Outpatient coders currently report procedures using CPT codes. That won’t change after the switch to ICD-10. However, some facilities currently require outpatient coders to also report procedures...
QUESTION: I work for a gastrointestinal (GI) practice and I have a question regarding the correct sequence for adding diagnosis codes to a claim. I have advised our physicians and billers that the primary diagnosis code is always the reason for the visit. I am a little confused about the remaining diagnosis codes the physician will write down in no specific order. Billers will report codes in the order the physicians write down the diagnoses and not always the reason for the visit. For example, a patient is referred for a consult due to weight loss. The patient comes for the consult and the physicians may put down 787.29 (other dysphagia), 401.1 (benign hypertension), 783.21 (abnormal loss of weight), 787.99 (change in bowel habits) in this order and leave it up to the person entering the info to figure it out. I would report 783.21 first since that was the reason for the visit but then I’ve been putting the GI codes next and then anything else last. What is the correct sequence when adding diagnosis codes to a claim?
CMS proposed extending the delay on enforcement of physician supervision rules for critical access hospitals and small and rural hospitals with 100 or fewer beds for one final year as part of the 2013 OPPS proposed rule. Debbie Mackaman, RHIA, CHCO, and Jugna Shah, MPH, detail some of the more significant proposals for 2013.
Hospital medicine is a specialty that provides inpatient services for patients admitted to the hospital. Hospitalists are often called on to consult in regards to and to follow medical problems that occur during hospitalization for surgery, psychiatric hospitalizations, and obstetrical patients. Lois E. Mazza, CPC, explains how to correctly report hospitalist services.
The Hospital Outpatient Payment Panel recommended CMS change the supervision requirements for 15 HCPCS and CPT ® codes during its second meeting this year in August. CMS released details of the meeting September 24.
Accurate reporting of observation services depends on a lot of factors. Deborah K. Hale, CCS, CCDS, and Cheryl Staley, RHIA, CCS, walk though five case studies to explain the ins and outs of observation coding.
Legendary Green Bay Packers coach Vince Lombardi once described the ideal linebacker as agile, hostile, and mobile. Sadly, some of our local linebackers are significantly less agile and somewhat...
The rugby players who come into the Fix ‘Em Up Clinic are a pretty tough group. They can shrug off broken ribs, downplay dislocations, and boast about bruises. They are no match for gnats, though...
We all know coder productivity will go down after the transition to ICD-10 and it may never rebound to current levels. The question is, how much will productivity decline? It could drop more than you...
Inpatient-only procedures are those that CMS has determined providers must perform on an inpatient basis. Kimberly Anderwood Hoy, JD, CPC, and Beverly Cunningham, MS, RN, unravel the complexities of coding for these procedures.
Provider documentation of inpatient wound care services may be confusing at best and completely lacking at worst. Coders end up trying to decipher exactly what procedure the provider performed. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, and Robert S. Gold, MD, offer tips to assist coders in choosing the correct code for inpatient wound care.
The OIG estimates that Medicare Administrative Contractors paid $8.4 million in overpayments to inpatient rehabilitation facilities (IRFs) because IRF and Medicare payment controls did not adequately identify late submissions of patient assessment instruments.
Q: I have a question about coding transplant complications. My understanding is if the complication affects the transplanted organ, then coders should assign a code for the transplant complication itself. Is this correct? Consider the following physician documentation: Final A/P: Acute renal failure in patient with history of renal transplant. Should coders report 996.81 (complications of transplanted kidney) and 584.9 (acute kidney failure, unspecified)? Also consider this documentation: CHF in heart transplant patient . Should coders report 996.83 (complications of transplanted heart) and 428.0 (CHF, unspecified)?
The HIM profession is constantly changing, but HIM professionals are still responsible for maintaining the integrity of the health records. Lou Ann Wiedemann, MS, RHIA, FAHIMA, CPEHR, explains why HIM professionals can—and should—also play a role in clinical documentation improvement (CDI).
News flash: The sky is NOT falling. You don’t need to press the panic button when you think about the transition to ICD-10. It’s time to prepare, practice, and plan. The transition will be a huge...
How tired are you of hearing the phrase “documentation, documentation, documentation” as you prepare for ICD-10? I have a new phrase that you’ll soon dread as well: “Practice, practice, practice.”...
Got an ICD-10 question? Answers are coming soon. ICD-10 implementation is still almost two years away, but the American Hospital Association’s Coding Clinic will add an ICD-10 section starting in the...
Hospitals and physician practices are used to being in competition with each other and maintaing a veil of secrecy over internal operations. Well, that’s not really limited to just healthcare, it...
In this month's issue, we examine correct coding for critical care, review shoulder anatomy to prepare for ICD-10, unravel coding confusion for chronic kidney disease, and answer your coding questions.
As you may know, ICD-9-CM V codes have been expanded to include higher body mass indexes (BMI). More specifically, code category V85.4x denotes a BMI of 40 or more in an adult. How can you calculate BMI?
Learn about the 2013 IPPS final rule, inpatient-on;y procedures, asthma terminology in ICD-10, computer-assisted coding, and body mass index calculation.
Now that CMS has finalized a 2014 implementation date for ICD-10-CM/PCS, increasingly more hospitals may turn to computer-assisted coding (CAC) to help ease the transition and mitigate anticipated productivity losses, says Angie Comfort, RHIT, CCS, director of HIM solutions at AHIMA in Chicago.
