The most recent quarterly update to the influenza virus vaccine code set includes a new HCPCS influenza virus vaccine code approved for use in 2019, according to CMS Transmittal 4127.
Medicare guidelines for reporting arthroscopic shoulder surgeries have changed significantly over the past decade. Review updated guidance and CPT coding for SLAP repairs as well as biceps tenotomy and tenodesis procedures to reduce audit risk. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: I received confusing guidance regarding CPT coding for a segmental spinal fusion with pedicle screws placed at L3 and L4 vertebrae. Would it be appropriate to report CPT code 22612 with add-on code 22614 for this procedure?
Coding leadership can assist the chargemaster team by providing input, preparing appeals, and tracking coding-related denials. Rose T. Dunn, MBA, RHIA, CPA/CGMA, FACHE, FHFMA, CHPS , describes how to effectively work with a team of coders to combat continued denials.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews the key characteristics of physician visits administered to patients in skilled nursing facilities and E/M coding for these services.
Q: Our team is having a hard time determining a principal diagnosis for a patient with a history of stage 5 chronic kidney disease (CKD) who is receiving chronic hemodialysis and is in acute renal failure (ARF) with volume overload. Which ICD-10-CM code should be the principal diagnosis?
Allen Frady, RN-BSN, CCDS, CCS, CRC, says that defending code assignment against denials requires more than reviewing the denial to determine if the condition was coded and reported according to the coding guidelines; it requires an understanding of payer requirements as well.
Inpatient coding audits need to be tailored to the type of record being reviewed, the time it may take to complete the audit, and any compliance-related issues that may crop up. This article focuses on how coding managers can streamline these aspects to ensure a successful audit. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Early readmissions were more likely to be preventable and amenable to hospital-based interventions, according to a recent study published in the Annals of Internal Medicine.
William E. Haik, MD, FCCP, CDIP, writes that complex pneumonias can segregate to a higher-weighted MS-DRG than other pneumonia types, so reviewing clinical elements with your physician staff may help improve documentation and avoid adverse determinations by external reviewers for these conditions.
Age-related macular degeneration (AMD) is a leading cause of vision loss among people age 50 and older, according to the National Eye Institute. Debbie Jones, CPC, CCA , reviews ICD-10-CM coding for AMD and CPT coding for treatments used to slow the disease’s progression.
The American Medical Association recently released the 2019 CPT code set, which includes 335 code changes, primarily for skin biopsies, fine needle aspirations, and central nervous system assessments. All changes take effect January 1.
A nine-month audit conducted by a CDI specialist at a family practice and internal medicine clinic revealed 1,353 coding errors on physician-coded claims for outpatient office visits. Tammy Trombley, RHIT, CDIP, CCDS , reviews findings from this 2017 audit and discusses implications for risk-adjustment coding.
According to the American Academy of Orthopedic Surgeons, in 2013, 2 million people in the U.S. saw a physician for a rotator cuff problem. Review shoulder anatomy and CPT coding for rotator cuff repairs to improve coding accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If a CDI specialist doesn’t enter the queried diagnosis in his or her working DRG, but the physician responds favorably to the queried diagnosis at the time of coding (or during the retrospective query process), would you consider this in the reconciliation process? If yes, how would we capture this type of data?
The European Heart Journal recently published the fourth universal definition of myocardial infarction (MI). The newest definition, which supersedes all previous versions, includes new and updated clinical concepts as well as new sections of guidance.
Cathy Farraher, RN, BSN, MBA, CCCM, CCDS , details the basics of the All Patient Refined Diagnosis Related Groups (APR-DRG), the system developed to allow for a more specific analysis of outcomes in the non-Medicare population, and shows coders and CDI teams how to better capture quality metrics through documentation.
Adriane Martin, DO, FACOS, CCDS , writes that abdominal aortic aneurysms (AAA) are the most common type of aortic aneurysm, and the complexities surrounding AAAs make reporting procedures related to them difficult for even the most skilled inpatient coder.
The fiscal year (FY) 2019 IPPS final rule contains extensive changes pertaining to MS-DRGs. This article details some of the most notable MS-DRG updates including revisions to epilepsy with neurostimulators and pacemaker insertion classifications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To effectively report opioid use, abuse, and dependence, coding and billing professionals must be able to recognize symptoms of these disorders and interpret detailed ICD-10-CM guidelines. Additionally, they must be able to identify complications associated with opioid misuse and overdose.
