CMS generally took the path of least resistance and cushioned the ongoing impact of the COVID-19 pandemic in the fiscal year (FY) 2022 IPPS final rule. Effective October 1, the final rule covers payment rate updates, new technology add-on payments, and changes to MS-DRG rate setting and groupings.
It’s not unusual for CDI and inpatient coding teams to cite physician education and engagement as one of their top struggles in the field. In this article, read how the CDI team at Avera Health System turned to their query data to craft a focused education program and meet their physicians on the same page.
Q: Our coding team has been having trouble reporting post-operative complications due to vague physician documentation. What language might you suggest that physicians use to clarify that the complication is indeed due to surgery?
Sarah Nehring, RHIT, CCS, CCDS, writes that in light of the fiscal year 2022 ICD-10-CM update to encephalopathy, now is a good time for inpatient coders to review common forms of encephalopathy and its reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released the FY 2022 IPPS final rule, which finalized updates to quality programs including the Hospital-Acquired Condition Reduction Program, the Hospital Readmissions Reduction Program, and the Hospital Value-Based Purchasing Program.
Through examples given within the wound care setting, Bobbie Starkey, RHIT, CCS-P , shows the importance of documentation and ICD-10-CM reporting to support hierarchical condition category (HCC) capture within the inpatient coding sphere. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We have a patient admitted for heart failure who is also being treated for latent autoimmune diabetes of adulthood (LADA). What is LADA and how would it be reported in ICD-10-CM?
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, writes that CDI professionals and inpatient coders need to pay attention to the definitions and clinical indicators of acute kidney injury (AKI) to ensure proper ICD-10-CM reporting and reimbursement.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, reviews how critical thinking is important within the CDI and coding realm in order to enhance review accuracy and query rates and to help loosen reliance on technological tools such as encoders.
CMS recently released the fiscal year (FY) 2022 IPPS final rule, which repealed the MS-DRG relative weight methodology finalized in the FY 2021 IPPS final rule.
Q: We recently had a patient admitted with severe acute meningitis causing respiratory decompensation. A diagnostic lumbar puncture and mechanical ventilation were both performed during the inpatient stay. Which of these two procedures would be the principal procedure?
The Office of Inspector General (OIG) recently released its fiscal year (FY) 2020 Healthcare Fraud and Abuse Control Program report. During FY 2020, the federal government won or negotiated more than $1.8 billion in healthcare fraud judgments and settlements, according to the report.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM/PCS reporting for the cardiac system is complex and requires frequent review in order to report the most accurate codes. In this article, Nehring covers ICD-10-CM/PCS coding and clinical indicators for cardiogenic shock, intra-aortic balloon pumps, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Dawn Valdez, RN, LNC, CDIP, CCDS, says that the clinical indicators used to validate sepsis can also have other possible etiologies that could be equally responsible for the clinical indicators that are present—these are known as competing diagnoses.
Judith L. Kares, JD, details pertinant changes found in the fiscal year (FY) 2022 IPPS final rule, including payment rate updates and the repeal of the MS-DRG relative weight (RW) methodology.
Howard Rodenberg, MD, MPH, CCDS, and Lynn Shay, CPHQ , say that making sense of varying COVID-19 case-mix index metrics is an important endeavor that will sometimes require a bit of DIY. In this article, they explain how they were able to unscramble their departments’ COVID-19 case-mix index data.
CMS released the fiscal year (FY) 2022 IPPS final rule on Monday, August 2, which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes that inpatient coding for pacemaker Insertions can be confusing to both novice and experienced coders. Because of this, it’s important for all inpatient coders to regularly review ICD-10-PCS reporting for these procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, reviews Coding Clinic , Second Quarter 2021, advice for reporting encephalopathy, a laparoscopic salpingo-oophorectomy, and more.
Sarah Nehring, RHIT, CCS, CCDS , reviews ICD-10-CM reporting and clinical criteria for various types of heart failure including diastolic, systolic, hypertensive, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, writes that organizations that aren’t reviewing all in-hospital mortality cases are missing some tremendous opportunities to improve reimbursement and documentation.
The fiscal year (FY) 2022 ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, both effective October 1, were recently released by the Centers for Disease Control and Prevention and CMS, respectively.
Q: Would telemetry and the continuation of home medications be considered continued care for a myocardial infarction (MI) or treatment when reporting in ICD-10-CM? Would this meet the definition of a secondary diagnosis?
