-P , and Jennifer Avery, CCS, CPC-H, CPC, CPC-I, discuss the guidelines related to root operations in ICD-10-PCS.
For anyone who has not yet started ICD-10 training, CMS posted a transcript, audio file, and slide presentation from the June 4 More ICD-10 Basics MLN Provider call on its website.
Dodge ball is not a game for wimps or the uncoordinated. Even master ball dodgers can end up in the Fix ‘Em Up Clinic. Steve engaged in a spirited game of dodge ball over the weekend, which resulted...
What do you get when you combine a full moon and Friday the 13th? Some really odd injuries at the Fix ‘Em Up Clinic. Fortunately, we here at the clinic suffer from neither paraskevidekatriaphobia (...
I recently spoke with Barbara Hinkle-Azzara, RHIA , vice president of HIM operations for HRS Coding in Baltimore about preparing for ICD-10 and, more specifically, about the anticipated MS-DRG...
Guidance for coding OB delivery lacerations sometimes differs between the CPT ® Manual and the American Congress of Obstetricians and Gynecologists. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , explains the difference in guidance and documentation necessary to report tears to the proper degree.
Q: If the clinical impression is physical assault, vomiting, blunt injury to abdomen, and head injury with loss of consciousness, can I code the history of hypertension, diabetes mellitus, headache, bipolar disorder, and depression?
On July 1, CMS will implement a variety of changes to current supervision requirements as recommended by the Hospital Outpatient Payment Panel. Debbie Mackaman, RHIA, CHCO , reviews the panel's recommendations, and which CMS plans to accept or reject.
A patient comes into the ED following an automobile accident. The physician documents that the patient has an open, displaced fracture of the lateral condyle of the right tibia. The physician also...
We all know that ICD-10 codes will require more complete documentation. We’ve been telling physicians that, but maybe we’re not explaining it well or correctly. What makes documentation better? It’s...
Both knee and shoulder replacement procedures include devices and fall under the ICD-10-PCS root operation Replacement (R). Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, CHTS-CP, and Nena Scott, MSEd, RHIA, CCS, CCS-P , review the definition of a device in ICD-10-PCS and review how to code for shoulder and knee replacements.
ICD-10-PCS root operations Occlusion, Restriction, and Dilation involve changing the diameter of a tubular body part. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Angie Comfort, RHIT, CDIP, CCS, review the definitions of these root operations and examine when they should be used.
Both knee and shoulder replacement procedures include devices and fall under the ICD-10-PCS root operation Replacement (R). Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, CHTS-CP, and Nena Scott, MSEd, RHIA, CCS, CCS-P , review the definition of a device in ICD-10-PCS and review how to code for shoulder and knee replacements.
CMS made relatively few changes in the April quarterly I/OCE update, introducing four new APCs, deleting one, and reclassifying several skin substitute codes.
April 1 was supposed to mark the final six months providers, payers, and CMS had to prepare for ICD-10's implementation on October 1, 2014. Instead, it brought another delay for the code set, with providers still waiting for CMS to announce a new deadline as of presstime.
CMS' 2015 IPPS proposed rule, released April 30, focuses on quality measures, such as HAC reduction, readmissions reduction, and hospital value-based purchasing (VBP) programs.
The April 1 confirmation of the delay in implementing the ICD-10 code set until at least October 1, 2015, certainly took the wind out of many healthcare organizations' sails.
In this month’s issue, we review the changes CMS proposed in the 2015 IPPS proposed rule. Shannon E. McCall explains why you should view the latest ICD-10 implementation delay with optimism instead of skepticism. Dr. Robert Gold discusses wound care coding in ICD-10.
Hospital outpatient therapeutic services, such as ED or clinic visits, that are paid under the OPPS or to critical access hospitals (CAH) on a cost basis must be furnished "incident to" a physician's service to be covered.
If you’ve glanced through the ICD-10-CM Manual, you likely noticed all of the codes for fractures, strains, and dislocations. We’re going to have a lot more choices in ICD-10-CM, which means we’re...
Q: I read that CPT ® code 20680 (removal of implant; deep, e.g., buried wire, pin, screw, metal band, nail, rod, or plate) is commonly used for deep hardware removal. What would be the proper code for removal on one screw that has already made its way out, is not under any muscle, and is easy to visualize?
The April quarterly I/OCE update brought relatively few changes, though CMS has continued to refine skin substitute reporting. Dave Fee, MBA, reviews the updated skin substitute categories, as well as updates to laboratory billing.
Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , looks at common dermatology conditions, including non-pressure chronic ulcers and psoriasis, as well as new concepts coders will need to look for to report these conditions in ICD-10-CM.
As the role of radiologists has expanded to new procedures, so have the codes to report their work in the CPT ® Manual . Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, writes about key terms for coders to look for in documentation to correctly report these procedures.
Recovery Auditors have found that modifier misuse is resulting in underpayments to providers, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
Ah, Memorial Day, the unofficial start of summer. And the day after Memorial Day is the unofficial start of summer injury season at Fix ’Em Up Clinic. Jackee took advantage of the long weekend by...