Coders play a crucial role in ensuring compliance, and the FY 2013 IPPS final rule , released August 1, gives them many reasons to showcase their skills.
When the AMA revised the instructions for reporting ancillary services with critical care in 2011, facilities knew they wouldn't see an immediate increase in payment. CMS determines payment amounts through use of claims data from two years earlier, meaning the earliest facilities could expect additional reimbursement is 2013.
Our coding experts answer your questions about coding for hysteroscopy prior to ablation, appending modifier -59 for MRI and MRA, charging for venipunctures, therapy caps under OPPS, reporting limits for Provenge®, modifier -59 and infusion therapy, Reporting TEE pre- and post-operativley, coding for toxic metabolic encephalopathy
Inpatient-only procedures are those that CMS has determined providers must perform on an inpatient basis because they are invasive and require at least 24 hours of postoperative recovery time or monitoring.
The transition to ICD-10 code set is expected to be one of the most substantial changes in medical coding history and providers and payers need to start preparing now. Undoubtedly, you still have...
Wouldn’t it be nice if the physician documented a definitive diagnosis for every patient at the time the patient left the office, clinic, or hospital? We know that will never happen. Sometimes, the...
Coders play a crucial role in ensuring compliance, and the FY 2013 IPPS final rule , released August 1, gives them many reasons to showcase their skills. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, detail the changes and how coders can take charge of them.
Patients aren’t the only ones paying attention to quality scores these days. Payers are, too. Cheryl Manchenton, RN, BSN, and Audrey G. Howard, RHIA, explain why coders and clinical documentation improvement specialists must understand which conditions affect provider profiles.
Providers may find themselves with a completely new definition of the term inpatient if CMS follows through with its intent to clarify this ever-confusing patient status, as explained in the 2013 OPPS proposed rule published July 30. The agency solicits input from providers on pp. 45155-45157 of the rule and suggests that it may implement fairly significant changes going forward.
Coders are the backbone of an organization’s fiscal health. Timely coding leads to timely revenue collection. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, discusses why coders must be willing to look beyond their traditional roles to help ensure the continued financial viability and success of the organization.
Football season is underway in Anytown and we have some crazy players coming in to Fix ‘Em Up Clinic with some crazy-looking knee injuries. Quarterback Tom is in after suffering an unhappy triad of...
What do you know, bubonic plague is still hanging around. It seems like we should have eradicated it by now. Turns out, if you go to the desert southwest and play with dead animals you too can...
Dr. Cap I. Larry is back at work on some blood vessels at Stitch ‘Em Up Hospital. Let’s see what she’s up to today. For all of Dr. Larry’s procedures, we’re going to be coding from the Medical and...
ICD-10-CM coronary artery disease and myocardial infarction codes will undoubtedly differ from their ICD-9-CM counterparts in some ways, but certain aspects will remain the same. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, explain what coders need to know about reporting these conditions.
Coders are already familiar with the Table of Drugs in ICD-9-CM, but they will find some important differences in ICD-10-CM. Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Ann Zeisset, RHIT, CCS, CCS-P, walk through the key similarities and differences in the Table of Drugs.
The publication of the final rule officially announcing a change in the ICD-10 compliance date from October 1, 2013 to October 1, 2014, ends the uncertainty surrounding ICD-10 implementation that has plagued the healthcare industry. Sue Bowman, MJ, RHIA, CCS, FAHIMA, details what healthcare organizations should be doing now to prepare.
Athenian philosopher Socrates famously drank poisonoud hemlock after being found guilty of corrupting the minds of the youth of Athens and of impiety for not believing in the gods of the state...
Ever have one of those nights when you just can’t sleep? Maybe you’re awake fretting about the transition to ICD-10. Or maybe you had one too many cups of coffee. Never fear, we have plenty of ICD-10...
Today we are taking a peek into OR 3 at the Stitch ‘Em Up Hospital to watch Dr. Cap I. Larry work on some blood vessels. Then we’re going to code her procedure. Dr. Larry is harvesting part of the...
Many of us are perfectly content with our present jobs. As coders, we may be thrilled to have secured a coding position that’s both challenging and satisfying. Others may feel differently about their work. Lois Mazza, CPC , discusses how to decide when to look for a new job and how to secure it.
Do you audit records before sending them to your Recovery Auditor? If not, your hospital may be one of many that simply doesn't have the resources to do so. Lori Brocato, Cathie Eikermann, MSN, RN, CNL, CHC, and Laura Legg, RHIT, CCS, reveal why hospitals should consider auditing records before sending them to the Recovery Auditor.
Providers are urging CMS to reconsider its current ICD-10 education and outreach strategy to ensure that providers are prepared to implement the new code set. CMS published and addressed specific provider comments in a final rule released August 25 that confirms the delay of ICD-10 to October 1, 2014.
Q: I need further clarification regarding documentation of toxic metabolic encephalopathy. I’m trying to code two different cases in which a physician documents acute mental status change secondary to an infectious process . In each case, the patient’s metabolic panels don’t appear to be abnormal; however, one of the patients is septic. The physician thinks that documenting and coding sepsis separately from encephalopathy would result in unbundling. However, I disagree because coding the sepsis separately demonstrates severity. What is the correct logic to use in each of these cases?