A recent study highlighted growing evidence that patients of all ages can develop type 1 diabetes after an acute COVID-19 infection. In this article, Susan Belley, RHIA, CPHQ, and Audrey Howard, RHIA, evaluate these findings as well as ICD-10-CM reporting for the two conditions.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2022 ICD-10-CM code set which includes 159 new, 20 revised, and 32 deleted ICD-10-CM codes. CMS also released the finalized ICD-10-PCS codes for FY 2022, which includes 191 new, 62 revised, and 107 deleted ICD-10-PCS codes. The code changes take effect October 1, 2021.
Q: Per Coding Clinic, Second Quarter 2017, when a spinal fusion is performed without bone grafting it cannot be coded to the root operation Fusion in ICD-10-PCS. Is this advice still accurate?
Judith L. Kares, JD, reviews potential updates found in the fiscal year (FY) 2022 IPPS proposed rule that pertain to quality programs for inpatient hospitals and changes to address existing inequities in the delivery of these services.
Pediatric record reviews require a different skill set than those in the traditional adult acute care space. Often, those reviewing these specialized charts are islands within their overall CDI or coding department, acting as the sole pediatric chart reviewer. This article sheds light on how some have perfected these reviews within their department.
Shelley C. Safian, PhD, RHIA, CCS-P, writes that inpatient Removals of a device from a lower bone may be performed less frequently than other procedures, which creates a need for more education on reporting ICD-10-PCS codes from table 0QP. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Howard Rodenberg, MD, MPH, CCDS , describes how internal reviews can be used to identify repeated coding errors and prevent payment penalties due to Patient Safety Indicators (PSI) and hospital-acquired conditions (HAC).
Medicare Recovery Auditors will review claims submitted by inpatient psychiatric facilities to ensure that billed services are medically reasonable and necessary, according to a recent Medicare Quarterly Provider Compliance Newsletter.
Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , summarizes findings from recent Office of Inspector General audits that highlight improper billing of high-level inpatient stays. He also outlines steps hospitals can take to prevent billing errors due to upcoding.
Approximately 1.5% of the general population sees a primary care physician each year for treatment of chest pain symptoms, according to Family Practice . In this article, Sarah Nehring, RHIT, CCS, CCDS , breaks down potentially confusing ICD-10-CM coding guidelines for chest pain and angina. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent Office of Inspector General audit estimates that Medicare improperly paid inpatient hospitals $267 million over a two-year period for transfer services incorrectly billed as discharges. Judith Kares, JD , analyzes documentation and billing rules for acute and post-acute transfers.
The Office of Inspector General (OIG) recently performed a compliance audit of specific diagnosis codes billed by Anthem Community Insurance Company Inc. to CMS and found that the company submitted unsupported diagnosis codes for 123 of the 203 enrollee-years.
CMS offers hospitals some breathing room to recover from the effects of the COVID-19 pandemic in the 2022 IPPS proposed rule. Review proposed updates to complication/comorbidity (CC) and major CC classifications, and a proposed new MS-DRG rate-setting method aimed at alleviating hospital burden.
Approximately 185,000 amputations occur in the U.S. each year, according to the Amputee Coalition. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down documentation and ICD-10-PCS coding for amputations of the upper and lower extremities. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.
A spinal fusion, or surgery to permanently connect two or more vertebrae in the spine, is sometimes necessary to correct spinal deformities and instability. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down ICD-10-CM and ICD-10-PCS coding for fusion procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, RHIT, CCS, CCDS , reviews documentation and ICD-10-CM guidance for reporting for toxic effects, adverse drug reactions, and underdosing of prescribed medications.
The evolution of the role of clinical documentation integrity (CDI) specialists and their impact on coders has changed the landscape of inpatient coding departments. Learn about how to effectively collaborate with CDI professionals when conducting physician queries.
Susan Belley, RHIA, CPHQ , and Audrey Howard, RHIA , analyze the frequently changing ICD-10-CM guidelines for reporting COVID-19 and related respiratory complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Spinal fusion procedures are reported using two different ICD-10-PCS tables, depending on the location of the vertebrae fused. Sarah Nehring, RHIT, CCS, CCDS , breaks down ICD-10-PCS coding for spinal fusions based on details in the operative note.
Before assessing a coder’s work performance, a facility must set goals that define that success. Review quality improvement standards that facilities use to define coding success.
CMS released the fiscal year (FY) 2022 IPPS proposed rule on April 27, with proposals for the annual ICD-10-CM/PCS code update, the creation of new MS-DRGs, and increases to hospital payment rates.
