Sarah Nehring, RHIT, CCS, CCDS , details three significant changes to the ICD-10-CM tabular list Excludes notes that may prove valuable to hospitals in fiscal year (FY) 2021, including updates to Excludes notes for encephalopathy, toxic encephalopathy, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Incorrect acute stroke diagnosis codes reported by Medicare providers resulted in millions of dollars in increased payments to Medicare Advantage organizations, according to a recent Office of Inspector General (OIG) report.
Up to now, public health data collection has been mainly focused on adult COVID-19 patients, but we are beginning to see data indicating that COVID-19 is impacting children’s health as well. With more of the spotlight on pediatric COVID-19 diagnoses, it’s important to ensure proper documentation to help improve data collection.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, writes that the better the CDI policies and procedures, the better CDI and inpatient coding departments can work efficiently together to achieve proper documentation, coding, and reimbursement.
Q: Our coding team is having trouble understanding the different types of chronic respiratory failure (CRF) and knowing when to suspect its presence when it’s not specifically documented by our physicians. Can you please help us with this?
Q: CMS created a new MS-DRG for chimeric antigen receptor T-cell (CAR-T) therapies in the fiscal year (FY) 2021 IPPS final rule. Which ICD-10-PCS codes group to this new MS-DRG and does it qualify for an additional new technology add-on payment?
Encephalopathy affects nearly one in three novel coronavirus (COVID-19) patients, according to a recent study published in the Annals of Clinical and Translational Neurology.
It’s more important than ever that organizations keep ahead of COVID-19 ICD-10-CM and MS-DRG audits and denials. The financial strain that many organizations are under makes it imperative that they minimize disruptions to revenue.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, RHIA , examines the reporting for codes in Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, of the ICD-10-CM manual, which included infectious arthropathies, inflammatory polyarthropathies, osteoarthritis, and other joint disorders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, CCS, CCDS, RHIT, writes that acute blood loss anemia can increase expected reimbursement, the expected length of stay, and the severity of illness for an encounter. For these reasons, she presents seven things coders wish providers knew about accurately documenting this condition.
According to Johns Hopkins Medicine, approximately 30% of patients with the novel coronavirus (COVID-19) have acute kidney injury (AKI). Because of this, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, details COVID-19-related AKI to ensure accurate documentation and appropriate queries.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews healthcare compliance as a whole, and says it is important to be aware of these healthcare compliance risks, especially in ICD-10-CM reporting.
Sarah Nehring, CCS, CCDS, RHIT, writes that although noted in the ICD-10-CM alphabetic index, cardiorenal syndrome is not always hypertensive heart and chronic kidney disease, which is why clinical knowledge for this condition is very important for proper ICD-10-CM reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to The Office of Inspector General’s (OIG) recent Work Plan update, it will be reviewing payments for COVID-19 discharges that grouped to the newly weighted COVID-19 MS-DRGs.
Q: We are having trouble with a case that involves an Implantation of a cardiac resynchronization therapy-pacemaker (CRT-P) with three leads and an envelope since our facility is new to using pacemaker envelopes. How should this procedure be reported in ICD-10-PCS?
CMS recently released the FY 2021 IPPS final rule, which increased hospital payment rates, created new MS-DRGs, and finalized the FY 2021 ICD-10-CM/PCS code sets and CC/MCC designations to be implemented October 1.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , details important ICD-10-PCS code updates and MS-DRG designation changes found in the fiscal year (FY) 2021 IPPS final rule. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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 two of this two-part series, Kuqi takes a look at myocardial infarctions (MI), treatments for MIs, and clinical documentation concepts.
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.
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.
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.
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.
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?
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.
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.
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.
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?
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.
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.
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.
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?
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.
