CMS designates a certain set of procedures as inpatient-only, meaning it will only reimburse facilities for these procedures when they are performed in the inpatient setting. Inpatient-only procedures present numerous problems for hospitals.
Editor's note: Andrea Clark-Rubinowitz, RHIA, CCS, CPCH , has more than 30 years of experience working with healthcare professionals, information systems, hospital coding, and operational and compliance training. She founded and led Healthcare Revenue Assurance Associates from 2001 to 2014. Contact her at 954-465-0968 or aclark5678@gmail.com .
The October update to the OPPS and Integrated Outpatient Code Editor (I/OCE) includes a payment correction, in addition to new HCPCS codes and other changes. Dave Fee, MBA, reviews CMS' changes and details the retroactive payment correction.
Q: A patient was in a hyperbaric oxygen chamber for eight minutes and the physician had to abort the treatment because the patient was feeling anxious. Which HCPCS/CPT ® code should the hospital bill: HCPCS code C1300 (hyperbaric oxygen under pressure, full body chamber, per 30 minute interval) or an E/M code? Which code should the supervising physician bill: CPT code 99183 (physician or other qualified healthcare professional attendance and supervision of hyperbaric oxygen therapy, per session) or an E/M code?
CMS has instructed MACs to reprocess claims and providers to reimburse beneficiaries due to a miscalculated copayment for stereotactic radiosurgery, according to the October update to the OPPS and Integrated Outpatient Code Editor (I/OCE).
In this issue, we review coding for sprains, strains, and dislocations in ICD-10-CM, exmine how to audit for denials of inpatient only procedures, and offer tips for identify documentation shortcomings. Robert S. Gold, MD, discusses how to handle situations when what the physician says he or she did is not what the physician actually did.
CMS officially declared October 1, 2015, the new ICD-10 implementation date with the publication of a final rule, "Administrative Simplification: Change to the Compliance Date for the ICD-10-CM and ICD-10-PCS Medical Data Code Sets," in the August 4 Federal Register .
In its latest survey of the healthcare industry's ICD-10 readiness, the Workgroup for Electronic Data Interchange (WEDI) found that this year's delay negatively impacted provider progress, with two-thirds reporting slowing down or putting implementation initiatives on hold as a result.
Evaluation and management services continue to be a major target for auditors. In the second part of a series, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about frequently targeted areas providers can review in order to protect against audits.
Coders and clinical documentation improvement (CDI) specialists have different perspectives and priorities even on common diagnoses. HCPro boot camp instructors Shannon E. McCall, RHIA, CCS, CCS-P,...
With flu season just around the corner (hey, where did summer go?), Melissa took her 4-year-old son Andrew to Dr. Spock, the pediatrician, for his flu shot Wednesday. With a minimum of fuss (and a...
Recovery Auditors have uncovered incorrect secondary diagnoses in patients who underwent amputations for musculoskeletal and circulatory system disorders. CMS revealed the findings in its Quarterly Compliance Newsletter .
If coders choose the wrong root operation in ICD-10-PCS, they will arrive at an incorrect code. Nena Scott, MSEd, RHIA, CCS, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer, Gretchen Young-Charles, RHIA, Anita Rapier, RHIT, CCS, and Nelly Leon-Chisen, RHIA, discuss some of the root operation clarifications offered by Coding Clinic .
Q: Is it okay to code a diagnosis if the physician documents two diagnoses using the phrase “versus” between them? For example, the patient arrives with abdominal pain and the physician orders labs and other tests, but they all come back normal. In the discharge note, the physician documents “abdominal pain, gastroenteritis versus irritable bowel syndrome (IBS).” When I first started as a CDI specialist I was told we could not use diagnoses when "versus” was stated, and that we had to query for clarification.
Not feeling well? The problem could be in your small intestine. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, reviews common conditions related to the small intestine.
ICD-10 implementation and coding present plenty of challenges, especially when it comes to ICD-10-PCS. Sue Bowman, RHIA, CCS, and Donna Smith, RHIA, clear up some misconceptions about ICD-10 implementation and use.
Some days I swear I have the attention span of a hyperactive hummingbird or Dug the talking dog from the movie “Up.” Maybe what I really have is attention deficit disorder (ADD). How would you code...
Q: What if the provider states that diabetes is due to the adverse effects of a drug, but doesn't tell us which drug? How do we report that in ICD-10-CM?
CMS recently updated the Medicare Claims Processing Manual , with changes announced in Transmittal 3020 , to include ICD-10-specific language ahead of next year's implementation.
Most diabetes codes in ICD-10-CM include more details than ICD-9-CM codes, but coders also need to consider additional codes. Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, MHP , and Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, review key aspects for coding diabetes in ICD-10-CM.
ICD-10-CM readiness goes beyond training coders on the new code set. Rhonda Buckholtz , Wendy Aiken, and Sid Hebert, look at the impact of implementation on physicians and payers, and how providers can ease the transition.