Modifiers -25 and -27 are used in the outpatient facility setting on E/M services. Learn more about how these modifiers should be applied in accordance with coding and Medicare guidelines.
Summer has ended. For some, that marks the start of school, the beginning of football season, and the return of the pumpkin spice latte. If you are an inpatient coder or CDI specialist, it marks two full quarters worth of Coding Clinic advice.
This month we are pleased to introduce Mary Ann Polantz, RHIT, CCS, CCDS, who has 34 years of experience in coding and 45 years of experience in the healthcare industry. Mary Ann is currently a consultant at CBIZ KA Consulting Services, LLC, located in East Windsor, N.J.
Risk is the new buzzword in healthcare, right up there with denial. In fact, CDI programs often deploy physician advisors to assist with shared risk payment models, denial prevention, and improved outcome performance.
Working remotely can be either totally fulfilling or a bit difficult. If you’re a people person, you will miss the camaraderie of working in the hospital setting, the ability to problem solve by bouncing ideas off your coworkers, the gossip, and the potlucks. On the other hand, if you’re organized and self-motivated enough, enjoy peace and quiet, and prefer wearing your pajamas to work, remote might be right up your alley.
Cancer is so prevalent that it is virtually impossible to find anyone who hasn’t personally been affected by or known someone who has this disease. According to the American Cancer Society , in 2017, there were an estimated 1,688,780 new cancer cases diagnosed and 600,920 cancer deaths in the United States.
E/M code assignment for hospital admissions based solely on the provider’s documentation of face-to-face-time spent with a patient can be confusing and requires a detailed understanding of CPT guidelines. Lori-Lynne A. Webb , CPC, CCS-P, CCP, CHDA, COBGC , reviews reporting requirements for E/M visit levels based on the provider’s documentation of time and CPT coding for hospital admissions.
The October 2018 OPPS quarterly update introduced two new HCPCS codes and granted passthrough payment status to eight separately payable drugs and biologicals.
In 2017, the U.S. Department of Health and Human Services (HHS) declared a nationwide public health emergency to address the opioid crisis, investing almost $900 million in opioid-specific funding to support treatment and recovery services. Learn about the epidemic and review ICD-10-CM coding and guidelines for reporting opioid use, abuse, dependence, and overdoses.
Continuing with numerous requests for comment in last year’s OPPS proposed rule, CMS is once again asking stakeholders for feedback on a variety of issues for potential future rulemaking. Review OPPS proposals for quality measure changes and policies aimed at improving interoperability and the electronic exchange of information between providers.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , provides background on vaccinations and writes that coding for vaccine administration isn’t relegated to the outpatient coder; inpatient coders also have codes to report for vaccine administration. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Jennifer Cayce, RHIT, CCS, CCS-P, CPC , explores the conundrums of reporting acute kidney disorders due to confusing clinical terminology and addresses some of the problematic areas of nephrology diagnoses.
Q: We have a patient who is diagnosed as having acute renal insufficiency due to dehydration with decreased urinary output and was admitted for IV hydration. What diagnosis codes should we assign?
CMS recently released the fiscal year (FY) 2019 IPPS final rule with significant reductions to reporting requirements for quality initiatives, updates to payment rates, changes to CC/MCC designations, and revisions to various MS-DRGs.
Q: In what instance would septic shock not be coded as a principal diagnosis (PDX)? I’ve been under the impression that septic shock should always be reported as a PDX.
CMS and the National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting. Changes include clarification on the usage of “with,” updated sepsis guidance, and added guidelines for subsequent myocardial infarction.
Adriane Martin, DO, FACOS, CCDS, says that knowledge of coding guidelines and Coding Clinic advice, as well as an understanding of the spine anatomy and the spinal fusion procedure itself, can go a long way toward helping put together the pieces of the fusion puzzle.
Chris Simons, MS, RHIA, details way to improve querying across health information management (HIM), coding, and CDI departments since querying providers is a key strategy for improving documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Continuing with numerous specific requests for comment in last year’s OPPS proposed rule, CMS is once again asking stakeholders for feedback on a variety of issues for the 2019 OPPS proposed rule for future potential rulemaking. You may submit comments to the agency until September 24, 2018.
Along with quality measure removals in the 2018 OPPS and MPFS final rules, CMS has continued to propose additional removals in the 2019 proposed rules. In addition, the agency is proposing to add to its ability to remove quality measures in the future.
