Q: Are coders required to report a social determinants of health (SDOH) ICD-10-CM code when a CPT code for an E/M service level is based on medical decision-making (MDM)?
Q: A patient’s previously implanted Impella, a small, catheter-based ventricular assist device, was removed and replaced due to an emergency. How would we report this in ICD-10-PCS and which DRG would it lead to?
Gastroparesis is a condition that affects stomach motility. Sarah Gould, CPC , explains how to report the condition and its complications in ICD-10-CM, in addition to treatment methods in ICD-10-PCS. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Despite its benefits, remote work has created obstacles for employees and managers. Healthcare leaders and educators share hard-earned knowledge used to keep their staff and providers’ attention during educational sessions.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews coding, CDI, and clinical validation challenges associated with acute kidney injury cases and gives insight into how coders and physicians can work together to increase accuracy.
A recent Office of Inspector General report found that CMS paid $41.4 million in improper payments to acute care hospitals for claims that were assigned incorrect discharge status codes.
Craniosynostosis, a congenital premature fusion of cranial sutures in infants, poses a complex challenge to the child’s appearance and health. Debbie Jones, CPC, CCA , explains the condition, as well as how to report its many types in ICD-10-CM and associated surgical correction procedures in CPT.
Coding staff and treating providers can increase E/M code reporting accuracy to ensure their claims hit the mark by reviewing these six Q&As. The material, created by Julia Kyles, CPC , covers medical decision making and time-based coding.
CMS' recently implemented October OPPS update brings with it a slew of new, revised, and deleted CPT and HCPCS Level II codes with effective dates ranging from April 18 to October 1. Among the additions are codes for vaccines, vaccine administration, skin substitutes, renal histotripsy, and breast imaging.
Wound care procedure reporting requires coders to follow many specific policies and procedures. This article reviews common wound care techniques of dressing changes, casting, negative pressure wound therapy, and the necessary documentation to report them in CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Critical care coding can challenge both new and seasoned coders. Jessica Miller-Dobbs, CPC, CPC-P, CGIC, offers tips and clarification on reporting critical care services in CPT, as well as sample provider documentation for these services.
Clinical validation has become one of the hottest targets in payer auditing. Denise Wilson, MS, RN, RRT, writes about strategies facilities can use to appeal clinical validation denials.
Our experts answer questions about 2024 ICD-10-CM guideline updates for cardiovascular coding, ICD-10-PCS coding for removal of external heart assist devices, and more.
Despite sepsis being the leading cause of hospital readmissions and in-hospital deaths in the U.S., its extensive history of clinical definitions and criteria can cause confusion for even the most experienced coders.
Review common wound care techniques of dressing changes, casting, negative pressure wound therapy, and the necessary documentation to report them in CPT.
Our experts answer questions about 2024 ICD-10-CM guideline updates for cardiovascular conditions, documenting social determinants of health, and more.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews coding, CDI, and clinical validation challenges associated with acute kidney injury cases and gives insight into how coders and physicians can work together to increase accuracy.
CMS recently published an infographic that defines social determinants of health (SDOH), explains the significance of capturing them, and lists which SDOH codes will go into effect October 1.
Kellie Halsted, MSN/MHA, RN, CCDS, CCM , writes about how her experience as a hospital case manager has given her additional insight into writing clinical validation appeal letters as a CDI specialist.
Reporting malnutrition correctly is a constant challenge that faces increasing payer scrutiny. Kate Siemens, RN, CMSRN, CCDS, defines malnutrition and its unique applicability to end-of-life care, documentation tips, and how to report associated 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.
There is one tell-tale sign that fall is here: the October implementation of the ICD-10 coding updates. Courtney Crozier, MA, RHIA, CCS, CDIP , explains the highlights of the update for fiscal year 2024, including 395 new codes, 25 deletions, 22 revisions, and 131 new headers.
The 2024 Medicare Physician Fee Schedule proposed rule received more than 17,000 stakeholder comments. Julie Kyles, CPC , highlights some of the major concerns that commenters expressed, such as requests for more telehealth policy flexibility and community health integration services.
