CMS recently released guidance stating that for inpatient novel coronavirus (COVID-19) claims, a positive viral test result is now required in order to be eligible for the 20% increase in the MS-DRG weighting factor. This became effective for all admissions on or after September 1.
Sarah Nehring, CCS, CCDS, RHIT , writes that the increased complexity and cost of implantable cardiac defibrillator devices is reflected in the higher relative weight and longer length of stay for these MS-DRGs compared to pacemaker MS-DRGs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When is it appropriate to report both flash or acute pulmonary edema and acute on chronic heart failure (diastolic, systolic, or other) in ICD-10-CM? What other etiologies lead to flash pulmonary edema and how do I know when to query?
Julian Everett, RN, BSN, CDIP, reviews ICD-10-CM reporting and clinical criteria for pneumonia and its causative agents and associated comorbidities. Everett also details documentation recommendations for providers to ensure inpatient coders can report this disease with the utmost accuracy.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM, explains the definition of acute ischemic syndrome and the clinical indicators that make a difference when reviewing a medical record. In part one of this two-part series, Kuqi takes a look at the myocardial anatomy, stable/unstable angina, and Prinzmetal's angina.
In July, the Office of Inspector General (OIG) released a report regarding the incorrect assignment of ICD-10-CM codes for severe malnutrition on inpatient hospital claims. In this article, Yvette M. DeVay, MHA, CPC, CPMA, CIC , reviews these findings and explains how to better document and report malnutrition.
Q: We have an elderly patient admitted in our hospital who is also presenting with glaucoma. Since we don’t report glaucoma on a regular basis, can you explain any background, guidelines, or tips for reporting glaucoma in ICD-10-CM?
Sharme Brodie, RN, CCDS, CCDS-O , writes that the cost of new technologies can lead to an overwhelming financial burden to hospitals and patients, which is why accurate reporting of ICD-10-PCS codes in the new technology section of the ICD-10-PCS manual is more important than ever.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that attention must be paid to coding conventions and general coding guidelines when reviewing the ICD-10-CM manual for correct code assignment for diseases of the skin and subcutaneous tissue. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This article details CDI quality review processes from various hospitals, some of which zero in on patient safety indicator and mortality cases to improve their facility’s severity of illness and rate of mortality scores.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, writes that it’s important for inpatient coders to acquaint themselves with any underlying conditions related to novel coronavirus (COVID-19) in order to ensure accurate reporting, reimbursement, and data gathering.
Q: We have patients being admitted for COVID-19 and most of them have a laundry list of various manifestations and complications. Do all manifestations and complications need to be reported in ICD-10-CM?
On July 30 CMS announced the addition of 12 new ICD-10-PCS codes to describe the Introduction or Transfusion of therapeutics for treating patients with COVID-19. These new codes became effective August 1.
Heart disease is a broad category, but for this article Julian Everett, RN, BSN, CDIP , takes a look at ICD-10-CM reporting for myocardial infarctions (MI). It is essential to understand what defines an MI, current quality initiatives for MIs, and documentation and coding requirements for this diagnosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to a recent audit by the Department of Health and Human Services’ Office of Inspector General (OIG), Ohio State University Hospital received millions in overpayments during an audit period due to errors in coding, MS-DRG assignment, and billing.
Sarah Nehring, CCS, CCDS , says to ensure ICD-10-PCS coding accuracy and appropriate MS-DRG assignment, inpatient coders must understand the device being inserted and how to apply the coding conventions and guidelines for pacemaker-related procedure coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
To deal with the rising rate of infection and increased hospital admissions for extraordinarily sick patients due to the novel coronavirus (COVID-19), CDI teams have had to act quickly by adapting to remote work, modifying CDI practices, and more.
Joel Moorhead, MD, PhD, CPC , writes that certain clinical indicators provide strong support for a diagnosis of acute-on-chronic congestive heart failure (CHF) in adults. Because of this, it’s important for inpatient coders to familiarize themselves with baselines and clinical indicators in order to ensure accurate reporting.
Q: We have a patient who gave birth while admitted for novel coronavirus (COVID-19). How should this be reported and sequenced in ICD-10-CM and which MS-DRG would this be assigned to?
Dawn Valdez RN, LNC, CCDS, reviews MS-DRG and code assignment for COVID-19-related pediatric multi-system inflammatory syndrome (PIMS), as well as common findings and treatments for the condition.
Q: We have a patient that was admitted with sepsis due to COVID-19 who also has human immunodeficiency virus (HIV). How should we report this in ICD-10-CM, and which MS-DRG would this be assigned to?
Cheryl Manchenton, RN, BSN, CCDS, CPHM, writes that when it comes it reporting novel coronavirus (COVID-19), our understanding of it and its sequelae/manifestations is continually evolving. There is one “manifestation” of COVID-19 that is of interest for experimental treatment: cytokines.