We won’t need to learn any new ICD-10-PCS codes or guidelines for 2015. CMS released the draft codes and guidelines and they include not much of anything. That’s not really a surprise since the code...
Q: We had a question regarding documentation in a record of SIRS due to acute peritonitis without sepsis. Our critical care physician on that case called it severe sepsis as well. What would you do in a situation like that?
Reporting codes for use, abuse, and dependence isn’t completely new for ICD-10-CM. Coders can report them in ICD-9-CM. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I , AHIMA-approved ICD-10-CM/PCS trainer, reviews the meaning of use, abuse, and dependence and how to code these conditions.
Some conditions, such as gangrene due to diabetes, require two codes to correctly report in ICD-9-CM. In ICD-10-CM, coders will only need one code. Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and William E. Haik, MD, FCCP, CDIP, explain how these combination codes act as their own CC or MCC in ICD-10-CM.
Coders can only use the documentation they have to code in ICD-9-CM and ICD-10-CM. Adelaide La Rosa, RN, BSN, CCDS, and Deborah Lantz, RHIA, discuss the importance of good documentation when coding for fractures and congestive heart failure in both systems.
Recently I have seen many articles casting a negative outlook on ICD-10. They scare everyone into believing that added specificity to the codes will create more work for everyone, especially the...
I’m going to pick on our friends from the Association of Clinical Documentation Improvement Specialists for one more day because I’ve heard some really good stories about the doings in Las Vegas last...
Our friends from the Association of Clinical Documentation Improvement Specialists came back from the desert with some minor maladies. Apparently everything that happens in Vegas doesn’t stay in...
Q: My office often has denials of evaluation and management (E/M) visits with our OB patients when using HCPCS modifier -GB (claim being resubmitted for payment because it is no longer covered under a global payment demonstration). Would coding with V22.2 (pregnant state, incidental) as a secondary diagnosis possibly alleviate this issue?
CMS' Comprehensive Error Rate Testing (CERT) program found "many" improper payments in a review of Part B psychiatry and psychotherapy services claims, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
Coders are very familiar with the diagnosis codes they use frequently, but the look of those codes will change in ICD-10-CM. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , reviews common dermatology conditions and how they will be reported with the new code set.
Some facilities plan to use both CPT ® and ICD-10-PCS to code procedures after implementation. Kristi Stanton, RHIT, CCS, CPC, CIRCC, and Angie Comfort, RHIT, CDIP, CCS, discuss the advantages and challenges of this strategy, and how to implement it.
We’re still waiting for CMS to release the interim final rule on the new ICD-10 implementation date, but we did get some news on the ICD-10 front this week. The Office of Budget and Management...
Today I will focus on the chronological transition to ICD-10 readiness. My intent is to dispel myths and compare real-world experience in the ICD-10 planning space with the commonly disseminated...
Q: I’m in a little debate: Does documentation of the patient’s body mass index (BMI) need to come from an ancillary clinician, like the dietitian or nurse? I thought that we could use such ancillary documentation for clinical indicators supporting our physician query, but the treating physician needed to document the BMI. Can you help clarify this for me?
Pneumonia is an inflammatory process that affects the lung tissue. Robert S. Gold, MD , and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, explain the clinical and documentation pieces of pneumonia coding.
Our good friends at the Association of Clinical Documentation Improvement Specialists (ACDIS) have descended on Sin City for the seventh annual ACDIS conference. And while what happens in Vegas might...
One day after an apparent stealth announcement of the new ICD-10 compliance date, CMS confirmed October 1, 2015, as the new implementation date. According to a CMS statement: On April 1, 2014, the...
We may have a new ICD-10 implementation date…or maybe not. In the IPPS proposed rule , released April 30, CMS states on page 648, “The ICD-10-CM/PCS transition is scheduled to take place on October 1...
CMS’ 2015 IPPS proposed rule , released April 30, focuses on quality measures, such as the hospital-acquired condition (HAC) reduction, readmissions reduction, and hospital value-based purchasing (VBP) programs.
CMS’ 2015 IPPS proposed rule , released April 30, focuses on quality measures, such as the hospital-acquired condition (HAC) reduction, readmissions reduction, and hospital value-based purchasing and hospital readmissions reduction programs.
When outpatient hospitals and physicians switch to ICD-10-CM diagnosis codes October 1, they will still continue to use CPT® codes to report procedures. But some facilities are planning to use the new procedure code set, ICD-10-PCS, as well.
At the time of this publication, the Protecting Access to Medicare Act of 2014 bill was recently passed. The status quo regarding physician reimbursement from Medicare has been maintained. So what? That system has been broken for 20 years. ICD-10 will be postponed for provider billing for another year. So what? Life will go on as it has for the past 36 years with ICD-9-CM. In other words, nothing has changed. We're good for another year. Pressure's off! ...Right?
In January, I wrote about the perfect storm that led to the release of the 2014 OPPS final rule. We endured a later-than-usual release, errors in the data files and a release of updated files, a government shutdown, and a vastly shortened window between the release of the final rule and implementation on January 1. Judging by the confusion among providers?and corrections and clarifications coming from CMS on what seems like a weekly basis on a wide range of issues?we're still not in the clear.
