Many CDI professionals are familiar with the saying that, since CDI is “already in the chart,” they can easily pick up a new review lens. The reality, however, is that each new responsibility can put a damper on staff bandwidth and productivity.
Shelley C. Safian, PhD, RHIA, CCS-P, and Mary A. Johnson, MBA-HM-HI, CPC, review the purpose of modifiers and analyze their integral part in reporting encounters, receiving reimbursement, and promoting continuity of care.
Orthopedists perform injections and aspirations to address a range of ailments, but reporting injections can be difficult. This article reviews proper CPT coding for sacroiliac joint injections and joint arthrocentesis.
Educating clinical staff on proper documentation of mechanical ventilation can avoid compliance issues and support accurate reimbursement. This article clarifies the complications of reporting mechanical ventilation in ICD-10-PCS.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes guidance from the 2024 first quarterly release of Coding Clinic , including reporting for postoperative complications, non-traumatic kidney injuries, and vertebral artery dissection.
Sarah McDonald, CPC , analyzes the process of reporting traumatic brain and spinal cord injuries ICD-10-CM, notably the cause of injury, reason for the encounter, and aftereffects. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This article explains the quality metrics of hospital-acquired infections and accidental punctures and lacerations, and details how collaborative efforts can reduce these risks.
Shelley C. Safian, PhD, RHIA, CCS-P , and Mary A. Johnson, MBA-HM-HI, CPC , review the purpose of modifiers and analyze their integral part in reporting encounters, receiving reimbursement, and promoting continuity of care. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , analyzes the challenges that both inpatient and outpatient CDI specialists encounter and offers advice to lessen provider opposition to participating in outpatient CDI.
Katie Patterson, CPC , summarizes the Medicare Quality Payment Program, provider qualifications, clinician participation, and how they work to achieve the program’s main objectives.
The Journal of the American Medical Association (JAMA) published a study in March found that “foot and ankle care was associated with an 11% lower likelihood of death…and a 9% lower likelihood of major amputation (above or below knee).”
CMS will be holding its next ICD-10 Coordination and Maintenance Committee meeting March 19-20. The committee will deliberate applications for new ICD-10-PCS and ICD-10-CM code assignments. If approved, the codes will become effective October 1, 2024.
Susan G. Michael, MSN, RN, CPHQ, CCDS , examines social determinants of health through a historical perspective and explains how they evolved into the codes that coders and researchers use today.
Shannon Oitker, MSN, RN , reviews the nine MS-DRGs for ventilator use, explains how DRGs are designed, and assesses whether hospitals are receiving adequate reimbursement for ventilation services.
Terry Tropin, MSHAI, RHIA, CCS-P , continues her exploration of ICD-10-PCS April updates with added options for intracranial brachytherapy, electroporation, sinus dilation, pedicled omentoplasty, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Kyles, CPC , summarizes the advice CMS provided during a January event about reporting HCPCS add-on code G2211 for increased complexity with E/M codes.
CMS retroactively added two new CPT codes for respiratory syncytial virus (RSV) vaccine administration. The codes affect services rendered on or after October 6, 2023.
C. diff results from a disruption of the normal bacterial flora of the colon. Recognize the diagnostic criteria, treatment, and ICD-10-CM coding tips for reporting this disorder. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This article explains the quality metrics of hospital-acquired infections and accidental punctures and lacerations, and details how collaborative efforts can reduce these risks.
Most fracture cases originate in the ED, so orthopedic coders must understand the various scenarios that may arise based on the patient’s condition and the intent of the performing clinician.
Shannon Oitker, MSN, RN , reviews the nine MS-DRGs for ventilator use, explains how DRGs are designed, and assesses whether hospitals are receiving adequate reimbursement for ventilation services.
Our experts answer questions about CPT/HCPCS codes for reporting obesity counseling, HCPCS reporting for social determinants of health assessments, and more.
Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, and Karla VonEschen, MS, CPC, CPMA, CCDS-O, look back at the progression of diagnosis and mortality coding before looking ahead to ICD-11 and how coding departments can prepare for it.
Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , summarizes guidance from the 2024 first quarterly release of Coding Clinic , including reporting for postoperative complications, non-traumatic kidney injuries, and vertebral artery dissection.
Our experts answer questions about payer criteria for chronic kidney disease diagnoses, ICD-10-CM documentation requirements for reporting chronic pain syndrome, and more.
Although every professional may be different, there are a few tricks of the trade to building the right garden and letting your CDI department show off some of that natural talent.
