Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes that understanding the epidemiology of HIV, its manifestations, and its stages are important when reviewing the medical record for ICD-10-CM coding, and interpreting provider documentation and understanding the coding guidelines are of the upmost importance for proper sequencing.
Sharme Brodie, RN, CCDS, reviews the most recent Coding Clinic guidance, which touches on common coding conundrums from subjects such as clostridium difficile, diabetes with ketoacidosis, myocardial infarction, pulmonary hypertension, and more.
Creating a query can be complicated, and there are a number of continued training tactics that prove successful for the coder when trying to improve upon physician query practices. This article takes a look at how improving a coder’s knowledge of principal and secondary diagnosis selection can produce a more effective physician query. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
More than 13 million Americans have bladder incontinence, and women are twice more likely than men to have it, according to the Agency for Healthcare Research and Quality. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, reviews ICD-10-CM/PCS coding for the bladder and writes that with so many Americans affected, knowledge of proper coding of bladder diagnoses and procedures is important.
Recent findings support the possibility that the Hospital Readmissions Reduction Program has had the unintended consequence of increased mortality in patients hospitalized with heart failure, says a study published by JAMA .
Q: Can acute respiratory failure be used as the principal diagnosis rather than ICD-10-CM code I46.9 (cardiac arrest, cause unspecified) when both are present on admission?
Candace Blankenship, BSN, RN, CCDS, details the scoring weight of the new ICD-10-CM heart failure codes and looks at potential reimbursement discrepancies as none of the new heart failure codes have been assigned to a CC/MCC.
James S. Kennedy, MD, CCS, CDIP, CCDS, writes that in order to comply with CMS’ ever-changing metrics, it’s important for physicians to learn new techniques for better documentation so that ICD-10-CM/PCS codes can be reported more completely.
In advance of ICD-10-CM/PCS, many institutions implemented computer-assisted coding (CAC) hoping to mitigate anticipated productivity losses. Erica E. Remer, MD, FACEP, CCDS, highlights some of the pitfalls of CAC and provides techniques to improve accuracy. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Cheryl Manchenton, RN, BSN, says that to achieve accurate quality rankings and value-based payments, efforts must extend far beyond coding and CDI to include clinical providers, quality specialists, and other healthcare professionals—and everyone must collaborate to achieve positive results.
Inpatient stays involving any opioid-related diagnosis increased by 14.1% after ICD-10-CM was implemented in 2015, according to a study recently published in Medical Care .
Crystal Stalter, CDIP, CCS-P, CPC, writes about the benefits of creating best practices at your facility and how they help avoid time lost and unnecessary delays in payment. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP, CCDS, writes that now that the fiscal year 2018 IPPS final rule and the 2018 ICD-10-CM Official Guidelines for Coding and Reporting have been released, it’s important to review MS-DRG dynamics that warrant consideration in documentation and coding compliance.
Q: If you have an acute exacerbation of chronic right heart failure (CHF) with a preserved ejection fraction (EF) above 55%, can you code it as heart failure (HF) with preserved EF? All the clinical symptoms exemplify right-sided heart failure (e.g., ascites, pronounced neck vein distension, swelling of ankles and feet).
On October 4, CMS issued a notice in the Federal Register containing numerous corrections to the 2018 IPPS final rule, including significant recalculations of MS-DRG relative weights and all budget neutrality factors.
James S. Kennedy, MD, CCS, CCDS, CDIP , deciphers the new information given for functional quadriplegia, marasmus, kwashiorkor, and palliative care found in the various fiscal year 2018 ICD-10-CM guidance updates.
Allen Frady, RN-BSN, CCDS, CCS, CRC, answers questions about the fiscal year 2018 IPPS final rule’s updates, additions, and deletions in hopes to help guide coders and clinical documentation improvement specialists through the implementation.
In 2017, an estimated 252,710 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS , details best practices when assigning ICD-10-CM/PCS codes for breast cancer diagnoses and procedures. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Now that the fiscal year 2018 ICD-10-CM/PCS codes have been implemented , James S. Kennedy, MD, CCS, CCDS, CDIP , reviews some of the compliance pitfalls that coders may encounter for diagnoses including Type 2 myocardial infarction, the pediatric Glasgow Coma Scale, and right heart failure.
While the Affordable Care Act has led to fewer 30-day readmissions, this reduction in readmissions does not correlate with 30-day mortality rates, according to a recent JAMA study.
