The Rh factor of positive and negative can lead to problems between a mother and the developing fetus, a condition known as mother-fetus incompatibility. In some cases, the mother must receive the Rho(D) immune globulin. Lori-Lynne A, Webb, COBGC, CPC, CCS-P, CCP, CHDA , explains the diagnostic and procedure coding options for Rho(D) immune globulin.
QUESTION: I've always coded labile hypertension with ICD-9-CM code 401.9 (unspecified essential hypertension) because I couldn't find a more specific one. My supervisor stated that I must use ICD-9-CM code 796.2 (elevated blood pressure reading without diagnosis of hypertension) because it means the patient's blood pressure was high without a history of hypertension. The physician's diagnosis is labile hypertension. What code would you use?
ICD-10-CM includes some specific guidelines to help coders decide when to code for a current malignancy or a personal history of malignancy. The physician excises a primary malignancy but the patient...
Summer means sand and sun for many people, but a day at the beach can result in a visit to the Fix ‘Em Up Clinic. Danielle hit the beach, but forgot her sunscreen. As a result, she ended up with a...
By now, you may have heard that the ICD-10-CM codes are more specific than those used in the ICD-9-CM system, and fracture coding is one of the areas undergoing the most changes. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CPC-I, CCDS, discusses fracture coding in ICD-10 and some of the expected documentation challenges associated them.
Many HIM directors and coding managers are aware of the decrease in productivity that is anticipated with the implementation of ICD-10. The concern is a valid one, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, who explains what’s ahead and how HIM professionals should prepare.
CMS has issued both a National Coverage Determination (NCD) Transmittal 143 and Medicare Claims Processing Transmittal 2473 on the coverage of extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) in certain circumstances under clinical research studies.
QUESTION: Do you predict coder productivity will decline as a result of ICD-10? If so, what do you think the declines will be six months after implementation?
A lot of learning is ahead for coders and others who will need to learn how to code in ICD-10. There are changes all around, and OB coding is no exception. Lori-Lynne A, Webb, COBGC, CPC, CCS-P, CCP, CHDA, explains coding for OB ultrasounds, amniocentesis, MRIs, and other procedures in CPT ® , ICD-9, and ICD-10
Some ICD-10-PCS root operations encompass a wide range of procedures. Think biopsy, excision, and extraction. Others cover a much smaller range of possible procedures, including fusion. Coders will...
A patient comes in for a face lift or another cosmetic procedure. What root operation should you code the procedure to in ICD-10-PCS? The answer: alteration (third character 0). The goal of an...
Facilities can't bill for skin substitutes unless they also bill for a skin substitute application procedure on the same date, according to the April update to the I/OCE. If facilities don't comply with this practice, they won't receive payment for the skin substitute. The April update includes a list of eight procedure codes (CPT codes 15271-15278) and 27 specific skin graft materials.
Consider this scenario: A physician orders three hours of hydration as well as a one-hour therapeutic antibiotic infusion for a patient. A nurse documents the hydration start time as 10 a.m. and the antibiotic start time as 11 a.m. Neither provider documents a stop time. What should coders report?
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 skull.
Inpatient hospitals will see CMS payment rates increase 2.3% in FY 2013 if the agency finalizes the change in the IPPS proposed rule released in April. CMS expects that in FY 2013, the documentation and coding adjustment will net an aggregate 0.2% increase. Other quality-of-care initiatives could reduce payments.
In this month's issue, we clear up confusion surrounding injections and infusions coding, provide an anatomy refresher for the skull, detail changes to the I/OCE for April, discuss the proposed implementation delay for ICD-10, and answer your coding questions.
Our coding experts answer your questions about payment for items in OPPS Addendum B and skin substitutes, incomplete documentation for IV infusions, coding for amputation of finger and aftercare, facility codes for peritoneal dialysis
Learn about the FY 2013 IPPS proposed rule, MAC prepayment reviews, tips for coding sepsis and SIRS, inpatient wound care coding challenges, acute respiratory failure CC/MCC status, and the importance of continuing ICD-10 preparations.
A writer paints a picture with words. The English language alone offers somewhere in the neighborhood of a quarter of a million words. But really how many does the average person use? According to...
Summer semi-officially arrived this week with Memorial Day and that means plenty of sun and sand related illnesses at the Fix ‘Em Up Clinic. Our first patient is Todd, who was trying to grill up the...
Providers will soon be reimbursed by Medicare for a new, less-invasive aortic valve replacement procedure. Medicare Acting Administrator Marilyn Tavenner announced CMS’ decision to pay for transcatheter aortic valve replacement under specific conditions.
Cardiac catheterization is a common procedure performed to study cardiac function and anatomy and to determine if a patient is a candidate for intervention. Terry Fletcher, CPC, CCC, CEMS, CCS-P, CCS, CMSCS, CMC, and Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, explain how to code the different catheterization procedures.
QUESTION: When would you use the table labeled as not otherwise classified drugs at the end of the HCPCS Level II Table of Drugs and Biologicals? Many other drugs are not assigned a HCPCS code and are not in this table.
