Adriane Martin, DO, FACOS, CCDS, explains the confusion behind the various sepsis definitions and provides guidance to coders when reporting sepsis in ICD-10-CM.
A new risk model provides a simple way to determine whether acute myocardial infarction (AMI) patients are at a high risk for hospital readmissions, says a study published in the Journal of the American Heart Association.
Q: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
Sharme Brodie, RN, CCDS, reviews recent guidance published in Coding Clinic , Third Quarter 2018, including advice on diabetes, acute myocardial infarctions (AMI), pressure ulcers, and more.
Crystal R. Stalter, CPC, CCS-P, CDIP, says that there is still confusion around documenting patient stays to show quality, especially in the inpatient realm. Is it really as simple as documenting conditions to their fullest specificity or does it involve a more complex approach?
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that understanding spinal anatomy, the reporting of detailed spinal diagnoses, and the selection of applicable procedure codes can ensure that these complicated claims are reimbursed correctly and in compliance with coding guidelines. 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 with a history of chronic heart failure (CHF) and end-stage renal disease (ESRD) who was admitted with volume overload due to acute kidney injury and dialysis noncompliance. How should we report this in ICD-10-CM?
The rate of most hospital-acquired conditions (HAC) continued to decline from 2014 to 2016, according to the latest national scorecard released by the Agency for Healthcare Research and Quality.
Cheryl Manchenton, RN, BSN, CCDS , details the recent updates to patient safety indicator (PSI) 90 and says that these changes are the reason why it’s more important than ever to ensure that PSI metrics are complete and accurate.
Chris Simons, MS, RHIA , outlines tasks that generally fall within the CDI department’s realm and writes that to ensure that inpatient CDI specialists can thoroughly complete these tasks, they must have strong clinical skills and a working knowledge of ICD-10-CM and MS-DRG assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Adriane Martin, DO, FACOS, CCDS , reviews some of the ICD-10-CM/PCS code and CC/MCC updates that made the final cut in the fiscal year 2019 IPPS final rule.
Creating a query and knowing when to query can be complicated, and there are a number of continued training tactics that prove successful for the coder when trying to improve upon physician query practices. This article looks at a few of the official sources that offer query guidance for coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We recently had a patient admitted for syncope workup. The workups were negative except for incidental findings of acute kidney injury (AKI). The physician documented “AKI likely 2/2 hypovolemia. Treatment focus is to trend creatinine levels and hydration.” Would the AKI or hypovolemia be sequenced as the principal diagnosis?
Cesar M. Limjoco, MD, writes that although different literature has become available on principal diagnosis selection through the years, questions and disputes keep popping up. In this article, he revisits the issue and provides additional insight to code selection for conditions such as acute respiratory failure and congestive heart failure.
Acute heart failure patients in an emergency department's clinical pathway program had a 13.1% lower readmission rate, according to a report published in the American Journal of Emergency Medicine.
Adriane Martin, DO, FACOS, CCDS, reviews Coding Clinic guidance published in the first and second quarters of this year as it pertains to coding guidelines, severity of illness, and MS-DRG assignment for the inpatient setting.
Q: Our team is having a hard time determining a principal diagnosis for a patient with a history of stage 5 chronic kidney disease (CKD) who is receiving chronic hemodialysis and is in acute renal failure (ARF) with volume overload. Which ICD-10-CM code should be the principal diagnosis?
Allen Frady, RN-BSN, CCDS, CCS, CRC, says that defending code assignment against denials requires more than reviewing the denial to determine if the condition was coded and reported according to the coding guidelines; it requires an understanding of payer requirements as well.
Inpatient coding audits need to be tailored to the type of record being reviewed, the time it may take to complete the audit, and any compliance-related issues that may crop up. This article focuses on how coding managers can streamline these aspects to ensure a successful audit. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Early readmissions were more likely to be preventable and amenable to hospital-based interventions, according to a recent study published in the Annals of Internal Medicine.
William E. Haik, MD, FCCP, CDIP, writes that complex pneumonias can segregate to a higher-weighted MS-DRG than other pneumonia types, so reviewing clinical elements with your physician staff may help improve documentation and avoid adverse determinations by external reviewers for these conditions.
Q: If a CDI specialist doesn’t enter the queried diagnosis in his or her working DRG, but the physician responds favorably to the queried diagnosis at the time of coding (or during the retrospective query process), would you consider this in the reconciliation process? If yes, how would we capture this type of data?
The European Heart Journal recently published the fourth universal definition of myocardial infarction (MI). The newest definition, which supersedes all previous versions, includes new and updated clinical concepts as well as new sections of guidance.
Cathy Farraher, RN, BSN, MBA, CCCM, CCDS , details the basics of the All Patient Refined Diagnosis Related Groups (APR-DRG), the system developed to allow for a more specific analysis of outcomes in the non-Medicare population, and shows coders and CDI teams how to better capture quality metrics through documentation.
