Before starting an ambulatory or outpatient 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.
CMS recently released two quarterly updates effective July 1: Medicare Claims Processing Transmittal 4313 , which is the July update to the OPPS, and Medicare Claims Processing Transmittal 4314 , which is the related July update to the Integrated Outpatient Code Editor (I/OCE) Specifications, Attachment B.
ED physicians commonly treat fractures. A fracture can be the result of a traumatic injury, such as a fall, or may be pathologic (i.e., due to a disease process). In general, fractures can be classified as open or closed, displaced or nondisplaced.
Keeping up with coding changes in the circulatory system chapter in the ICD-10-CM manual is an ongoing process. Almost every fiscal year coders are met with new codes for myocardial infarctions (MI), changes to congestive heart failure codes, and updates to the guidelines for reporting cerebrovascular diseases.
This summary, organized by major diagnostic category (MDC), highlights some of the changes to the IPPS proposed rule affecting MS-DRG and ICD-10-CM/PCS code assignment.
Acute kidney injury (AKI) and acute tubular necrosis (ATN) remain targets for both coding and clinical validation. Over the years, we’ve gleaned valuable insights from appealing hundreds of coding and clinical validation denials for AKI and ATN.
CMS recently released the fiscal year (FY) 2020 ICD-10-PCS changes and Official Guidelines for Coding and Reporting for the procedural coding system which will affect discharges occurring from October 1, 2019, through September 30, 2020.
Correct documentation and coding are key to accurate reimbursement, but according to the Office of Inspector General, organizations aren’t hitting the mark on either when billing for inpatient rehabilitation facility (IRF) services.
Treatment options for spinal conditions are varied and may include pain management with medications, injections, or surgical interventions. Adrienne Commeree , CPC, CPMA, CCS, CEMC, CPIP , breaks down spinal anatomy and ICD-10-PCS coding for spinal fusions and laminectomy procedures.
The fiscal year 2020 IPPS proposed rule includes nearly 1,500 CC/MCC designation changes, which impact MS-DRG groupings used to calculate pricing for inpatient hospital claims. Rhonda Butler, CCS, CCS-P , reviews noteworthy proposed changes to MS-DRG assignment for the coming fiscal year. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released quarterly updates to the OPPS and Integrated Outpatient Code Editor (I/OCE), effective July 1. Judith Kares, JD , summarizes key coding and billing policy updates, including changes to APCs, status indicators, revenue code changes, and more.
The skin maintains homeostasis by generating new tissue in response disease or damage. Sometimes, however, surgical interventions are used lessen the severity of the wound and prevent infection. Review integumentary system anatomy and CPT coding for removals and repairs used to facilitate wound healing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A clinician documented "combination Type 1 and Type 2, diabetes mellitus in poor control." This condition is sometimes called Type 1.5 diabetes. What is the correct ICD-10-CM code assignment for Type 1.5 diabetes?
The July 2019 quarterly update to the OPPS, released by CMS in late May, announces an effective date of July 1 for 20 CPT Category III codes and revises status indicators for CPT codes used to report imaging by magnetocardiography.
The use of ultrasound at the bedside, or within the office practice, has become more common in provider-based clinic settings. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , details documentation requirements and CPT and ICD-10-CM coding for diagnostic ultrasound services.
Q: We have a patient who received a pancreas transplant for the treatment of diabetes. The patient was later admitted to the hospital for treatment of an unrelated kidney stone. Would it be appropriate to assign the ICD-10-CM code for diabetes as a chronic condition based on the patient’s medical history?
The estimated annual cost of sepsis readmissions is more than half the annual cost of all Medicare Hospital Readmissions Reduction Program conditions combined, according to a study published in CHEST Journal .
Patients who use oxygen at home for a primary respiratory condition typically present with some degree of respiratory failure. Howard Rodenberg, MD, MPH, CCDS , describes common documentation issues related to oxygen requirements for the diagnosis of acute respiratory failure.
Diagnosis coding for neoplasms can be particularly challenging, as neoplasms are classified by site, behavior, and morphology. Review ICD-10-CM coding and guidelines for reporting solid organ tumors and cancers affecting the bone marrow and lymphatic system. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Learn how ICD-10-CM coding accuracy, specificity, and compliance impacts provider performance in each of the four performance categories under the Merit-based Incentive Payment System (MIPS). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A physician orders a comprehensive metabolic panel and a quantitative blood sample to measure blood glucose level. How would a coder report these services using CPT codes, and what modifier would he or she use to indicate that the blood sample was performed separately from the panel?
