CMS proposed a new framework for the Merit-based Incentive Payment System (MIPS) intended to make the transition to value-based care easier for physicians. Read up on the proposed framework, MIPS Value Pathways (MVP), and its potential impact on patients and providers beginning in 2021.
When applying CPT modifiers -80, -81, and -82, physician coders must carefully consider details in the operative note. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about the correct application of modifiers used to identify services performed by surgical assistants.
Q: What would be reported as the principal diagnosis if a patient was admitted with both a urinary tract infection (UTI) and sepsis? What would be reported first if the patient developed a catheter-associated UTI with sepsis?
CMS released the FY 2020 IPPS final rule on August 2, which finalized its decision on requests for new MS-DRG designations for chimeric antigen receptor T-cell (CAR-T) therapies. Upheld from the proposed rule, CMS denied these requests.
Cathy Farraher, RN, BSN, MBA, CCM, CCDS, writes that CDI professionals can work to reduce the incidence of physician query fatigue and gives recommendations to help improve provider response rate while reducing query frustration.
Regularly reviewing hospital-acquired conditions (HAC) and preparing for unanticipated reporting situations will ensure your facility can submit these with the utmost accuracy. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, helps coders better understand HACs by outlining the basics and giving tips for improving inpatient documentation and coding for these conditions.
It’s that time of year when coders eagerly await the release of the new ICD-10-CM/PCS codes and guideline updates for the upcoming year. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, tackles the fiscal year (FY) 2020 IPPS final rule to highlight 2020 code set and guideline changes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Drug administration is one of the most commonly performed procedures in outpatient departments; however, this topic continues to generate confusion for coders and providers alike. Brush up on CPT coding rules for intravenous (IV) injections, infusions, and hydration services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The four organizations that make up the Cooperating Parties for ICD-10 recently approved the 2020 ICD-10-CM guidelines, which include updated guidance for reporting pressure-induced deep tissue damage, multiple drugs or medicinal substances, injuries and complications.
Q: A patient presents to a wound care clinic for assessment of a 15 sq. cm open wound. A nurse evaluates the wound and performs selective debridement. Would it be appropriate to bill an E/M code and if so, should we report modifier -25?
The 2020 Medicare Physician Fee Schedule proposed rule includes significant documentation and payment changes for outpatient office visits reporting using E/M codes 99202-99215. Beginning in 2021, these proposed updates could add billions of dollars to the national E/M revenue stream.
Atrial fibrillation (AF) is the most common type of heart arrhythmia, according to the Centers for Disease Control and Prevention. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , reviews outpatient coding for AF and surgical techniques used to treat the condition on a case-by-case basis.
While it is essential to receive continuing education on ICD-10-CM/PCS code selection, it is also important to stay current with industry news. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , reviews inpatient reporting and guideline updates for fiscal year 2020. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A diabetic patient is diagnosed with a gangrenous decubitus ulcer of the left heel and admitted to the hospital for treatment. If the provider documents an association between diabetes and the decubitus ulcer, which condition should be sequenced as the principal diagnosis?
CMS released the fiscal year (FY) 2020 IPPS final rule on August 2 with updates to payment rates and wage index values, changes to CC/MCC designations, and revisions to various MS-DRGs. Policy updates affect approximately 3,300 acute care hospitals and apply to discharges beginning October 1.
Tamara Hicks, RN, BSN, MHA, CCS, CCS, ACM-RN, CCDS-O , explains how her organization implemented a CDI career ladder and why it’s an important step for hospitals looking to expand their coding and CDI departments.
Allen Frady, RN, BSN, CCDS, CCS, CRC , reviews the answers to commonly asked questions pertaining to sepsis documentation to help coders and CDI specialists ensure accurate reporting of this condition.
Sepsis is a potentially fatal condition that affects nearly 1.7 million adults in America each year, according to the Centers for Disease Control and Prevention (CDC). Nearly 270,000 Americans die each year from sepsis-related complications.
When you work in the CDI program of a medical facility, you are continually thinking of ways to elicit improved documentation from the medical staff. You also spend a fair amount of time lamenting why some physicians or service lines seem to ignore all educational efforts regarding the importance of explicit and accurate documentation. “If it is important to us,” you might say, “why is it not to them?”
We have come a long way in our understanding of post-traumatic stress disorder (PTSD) but still have a lot to learn about the condition’s prevalence and impact.