Critical care coding can challenge both new and seasoned coders. Jessica Miller-Dobbs, CPC, CPC-P, CGIC , offers tips and clarification on reporting critical care services in CPT, as well as sample provider documentation for these services.
AMA published the 2024 CPT code set with 349 total editorial changes, including 230 additions, 49 deletions, and 70 revisions. The press release announced revisions for immunization/administration sections, E/M clarification, and new Spanish procedure descriptions.
The U.S. has experienced extreme weather events in recent years, including cataclysmic hurricanes and tornadoes. Terry Tropin, MSHAI, RHIA, CCS-P , explains how coders should use and sequence external cause codes in ICD-10-CM for injuries caused by these storms. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
It can be advantageous for patients and facilities to capture social determinants of health (SDOH) alongside medical conditions. Joscelyn Thomas, RHIT , explains how incorporating screening tools into facilities can help providers and coders promote better health outcomes, reduce disparities, and increase patient engagement.
Building ICD-10-PCS codes for cardiovascular surgery can be tricky given the number of root operations that may apply. Sarah Gould, CPC , reviews cardiac anatomy and ICD-10-PCS guidelines for reporting cardiac insertion and bypass procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A Journal of Hospital Medicine study published online in August found that decreases in readmission associated with CMS’ Hospital Readmission Reduction Program (HRRP) correlated with an increase in patient mortality for certain conditions.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes the highlights from the newest installment of Coding Clinic, which includes guidance on reporting pancytopenia, inherent conditions, ORIF, and neurally adjusted ventilatory assist devices.
Providers and coders alike can find NCCI policies challenging to apply. Denise Williams, COC, CHRI , explains the basics of NCCI by defining the initiative, edits, modifiers, and clinical procedure examples.
The 2024 ICD-10-CM update brings almost 400 code changes, including new codes for sickle-cell retinopathy and orbital muscle entrapment. This article delves into the causes, symptoms, and reporting methods for these two ocular conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS updated its E/M Services Guide in August, reflecting changes for E/M services that went into effect January 1. The guide includes plain-language explanations of policy changes, but some do not align perfectly with AMA guidance.
CMS recently proposed to pay for certain currently bundled caregiver training service CPT codes and three new CPT codes that, if finalized, will be established January 1. Review the criteria of defining a caregiver and which caregiver training services apply.
Our experts answer questions about 2024 ICD-10-CM coding for HIV-related encounters, ICD-10-PCS reporting for Impella insertions and removals, and more.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes the highlights from the newest installment of Coding Clinic, which includes guidance on reporting pancytopenia, inherent conditions, ORIF, and neurally adjusted ventilatory assist devices.
Cardiopulmonary resuscitation (CPR) is a lifesaving treatment used when the heart or lungs cease to function. Whether CPR is conducted alone or with other services, Nancy Reading, RN, CPC, CPC-P , covers the various ways that CPR can be reported and how to do so.
Providers and coders alike can find NCCI policies challenging to follow and apply. Denise Williams, COC, CHRI , explains the basics of NCCI by defining the initiative, edits, modifiers, and clinical procedure examples.
Coders should take note of hundreds of updates to the tabular addenda that serves as an instruction guide to the 2024 ICD-10-CM code set. Both take effect October 1.
There is one tell-tale sign that fall is here: the October implementation of the ICD-10 coding updates. Courtney Crozier, MA, RHIA, CCS, CDIP , explains the highlights of the update for fiscal year 2024, including 395 new codes, 25 deletions, 22 revisions, and 131 new headers.
The fiscal year (FY) 2024 IPPS final rule, released in August, provides updates on inpatient hospital reimbursement, ICD-10-CM/PCS coding and DRG changes, quality and reporting programs, and more.
The heart is a restless organ whose constant rhythm is integral to normal bodily functions. Unfortunately, there are many maladies that can occur, as Linda Martien, CPC, CPC-I, COC, CPMA, CRC, explains through her review of normal cardiac pathophysiology and how to report common rhythm abnormalities in ICD-10-CM.