Atrial fibrillation is the most common type of heart arrhythmia in the U.S. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes that an understanding of ICD-10-CM coding and sequencing for this condition is key, but coders still need to navigate ICD-10-PCS codes to capture the surgical services performed at the facility. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Mortality reviews pose a special challenge—not only does the CDI specialist need to know the ins and outs of severity of illness and risk of mortality, but the cases themselves are typically more complicated than an average hospital stay, making these essential reviews even more complex.
The amount of energy it takes to stay up-to-date on all the relevant payment and coding updates can be overwhelming, and one relatively new solution to this conundrum is the addition of a CDI educator—an individual dedicated to the educational needs of the CDI team and, in some cases, even physicians.
CMS recently released the 2018 IPPS final rule, which featured 2,916 of its now-annual ICD-10-PCS code additions, deletions, and revisions. This article reviews changes to ICD-10-PCS codes including the addition of short-term device characters and various table updates. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The Centers for Disease Control and Prevention (CDC), one of the Cooperating Parties responsible for the ICD-10-CM codes and guidelines, recently released a 2018 ICD-10-CM Official Guidelines for Coding and Reporting errata. Slight changes were made to the guidelines for diabetes, hypertension, and principal diagnosis selection.
Q: When it comes to conditions not related to hypertension, is it sufficient to attribute the diagnosis to another etiology or does the provider need to specifically document that the congestive heart failure (CHF) is not due to hypertension?
James S. Kennedy, MD, CCS, CCDS, CDIP, details how Coding Clinic , Second Quarter 2017, did not disappoint in addressing clinical issues affecting those in coding compliance and instructing how to properly use the ICD-10-CM Index and Table .
Beginning or expanding a remote CDI program requires planning, and it might not be for everyone. But, with the right preparation, organizations can make the transition beneficial to all.
The fiscal year 2018 IPPS final rule included updates to payment rates and quality initiatives, as well as an ample amount of code changes and updates to ICD-10-PCS non-OR to OR code designations.
Q: If a patient is admitted for anemia related to a malignancy and is treated only for anemia, the principal diagnosis goes to the malignancy. Could you still code for the malignancy as the principal diagnosis if the patient was treated for other conditions at the same time?
CMS recently released the 2018 IPPS final rule, with updates to various quality initiatives, annual payment updates for inpatient services, and an extensive amount of now-annual ICD-10-PCS code additions, deletions, and revisions. This article reviews guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Hammerman, RHIA, CPHQ , and Sam Champagnie , explain how the newness and specificity of ICD-10 ushered in a stronger focus on clinical coding audits and how coding audit best practices shifted following implementation.
Don’t automatically presume a link between two conditions within a combination code in cases when a guideline requires that link to be explicitly documented, the latest version of the ICD-10-CM coding guidelines clarify.
In Major Diagnostic Category 1, Diseases and Disorders of the Nervous System, which covers MS-DRGs 020-103, CMS made changes to the classification of the diagnoses of functional quadriplegia and precerebral occlusion or transient ischemic attack with the use of a thrombolytic, as well as for the insertion of a responsive neurostimulator system. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about congestive heart failure and covers symptoms, coding best practices, and treatment for the disease using new ICD-10 for 2018.
On Wednesday, August 2, CMS released the fiscal year 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
Crystal Stalter, CDIP, CCS-P, CPC, writes that with the release of the 2018 IPPS final rule, hospitals around the country are poring over it to see what impact the changes might bring to their case-mix index, quality initiatives, and overall reimbursement. In the midst of this are coders and CDI specialists who need to be kept abreast of these changes.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews coding guidelines, signs, and symptoms of gastroparesis and helps coders avoid tricky guidance that can lead to reporting errors. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our team had a recent case that involved a small midline episiotomy which extended to a second-degree laceration which was repaired with 3-0 vicryl rapide sutures. Would we code the episiotomy and repair or just the repair, and why?
James S. Kennedy, MD, CCS, CDIP, CCDS, says that with the news codes available October 1, coders will face significant changes in documentation and coding practices. He discusses some of the additional new codes, including type 2 diabetes mellitus with ketoacidosis and pulmonary hypertension.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that coding for skin cancers requires understanding the guidelines as well as knowledge of how the conditions are classified in the ICD-10-CM manual. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP , explains how ICD-10-CM addresses kidney illness and advises on how to ensure documentation and coding integrity through certain challenges including risk-adjustment methodologies and functional versus anatomic diagnoses.