Behavioral health is a highly specialized area of coding that many coders and billers are unfamiliar with. There are hundreds of ICD-10-CM codes for mental disorders with unique characters to specify symptoms and complications.
The American Hospital Association (AHA) released Coding Clinic, Second Quarter 2019, just in time for summer vacation. If Coding Clinic didn’t make your summer must-read list, then be sure to review this article, which summarizes coding updates discussed in the quarterly newsletter and their impact on severity and DRG assignment
Even if a hospital is not a teaching hospital, it may have services that require National Clinical Trial (NCT) reporting. It is logical for revenue integrity leadership to own this issue, but an explanation of the requirements for NCT reporting should be shared with all staff within the revenue cycle so there is a better appreciation of the fact that clinical trial billing rules apply more broadly than merely just to research or clinical trial studies.
Q: Suppose a patient comes in for psychological testing evaluation. The provider interprets the test results and patient data, prepares a report, and begins treatment planning. If the interactive feedback session is held several days later, how would this be reported using CPT codes?
CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) and OPPS proposed rules on July 29, introducing new CPT codes and extensive changes to documentation requirements for E/M office visits, and seeking commentary on how to overhaul MIPS and potentially undo its payment policy for drugs purchased through the 340B discount program.
Before starting an ambulatory or outpatient clinical documentation improvement (CDI) program, those tasked with the project must first create some universal definitions, so everyone is on the same page and speaking the same language.
Several surgical techniques can be used to excise or slow the growth of a paratubal cyst. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes the etiology of paratubal cysts and CPT coding for their treatment.
Physician coders need to know when it’s appropriate it apply modifier -25 for significant, separately identifiable E/M service. Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC , reviews the correct application of this frequently misused modifier. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sepsis and systemic inflammatory response syndrome (SIRS) have historically been difficult to report due to changing terminology and continuous updates to ICD-10-CM coding guidelines. Review clinical terminology and complex guidelines to select the most specific codes for both conditions.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , explains why physicians may feel that coding and CDI professionals are asking too much and offers potential solutions to ease workplace tensions.
Adriane Martin, DO, FACOS, CCDS , describes key takeaways from Coding Clinic , Second Quarter 2019, including helpful advice on well-known coding challenges and their impact on severity and DRG assignment.
A retrospective billing study conducted by researchers at Mayo Clinic in Jacksonville, Florida, showed that pre-existing psychiatric comorbidities independently predicted elevated healthcare costs for a large population of patients treated with radiation at the institution.
The ICD-10-CM Manual lists hundreds of code options for mental disorders with unique characters to specify symptoms and complications. This article breaks down outpatient coding for commonly reported mental health conditions, psychiatric assessments, and psychotherapy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A Medicare billing study recently published in The Journal of Hand Surgery found that provider reimbursement for magnetic resonance imaging (MRI) and computed tomography (CT) scans of the upper extremities significantly decreased over the last decade.
Medicare appropriate use criteria (AUC) requirements, currently in a voluntary testing period, will become mandatory starting January 1, 2020. Denise Williams, COC, CHRI , shares insight and analysis on AUC reporting requirements to help facilities prepare for what’s to come.
CMS released the 2020 ICD-10-CM code set in May, adding 273 new codes effective for reporting beginning October 1. Shelley C. Safian, PhD, RHIA, CCS-P, COC , reviews new ICD-10-CM Z codes for factors influencing health status and Y codes for legal interventions.
PTSD is marked by persistent mental and emotional stress that occurs as a result of severe psychological shock. Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews symptoms of and ICD-10-CM coding for PTSD, as well as barriers to psychosocial treatment for the condition.
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve. Review advice from experts on improving internal processes for dealing with commercial audits.
CMS announced on June 21 that it updated the national coverage policy for transcatheter aortic valve replacement (TAVR), requiring covered hospitals and physicians to begin or maintain a TAVR program and adhere to updated volume requirements.
Adriane Martin, DO, FACOS, CCDS , writes about how to accurately capture and report social determinants of health to improve patient outcomes and decrease costs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In 2013, “Guidelines for Achieving a Compliant Query Practice,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. The 2019 update reinforces the information set forth in the preceding practice briefs while also introducing some newer guidelines reflective of today’s healthcare environment.
