Office politics are a fact of life, but can lead to poor or unjust outcomes. Lois Mazza, CPC, offers tips to help coders navigate the political waters in the office.
Q: Can you clarify the requirements surrounding the use of E codes? We have been working on documentation concerns related to patient safety indicator (PSI) 15 and wonder if E codes are required. Can a facility simply decide not to use them?
Coders remain highly accurate when reporting present-on-admission (POA) indicators, but they need to maintain that accuracy. The OIG reiterates the importance of POA reporting in terms of monitoring hospital quality of care and the role that such reporting plays in CMS’ effort to align payment incentives with patient outcomes. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Nena Scott, MS, RHIA, CCS, CCS-P, offer tips to ensure complaint POA reporting.
Q: A patient with undiagnosed syncope is admitted to observation. Later that evening, the patient is diagnosed with syncope and develops complications that warrant an inpatient admission. Should the patient be considered an inpatient from the time inpatient criteria are met or from the time the inpatient order is written?
More than 450 healthcare organizations will participate in CMS’ Bundled Payments for Care Improvement Initiative . CMS announced the specific organizations in January, and some participants will begin receiving bundled payments as early as April. The program will be in effect for three years.
Recovery Auditors are currently performing prepayment MS-DRG validation and coding reviews of MS-DRG 312 (syncope and collapse). Ralph Wuebker, MD, MBA, and Stacey Levitt, RN, MSN, CPC, discuss the scope of the new reviews and what coders need to look for in documentation of syncope.
Obstetric coding has always been challenging for coders and coding multiple births is particularly difficult. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA COBGC, reviews how coding for multiple births differs between ICD-9-CM and ICD-10-CM.
Physician documentation must reflect severity of illness and risk of mortality for all patients. Robert S. Gold, MD, and Valerie Bica, BSN, RN, CPN, explain why pediatric patients require special attention in terms of clinical documentation improvement specialists.
Thirty-day readmissions for heart failure, heart attack, and pneumonia occur most frequently for reasons other than the cause of the initial hospitalization, according to a study published in the January 23 issue of the Journal of the American Medical Association (JAMA).
Coders are under constant stress and pressure. They must remain incredibly focused and pay attention to detail regularly. Lois E. Mazza, CPC, discusses why coders need to think about their health.
According to the ICD-9-CM Official Guidelines for Coding and Reporting, it’s unusual for two or more diagnoses to meet the definition of principal diagnosis. Coders know the opposite is true. William E. Haik, MD, FCCP, CDIP, Donna Didier, MEd, RHIA, CCS, and Cheryl Ericson, MS, RN, CCDS, CDIP, offer tips for determining whether multiple conditions meet the criteria for principal diagnosis.
Q: A patient presents with a sore throat, and the physician states “Sore throat; differential diagnoses include streptococcal sore throat, tonsillitis, postnasal drip.” If the physician doesn’t rule out any of the differential diagnoses, should the coder query for clarification or simply choose one of the differential diagnoses?
One of AHIMA’s long-time goals is to empower HIM professionals to be heavily involved in the ICD-10 overhaul and perhaps even leading the transition in their facility.
The FY 2013 ICD-10-CM Official Guidelines for Coding and Reporting probably look very familiar to coders. Lorraine Began, CPC, CPC-I, CCS-P, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, reveal the similarities and differences between the guidelines for ICD-10-CM and ICD-9-CM.
MS-DRGs won’t change much in the first year after the transition to ICD-10, but hospitals still need to understand the details of the transition. Janice Bonazelli and Dwan Thomas Flowers, MBA, RHIA, CCS, explain how to use the draft ICD-10 MS-DRG Definitions Manual to prepare for MS-DRGs in ICD-10.
ICD-10-PCS differs significantly from ICD-9-CM procedure coding, but fortunately, the Cooperating Parties are providing plenty of guidelines. Laura Legg, RHIT, CCS, discusses some of the key ICD-10-PCS guidelines and why coders should learn them.
