The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
I wanted to share some interesting numbers from Torrey Barnhouse's presentation at the AHIMA ICD-10 Summit in Baltimore. Torrey is the founder and president of TrustHCS, which conducted an industry...
Trust is a basic human emotion. It allows us to explore out surroundings and grow. You can't expect grouth or change without trust. Cindy Seel, MSA, RHIA, director of education and training at HRS,...
Any healthcare organizations are considering computer-assisted coding (CAC) to help minimize the expected coder productivity decline in ICD-10. Lisa Knowles-Ward, RHIT, coding and reimbursement for...
ICD-10 implementation is only 18 months away. Sounds like a long time, doesn't it? It's really not, Kathleen Frawley, JD, MS, RHIA, FAHIMA, told attendees at the 2013 AHIMA ICD-10 and CAC Summit in...
By now you have probably heard that you need to train more than just your coders on ICD-10. Shelley Weems, RHIA, CCS, implementation lead for the Health Information Management Program Office for the...
More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on. Andrea Clark, RHIA, CCS, CPC-H, CEO, Debbie Mackaman, RHIA, CHCO, and Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , explain how coders and their organizations can benefit from internal audits.
At first glance, the new CPT ® codes for reporting molecular pathology services might seem simple. They certainly look easier than the old stacking codes that focused on methodology and processes, resulting in multiple codes and quantities being used to report a single test. Jugna Shah, MPH, and Michelle L. Ruben, detail some of the nuances of correct code assignment for molecular pathology tests.
CMS added seven CPT ® codes to the conditionally bilateral list as part of the April update to the Integrated Outpatient Code Editor. When a provider performs a conditionally bilateral service bilaterally, coders must append modifier -50 (bilateral procedure) to the code.
Q: A physician's office collects a pap specimen and sends the specimen to the hospital lab for processing. The physician's office lists ICD-9-CM code V72.31 (general gynecological examination with or without Papanicolaou cervical smear) as the diagnosis for this service. What is the proper diagnosis code for the hospital to use for billing when only processing the specimen?
How often do you default to an unlisted code or a non-specific code in ICD-9 because the physician just didn’t document enough information? For example, how many times do you see documentation...
Here’s a stat that will come as no surprise to most coders: approximately 50% of physicians, physician assistants, and nurse practitioners have no clue about ICD-10. Of the remaining 50%, only a very...
Editor’s note: For purposes of today’s example, we are ignoring medical necessity. We’re going to say Sidney is an inpatient. In the real world, he would need to meet the criteria for an inpatient...
Change is consistently a part of HIM and coding. Rules, regulations, and codes change yearly and sometimes quarterly. Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, reveals why the switch to ICD-10 is different from the annual changes coders are used to and how coders and organizations can prepare.
Three out of four providers have completed only 25% or less of their ICD-10-CM/PCS conversion process, according to an ICD-10 snapshot survey conducted by the Aloft Group in February. However, CMS and others are busy helping to ensure that providers and payers are ready for the transition to ICD-10-CM/PCS.
Choosing the correct root operation may be one of the most challenging aspects of ICD-10-PCS. Sandra Macica, MS, RHIA, CCS, and Kristi Stanton, RHIT, CCS, CPC, define some of the root operations in the surgical section of ICD-10-PCS and explain when to report them.
Q: Using the ICD-10-CM guidelines for the seventh character extensions for fracture codes, how should I identify each of the following? Avascular necrosis following fracture Cast change or removal Emergency treatment Evaluation and management by a new physician Follow-up visits following fracture treatment Infection on open fracture site Malunion of fracture Nonunion of fracture Medication adjustment Patient delayed seeking treatment for the fracture or nonunion Removal of external of internal fixation device Surgical treatment
Many organizations are concerned about the expected drop in coder productivity after the transition to ICD-10. Angie Comfort, RHIT, CDIP, CCS, discusses the pros and cons of using computer-assisted coding to help offset those productivity losses.
Never do today what you can put off till tomorrow. Maybe that worked for Aaron Burr, but it doesn’t really work for the ICD-10 transition. I’ve seen some disturbing numbers about ICD-10 preparation...
Anytown’s baseball team just completed its home opener and while the team came away with a win, not all of the players made it through the game. Eddie the outfielder suffered a painful run-in with...
Will you be ready for ICD-10? The ICD-10 implementation date draws closer by the day and CMS wants to help you make sure you’re ready. CMS is hosting a national provider call to discuss ICD-10...
With no national guidelines in place for facilities to use to determine evaluation and management (E/M) level, coders must apply their facility’s guidelines when coding an outpatient visit. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, and Joanne M. Becker, RHIT, CCS, CCS-P, CPC, CPC-I, use three ED case studies to highlight potential pitfalls for ED E/M leveling.
Breast biopsies should be easy to code because coders have so few codes to assign, but it is one area where documentation is lacking. Stacie L. Buck, RHIA, CCS-P, RCC, CIC, reveals what key elements coders should look for in a breast biopsy note.
CMS added numerous device/procedure edits as part of the April update to the Integrated Outpatient Code Editor . To avoid triggering the edits, coders must report particular procedure codes and device codes together on the claim form.
