Sarah Nehring, RHIT, CCS, CCDS, reviews several new COVID-19-related ICD-10-CM and ICD-10-PCS codes recently released by CMS that will become effective January 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Is there ICD-10-CM sequencing guidance for a patient who had a hemorrhagic stroke and then a seizure without a pre-existing seizure disorder? Would it be appropriate to report epilepsy, and are there any inclusion terms we should be aware of?
Julian Everett, RN, BSN, CDIP, details COVID-19’s recent impact on our healthcare system including healthcare spending, health disparities, and the future of the system among COVID-19. Everett also assesses ICD-10-CM reporting for these disparities and social determinants of health.
CMS recently announced that it will take steps to increase hospital capacity by allowing care to be provided to patients outside a traditional, inpatient hospital setting amid a rising number of COVID-19 hospitalizations.
Q: What are the benefits to having coders review charts for appropriate capture of CCs and MCCs, and how can our coding team get started in this process?
CMS recently announced 27 new ICD-10-CM and ICD-10-PCS codes, along with corresponding MS-DRG assignment, for diagnoses and procedures related to COVID-19. These new codes will become effective for discharges on or after January 1.
Emmel Golden, MD, FCCP, CCDS , reviews three recent studies detailing sepsis trends in the U.S. and writes that now is a great time to shed light on how important complete, precise documentation and coding are to understanding the sepsis health challenges we face as a country.
Clinical indicators for certain conditions frequently require greater specificity in ICD-10-CM for which a query is often required. This article takes a closer look at clinical indicators and ICD-10-CM reporting for transient ischemic attack (TIA) and underlying causes and consequences. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sydni Johnson, RN, BSN, CCDS , and Denice Piwowar, BSN, RN, CCDS , detail some basics of clinical validation and how to request supporting indicators of a documented diagnosis without questioning the provider’s judgment.
Q: We have an elderly patient admitted to our hospital who is also presenting with osteoarthritis (OA) of the right knee. How can we determine primary versus secondary OA, and how would it be reported in ICD-10-CM?
The Office of Inspector General (OIG) recently announced it plans to audit hospital inpatient claims. According to the report, the OIG wants to determine if inpatient claims with short lengths of stay were incorrectly billed as inpatient when they should have been billed as outpatient or outpatient with observation.
Sarah A. Nehring, RHIT, CCS, CCDS, details ICD-10-CM reporting and clinical indicators for hepatic fibrosis, cirrhosis, and complications caused by cirrhosis such as ascites and spontaneous bacterial peritonitis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alicia Kutzer, Esq., LL.M., M.H.A , reviews CMS’ Interim Final Rule with Request for Comments (IFC) concerning coverage, billing, and payment for COVID-19 vaccines and therapeutics. This guidance is imperative for inpatient hospitals to evaluate to ensure proper documentation and reimbursement.
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?
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.
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?