According to a study published in Annals of Emergency Medicine, researchers studying emergency department (ED) visits found that electronic sepsis alert implementation increased ED sepsis detection from 83% to 96%.
Daniel E. Catalano, MD, FACOG, says that from the CDI perspective, the ability to communicate pediatric severity of illness is complicated by the fact that pediatricians have a lexicon that is not well captured in ICD-10-CM. This, he writes, is especially true for pediatric cardiology.
In June, CMS released the 2018 ICD-10-PCS Official Guidelines for Coding and Reporting which include various revisions from the 2017 guidelines. These changes come on the heels of the 2018 IPPS proposed rule and recently released ICD-10-PCS codes.
James S. Kennedy, MD, CCS, CDIP, writes that while you might have thought you’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the compliance risks and opportunities with a new risk-adjustment method: Hierarchical Condition Categories.
Q: At my institution, all of our congestive heart failure exacerbations get at least one chest x-ray. Is that enough “diagnostic testing” to code the secondary condition in accordance to Coding Clinic ?
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , explains that as a coding manager, whether your inpatient team is on-site, off-site, or remote, creating the appropriate environment and selecting proper locations are key to any successful team. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Beginning and sustaining a remote CDI program can be a challenge for even seasoned professionals. Traditionally, CDI specialists put in varying amounts of face-to-face time with the physicians. Ideally, that in-person interaction makes the physicians more open to CDI efforts. However, many remote CDI programs and individual specialists have found creative ways around this face-to-face time.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , takes a look at scleroderma diagnoses and helps coders to breakdown the disease components and treatment to better identify it in documentation and improve coding. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
On June 13, CMS released the final 2018 ICD-10-PCS codes that will become effective October 1. These changes come on the heels of April’s IPPS proposed rule.
Q: I can't distinguish between "code first" and "in diseases classified elsewhere.” Both are used with manifestations and both can't be sequenced as principal diagnosis and both need etiology codes, so what is the difference?
Laura Legg, RHIT, CCS, CDIP, writes that coders will benefit from digging deeper into the meanings of the new fiscal year 2018 ICD-10-PCS cardiovascular code descriptions to be able to fully comprehend and use them.
Sharme Brodie, RN, CCDS, reviews 2017 First and Second Quarter Coding Clinic advice, which includes sequencing chronic obstructive pulmonary disease with other respiratory diagnoses and body mass index reporting instructions.
A recent study piloted by CHEST Journal found that surveillance-based clinical data, such as electronic health records, offered more reliable estimates of septic shock trends than coded records.
In today’s virtual environment, with its focus on flexible schedules, organizing an inpatient coding team requires consideration of time zones, team member skills, volume of work, and claim-processing schedules. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP , writes that if a payer has criteria that differs from that of the provider or the facility, Recovery Auditors can deny ICD-10-CM/PCS codes they deem not to fit these criteria. Kennedy gives solutions for coding compliance for conditions such as sepsis, coma, and encephalopathy.
Q: We use an electronic system at our hospital, and find it is difficult to query a physician since we all have our own processes. Would you recommend having a set format for a query that is used electronically?
On April 14, CMS released the fiscal year 2018 IPPS proposed rule, which included a proposal for the discontinuation of the CardioMEMS heart failure monitoring system add-on payment.
Cheryl Ericson, MS, RN, CCDS, CDIP, explains why so many CDI departments are expanding their review processes to include consideration of how CMS quality measures are affected by claims data.
James S. Kennedy, MD, CCS, CDIP, helps coders and CDI specialists process important aspects of Coding Clinic’s First Quarter 2017 guidance such as the sequencing of pneumonia in the setting of chronic obstructive pulmonary disease.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes about how understanding the different forms of viral hepatitis and alcoholic hepatitis, as well as their effects on the liver, help to clarify coding assignment. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Joel Moorhead, MD, PhD, CPC , explains that a patient with an atypical presentation, by definition, may have the disease but might not meet typical criteria for diagnosis; thus, the patient needs to be at the center of clinical validation.
Ghazal Irfan, RHIA, writes that it’s pivotal that coders have a thorough and in-depth understanding of complex surgeries such as excisional debridements, along with comprehensive knowledge of relevant Coding Clinics and guidelines.