Diabetes mellitus is a common condition that occurs when a patient’s blood sugar (blood glucose) is consistently too high. Sarah Gould, CPC , delves into the disorder and covers how to report some of its many complications in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Centers for Disease Control and Prevention (CDC) announced the launch of its Hospital Sepsis Program Core Elements initiative on August 24. The program offers resources for hospitals to improve identification and management of sepsis.
Q: Our coding department has a longstanding issue with physicians not presenting enough information to properly report CPT debridement services for ulcers, resulting in queries and denials. What do you recommend?
As coders witness annually, the ICD continues to evolve over its decades of use. This article covers the history of disease classification, current coding techniques, and possible future technologies of the industry. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Cardiopulmonary resuscitation (CPR) is a lifesaving treatment used when the heart or lungs cease to function. Whether CPR is conducted alone or with other services, Nancy Reading, RN, CPC, CPC-P , covers the various ways that CPR can be reported and how to do so.
In this article, the author takes a closer look at CMS’ 2024 Medicare Physician Fee Schedule (MPFS) proposed rule—specifically a proposal to allow new providers to perform and bill behavioral health codes, offer providers new service categories, and give a code-valuation adjustment.
CMS recently released a national coverage determination update to the Medicare Claims Processing Manual . This update covers new requirements for CPT coding associated with acupuncture and dry needling services.
Terry Tropin, MSHAI, RHIA, CCS-P , reviews the biggest changes to the 2024 ICD-10-CM guidelines and tabular list set to take effect October 1, including deletions of certain COVID-19 screening guidelines, and additional direction for new resistant hypertension and myocardial infarction codes.
As the summer temperatures continue to soar worldwide, so does the number of patients with heat-related illnesses (HRI). This article defines common HRIs and includes guidance on how to report them correctly in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published a summary of its second quarter 2023 HCPCS Level II code update application decisions, accepting 16 of 24 submissions. Many of the changes addressed in the announcement have an effective date of October 1, but one code revision and one code discontinuation will take effect before then.
While taking time to relax is important, professionals must seize all opportunities to prepare for updates. Connie White, CPC, CPAR , reviews the process her team at Northside Hospital in Atlanta, Georgia takes to prepare for annual CPT code changes.
With certain medical conditions, encountering differing opinions and discrepancies in provider documentation is inevitable. Deanne Wilk, MPS, RN, CCDS, CCDS-O, CDIP, CCS , reviews 10 diagnoses whose documentation commonly features discrepancies.
A July JAMA Network study found that cannabis use disorder slightly increased patient morbidity and in-hospital mortality. The study included 12,422 hospitalizations following major elective inpatient surgeries.
Q: Is there a hierarchy of social determinants of health codes? Is there an order of importance for us to sequence first, since only a certain number will fit on a Medicare claim?
Parkinson's disease is a chronic and progressive neurodegenerative disorder that affects the central nervous system. Debbie Jones, CPC, CCA , explains the symptoms, treatment, and how 2024 ICD-10-CM coding changes will affect reporting for this disease.
Hemodialysis involves diverting blood into an external machine, where it is filtered and returned to the body. Sarah Gould, CPC , describes the vascular surgical options for hemodialysis (fistulas and grafts), their various types, and how to report them in ICD-10-PCS. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ 2024 OPPS proposed rule, released in July, details major changes to price transparency requirements and proposes numerous changes to behavioral health reimbursement, coverage of dental services, and more.
Our experts answer questions about documentation requirements for CPT debridement codes, sequencing social determinants of health ICD-10-CM codes, and more.
Terry Tropin, MSHAI, RHIA, CCS-P, reviews the biggest changes to the 2024 ICD-10-CM guidelines and tabular list set to take effect October 1, including deletions of certain COVID-19 screening guidelines, and additional direction for new resistant hypertension and myocardial infarction codes.
The fiscal year 2024 IPPS final rule, released in August, provides updates on inpatient hospital reimbursement, ICD-10-CM/PCS coding and DRG changes, quality and reporting programs, and more.
Surgeons are often the toughest contingent of any medical staff with which a CDI program must make headway. Understanding a little surgeon psychology is the key to making positive inroads. Surgeons see themselves as “doers” or “fixers,” while they consider most other medical specialties as “thinkers” who are not “doers.”