The guiding principle is the definitive methodology used for all risk adjustment medical record reviews. Successful Medicare Advantage (MA) plans focus on early disease detection, coordination of care, and accurate reporting of members’ chronic conditions by primary care physicians, retrospective and prospective pursuits to drive and improve health outcomes. Holly J. Cassano, CPC, guides coders through the principles of risk adjustment for MA plans.
When a physician performs a procedure intended to narrow the diameter of a tubular body part or orifice, coders will select the root operation restriction in ICD-10-PCS. Restriction includes both...
Our Town Zoo hosted its annual black tie fundraiser and things got a little, well, wild as the patients at the Fix ‘Em Up Clinic prove. Tiffany made a fashion statement with a bright blue shimmering...
Do not view the proposed rule extending the ICD-10 implementation date from October 1, 2013, to October 1, 2014, as a year-long break from ICD-10 preparations. Rather, focus on using the additional time allotted to your advantage. This includes conducting documentation and coding assessments to gauge ICD-10 readiness. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, explains why—and how—facilities should start assessing the readiness of their coding staff and documentation procedures in relation to ICD-10 requirements and create strategies to manage any deficiencies.
Depending on the demographics of the region a hospital serves, its coders could determine code assignment for hundreds of deliveries and pregnancy-related services annually. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, and Susan Proctor, RHIT, CCS, CPC, review the relevant coding guidelines for coders who handle coding for these patient encounters.
Many physicians say that systemic inflammatory response syndrome (SIRS) criteria are insufficient and confusing at best, and don't indicate whether a patient is truly sick. Some patients may meet necessary criteria for SIRS and truly have sepsis or another severe diagnosis. Others, however, may meet two of four criteria but not actually have SIRS. Where does all of this information leave coders? Often between a rock and hard place. Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, and Robert S. Gold, MD, offer seven tips for coders who need to negotiate tricky sepsis coding.
QUESTION: Our pulmonologists are not comfortable documenting acute respiratory failure unless the patient is on a ventilator. Also, they rarely document chronic respiratory failure, even in chronic obstructive pulmonary disease (COPD) patients on continuous home oxygen. I’m trying to develop standard query forms for acute and chronic respiratory failure and am running into these obstacles. How do you recommend handling this problem?
CMS released its latest MLN Medicare Quarterly Provider Compliance Newsletter in April. The newsletter features educational information for providers related to recent audit targets and findings.
In ICD-10-CM, coders must report two codes to fully describe certain conditions. They will find “Use additional code” notes in the Tabular List at codes when they need to report a secondary code to...
So we’ve survived the zombie apocalypse, but we’re not out of the undead woods yet. It seems a group of vampires is trying to one-up the zombies. But, never fear, vampires can actually be regular...
Gregory House, MD, is hanging up his stethoscope before the transition to ICD-10-CM. I loved House MD when Fox first starting airing it in 2005, but the last few seasons, not so much. Let’s ask Dr...
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. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, takes coders on a trip through the digestive system.
Coders will need very specific information in order to code for fractures in ICD-10-CM, including the type of fracture, specific bone fractured, and whether the patient is seen for an initial or subsequent visit. Robert S. Gold, MD, Sandy Nicholson, MA, RHIA, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, detail the information physicians must document for accurate fracture code assignment.
The American Health Information Management Association (AHIMA) continues to advocate for no delay in the implementation date for ICD-10-CM and ICD-10-PCS.
QUESTION: We are a small anesthesia group and we are concerned about the specificity for ICD-10-CM. If we submit a claim with an unspecified code and the surgeon submits a claim with more specificity, will we still get paid?
Coders and clinicians often seem to speak different languages. What a clinician considers important information may not be what a coder needs to assign the correct code. Clinicians may not document a piece of information that is vital to the coder. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, Joseph Nichols, MD, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, explain how clinicians and coders can work together to improve communication.
Coders often report signs and symptoms when physicians document them in the patient’s medical record. However, coders should not always report additional codes for signs and symptoms. How can coders...
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. ICD-10-CM coding conventions for such conditions require coders to report...
When a physician performs a procedure to enlarge the diameter of a tubular body part or orifice, coders will report root operation dilation with 7 as the third character in the medical and surgical...
QUESTION: A physician documents in an operative report debridement of a necrotic muscle (not due to an open wound). Must the physician also document how the muscle is removed to report ICD-9-CM procedure code 83.45 (other myectomy)? Is this considered excisional or nonexcisional debridement? What documentation is required to code the removal of a necrotic portion of a muscle?
While we know the implementation date of ICD-10 may change to the proposed 2014 deadline, healthcare organizations must keep moving forward with preparations. Annie Boynton, BS, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, CPhT, explains how organizations can use the additional time to better handle the change process associated with ICD-10, especially planning for education and training.
Although MS-DRGs have stolen the spotlight since CMS implemented them in 2007, hospitals are increasingly using All Patient Refined DRGs (APR-DRG) to compile the most accurate assessment of patient severity of illness (SOI) and risk of mortality (ROM). Cheryl M. Manchenton, RN, BSN, and Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM, describe why APR-DRGs are the most widely-used SOI and ROM-adjusted DRGs and how organizations can use them to their advantage.
Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) proposed rule, released April 24. The 2.3% is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.