When outpatient hospitals and physicians switch to ICD-10-CM diagnosis codes October 1, they will still continue to use CPT ® codes to report procedures. But some facilities are planning to use the new procedure code set, ICD-10-PCS, as well.
When Congress passed the Protecting Access to Medicare Act of 2014, it mandated at least a one-year delay in ICD-10 implementation. Members of the Briefings on Coding Compliance Strategies editorial board, who represent a wide range of industry stakeholders, offered their thoughts on two questions related to the delay.
Congress needed just a week to throw a huge monkey wrench into the healthcare industry's plans for ICD-10 implementation. On March 26, House leadership introduced H.R. 4302, "Protecting Access to Medicare Act of 2014." By April 1, the bill had passed the Senate and been signed into law by President Obama.
This month’s issue focuses on the ICD-10 implementation delay and what it means for providers and coders. Members of the Briefings on Coding Compliance Strategies, as well as Robert S. Gold, MD, offer their takes on the delay. In addition, we highlight a new concept in ICD-10-CM—principal diagnoses that act as their own CC or MCC. And we answer your coding questions.
Since January, providers have been struggling to reconcile conflicts between CMS' rules and regulations and those published by the CPT® Manual and other AMA publications.
A diabetic patient is admitted with gangrene. The physician does not specifically link the diabetes and the gangrene, but also does not document any other potential cause of the gangrene. Should you code both conditions?
The ears--more formally, the auditory system--have their own chapter in ICD-10-CM, no longer relegated to the end of the neurology codes. Codes in Chapter 8, Diseases of the Ear and Mastoid Process (H60-H95), are located between the chapters for the optical system and the circulatory system.
CMS’ 2015 IPPS proposed rule , released April 30, focuses on quality measures, such as the hospital-acquired condition (HAC) reduction, readmissions reduction, and hospital value-based purchasing and hospital readmissions reduction programs.
Q: I have been told to use the general surgery CPT ® codes in the 20000 series for reporting excisions of sebaceous cysts when the surgeon must cut into the subcutaneous layer. I don’t agree with this, since the 20000 codes do not give ICD-9-CM code 706.2 (sebaceous cyst) as a billable diagnosis code. Because a sebaceous, epidermal, or pilar cyst begins in the skin and may grow large enough to press into the subcutaneous layer, I think we should report an excision code from the 11400 series, and if need be, the 12000 codes for closure.
Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews which diagnosis codes, in both ICD-9-CM and ICD-10-CM, Medicare recently approved to provide medically necessary for inserting pacemaker systems.
The ICD-10 implementation delay has impacted training timelines for many providers. Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC , talks about how this time can be used to improve physician documentation, easing the transition for both coders and providers.
Providers struggle to reconcile conflicts between recent CMS regulations and the CPT® Manual and other AMA publications. Jugna Shah, MPH , Valerie A. Rinkle, MPA , and Linda S. Dietz, RHIA, CCS, CCS-P , look at specific areas of confusion and how to code them accurately.
A review of Medicare CT scan claims from July 2011 to June 2012 found that 16% claims had an improper payment rate, according to the most recent Medicare Quarterly Provider Compliance Newsletter .
During AHIMA’s two-day ICD-10-CM/PCS and Computer-Assisted Coding Summit April 22-23, AHIMA ran some real-time polls with attendees texting in their responses. The results of the polls provide some...
Some body parts just need a little reinforcement. Or maybe a little augmentation. Use root operation Supplement (third character U) to report procedures that involve putting in or on biological or...
Rose Dunn, MBA, RHIA, CPA, CHPS, FACHE, FAHIMA, chief operating officer of First Class Solutions, started the second day of the AHIMA ICD-10 and CAC Summit with a rundown of ways HIM professionals...
The American Hospital Association (AHA), along with four hospital associations and several hospitals, filed two complaints April 14 in opposition of CMS’ 2-midnight rule for inpatient admissions, according to an AHA press release.
Q: A patient is admitted with a high white blood count, tachycardia, tachypnea, and chills. The blood culture shows positive for methicillin-resistant Staphylococcus aureus (MRSA). The attending physician documents MRSA sepsis in the progress notes. Antibiotics are changed based on the blood culture and the patient is treated with appropriate antibiotics. Due to poor vascular access, a central venous catheter (CVC) is inserted and antibiotics are infused through this access. The patient responded slowly to treatment and CVC access becomes red and inflamed. The catheter is removed and cultured. The physician documents this to be an infection due to MRSA. What’s the diagnosis code for this?
Four ICD-10-PCS root operations involve procedures that put in, put back, or move some or all of a body part. Gerri Walk, RHIA, CCS, and Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, CHTS-CP, highlight the differences among Reattachment, Reposition, Transfer, and Transplantation.
Healthcare facilities are subjected to a myriad of auditorswho scrutinize everything from how many units of a drug were billed to whether or not a patient actually needed to be admitted to the hospital. Trey La Charité, MD , explains how to turn every denial into a learning experience.