With new data feeding into DRGs, facilities can finally start to see the impact of coders reporting new ICD-10 specificity and if cases are going to the same DRG groups that they did in ICD-9-CM. One MS-DRG group falling into question this year is for acute ischemic stroke with use of thrombolytic agent. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We are currently coding a chart for an acute kidney injury which has the baseline serum creatinine and urine output missing from the chart. Is there something we can do before we have to query the physician?
On Friday, April 14, CMS released the fiscal year 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-PCS and ICD-10-CM code proposals.
Query practices have changed a lot over the years. With so many shifts, coders and clinical documentation specialists may need to take a step back and take stock of the changes they’ve worked through, reassessing current practices against industry recommendations and shoring up policies to prevent well-known pitfalls.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, discusses the reporting of alcoholism, its key documentation details, and its effect on MS-DRGs in ICD-10. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Ghazal Irfan, RHIA, writes about healthcare’s shift from fee-for-service to pay-for-performance, volume-based care to value-based reimbursement, and case-mix index to outcome measures, and how your facility can achieve compliant coding practices among these changes.
Q: Can you please help me determine the query opportunities and code assignment/sequencing argument related to a patient who was admitted with pneumonia, congestive heart failure, acute respiratory failure, and encephalopathy?
Written comments on upcoming ICD-10-CM/PCS code changes presented during the ICD-10 Coordination and Maintenance Committee meeting in March are due Friday, April 7.
Erica E. Remer, MD, FACEP, CCDS , comments on a recent Coding Clinic that has garnered a lot of questions on inpatient obstetrics coding and gives advice on how she thinks this new guidance is flawed. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , writes about hemophilia and how this condition is important for inpatient coders to understand since incorrect reporting can affect MS-DRG assignment.
Clinical documentation improvement (CDI) specialists bridge the gap between physicians and coders. This article takes a look at the benefits of CDI and coding collaboration, and how CDI specialists can address coding hot topics at their own facilities.
Since the physician doesn't need to document a specific root operation, coders cannot rely solely on the terms the physician uses; thus it is important for each coder to fully understand each definition. This article takes a look at the root operations Drainage, Extirpation, and Fragmentation. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, discusses the importance of monitoring your facility’s case-mix index, and how evaluating each component of a case-mix index allows you to narrow your focus and to hone in on all of the factors that might be affecting them.
Q: One of my coworkers thought we needed the phrase “unable to clinically determine” as an option on every multiple-choice query we send. My take on it is that if we have “other” with an option for free text, that would cover us for compliance. Further, I thought it was inappropriate to include this option in some cases, as it may offer an option that is preventing me from obtaining the detail and specificity I need.
On March 8, CMS released eight frequently asked questions (FAQ) related to the Medicare Outpatient Observation Notice (MOON). The FAQs reinforce that psychiatric hospitals must comply with the Notice of Observation Treatment and Implication for Care Eligibility Act and MOON.
James S. Kennedy, MD, CCS, CDIP , reviews recent coding audits at that Northside Medical Center of Youngstown, Ohio, and Vidant Medical Center of Greenville, North Carolina, and gives readers tips on how to better prepare their facilities through these examples.
Laura Legg, RHIT, CCS, CDIP , explains how external coding audits are an important part of shining a light into all coding operations and turning risk into security and peace of mind. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The incidence of stroke and transient ischemic attack is increasing as the baby-boomer population ages. James S. Kennedy, MD, CCS, CDIP , writes that understanding and embracing clinical and coding fundamentals for these conditions is essential in the joint effort to promote providers’ complete documentation and the coder’s assignment of clinically valid codes.
A study conducted by Journal of American Medical Association (JAMA) based on data obtained from the 2013 Nationwide Readmissions Database, revealed that sepsis accounts for a higher rate of unplanned readmissions than the other studied medical conditions.
Q: I am the coding manager for our inpatient coding department. I am wondering if I should create an audit plan to monitor new coders or difficult diagnosis. If so, is there anything specific I should consider when trying to implement a plan?
Erica E. Remer, MD, FACEP, CCDS , explains what clinical validation denials are, how they are determined, and how a coder can help to limit these rebuffs.
Q: If a patient is admitted to the hospital with diabetic ketoacidosis (DKA) and cholelithiasis, and is treated for both, would you code the cholelithiasis as the principal diagnosis because the patient had his or her gallbladder removed?
Amber Sterling, RN, BSN, CCDS , and Jana Armstrong, RHIA, CPC , discuss revenue integrity and how it focuses on three operational pillars: clinical coding, clinical documentation improvement, and physician education.
