With the ICD-10 implementation date set for October 1, 2015, CMS has continued its efforts to provide education and information to help organizations prepare for the change. Recently, CMS published a recording of its Transitioning to ICD-10 Provider Call and a new Coding for ICD-10-CM video to YouTube.
Recovery Auditors have identified improper payments for claims involving end-stage renal disease (ESRD) services when more than one monthly service was billed per month and per-day codes exceeded the limit, according to the latest Medicare Quarterly Provider Compliance Newsletter .
Q: I have a question regarding CPT ® code 99184 (initiation of selective head or total body hypothermia in critically ill neonate, includes appropriate patient selection by review of clinical, imaging, and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling) in the 2015 CPT Manual . What if the neonate is in the hospital for several weeks? The total body hypothermia is performed, the baby improves, but remains in the hospital and then needs the procedure performed a second time. Can we report it a second time if several weeks have elapsed?
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about how to reduce queries by highlighting the information providers need to document for the most common OB ultrasound procedures.
The added detail found in ICD-10-CM may require coders to brush up on their anatomy and physiology training to select the most appropriate codes. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews the anatomy of the male reproductive system and how coding for it will change in ICD-10-CM.
Q: We have a patient diagnosed with neuropathy due to poorly controlled insulin-dependent Type 1 diabetes mellitus. What should we report in ICD-10-CM?
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the endocrine system and how to code for conditions affecting it.
AHIMA is calling for coders, billers, and providers to contact Congress to ask for no additional delays to ICD-10 after physician groups have recently started to advocate for members to petition Congress to introduce a new, two-year implementation delay to push the compliance date to October 1, 2017.
The majority of providers either stopped or slowed their ICD-10 preparations as a result of the latest implementation delay, but now providers have less than a year to become ready. CMS' Denesecia Green and Stacey Shagena offer advice on how providers can create an action plan to be ready by October 1, 2015—even if they haven't started yet.
Nearly 30% of Medicare patients are enrolled in Medicare Advantage (MA) programs, which come with specific coding and documentation challenges. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, and Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, highlight key requirements for reporting diagnoses that map to Hierarchical Condition Category codes, the basis of MA plans.
CMS finalized a new data collection requirement for services performed in off-campus, provider-based clinics in the 2015 OPPS final rule , which was released October 31.
The House of Representatives recently passed a bill that would impact supervision levels for certain outpatient services. Debbie Mackaman, RHIA, CPCO , reviews the impact of the legislation and which provider types and services it would affect.
Q: I work in a large, provider-based orthopedic clinic with a rheumatology department that has many patients who are very ill with several comorbid conditions. Does the physician need to document every comorbid condition that impacts his or her medical decision making for each encounter? Do we need to code every comorbidity each time in order to meet hierarchical condition category (HCC) requirements?
Q: Do any general guidelines exist for queries on outpatient services? We are beginning the process of developing such a query system for our hospital outpatient services and clinical documentation team.
Coders aren’t the only ones who run into problems due to a lack of complete physician documentation. Lack of sufficient documentation also causes problems for audit review of submitted claims, which in turn leads to delays in payment, according to the October 2014 Medicare Quarterly Provider Compliance Newsletter .
Steven Espinosa , CCS , AHIMA-approved ICD-10-CM/PCS trainer, and Denise Williams, RN, CPC-H, outline the anatomy of the upper gastrointestinal system and how anatomical details, along with the provider's approach and intent, help determine the proper procedure code.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the thoracic cage and coding concepts in ICD-10-CM related to coding diagnoses of this region.
When is a mammogram a screening procedure and when does it qualify as a diagnostic test? Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, outlines the differences between the two and what to look for in the documentation.
In its latest survey of the healthcare industry's ICD-10 readiness, the Workgroup for Electronic Data Interchange (WEDI) found that this year's delay negatively impacted provider progress, with two-thirds reporting slowing down or putting implementation initiatives on hold as a result.
Evaluation and management services continue to be a major target for auditors. In the second part of a series, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about frequently targeted areas providers can review in order to protect against audits.
