In this month's issue, our coding experts answer questions about how to differentiate between modifiers -52, -73, -74, coding for negative pressure wound therapy, and billing the technical component of pathology services.
In this month's issue, we unravel confusion surrounding use of modifier -59, explain the difference between NCCI and MUE coding edits, discuss building E/M ED visit level, review the updates to the I/OCE, and answer reader questions.
A lack of funding shouldn't prevent you from getting creative in your morale-boosting celebrations, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, and Nicolet Araujo, RHIA. So when your staff members are around, this time of year can be a great time to boost their morale with summer outings and special staff recognition for jobs well done.
What happens in Vegas might stay in Vegas, but when things go wrong in Atlantic City, people end up at Fix ‘Em Up Clinic. Today, we have several bachelor party victims who made the clinic their first...
Why hello there, Mr. Coyote. Long time, no see. Are you still chasing that roadrunner? You are? Well, you are certainly persistent, I’ll give you that. So what brings you into the Acme Clinic today?...
The American Osteopathic Association (AOA) House of Delegates has joined the American Medical Association’s (AMA) crusade to crush ICD-10 implementation. Back in November 2011, the AMA’s House of...
Cross-training coders has definitive short-term advantages, such as enhancing staff coverage during holidays and vacations and increasing the department's ability to handle periods of fluctuation in certain bill types. But coding managers might not realize that these benefits can also help hospitals with long-term preparation for ICD-10. Angie Comfort, RHIT, CCS, and Rose T. Dunn, MBA, RHIA, CPA, FACHE, explain the benefits of cross training coders as ICD-10 approaches.
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? Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Jill Young, CPC, CEDC, CIMC, and Donna Smith, RHIT, dissect the differences in coding for diabetes mellitus in ICD-9-CM and ICD-10-CM.
The National Center for Health Statistics, the Centers for Disease Control and Prevention (CDC), and CMS have posted updated files for ICD-10-CM for 2013.
Over the weekend, Matt decided to grill up dinner, which sounds at first like a good idea. He started with chicken, then added some vegetables, unfortunately including some cherry tomatoes. While he...
Epilepsy affects nearly 3 million Americans and 50 million people worldwide, so you may see some of these patients come through your facility or practice. In ICD-9-CM, you find many of the epilepsy...
The National Center for Health Statistics, the Centers for Disease Control and Prevention, and CMS have posted some updated files for ICD-10-CM for 2013. The following files are available for...
I grew up in Western Pennsylvania coal country, where coal mines at one time were prevalent and back in the day, you could smell the hydrogen sulphide (at least according to my mother). A lot of the...
The digestion process is complex and there’s a lot that can go wrong. Thankfully, Robert S. Gold, MD, unravels the topic of mechanical and paralytic ileuses in this week’s article.
QUESTION: A patient is admitted with pneumonia and atrial fibrillation and both are present on admission. The patient receives antibiotics for the pneumonia and a pacemaker during the stay, but undergoes no other procedures. Does the procedure automatically make ICD-9-CM code 427.31 for the atrial fibrillation the principal diagnosis?
New clinical guidelines for malnutrition could help alleviate compliance challenges associated with coding the condition, which has never had universally accepted clinical criteria. Jane White, James S. Kennedy, MD, CCS, CDIP, and Alice Zentner, RHIA, describe the new guidelines and what coders need to know about malnutrition coding.
The thought of learning ICD-10 is intimidating for many coders, but does it need to be? Robert S. Gold, MD, and Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explain why coders may not need to fear the transition quite as much as they think.
In late May, CMS released nationwide a new short-term (ST) acute care Program for Evaluating Payment Patterns Electronic Report (PEPPER). The ST PEPPER provides short-term acute care hospital (STACH) statistical data for the most recent 12 federal fiscal quarters, ending with the first quarter of fiscal year 2012.
We’re having a heat wave, a tropical heat wave, here at Anytown, which means the Fix ‘Em Up Clinic is seeing plenty of heat-related illnesses. Meredith, our first patient, comes in complaining of a...
In ICD-10-PCS, coders will only report a device when the device remains in the patient after the procedure. If it’s removed, it’s not a device and your sixth character will be Z. For many procedures...
Does even the mere thought of coding in ICD-10-CM give you a pounding headache? Well, you’re in luck. ICD-10-CM has plenty of codes for reporting that headache. In order to code for a headache, we...
Pain is an expected component of injuries, illnesses, and surgical procedures. In some instances, however, the patient's pain is unexpected or is worse than predicted. Sometimes, the pain can last well beyond the time it should have resolved. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, and Susan E. Garrison, CHCA, CHCAS, CHC, PCS, FCS, CCS-P, CPAR, CPC, CPC-H, provide tips and guidance to help coders accurately report pain management diagnoses and procedures.
CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS) proposed rule , released July 6. One has to do with how CMS proposes to calculate APC relative weights and the other with the reimbursement level for separately payable drugs and biologicals without pass-through status.
Coders can run into two types of edits that may require them to append modifier -59 (distinct procedural service) to override: National Correct Coding Initiative (NCCI) edits and medically unlikely edits (MUE). Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, explain the differences between the edits and how to correctly determine when to override the edit.
QUESTION: Our laboratory medical director sent out a notification to our medical staff, patient care departments, and order entry personnel that a physician order that read “CBC” or “CBC with differential” would be completed as a CBC with automated or manual differential and coded using CPT ® code 85025 (blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count] and automated differential WBC count). Should we code 85025 when the order just reads CBC and when we do a manual differential with the CBC?
An anesthesia provider faces plenty of challenges: cancelled anesthesia, failed medical direction, monitored anesthesia care, time issues, invasive line placement rules, and start/stop times. Judy A. Wilson, CPC, CPC-H, CPCO, CPC-P, CANPC, CPC-I, CMRS, reviews some of the common challenges coders face when reporting anesthesia services.
One advantage to using ICD-10-PCS is increased specificity. Coders will find increased specificity for the procedure, approach, device, and even anatomical region or body system. In the Medical and...
The eyes are the windows to the soul, but even the best windows can get cloudy or scratched or suffer some other type of trauma. Suppose a patient comes in with cloudy vision. The patient could be...
ICD-10-CM coronary artery disease and myocardial infarction codes will undoubtedly differ from their ICD-9-CM counterparts in some ways, but some aspects will remain the same.
In this month's issue, we examine pain management diagnosis and procedure coding, reveal how to differentiate between types of wounds when coding, explain how to read an operative report, and address your coding questions.
A physician can debride a wound to remove dead, damaged, or infected tissue so the remaining healthy tissue can better heal. Coders need to look for specific information in the documentation of wound debridement.
To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report. But simply having the OP report isn't enough. Coders also must be able to read the report and pick out the important information.
New clinical guidelines for malnutrition could help alleviate compliance challenges associated with coding the condition, which has never had universally accepted clinical criteria.
Learn about ICD-10-CM coronary artery disease and myocardial infarction codes, three-day payment rule audits, malnutrition clinical guidelines, the causes of mechanical and paralytical ileuses, and the importance of documenting the history of present illness.
Our coding experts answer your questions about correct use of modifier –PD, coding infusions to correct low potassium levels, payment for HCPCS code J2354, appropriate reporting of IV push followed by infusion of the same drug, and the difference between modifiers –AS and -80.
Pain is an expected component of injuries, illnesses, and surgical procedures. Let's face it, breaking your leg hurts. In some instances, however, the patient's pain is unexpected or is worse than predicted. Sometimes, the pain can last well beyond the time it should have resolved.
As expected, not much has changed for 2013 with ICD-10-PCS codes. The updated code set is now available on the the CMS website . CMS confirmed in April that the code freeze will hold until ICD-10-CM/...
Remember when your grade school English teacher drilled the rule of punctuation into your head? Instead of an English lesson, consider this an ICD-10-CM punctuation lesson. Brackets are used in the...
Until HHS issues a clear and direct statement on a final ICD-10-CM/PCS implementation date, some healthcare entities will stop any progress to compliance with new ICD-10 requirements, according to...
CMS reassigned 10 codes to status indicator K (paid under OPPS; separate APC payment) as part of the July update to the Integrated Outpatient Code Editor .
QUESTION: The vendor for our cochlear implants has stated it’s standard to provide our operating suite with the cochlear device and two external speech processors. Should we report HCPCS Level II code L8614 (cochlear device, includes all internal and external components) for the one device and two external speech processors even though one processor is sent home with the patient? If so this means that we should charge the patient for the device and two processors as one price under revenue code 278.
Chronic kidney disease (CKD) is the permanent alteration in the kidney’s ability to perform filtration and reabsorption functions. Patients with CKD can come into an outpatient clinic or may be admitted as an inpatient, either for the CKD or some other condition. Debra Lawson, CPC, PCS, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, explain the ICD-9-CM and CPT ® coding for CKD.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, we will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. This month’s column addresses the anatomy of the eye.
Emergency Departments (EDs) see a wide range of illnesses and injuries, from minor to major, which may require critical care. Lois E. Mazza, CPC, details how critical care is defined, what elements providers must document, and under what circumstances critical care can be coded for ED patients.
Mother’s Day and Father’s Day have already passed (and Grandparents Day isn’t until September), but we still see plenty of babies (and grouchy parents) here at Fix ‘Em Up Clinic. Sativa brings in...