CMS released Transmittal 4313 on May 24 describing changes that will be implemented in the July 2019 quarterly update to the OPPS. These changes included several new HCPCS codes for reporting certain drugs and biologicals.
A May report from the Office of Inspector General (OIG) found that some physician practices were at the root of basic coding errors that caused federal overpayments. Although the Essence audit was small, the findings have significant implications for physician coders.
Because lower extremity diagnoses are often associated with issues in other parts of the body, assessing the severity of a patient’s podiatric condition can be challenging. Shelley Safian, PhD, RHIA, HCISPP, COC, CPC-I , reviews physician E/M coding for patients seeking treatment for foot and lower leg problems.
If you only bill using the CMS-1500 claim form, then you’ve probably never seen a revenue code. But if you need to bill for facilities, you know revenue codes play an important communicative role between providers and insurers. UB-04 claim forms sent to an insurance company without a revenue code associated with each charge will be rejected.
Having taken on more diverse responsibilities, many providers regard medical coding as a necessary evil; their primary focus is caring for their patients. Although many physicians select codes for the work they perform, they rely on specialized coding and auditing professionals to review their documentation and reporting for accuracy.
Valerie Rinkle, MPA, CHRI, covers important proposals found in the fiscal year (FY) 2020 IPPS proposed rule, including coding updates, new technology payment changes, and increases to low wage index hospitals.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that accurate ICD-10-CM/PCS coding for the heart improves data quality, which in turn is used for statistics and tracking trends, so it is imperative to ensure the disease process is captured correctly.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, presents a review of MS-DRG basics to ensure that inpatient coders have a thorough understanding of MS-DRGs’ intricacies, thus perfecting assignment and reimbursement accuracy.
At the beginnings of inpatient coding and CDI, we had books like DRG Expert and Excel-based programs for MS-DRG selections. More than 10 years later, vendors are offering web-based technologies that use artificial intelligence and machine learning to make us even more productive in both coding and CDI. The real question, however, is how we can best leverage those technologies.
With the addition of the two new telehealth service codes for 2019, providers now have 98 CMS-approved telehealth services to report. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , describes the two newest telehealth HCPCS codes and breaks down 2019 billing regulations surrounding telehealth.
Q: A patient presents to the ED seeking treatment for impacted cerumen affecting both ear canals. How would you report a bilateral cerumen removal using CPT codes?
At a Senate Committee on Finance hearing on May 8, physician groups urged Congress to work with CMS to improve the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) by establishing new performance measures and providing greater financial incentives for participating providers.
The month of May is designated Skin Cancer Awareness Month by the American Academy of Dermatology. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D , writes about ICD-10-CM/CPT coding for common types of skin cancer and their treatments.
Diagnosis coding for skin ulcers can be particularly confusing as different kinds of ulcers have their own etiology and associated ICD-10-CM code. Review ICD-10-CM coding and reporting for venous, pressure, and diabetic skin ulcers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our department has been having trouble reporting comas in ICD-10-CM. Are there any tools we can use to help us report these diagnoses more accurately?
CMS released the fiscal year 2020 IPPS proposed rule in April, which addressed various requests for MS-DRG designations, and in particular, the request for a new MS-DRG designation for chimeric antigen receptor T-cell (CAR-T) therapies that CMS subsequently denied.
Sarah Nehring, CCS, CCDS, says that from the inpatient coding and CDI perspective, sepsis can be one of the trickiest diagnoses. In this article, she reviews 10 things coders wish physicians knew about sepsis documentation and coding.
Adriane Martin, DO, FACOS, CCDS, reviews recent Coding Clinic, First Quarter 2019, advice, which includes guidance on reporting abdominal aortic aneurysm (AAA) repairs, spinal fusions, Whipple procedures, midline and central venous catheters, and more.
Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that due to the frequency of diagnoses and treatments for breast cancer, it’s more important than ever for inpatient coders to make sure they are reporting these diagnoses and procedures with the utmost accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The spread of acute flaccid myelitis (AFM), a serious, paralysis-inducing syndrome, is beginning to alarm epidemiologists who have yet to identify its cause. Recognize the first signs of AFM and learn how to report the condition using ICD-10-CM codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ recently released fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule includes 273 proposed ICD-10-CM code additions mainly affecting reporting for legal interventions, orbital roof fractures, and pressure-induced deep tissue damage. The code changes, if finalized, will take effect October 1, 2019.
