According to Deanne Wilk, BSN, RN, CCDS, CDIP, CCDS-O, CCS, patient safety and quality of care are forerunning concerns for organizations today, and hospitals need to examine how and when they evaluate that quality of care in order to remain ethical and compliant.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , writes that one diagnosis in particular that can take extra effort to understand is acute kidney injury (AKI). Frequently reviewing coding and CDI challenges related to AKI will ensure proper coding and reimbursement.
Coders and CDI professionals should be active in the rule-making process for the IPPS, as their specific skills and knowledge can make a large impact on what appears in the final rule.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks CPT coding for breast biopsies, mastectomies, lymph node excisions, breast reconstructions, and other procedures used to prevent and treat breast cancer.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Effective January 1, CMS is expanding coverage for the use of telehealth technology to include the delivery of mental health services in underserved areas.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges.
All inpatient coding and CDI professionals, whether new to the field or industry veterans, should be familiar with the American Hospital Association’s Coding Clinic . This article reviews the steps to take and the importance of submitting coding questions.
According to a recent audit performed by the Office of Inspector General (OIG), Coventry Health Care of Missouri Inc. received nearly half a million dollars in overpayments from 2014 through 2016 for incorrectly submitting diagnosis codes from high-risk groups.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down acute respiratory distress syndrome (ARDS) and sepsis criteria and reviews documentation and querying for these diagnoses through a case study.
Due to the drug ivermectin’s uptick in misuse for treating COVID-19, Susan Belley, MEd, RHIA, CPHQ, reviews ICD-10-CM reporting for poisonings, adverse and toxic effects, and underdosing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our facility has been seeing more denials lately for acute respiratory distress syndrome (ARDS), especially when both respiratory failure and ARDS are documented in the same record. How should ARDS be reported in ICD-10-CM, and which MS-DRG does this diagnosis group to?
Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for mammography, breast ultrasound, and breast magnetic resonance imaging for cancer screening and diagnosis.
Read up on documentation requirements and CPT coding for psychiatric diagnostic evaluations and psychotherapy services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Four new CPT codes for principal care management services take effect January 1, 2022. Review documentation requirements and billing edits that will affect reporting of these new codes.
CMS recently released the 2022 Medicare Physician Fee Schedule (MPFS) and OPPS final rules, revising E/M coding guidelines for split visit services, retaining Category 3 telehealth codes through 2023, and increasing monetary penalties for hospital price transparency noncompliance.
The Office of Inspector General (OIG) recently announced its intention to publish a toolkit for identifying adverse events through medical record reviews for inpatient hospitals. The OIG plans to have the toolkit published in fiscal year 2022.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down the various definitions and criteria for sepsis and reviews documentation and querying for this diagnosis through a case study.
Sarah Nehring, RHIT, CCS, CCDS , shares insight on the clinical concepts behind new fiscal year 2022 ICD-10-CM code I5A (non-ischemic [non-traumatic] myocardial injury) and Coding Clinic, Third Quarter 2021, advice regarding myocardial infarctions due to in-stent stenosis. 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, writes that through updated heart failure definitions and clinical criteria, coders and CDI teams now have help to ensure that congestive heart failure is properly documented and denials are avoided.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CACO, CAC, reviews findings from a recent Office of Inspector General audit of claims for neurostimulator implantation surgeries and their implications for coders.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include a new code for a booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine.
Q: What are the reporting requirements for CPT code 99483 (assessment of and care planning for a patient with cognitive impairment) for cognitive assessment and care planning services?
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, breaks down ICD-10-CM and CPT coding for Meniere’s disease and perilymphatic fistulas—two conditions of the inner ear that affect hearing and balance.
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia.
For FY 2022, CMS continues to expand inpatient access to cutting edge health care technologies by increasing the additional payments designed to cover their development costs and streamlining applicable FDA approval processes.
Applying data governance strategies can help healthcare facilities capture and use social determinants of health (SDOH) data, and a key part of that process is appropriate ICD-10-CM coding, according to a recent AHIMA white paper.
To select the most specific codes for pediatric conditions, inpatient coders must understand the difference between the terms “neonate,” “newborn,” and “infant.”
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down a clinical scenario and corresponding query so inpatient coders and CDI specialists can better work to ensure proper reporting and reimbursement for diagnoses related to acute tubular necrosis (ATN).
Hospitals often put significant thought, time, and energy into hiring new team members, and while coding and CDI managers can have the best possible staff, if they don’t feel appreciated, the odds of them staying with the company long term are low.
The Surviving Sepsis Campaign recently released a 2021 update to guidelines for the care of patients with sepsis. The updated guidelines emphasize the difficulties with treating patients who are experiencing long-term effects of sepsis.
In part two of this two-part series, Audrey Howard, RHIA, covers fiscal year (FY) 2022 updates to ICD-10-PCS reporting for spinal procedures, specificity updates to the ICD-10-CM official coding guidelines, and modified MS-DRG logic for type 2 myocardial infarctions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Between 2016 and 2017, CMS overpaid hospitals and other providers an estimated $636 million in unallowable Medicare payments associated with neurostimulator implantation surgeries, according to a recent Office of Inspector General (OIG) report.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews ICD-10-CM and CPT coding for cervical incompetence, in vitro fertilization (IVF), and postpartum care complications.
Kimberly A. Hoy, JD, CPC , summarizes proposed changes to physician coding and billing for therapy assistant services in the 2022 Medicare Physician Fee Schedule proposed rule.