Q: We received an outpatient radiology report (exam performed 7/11/12) where the radiologist states: CLINICAL INDICATION: LUMBOSACRAL NEURITIS EXAM: LUM SPINE AP/LAT CLINICAL STATEMENT: LUMBOSACRAL NEURITIS COMPARISON: MAY 23, 2012 FINDINGS: There is posterior spinal fusion L-3-L-5 with solid posterolateral bridging bone graft. Pedicle screws and rods are stable in position. There are bilateral laminectomy defects at L3-L-4. The vertebral body and disc space heights are preserved. The spinal alignment is maintained without evidence of spondylolisthesis. No acute fracture is identified. No lytic or blastic lesions are seen. The sacroiliac joints are unremarkable. IMPRESSION: Stable postsurgical changes with solid posterolateral fusion graft. Would you use the following ICD-9 codes: V67.09, 724.4. or 724.4, V45.4? Our coders disagree.
CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them from line-item edits to date-of-service edits, effective April 1. Jugna Shah, MPH, Kathy Dorale, RHIA, CCS, CCS-P, John Settlemyer, MBA/MHA, and Valerie Rinkle, MPA, explain how the change could affect coding and reimbursement.
In this month's issue, we discuss the upcoming changes to the Medically Unlikley Edits, review current coding for molecular pathology coding, and offer tips for auditing records. In addition, our experts answer your questions.
DRGs for procedures unrelated to the principal diagnosis shouldn't occur frequently. If they do, coding managers should take a closer look at coding compliance efforts to ensure accuracy and avoid costly audits.
DRGs for procedures unrelated to the principal diagnosis shouldn't occur frequently. If they do, coding managers should take a closer look at coding compliance efforts to ensure accuracy and avoid costly audits.
Being audited is rarely fun. After all, you're probably going to lose money, face a fine, or both. More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on.
Although coders and billers don't play a role in determining whether condition code 44 is appropriate, they most certainly ensure correct billing of the code.
Editor's note: Facilities need to address coding, payment, and coverage issues for molecular pathology. This article is the first in a series and discusses molecular pathology coding.
CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them from line-item edits to date-of-service (DOS) edits, effective April 1.
Our experts answer questions about, modifier -25, cardioversion performed during an ED code, denials for multiple port film line items, and procedure discontinued after administration of anesthesia.
When Lori Belanger, RN, BSN, RHIT, inpatient coder and CDI specialist at Northern Maine Medical Center in Fort Kent, Maine, began to practice coding charts using ICD-10-CM/PCS, she was a bit surprised by how much her productivity decreased.
CMS Transmittal 1199 updates the national coverage determination (NCD) hard-coded shared system edits to include ICD-10-CM codes. CMS included 30 spreadsheets with the transmittal. The spreadsheets...
Office politics are a fact of life, but can lead to poor or unjust outcomes. Lois Mazza, CPC, offers tips to help coders navigate the political waters in the office.
The OIG is taking a closer look at mechanical ventilation, according to its FY 2013 Work Plan. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explain why your facility should do the same.
Q: Can you clarify the requirements surrounding the use of E codes? We have been working on documentation concerns related to patient safety indicator (PSI) 15 and wonder if E codes are required. Can a facility simply decide not to use them?
Coded data is incredibly important to a wide range of people. Bill Rudman, PhD, RHIA, Roxanne Andrews, PhD, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Susan Beever, RHIT, CCS, reveal how accurate coding aids research and law enforcement and improves quality of care.
Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the four Recovery Auditors in FY 2013 first quarter (October 2012–December 2012), according to the most recent release of improper payment statistics .
When last we left our intrepid hero, Luke Skywalker, he was well on the road to recovery after being bashed by a wampa and spending the night in the belly of a Tauntaun. Now he’s off to the Dagobah...
Q: A patient received Toradol 30 mg IV and Zofran 4 mg IV at 14:38. He also had normal saline wide open with documented start of 14:30 and stop of 15:40. Is the hydration chargeable as 96361 (intravenous infusion, hydration; each additional hour) even though the initial service is not 90 minutes? Is the hydration a concurrent service?
In the coding world, it’s a never-ending clash that can cause compliance concerns—facility vs. professional. Kimberly Anderwood Hoy, JD, CPC , and Peggy Blue, MPH, CPC, CCS-P, explain how coders in each setting use different codes for the exact same services based on the payment systems, the rules, and how each setting applies those rules.
Evaluation and management (E/M) coding is incredibly subjective. Two coders can look at the same documentation and choose two different E/M levels and both will be able to justify their choice. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer , Lori Owens, RHIT, CCS, and Deborah Robb, BSHA, CPC, discuss how electronic medical records can complicate E/M coding even more.
CMS added 410 new codes and seven new therapy and patient condition modifiers to the Integrated Outpatient Code Editor (I/OCE) as part of the January 2013 update. Dave Fee, MBA, highlights the key changes to the I/OCE.
On March 13, CMS issued a notice of ruling that establishes a policy that revises the current policy on Part B billing following the denial of a Part A inpatient hospital claim that a Medicare review contractor deemed to be not reasonable or necessary. The revisions are intended as an interim measure until CMS can finalize an official policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council decisions going forward.
We all know that procedure coding will change considerably on October 1, 2014 with the implementation of ICD-10-PCS. But what about change as an ICD-10-PCS root operation? In ICD-10-PCS, you will use...
The first series of codes in both the ICD-9-CM and ICD-10-CM manuals are infectious and parasitic diseases. What a fun (cough, cough) place to start. The very first disease listed in the ICD-9-CM...
Recovery Auditors are currently performing prepayment MS-DRG validation and coding reviews of MS-DRG 312 (syncope and collapse). Ralph Wuebker, MD, MBA, and Stacey Levitt, RN, MSN, CPC, discuss the scope of the new reviews and what coders need to look for in documentation of syncope.
