Program for Evaluating Payment Patterns Electronic Report compares hospital data regarding a variety of benchmarks. John Zelem, MD, FACS, and Brenda Hogan, RN, BS, explain how hospitals can use PEPPER to identify risk areas and create a plan for self-auditing.
By now, you probably know that ICD-10-PCS codes contain seven alpha-numeric characters. Each character represents a specific piece of information and those meanings can vary by section. In the...
If you have looked at the ICD-10-PCS Manual, you know that the codes are arranged in tables based on the first three characters of the code. The table contains all of the possible choices for...
Physicians and facilities use the same codes to report evaluation and management (E/M) levels for emergency department (ED) services, but follow different rules. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, and Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, explain how to correctly choose the most appropriate E/M code for ED services.
CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6. One has to do with how CMS proposes to calculate APC relative weights; the other addresses the reimbursement level for separately payable drugs and biologicals without pass-through status. Jugna Shah, MPH, and Debbie Mackaman, RHIA, CHCO, discuss the proposed changes for OPPS payment.
Providers will now soon need only one unique health plan identifier when billing insurance companies. CMS finalized the Administrative Simplification: Adoption of Standard for Unique Health Plan Identifier rule released August 24.
QUESTION: I work in an urgent care setting and need to know if we can bill an administration code for injection of Toradol. For example, a patient comes in, and the provider performs an E/M and administers 60mg Toradol intramuscular. I have not been charging for it, thinking it’s bundled into the E/M.
Labor Day might mark the unofficial end of summer, but we have plenty of summer-related injuries today at the Fix ‘Em Up Clinic. Our first guest of the day, James, went rock climbing for the first (...
In this month's issue, we review the proposed changes in the 2013 OPPS proposed rule, compare coding for diabetes in ICD-9-CM, ICD-10-CM, and answer reader questions.
Many coders can quickly quote the code for diabetes mellitus in ICD-9-CM (code 250.00) when the physician only documents diabetes mellitus. But what will coders need in the documentation for diabetes mellitus in ICD-10-CM? Dissect the differences in coding for diabetes mellitus in ICD-9-CM and ICD-10-CM.
Do you audit records before sending them to your Recovery Auditor? If not, your hospital may be one of many that simply don't have the resources to do so.
Our coding experts answer questions about reporting dialysis for ESRD patient in ED, coding for sequential infusions, procedures on the inpatient-only list, replacement code for C9732, and new drug HCPCS codes.
Information received by TMF Quality Institute during the past year indicates that 61% of hospitals use PEPPER data to guide their auditing process and help them focus on areas of potential vulnerability.
Learn about ICD-10-CM stroke and coma codes, how coding and clinical terminology differences make coding complications difficult, why code evolution is sometimes for better and sometimes for worse, how self-audits benefit the Recovery Audit process, how PEPPER benefits an audit program, and how to help physicians understand what coders need.
Coding managers and their team members sometimes must approach physicians in person regarding documentation. Clarification may be necessary, or perhaps you will need to coax the physician to complete certain records without further delay.
CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6. One has to do with how CMS proposes to calculate APC relative weights; the other addresses the reimbursement level for separately payable drugs and biologicals without pass-through status.
Welcome to Stitch ‘Em Hospital, where we’re preparing for ICD-10-PCS by actually coding some of our procedures using the new system. We want to make sure we’re ready to go on October 1, 2014, and...
HHS will delay implementation of ICD-10 by one year, from October 1, 2013, to October 1, 2014. HHS announced the delay as part of the Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10thEdition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets final rule released August 24.
Neoplasm coding in ICD-10-CM is similar to the current ICD-9-CM coding. Most benign and all malignant neoplasm codes are found in chapter 2 of ICD-10-CM, just as in ICD-9-CM, according to Betty Hovey, BA, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC. She explains some of the ICD-10-CM guidelines for proper coding.
Retain. Train. Assess. Investigate. Analyze. HIM professionals have undoubtedly come across action verbs like these since HHS announced the replacement of the ICD-9-CM code set with the more advanced ICD-10-CM code set currently used in other nations. Mark Jahn, Luisa Dileso, RHIA, MS, CCS, and James S. Kennedy, MD, CCS, CDIP, explain what HIM professionals need to do over the next two years to be ready for the final implementation date of October 1, 2014.
ICD-9-CM and ICD-10-CM stroke and coma codes reveal many similarities and some important differences. Alice Zentner, RHIA, and James S. Kennedy, MD, CCS, CDIP, explain the changes and what coders need to know to prepare for ICD-10-CM stroke and coma coding.
We’ve all heard of deranged killers, but have you ever heard of a deranged knee? Better yet, can you code for it? Coding for a derangement isn’t new. We have derangement codes in ICD-9-CM. For...
HHS will delay implementation of ICD-10 by one year, from October 1, 2013 to October 1, 2014. HHS announced the delay August 24 as part of the Administrative Simplification: Adoption of a Standard...
Penny came into the Fix ‘Em Up emergency department Friday, complaining of tingling and numbness in her face and arm. She was also somewhat unsteady on her feet. Her husband Dave also reported Penny...
