While focusing on documentation and coding, providers might not have considered the impact of MS-DRG shifts as a result ICD-10 implementation. Gloryanne Bryant, RHIA, RHIT, CCS, CDIP, CCDS, and Lori P. Jayne, RHIA, review how the new code set will affect several diagnoses.
In the first three years after implementation, incentives and penalties tied to the Hospital Value-Based Purchasing (HVBP) Program had a minimal effect on Medicare, while doing little to improve quality trends, according to a recent Government Accountability Office (GAO) report.
The 2016 IPPS final rule includes many new claims-based measures for 2018 and 2019 payment determination. Shannon Newell, RHIA, CCS, provides an overview of those measures and additional changes to theHospital Value-Based Purchasing and Hospital-Acquired Conditions Reduction programs.
Q: I am having trouble with ICD-10-PCS coding for a perineal laceration repair. Some sources state that the correct code uses the perineal anatomic region, not muscle repair. Could you please clarify the correct ICD-10-PCS code for a second-degree obstetrical (perineum) laceration that includes muscle?
Providers need to report all services from October 1 forward with ICD-10 codes, but many will likely face scenarios with patients whose dates of service begin prior to October 1 and end after implementation. CMS has released special guidance to clarify how those instances would be billed with each bill type in MLN Matters ® SE1325 .
Coders will need to master root operations in order to be successful in ICD-10-PCS. Cindy Basham, MHA, MSCCS, BSN, CCS, CPC, writes about which root operations will be most frequently used for cardiovascular procedures and how to interpret the guidelines related to them.
Queries will no doubt increase due to the increased specificity in ICD-10-PCS. John C. Alexander Jr., MD, MBA, James Fee, MD, CCS, CCDS, and George W. Wood II, MD, offer insight into which specialties will be most impacted and how coders can talk to surgeons about the query process.
Q: How can our team prepare for potential productivity losses post-ICD-10 implementation, specifically regarding procedure codes? Should we consider hiring additional staff or staff with a surgical background?
ICD-10-CM seventh characters can be used to report more than just the episode of care. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, explains different seventh character uses and when to report them.
The 2016 IPPS final rule continues CMS’ plan to shift Medicare payments from volume to quality. Shannon Newell, RHIA, CCS, and James S. Kennedy, MD, CCS, CDIP, analyze the rule and the impact it could have on providers.
Six ICD-10-PCS root operations require a device, including Revision, Replacement, and Removal. Gretchen Young-Charles, RHIA, and Anita Rapier, RHIT, CCS, review how to differentiate these root operations and report associated devices.
CMS has released a transcript and recording of its August 27 MLN Connects Call featuring ICD-10 coding guidance and the results of CMS’ final round of end-to-end testing.
Q: In my facility, we are supposed to send an email to our physician advisor (PA) and to administration if a query is not answered within a week. However, this policy doesn’t work well because administration does not do anything with that information, and the PA doesn’t have time to review unanswered queries. Do you have any suggestions concerning when to let a query go unanswered?
The only difference between ICD-10-PCS root operations Excision and Resection is the amount of the body part removed. Jennifer Avery, CCS, COC, CPC, CPC-I, Anita Rapier, RHIT, CCS, and Cheree Lueck, BSN, RN, provide tips for determining the correct root operation.
In ICD-10-CM, to tell the patient’s whole story, coders need to report external cause codes. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, explains the benefits of these codes and how to report them.