TaraJo Vaught, MSN, RN, CCDS , shines a light on the crucial roles played by coding and CDI specialists, compares their respective realms, and offers insights for transitioning between them.
Terry Tropin, MSHAI, RHIA, CCS-P , explores the 2024 ICD-10-PCS updates that will become effective April 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent study has suggested that COVID-19 patients who have a history of inflammatory bowel disease (IBD) are at an increased risk of sepsis, shock, and acute kidney injury.
Heart failure affects more than 6 million adults in the U.S. and costs the nation more than $30 billion. Review ICD-10-CM guidance and documentation details required for accurately reporting the condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Artificial intelligence (AI) has burst on the scene with numerous clinical and coding applications for providers. This article looks at how the technology can be used and where human oversight is still required.
A JAMA study published in January found that patients with the highest risk for severe COVID-19 infection received outpatient therapy less often than those with the least risk.
Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, and Karla VonEschen, MS, CPC, CPMA, CCDS-O, take a look back at the progression of diagnosis and mortality coding before looking ahead to ICD-11 and how coding departments can prepare for it.
Q: How should we report services with modifier -50 (bilateral procedure) for physician claims when a private payer’s instructions contradict our Medicare administrative contractor (MAC)?
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC , analyzes various types of postprocedural complications, such as respiratory failure, infection, ileus, shock, and offers direction on how to report them.
The CDC posted its updated 2024 ICD-10-CM guidelines in January that include a sequencing update for sepsis due to postprocedural infection. The guidelines will take effect April 1.
Penny Jefferson, MSN, RN, CCDS, CCDS-O, CCS, CDIP, CRC, CHDA, CRCR, CPHQ , explains how professional development in CDI is a journey, demanding integration of specific knowledge, continuous learning, and adaptability.
Nancy Reading, RN, CPC, CPC-P, examines the complex relationships between ketoacidosis, hyperglycemia, and hyponatremia, and gives advice on reporting these diabetic 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.
Q: A patient who presents with complaints of progressive neck and bilateral arm symptoms is diagnosed with cervical spondylosis—worse at joints C5-C6 and C6-C7. Which ICD-10-CM codes would be reported?
CMS published a summary of its fourth quarter 2023 HCPCS Level II code update application decisions, including 36 additions, four revisions, and 18 deletions.
The behavioral health coverage that CMS calls among the most important in Medicare history were finalized and expanded in the 2024 Medicare Physician Fee Schedule final rule.
Most fracture cases originate in the ED, so orthopedic coders must understand the various scenarios that may arise based on the patient’s condition and the intent of the performing clinician. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Teresa Seville, RHIT, CCS , explains that a thorough review of code updates must include analysis of the addenda, including index, tabular notes, guidelines, and committee meeting highlights.
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC , analyzes various types of postprocedural complications, such as respiratory failure, infection, ileus, shock, and offers direction on how to report them.
TaraJo Vaught, MSN, RN, CCDS , shines a light on the crucial roles played by coding and CDI specialists, compares their respective realms, and offers insights for transitioning between them.
While certifications specific to CDI are by no means a requirement to get into the CDI field, they have grown to become a rite of passage for many CDI professionals.
Teresa Seville, RHIT, CCS, explains that a thorough review of ICD-10 updates must include analysis of the addenda, including the index, tabular notes, guidelines, and committee meeting highlights.
Diane Pittman, CPC, CPMA, CRC, CCD-O, and April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O, explain how reporting ICD-10-CM social determinants of health, their context, and coder feedback can influence natural language understanding.
Our experts answer questions about conflicting payer and MAC guidance, identifying CPT/HCPCS services and supplies that are not separately reportable, and more.
Alysia Minott, CCS, CIRCC, CDIP, explains anatomic and documentation details coding professionals need to know to report cardiac and interventional radiology procedures.
Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CCS , defines the Diagnosis, Etiology, Evidence, Plan (DEEP) methodology to identify and instill good habits for provider documentation.
Q: Can a “yes/no” query be sent based on this documentation to confirm yes, there is a postoperative hematoma, no, there is not a postoperative hematoma, or other?
The AHA responded with potential provider concerns to the government’s recent request for information (RFI) as it prepares for the potential transition from ICD-10 to ICD-11 for morbidity coding.
April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O , and Will Morriss, CCS, CCDS-O , describe how artificial intelligence (AI) has impacted providers, coders, and the healthcare industry.