ICD-10 implementation will impact different specialties and hospital departments in distinct ways. Andrew D. Boyd, MD, and Neeta K. Venepalli, MD, MBA , recently conducted a pair of studies to determine the financial and informational impact of ICD-10 on a variety of specialties.
CMS is currently hosting an ICD-10 "Code-a-thon" (a title which instantly brings to mind all of the PBS pledge drives I’ve unwittingly watched). One of the questions that has come up repeatedly is...
Ebola has been in the news quite a bit recently and it’s actually a good global case study for why we should be using ICD-10-CM codes. ICD-9-CM does not include a specific code for Ebola. It gets...
The 2015 IPPS final rule focused on quality measures. James S. Kennedy, MD, CCS, CDIP, and Cheryl Ericson, MS, RN, CCDS, CDI-P, highlight the changes and explain the role of coding in quality scores.
ICD-10-PCS root operations Control and Repair are used when a procedure doesn’t really fit into a different root operation. Nena Scott, MSEd, RHIA, CCS, CCS-P, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS , discuss when coders should use these two root operations.
Q: We’re having a lot of discussions with physicians right now and need to get some clarity on acute cor pulmonale versus chronic. Do you have any insight on that differentiation between the two with right-sided heart failure, chronic obstructive pulmonary disease (COPD), shortness of breath, and edema?
In part 2 of his series on medical necessity and coding, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, examines medical necessity and the 2-midnight rule using a case study.
CDI programs are essential to an organization’s efforts to move forward with ICD-10 implementation and training. Join us at 1 p.m. September 10 for the live 90-minute webinar, Dual Coding/CDI:...
The truth is often stranger than fiction because fiction has to make sense. Apparently a panda in China figured out that pregnant pandas get better treatment, so she pretended to be expecting ...
The ICD-10-CM delay has at least one silver lining: the ability to spend more time on coding and documentation requirements before implementation. Providers may want to also think about aligning their ICD-10-CM efforts with outpatient clinical documentation improvement (CDI) during this time. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, examines the benefits and challenges of outpatient CDI programs.
The 2015 OPPS proposed rule includes new Comprehensive APCs, increased packaging, and many other changes. Kimberly Anderwood Hoy Baker, JD, and Jugna Shah, MPH , review the proposed rule and policies that may be finalized by CMS.
Q: We're not sure what to report in this situation: A patient comes to the ED and goes into respiratory failure. The respiratory therapist comes in to put patient on a vent in the ED, then the patient is transferred to another facility. We can’t report CPT ® code 94002 (ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day) because it is for inpatient/observation, per the definition. We wondered about using 94660 (continuous positive airway pressure ventilation [CPAP], initiation and management) for the CPAP. The lay description seems to be basically the same as 94002, except for “applies to ventilation assistance using adjustments in volume and pressure on the initial day…" Would 94660 be appropriate?
CMS is introducing four new HCPCS modifiers to specifically define subsets of modifier -59 (distinct procedural service), the most frequently used modifier.
Evaluation and management (E/M) services are one of the top areas of review by federal auditors. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about common errors found in audits and how providers can take steps to correct them.
Labor Day marks the unofficial end of summer, and hopefully, the end of patients with picnic-induced problems at the Fix ‘Em Up Clinic. The first patient in on this Tuesday after Labor Day is Sam...
CMS refined and updated its Comprehensive APC policy in the 2015 OPPS proposed rule released July 3, adding a new complexity adjustment factor. CMS also proposes significantly expanding the packaging of ancillary services. Additionally, the proposed rule includes a significant change to requirements related to inpatient physician certification.
Quality measures, such as the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program, form the basis of the 2015 IPPS final rule, released August 4.
When CMS releases rules, the length can be intimidating. But even at a relatively slim 700 pages, the 2015 OPPS proposed rule isn't able to include details on each of the changes CMS is planning. This is probably a good thing?otherwise the rules could be thousands of pages long. Updates like codes being moved around or status indicators changing often aren't described in full in the narrative text, necessitating a deeper look at the addenda CMS releases as Excel® files on its website.
ICD-10 implementation and coding present plenty of challenges, especially when it comes to ICD-10-PCS. Plenty of myths are also floating around and some of them fairly prevalent. One way to make sure the most recent ICD-10 implementation delay is the last ICD-10 implementation delay is to bust some of these myths.
In this month's issue, we examine the quality measures in the 2015 IPPS final rule, debunk seven myths about ICD-10, and explain what coders can do to prevent another ICD-10 implentation delay. In addition, Robert S. Gold, MD, discusses the importance of ethical coding.
As the largest organ in the body, the skin is subject to a number of diseases and conditions. With ICD-10-CM, coders will report these conditions with a much higher degree of specificity.
