Our coding experts answer your questions about how to determine the correct units for drugs, billing for fluoroscopy, therapy caps under OPPS, and payment for critical care and separately reported services
The manager of clinical documentation integrity program/HIMS at a 300-bed academic medical center and pediatric specialty hospital has high hopes for computer-assisted coding (CAC). In particular, she anticipates that it will increase productivity and ease the transition from ICD-9-CM to ICD-10-CM/PCS.
In this month's issue, we unravel the complexities of billing for self-administered drugs, explain how to jump-start your ICD-10 transition plans, discuss changes to the I/OCE, and answer reader coding questions.
Hurricane Sandy blasted the Mid-Atlantic region this week, causing plenty of destruction in its wake. We could undoubtedly spend a lot of time coding for the injuries people suffered as a result of...
Q: It appears that one requirement for using CPT ® codes 15002–15005 with application of negative pressure wound therapy (NPWT) is that the wound must be healing by primary intention. Can you explain this? We have never used these codes with preparation for vacuum assisted closure (VAC) placement, but it doesn't make sense, as NPWT is almost always used for wounds healing by secondary intention. Our physicians appreciate any clarification.
Basing a coder’s successful completion of a coding audit only on coding accuracy overlooks importance of local coverage determinations (LCD) and national coverage determinations (NCDs). Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explains the role LCDs and NCDs play in determining practical day-to-day coding accuracy.
The CPT ® Editorial Panel revised its guidance for critical care codes to specifically state that, for hospital reporting purposes, critical care codes do not include specified ancillary services. Denise Williams, RN, CPC-H, and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, discuss how coders should code for critical care services and review which services are bundled into critical care.
The rules for coding for facilities and physicians are basically the same for most services, but coders follow different rules for appending certain modifiers. Christi Sarasin, CCS, CCDS, CPC-H, FCS , Kimberly Anderwood Hoy, JD, CPC , and Peggy Blue, MPH, CPC, CCS-P, separate physician and facility rules for using modifiers -26, -TC, and -79.
Providers are beginning to see some translation of CMS’ National Coverage Determinations (NCD) for ICD-10 with the release of Transmittal R1122OTN and Medlearn Matters Article MM7818 .
Inpatient coders will face a big learning curve when it comes to ICD-10-PCS. It’s a completely different system with a lot more detail than ICD-9-CM Volume 3. The biggest potential problem could be...
Anytown hosted a national ICD-10 conference this week and some of the Fix ‘Em Up Clinic’s coders attended the sessions to learn all about the new coding system. The rest of us got to meet some of the...
ICD-10-CM code category J45.- includes new, more specific terms for asthma that may help improve data quality and lead to more effective research and treatments. Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, and Suzan Berman, CPC, CEMC, CEDC, detail the new terminology for asthma coding in ICD-10-CM.
CMS has published two ICD-10-related Special Edition Medlearn Matters articles that may be of interest to providers and serve as tools to assist with implementation.
Assess. Educate/train. Practice. Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, and Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, reveal how following those three steps can prepare you for ICD-10 implementation.
In ICD-9-CM, coders report specific codes to indicate a surgeon used robotic assistance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains how that will change in ICD-10-PCS.
Getting physicians on board with the transition to ICD-10 won’t be easy, but CMS is trying to help. CMS will host a National Provider Call: Preparing Physicians for ICD-10 Implementation at 1:30 p.m...
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...
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.
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?