With certain medical conditions, encountering differing opinions and discrepancies in provider documentation is inevitable. Deanne Wilk, MPS, RN, CCDS, CCDS-O, CDIP, CCS , reviews 10 diagnoses whose documentation commonly features discrepancies.
CMS published the 2024 Medicare Physician Fee Schedule (MPFS) proposed rule on July 13 with new potential policies and codes affecting physician reporting, including new HCPCS codes for E/M services and behavioral health.
Chronic ulcers are a prolific, costly problem in hospitals. This article examines the most common types of chronic ulcers—diabetic, venous, and pressure ulcers—and the ICD-10-CM guidance coders should know to properly report them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ 2024 OPPS proposed rule, released July 13, details major changes to price transparency requirements and proposes numerous changes to behavioral health reimbursement, coverage of dental services, and more.
Kate Siemens, RN, CMSRN, CCDS , offers her nursing and coding experience to explain postoperative ileus, a common complication after gastrointestinal surgery, and associated ICD-10-CM coding.
Shelley Safian, PhD, RHIA, CCS-P, COC, CPC-I, defines hand-assisted laparoscopic surgery (HALS) procedures and how to report them according to new guidance in the 2024 ICD-10-PCS guidelines. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders should take note of hundreds of updates to the tabular addenda that serves as an instruction guide to the 2024 ICD-10-CM code set. Both take effect October 1.
Q: CMS recommends greater than 38°C as the upper limit temperature threshold for sepsis in the Sepsis-1 bundle, but our consulting group recommends greater than 38.3°C. What would you recommend using as the temperature threshold for diagnosing sepsis?
A recent study from Epic Research showed that the average length of provider notes increased, but note-taking time decreased since 2020. The study explains the reason for this change and the effect it has on providers.
Q: What are some tips for organizations that are just starting out capturing the type of information to report social determinant of health (SDOH) diagnoses in ICD-10-CM?
Sickle cell disease is a group of inherited disorders that causes red blood cell deformation. This article discusses the disease and covers new guidance for it and its manifestations according to FY 2024 ICD-10-CM guidelines and codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , covers the highlights from the Coding Clinic’s latest installment. It includes sequencing for cancer, COVID-19 screening updates, and analysis of “with” guidelines in ICD-10-CM.
CMS released the fiscal year 2024 ICD-10-CM Official Guidelines for Coding and Reporting on July 5. The release included updated language and examples for reporting COVID-19 preoperative testing, sepsis, the coma scale, and other conditions.
Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths in the U.S. Tonya Chandler, RHIT , examines ICD-10-CM reporting for fentanyl use, overdose, symptoms, and dependence through several coding scenarios.
ICD-10-PCS provides many codes related to respiratory assistance, ECMO, and ultrasound for procedures for newborns/neonates. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews these procedures and offers clinical coding scenarios to clear up confusion. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Kate Siemens, RN, CMSRN, CCDS , conducts an interview with Majed Gharfeh, MD, to offer a physician’s perspective on queries and tips on how coders can receive the best results from querying their providers.
A June study in The Journal of the American Medical Association concluded that data collection and reporting efforts to comply with CMS inpatient hospital quality programs cost more than $5 million and took more than 100,000 personnel hours for a large hospital.
The rise in remote work has enabled many healthcare systems to transition to a systemwide model. This change has left some CDI departments struggling to create a unified team. Learn from other facilities on how to overcome these challenges.
Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths in the U.S. Tonya Chandler, RHIT, examines ICD-10-CM reporting for fentanyl use, overdose, symptoms, and dependence through several coding scenarios.
Shelley Safian, PhD, RHIA, CCS-P, COC, CPC-I, defines hand-assisted laparoscopic surgery (HALS) procedures and how to report them according to new guidance in the 2024 ICD-10-PCS guidelines.
As the COVID-19 public health emergency has ended, audits are likely to pick up steam. To prepare for this increase in audit activity, it’s essential for providers and coders to examine both current and upcoming trends.
Coders saw extensive code changes and expansion for ICD-10-CM category O35.- in 2023. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG, reviews what coders need to know when reporting fetal conditions affecting the management of the mother.