The ICD-10-CM Coordination and Maintenance Committee recently released the fiscal year (FY) 2021 ICD-10-CM code set, which includes 490 new, 58 deleted, and 47 revised ICD-10-CM codes. Along with updates to the Tabular index, these changes include new codes for reporting chronic kidney disease and body mass index.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, reviews Chapter 11 of the ICD-10-CM manual, Diseases of the Digestive System, as attention must be paid to the coding conventions and general coding guidelines when reviewing the manual for correct code assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julian Everett, RN, BSN, CDIP, writes that as some hospitals see revenue continue to decline due to the current COVID-19 pandemic, inpatient coders and CDI specialists need to brush up on the criteria, treatment, and ICD-10-CM reporting for malnutrition diagnoses to avoid any more loss in revenue.
Jannifer Owens, MSA, BSHA, CCS, and Denise Coast, RHIA, CCS, detail tips for reporting the novel coronavirus (COVID-19) and say that we have a plethora of ICD-10-CM codes to help describe the patient story and we should use them to ensure optimal coding and enhanced data capture. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ recently released the fiscal year (FY) 2021 IPPS proposed rule which included proposals for the creation and revision of various MS-DRGs. In particular, CMS proposed the creation of a new MS-DRG for cases involving chimeric antigen receptor T-cell (CAR-T) therapies.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC , gives guidance to CDI teams working on clinical validation, denials prevention, and appeals processes to help ensure proper reimbursement for their hospitals.
Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , reviews Coding Clinic , First Quarter 2020, guidance, which includes topics such as reporting vaping-related disorders, malnutrition, and bariatric procedures.
Sarah A. Nehring, CCS, CCDS, writes that an inpatient coder’s first concern regarding the reporting of novel coronavirus (COVID-19) is to code all confirmed cases and only confirmed cases. In this article, Nehring details guidelines on how to accomplish this.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, details coding guidelines and instructional notes in Chapter 9 of the ICD-10-CM manual, which contains codes for diseases of the circulatory system, including rheumatic fever, hypertension, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released the fiscal year (FY) 2021 ICD-10-PCS code set and ICD-10-PCS Official Guidelines for Coding and Reporting . The ICD-10-PCS code update includes new codes for Fragmentation and Drainage, while the guidelines update includes new and revised guidelines for certain root operations, approach values, and device combinations.
Q: If an inpatient is transferred before we receive a positive novel coronavirus (COVID-19) lab result, do we need to query the provider to amend the discharge summary to state “COVID-19 positive”?
Clinical validation reviews and queries ensure that the documented diagnoses and clinical indicators hold up to inspection. This article gives an overview on processes and templates, top queried diagnoses, and physician engagement to help CDI teams perfect their clinical validation efforts.
Q: How should we report positive COVID-19 cases in ICD-10-CM without respiratory manifestations or any signs or symptoms and no prior suspected exposure?
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, details MS-DRG updates found in the fiscal year (FY) 2021 IPPS proposed rule, including the proposed creation of MS-DRG 521 (Hip Replacement with Principal Diagnosis of Hip Fracture with MCC) and MS-DRG 522 (Hip Replacement with Principal Diagnosis of Hip Fracture without MCC). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released the fiscal year (FY) 2021 IPPS proposed rule this week, with proposals for the annual ICD-10-CM/PCS code update, the creation of new MS-DRGs, and increases to hospital payment rates.
Pulmonary hypertension is a complex, progressive disease that affects both children and adults, and leads to significant morbidity and mortality. In this article, Amy Sanderson, MD , reviews this disease to help ensure proper inpatient reporting and more precise queries.
Sarah Nehring, CCS, CCDS, says that strokes are complicated, which is why it is important for inpatient coders to be familiar with the brain’s anatomy and the clinical concepts of a stroke in order to report the most accurate ICD-10-CM codes.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that attention must be paid to coding guidelines and instructional notes for blindness, low vision, and laterality when reporting diseases of the eye and adnexa in Chapter 7 of 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.
The state of New York issued an executive order directly effecting the work of health information management professionals that limits documentation and coding requirements for COVID-19 patients. Around the same time, the U.S. Department of Health and Human Services announced it will reimburse hospitals nationwide at Medicare rates for treating uninsured COVID-19 patients.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes that one area of risk unique to CDI and coding staff is the physician query. While the creation of the individual physician query usually garners most of the attention, maintenance of query compliance is equally important and frequently overlooked.
Sarah A. Nehring, CCS, CCDS, details ICD-10-PCS reporting for extracorporeal membranous oxygenation (ECMO) procedures and says basic knowledge of what an ECMO procedure is, how it is established in a patient, and why it is used can have a large impact on proper reporting and hospital reimbursement.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