Adriane Martin, DO, FACOS, CCDS , writes that abdominal aortic aneurysms (AAA) are the most common type of aortic aneurysm, and the complexities surrounding AAAs make reporting procedures related to them difficult for even the most skilled inpatient coder.
The fiscal year (FY) 2019 IPPS final rule contains extensive changes pertaining to MS-DRGs. This article details some of the most notable MS-DRG updates including revisions to epilepsy with neurostimulators and pacemaker insertion classifications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , provides background on vaccinations and writes that coding for vaccine administration isn’t relegated to the outpatient coder; inpatient coders also have codes to report for vaccine administration. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Jennifer Cayce, RHIT, CCS, CCS-P, CPC , explores the conundrums of reporting acute kidney disorders due to confusing clinical terminology and addresses some of the problematic areas of nephrology diagnoses.
Q: We have a patient who is diagnosed as having acute renal insufficiency due to dehydration with decreased urinary output and was admitted for IV hydration. What diagnosis codes should we assign?
CMS recently released the fiscal year (FY) 2019 IPPS final rule with significant reductions to reporting requirements for quality initiatives, updates to payment rates, changes to CC/MCC designations, and revisions to various MS-DRGs.
Q: In what instance would septic shock not be coded as a principal diagnosis (PDX)? I’ve been under the impression that septic shock should always be reported as a PDX.
CMS and the National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting. Changes include clarification on the usage of “with,” updated sepsis guidance, and added guidelines for subsequent myocardial infarction.
Adriane Martin, DO, FACOS, CCDS, says that knowledge of coding guidelines and Coding Clinic advice, as well as an understanding of the spine anatomy and the spinal fusion procedure itself, can go a long way toward helping put together the pieces of the fusion puzzle.
Chris Simons, MS, RHIA, details way to improve querying across health information management (HIM), coding, and CDI departments since querying providers is a key strategy for improving documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our coding team is currently debating how to report acute tubular necrosis (ATN) in ICD-10-CM for a patient after a renal transplant. Can you provide any guidance?
Amy Sanderson, MD, says that the term “dysphagia” has many synonyms used by providers in medical documentation. However, not all of these symptoms are able to describe the diagnosis with enough specificity so that it can be translated into its corresponding code assignment.
Adriane Martin, DO, FACOS, CCDS, summarizes the proposed changes found in the fiscal year (FY) 2019 IPPS proposed rule, broken down by Major Diagnostic Category (MDC), that would impact ICD-10-CM/PCS codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In June, an article detailing the upcoming release of the fourth edition of the universal definition of myocardial infarction (MI) was published in the American Journal of Medicine .
William E. Haik, MD, FCCP, CDIP , AHIMA-approved ICD-10-CM/PCS trainer, Jonathan Besler, CPA, MA , and Mary Devine, RN , write that while it is well-known that ICD-10-CM/PCS code assignment impacts hospital reimbursement and compliance, there is an additional code that often flies under the radar for inpatient coders and has a huge impact on reimbursement: the discharge status code.
Q: In ICD-10-CM, how would you report a patient who is receiving hemodialysis and has chronic kidney disease (CKD) when a failed kidney transplant is also documented?
In many cases, knowing when to query is simple, but the more challenging cases contain clues that require additional interpretation. Drew Siegel, MD, CCDS, takes a look at a few of the more interesting and often undocumented diagnoses, including respiratory failure and acute kidney injury, and points out the diagnostic clues to form a compliant query.
Rose T. Dunn, MBA, RHIA, CPA/CGMA, FACHE, FHFMA, CHPS , writes that beyond auditing for code assignment, coding reviews also provide an opportunity for you to conduct a thorough compliance evaluation that not only addresses other components of the coding process but also the integrity of the patient’s record. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Surviving Sepsis Campaign recently released a 2018 update to guidelines for the care of patients with sepsis. The update includes a new “hour-one bundle” which replaces previous versions of the Surviving Sepsis Campaign guidelines.
Erica E. Remer, MD, FACEP, CCDS, reviews recent Coding Clinic guidance surrounding the code assignment of a Salter-Harris type I physeal fracture of the third metatarsal bone of the left foot.
According to the National Institute of Health, approximately 100,000 Americans have sickle-cell disease. In this article, Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , breaks down the complexities of the disease and clarifies reporting of the diagnosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Could you shed some light on reporting ICD-10-CM codes K66.1 (hemoperitoneum), an MCC, and R58 (hemorrhage, not elsewhere classified), which is not considered a CC or an MCC?
On June 18, the World Health Organization (WHO) released a version of the 11th Revision of the International Classification of Diseases (ICD-11). ICD-11 reflects critical advances in science and medicine and is the first code set revision to be well integrated with electronic health applications and information systems, WHO says.
Just like their inpatient acute care counterparts, inpatient psychiatric facilities use ICD-10-CM codes, but their payment structure, documentation requirements, prevalent clinical conditions, and additional documentation requirements needing capture are vastly different.