The FY 2013 Office of Inspector General (OIG) Work Plan includes plenty of new additions that might interest inpatient hospitals. Sara Kay Wheeler, Kimberly Anderwood Hoy, JD, CPC, Monica Lenahan, CCS, and William E. Haik, MD, FCCP, CDIP, review those new additions and offer tips for dealing with OIG scrutiny.
If you’re curious about whether something you’ve heard or read about the Recovery Auditor program is true, be sure to check out new information published on the CMS Web site. The agency released a document that addresses 14 common myths about the program.
Coders should avoid reporting signs and symptoms as the principal diagnosis when possible. However, that’s not always possible. William E. Haik, MD, FCCP, CDIP, reviews the ICD-9-CM principal diagnosis selection guidelines and when coders should report signs and symptoms as the principal diagnosis.
Q: One of our orthopedic surgeons started to perform spinal fusions percutaneously. CPT ® provides instruction on how to code this procedure; however, these are inpatient surgeries, so we need an ICD-9-CM code. We’re leaning toward code 81.00 (spinal fusion unspecified). Do you think this is the correct code?
Electronic health records (EHR) provide opportunities for more efficient and effective care, yet they also provide coding and documentation challenges. Jill M. Young, CPC, CEDC, CIMC, explains what coders need to be wary of when coding from an EHR.
National Government Services, under contract with CMS, will host a series of listening sessions about lessons learned from the Version 5010 upgrade to prepare providers, vendors, and payers for the transition to ICD-10-CM/PCS.
Physicians, especially ED physicians, need to start paying attention to how their documentation affects the facility. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Bernadette Larson, CPMA, discuss how documentation in the ED affects medical necessity and inpatient coding.
Q: I’ve heard that queries differ between critical access and short-term acute care hospital settings. Is this true, and if so, where can I find more information?
Leading queries are frequently a topic of discussion among coding and clinical documentation improvement professionals. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, explains how to determine what constitutes a leading query and how to craft compliant queries.
MLN Matters ® article SE1236, which discusses documenting medical necessity for major joint replacements, may be aimed at physicians, but Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, and Lynn Marlow, BS, RHIT, CCS, explain how it also applies to hospitals and coders.
In a recent CMS email to providers, the agency reminded hospitals that any department, form, template, or other information that uses ICD-9-CM codes today will need to accommodate ICD-10-CM/PCS codes as of October 1, 2014.
ICD-10-CM Chapter 19 codes for injury, poisoning, and certain other consequences of external causes (S00-T88) demonstrate the specificity inherent in the new coding system. Betsy Nicoletti, MS, CPC, and Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, dig into the details of codes for injuries and underdosing.
Nervous or worried about the upcoming transition to ICD-10-PCS? Don’t be. Charlotte Lane, RHIA, CCS, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, offer up tips to reduce your anxiety about the new coding system.
Q: A patient has unintentionally failed to take a prescribed dosage of insulin due to his Alzheimer’s dementia (age-related debility), and is admitted for initial care with inadequately controlled Type 1 diabetes mellitus. Which ICD-10-CM code(s) should we assign?
In order to assign the correct ICD-10-PCS code, coders will need to determine the correct root operation. Christina Benjamin, MA, RHIA, CCS, CCS-P, discusses the various root operations found in the medical and surgical section of ICD-10-PCS.
Q: As a traveling consultant, I review many types of inpatient hospital records. As hospitals have implemented electronic health records (EHR), I’ve seen documentation worsen. The ability to cut and paste information in the record has compromised coding accuracy. It has also increased the volume of queries, which frustrates physicians. For example, a physician performs a history and physical (H&P) in his or her office one week prior to admitting a patient to the hospital. The first progress note in the EHR—as well as each subsequent progress note—includes the exact same documentation. This documentation, which continues for four days while the patient is in the hospital, is clearly based on the original H&P. Obviously, the documentation has been copied and pasted from one note to another. Even the patient’s vital signs remain exactly the same as they were in the physician’s office. Coders have no way of knowing whether physicians who treat the patient in the hospital agree with any test findings because residents simply cut and paste the results in each subsequent progress note. Residents claim that they do this solely for the attending physician’s convenience. Clinical documentation improvement (CDI) specialists don’t address the problem because they are more focused on determining the accuracy of the MS-DRG. Is there a solution that will keep physicians, coders, and CDI specialists all on the same page?