Q. When is it appropriate to append modifier -74 (procedures discontinued after anesthesia administration or after the procedure has begun) or -73 (procedures discontinued prior to anesthesia) instead of to modifier -52 (reduced service)? Is there more than anesthesia that determines their use? The report below was coded with CPT ® 62311 (injection[s] of diagnostic or therapeutic substance[s]…; lumbar or sacral [caudal]). I asked the coder if modifier -74 should be appended, and the coder said that -52 should be appended. Is this correct? Procedure: Attempted lumbar midline interlaminar epidural steroid injection L5-S1 with fluoroscopy After identifying the L5-S1 interlaminar space fluoroscopically, the skin was sterilely prepped and draped. The skin and subcutaneous tissue were anesthetized with 1% lidocaine. Utilizing a loss of resistance technique and intermittent fluoroscopic guidance, an 18 gauge Tuohy needle was utilized to approach the epidural space. I was not able to successfully identify the epidural space secondary to encountered resistance. The needle depth was checked on lateral views and noted to be superficial to the epidural space when resistance was encountered. We were going to utilize a caudal approach, however skin breakdown was noted. At this point, I elected to have her return for care in 2 weeks and get the skin breakdown in the caudal area treated.
Coders face many challenges when coding for services provided by teaching physicians, interns, residents, and students. Medicare has specific rules and regulations surrounding what services it will pay for when an intern, a resident, or a student provides services. Lori-Lynne A. Webb, CPC, COBGC, CCS-P, CCP, CHDA, details what coders need to see in the documentation before reporting these services.
Some wounds and conditions don’t respond to conventional therapies and treatment modalities. In those cases, providers may consider hyperbaric oxygen therapy (HBO). Gloria Miller CPC, CPMA, and Todd Sommer, DO, DPM, CWS, review the conditions eligible for HBO therapy and correct code assignment for these services.
When is in appropriate to use modifier -59 to override coding edits? When is another modifier more appropriate? Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, and Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS , explain the appropriate use of modifier -59.
We’ve hit the middle of August and Anytown’s summer adult baseball league is winding down its season. Just like the pros, though, our players haven’t escaped injury free. Randy, the league’s top...
What do cubism and coding have in common? Both can be viewed as art forms. Joel Moorhead, MD, PhD, CPC, details the three steps that the coding artist performs in reassembling medical record elements into abstracted form.
Q: A patient has been diagnosed with peritonsillar cellulitis and oropharyngeal cellulitis. The physician documents that he performed a “needle aspiration of the left peritonsillar abscess.” In the body of the operative report, the physician states, “An 18-gauge needle was inserted and 1 cc of pus was aspirated. This was sent for aerobic, anaerobic, C&S [culture & sensitivity], and gram stain. I then put the 18-gauge needle in again and multiple passes were obtained without any aspirate.” Because ICD-9-CM does not include a code for “aspiration of peritonsillar abscess” some coders wanted to use ICD-9-CM procedure code 28.0 (incision and drainage of tonsil and peritonsillar structures) while others want to report code 28.99 (other operations on tonsils and adenoids). Which code is correct?
CMS officially announced the Recovery Auditor prepayment review demonstration in November 2011, but then in January 2012 decided to delay the program by three months. Since then—despite rumors that the program could be coming soon —the official start date has been unknown to the public. This changed however, when CMS announced Friday, August 3, that Recovery Auditor prepayment reviews will begin August 27.
Physicians often use the acronyms IBS (which should indicate irritable bowel syndrome) and IBD (which should indicate inflammatory bowel disease) interchangeably even though they represent completely different conditions with different treatment and prognoses. Robert S. Gold, MD, and Drew K. Siegel, MD, CPC, offer tips on how to decipher documentation related to these two conditions.
Diseases of the ear and mastoid process are moving up in the ICD-10-CM world. They’re getting their own chapter. In ICD-9-CM, eyes and ears shared a section. You’ll find diseases of the ear in...
We’re one step closer to knowing whether the Department of Health and Human Services (HHS) will actually delay ICD-10 implementation and if so, by how long. The Office of Management and Budget (OMB)...
The dogs days of summer have arrived so the residents of Anytown descended on the dog park with their furry friends today. Sadly, not all of the puppies (and people) play well together and some of...
As part of the July update to the Intergrated Outpatient Code Editor, CMS reinstated HCPCS C1882 to the list of acceptable devices for CPT code 33249. Dave Fee, MBA, explains the implications of the change and reviews code changes included in the update.
Physicians can perform three different types of wound debridement and coders will find different codes for each type. Gloria Miller, CPC, CPMA, and John David Rosdeutscher, MD, discuss the different types of debridement, as well as coding and documentation requirements.
Inpatient facilities received mixed news on proposed changes to the list of complications and comorbidities (CC) and major CCs (MCC) in the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) final rule , released August 1.
Observation services can generate so much confusion that CMS actually asked for comments on observation and inpatient status as part of the 2013 OPPS proposed rule. Kimberly Anderwood Hoy, JD, CPC, and Deborah K. Hale, CCS, CCDS, help coders unravel the complexities of observation services.
QUESTION: A patient complained of intractable pain from compression fracture (sustained the day prior to admission). The guidelines state if pain is not documented as acute or chronic, don't assign codes from the 338 category. Should we query the physician if the pain was acute or chronic rather than just using the fracture code if it appears that pain control was the main reason for the visit?
When a physician places a device that takes the place of all or some of a body part, assign a code from ICD-10-PCS root operation replacement (third character R). Think of a total knee replacement or...
Patience may be a virtue, but knowledge is power. Okay, enough clichés. The bottom line is we’re still waiting for a new ICD-10 implementation date. HHS published the proposed rule, moving...
Learn about documentation and principal diagnoses, coders and EHR implementation, clarifying IBS and IBD for accurate code assignment, and ICD-10 fracture codes.
