The American Health Information Management Association (AHIMA) has urged CMS not to delay ICD-10-CM/PCS implementation in its February 23 letter to HHS Secretary Kathleen Sebelius . Meanwhile, the...
Who knew St. Patrick’s Day was such a dangerous holiday? Take a look around the Fix ‘Em Up Clinic and see for yourself. First, we have Bobby, who was looking for a four-leaf clover. Unfortunately, he...
The Office of E-Health Standards and Services (OESS) announced a second delay in the enforcement of HIPAA 5010, CMS announced March 15 . OESS announced the first enforcement delay November 17, 2011...
ICD-10-CM is full of oddly specific codes for causes of injuries. Some of them are funny (I’m talking to you, W61.43, pecked by turkey) and others are so strange that most coders will probably never...
Special Edition MLN Matters article #SE1210 , “Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders,” outlines recovery auditor findings upon completion of medical necessity reviews. In the article, which addresses documentation and billing for inpatients, recovery auditors concluded that providers had been admitting patients even for clinical situations for which outpatient observation services would have been appropriate.
QUESTION: Recently, reviewers have denied diagnostic code 584.9 (acute renal failure [ARF]) based on lab values. The diagnosis is well documented and treated by the attending physician, but reviewers are stating the lab values do not support the diagnosis of ARF. The lab values (creatinine/blood urea nitrogen) went from normal to abnormal, and we found no definitive standards for lab parameters to meet the definition of ARF. Following coding guidelines for reporting secondary diagnoses, the ARF was clinically evaluated, the patient received therapeutic and diagnostic procedures, and there was an extended length of stay/increased nursing care. As coders, we feel it is inappropriate to question the physician’s clinical judgment, and reporting the ARF as a secondary diagnosis is correct. Based on the documentation in the record, is it appropriate to code the ARF?
What should inpatient coders remember about the three-day payment window requirements? Although it may seem counterintuitive, Debbie Mackaman, RHIA, CHCO, and Marion G. Kruse, RN, MBA, explain that inpatient coders need to be aware of certain outpatient services that they may need to include on inpatient claims, as well as when they need to alert billers to assign condition code 51.
When a provider notes a diagnosis on the hospital-acquired condition (HAC) list, coders must be diligent about looking throughout the rest of the chart to ensure documentation clearly indicates the presence of a HAC. For example, if the condition is a pressure ulcer, the condition may have been present on admission. Shelia Bullock, RN, BSN, MBA, CCM, CCDS, and Beverly Cunningham, MS, RN, address the importance of coder participation as members of hospital HAC committees and the development of best practices to ensure accurate HAC and HCAC reporting.
Physicians use a lot of shortcuts and abbreviations. Some of them may even make it onto the official abbreviation list at their hospital. Some don’t. And even if they did, some physicians will use the wrong term. Robert S. Gold, MD, discusses an example that was featured in the January Medicare Quarterly Provider Compliance Newsletter regarding proper identification and ICD-9-CM coding of a bronchoscopy with biopsy (TBB) vs. a bronchoscopic lung biopsy (TBLB).
The ICD-10-PCS defines root operations excision and resection in a very similar way. Excision is cutting out or off, without replacement, a portion of a body part. Coders should report the qualifier...
Coders use ICD-9-CM E codes to describe the accident, circumstance, event, or specific agent that caused a patient’s injury. In ICD-10-CM, these codes will not be prefaced with the letter ‘E,’ and...
Can you begin to imagine how complex a piece of great literature would be if we had to include complete documentation of each medical incident? Or have to stop every time we have to develop physician...
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
The January update to the Integrated Outpatient Code editor generally includes a large number of changes and the January 2012 update is no exception. Dave Fee, MBA, highlights the most significant changes including the addition of modifier –PD, which he calls one of the real sleepers in this release.
Otolaryngology coding covers a wide range of procedures and four parts of the respiratory system—the ears, nose, sinuses, and throat (ENT). Stephanie Ellis, RN, CPC, and Kim Pollock, RN, MBA, CPC, explore some common ENT coding trouble spots.
Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
Some of the ICD-10-PCS root operations are very similar—think excision (cutting out or off, without replacement, a portion of a body part) and resection (cutting out or off, without replacement, all...
In honor of Dr. Seuss' birthday, we present: Oh, the ICD-10-CM codes you’ll find Hit by a truck? Bit by a duck? There’s an ICD-10-CM code for that. Liver contused? Wrong substance infused? There’s an...