Providers will continue to use the same definition of inpatient status that they already know. That’s because despite CMS’ consideration of various provider comments, the agency has not establish new criteria.
ICD-10-CM/PCS incorporates laterality, acuity, anatomical specificity, and a slew of additional combination and complication codes. Who will submit queries when this information is missing in a medical record? Will coders or clinical documentation improvement specialists take on this role? Cheryl Ericson, MS, RN, CCDS, CDI-P, and Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA, offer suggestions for determining who will submit queries.
Hospitals are approximately two months into the Fiscal Year (FY) 2013 Value-Based Purchasing (VBP) Program that began with Medicare fee-for-service discharges on or after October 1, 2012. The Hospital Readmission Reduction Program is also well underway. Deborah K. Hale, CCS, CCDS, and Susan Wallace, Med, RHIA, CCS, CDIP, CCDS, explain the important role coded data plays in these and many other quality-of-care-related initiatives.
Recovery Auditors have already begun prepayment audits of MS-DRG 312 (syncope and collapse). Laura Legg, RHIT, CCS, details how hospitals can ensure the appropriate assignment of MS-DRG 312.
So many coding topics to audit, yet so few staff members to perform those audits. Julie Daube, BS, RHIT, CCS, CCS-P, reveals steps you can take to resolve this dilemma and determine which areas to audit in 2013.
Every few years, the AHA publishes guidance in Coding Clinic that can significantly affect inpatient coders, such as guidance published in the Second Quarter 2012 on neoplasm coding. Randy Wagner, BSN, RN, CCS, and Paul Dickson, MD, CCS, CPC, review the new guidance and how to use the TNM cancer staging system.
Hospitals are overturning Recovery Auditor denials nearly 75% of the time, according to recent RACTrac data. That’s why the American Hospital Association adamantly supports a new proposed bill—the Medicare Audit Improvement Act of 2012 —aimed at holding Recovery Auditors accountable for inappropriate denials.
Q: Should we query for the specific pulmonary exacerbation of cystic fibrosis (CF)? Coding Clinic states that the exacerbation of CF should be listed first.
Maternal fetal medicine procedures highlight the differences between ICD-9-CM procedure codes and ICD-10-PCS codes and can serve as a foundation for understanding ICD-10-PCS. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, demonstrates how coding for fetal thoracentesis will change after the switch to ICD-10.
Coders can go a bit overboard when reporting CCs and MCCs. Cheryl Ericson, MS, RN, CCDS, CDIP, and Deborah K. Hale, CCS, CCDS, reveal the dangers of over-reporting CCs and MCCs and how to report them appropriately.
Although hospital infection rates continue to decline, Medicare payment penalties are not the cause, according to the New England Journal of Medicine article titled Effect of Nonpayment for Preventable Infections in U.S. Hospitals .
Ethical dilemmas can creep in at any time during a coder’s average workday. However, one might be hard pressed to find a coder who will openly acknowledge this. Brad Hart, MBA, MS, CMPE, CPC, COBGC, and Kathy DeVault, RHIA, CCS, CCS-P, explore how coders can and should handle ethical dilemmas.
Thinking about exiting the coding profession before the transition to ICD-10? Laura Legg, RHIT, CCS, enjoys coding too much to give it up and offers some tips for how to prepare for the transition.
ICD-10-CM code category J45.- includes new, more specific terms for asthma that may help improve data quality and lead to more effective research and treatments. Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, and Suzan Berman, CPC, CEMC, CEDC, detail the new terminology for asthma coding in ICD-10-CM.
Assess. Educate/train. Practice. Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, and Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, reveal how following those three steps can prepare you for ICD-10 implementation.