Nancy Reading, RN, CPC, CPC-P , explains how employing clinical and coding criteria for assigning or auditing ICD-10-CM codes for malnutrition can have a significant impact on reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
For accurate CPT and ICD-10-CM coding of fractures, coders will need to identify many pieces of information, including location and type. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Diane Pittman, CPC, CPMA, CRC, CCD-O, and April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O , explain how reporting ICD-10-CM social determinants of health, their context, and coder feedback can influence natural language understanding.
Marlene Goodwin-Esola, MSN, RN-BC , recounts her personal journey with heart disease, undergoing cardiac catheterization, and offers her viewpoint on being on the other side of a coding chart.
2024 ICD-10-CM code changes pertaining to acute appendicitis and small intestinal bacterial overgrowth give coders the opportunity to report these conditions with greater accuracy and specificity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC , explains the differing definitions of “complication” for providers vs. coders, reviews types of complications, and codes an intraoperative laceration case study.
Michael Malohifo’ou, RN, MBA, PhD , explains how excessive use of emergency departments can result in unfavorable outcomes . He also assesses the complicated relationships between EDs, social determinants of health ICD-10-CM coding, and mental and behavioral health CPT services.
This Q&A with Nancy Enos, FACMPE, CPC-I, CPMA, CEMC , covers independent historians, independent interpretations, discussion with external physicians, risk, and billing for separate E/M visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS posted its 2024 Therapy Code List and Dispositions on December 28. This list indicates whether therapy services, as distinguished by HCPCS Level II and CPT codes, are recognized under CMS as “sometimes therapy” or “always therapy.”
Q: What terms need to be included in physician documentation to code in ICD-10-CM whether the patient’s migraine is chronic, intractable, or with status migrainosus?
Julia Kyles, CPC , reviews the 2024 First Quarter National Correct Coding Initiative (NCCI) code update, which included 929 new procedure-to-procedure edit pairs.
April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O, and Will Morriss, CCS, CCDS-O, describe how artificial intelligence (AI) has impacted providers, coders, and the healthcare industry.
Michael Malohifo’ou, RN, MBA, PhD, explains how excessive use of emergency departments can result in unfavorable outcomes . He also assesses the complicated relationships between EDs, social determinants of health ICD-10-CM coding, and mental and behavioral health CPT services.
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC, explains the differing definitions of “complication” for providers vs. coders, reviews types of complications, and codes an intraoperative laceration case study.
The 2024 ICD-10-CM update added 36 codes to the now nearly 400 codes in category M80.- (osteoporosis with current pathological fracture). The additional codes add further specificity for pelvis fractures due to age-related osteoporosis.
Professional development in CDI is a multifaceted and continuous journey, demanding integration of specific knowledge, continuous learning, and adaptability.
A scan of healthcare news sources or the Office of Inspector General work plan often finds psychiatry and mental health practices under scrutiny. Laurie Bouzarelos, MHA, CPC, reviews revenue cycle functions, provider contracting/credentialing, and coding and documentation tips to avoid denials.
This Q&A is part of an interview with Nancy Enos, FACMPE, CPC-I, CPMA, CEMC , covering physician CPT E/M reporting and medical decision-making. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A physician debrides a hyperkeratotic lesion on a patient’s left foot, second toe. During the same encounter, he performs a debridement of the five toenails. Which CPT codes and modifiers would be reported for this procedure?
Providers can receive additional revenue when they check a patient for social determinants of health, but the service requires patient selection, a standardized tool, and follow up. Julia Kyles, CPC, explains how practices can report this service with a new HCPCS code for 2024.
Michael Lonski, Ph.D., a licensed psychologist, was sentenced to 27 months of imprisonment and three years of supervised release for conducting $2.6 million in Medicare and Medicaid fraud, the Department of Justice announced December 19.
A scan of healthcare news sources or the Office of Inspector General work plan often finds psychiatry and mental health practices under scrutiny . Laurie Bouzarelos, MHA, CPC , reviews revenue cycle functions, provider contracting/credentialing, and coding and documentation tips to avoid denials.
Medical necessity is the foundation for justifying the need for services. It provides the reason for the diagnostic test or therapeutic services. Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI , reviews the fundamentals of medical necessity and explains its importance.
The 2024 ICD-10-CM update added 36 codes to the now nearly 400 codes in category M80.- (osteoporosis with current pathological fracture). The additional codes add further specificity for pelvis fractures due to age-related osteoporosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a broad federal law that establishes the basic privacy and security protections that coders are required to follow.
