CMS recently published its evaluation of New Technology Add-on Payment (NTAP) applications and proposed revisions to NTAP eligibility criteria in its fiscal year (FY) 2024 IPPS proposed rule.
The gap between clinical reality and coding terminology can be addressed by empowering coders to use clinical judgment. Merle Zuel, RN, CCDS , discusses when it is appropriate for coders to interpret provider documentation and use their clinical judgment to code it in a certain way.
Q: A patient with fatty liver disease undergoes ultrasound cavitation. What diagnoses are treated using ultrasound cavitation and how is the procedure reported in ICD-10-PCS?
What may be considered a simple task, such as confirming present on admission status, can be complicated by discrepancies between coding and quality reporting criteria. Kate Siemens, RN, CMSRN, CCDS , outlines the ways in which coding and quality metrics do not align.
Pneumonia is the eighth-leading cause of death in the U.S. This article outlines signs and symptoms of respiratory infection, pneumonia etiologies, and ICD-10-CM coding for complex pneumonia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS proposes 395 new, 12 revised, and 25 invalidated codes for implementation in October, according to the 2024 IPPS proposed rule. Read up on the changes which, if finalized, will have an impact on reimbursement and documentation.
Congestive heart failure (CHF) is used ubiquitously in medical records. Nancy Reading, RN, CPC , breaks down CHF types and pathophysiology, and discusses ICD-10-CM coding for the condition.
Approximately 1.7 million adults in America develop sepsis each year, according to the Centers for Disease Control and Prevention. Review documentation requirements and ICD-10-CM coding for severe sepsis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Patients with Alzheimer’s disease and related dementias have higher readmission rates than the general geriatric population, according to a retrospective cohort study published in JAMA Network Open .
Functional and structural disorders, infections, and irritations of the large intestine can cause debilitating digestive complications that require surgical intervention. Review ICD-10-PCS coding for colectomy and ostomy procedures. 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) 2024 IPPS proposed rule on April 10, with proposals for the annual ICD-10-CM/PCS code update and increases to hospital payment rates. The rule also introduces new quality measures aimed at reducing health equity gaps.
CMS’ quality measures rank hospital mortality data as better than, no different than, or worse than the national mortality rate. JoAnne Mullins, DNP, MSN, RN, CCDS , describes how to perform quality reviews targeting missed coding opportunities and other factors that influence mortality data.
When reporting ICD-10-CM codes for encephalopathy with comorbidities, coders must carefully review documentation to determine which conditions are separately reportable. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , breaks down ICD-10-CM reporting guidance for complex cases of encephalopathy.
Encephalopathy refers to any disease of the brain that alters its function or structure. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , breaks down documentation requirements and ICD-10-CM coding for toxic, acute, and chronic encephalopathy.
Nearly 80% of healthcare organizations are collecting data on social determinants of health (SDoH), or non-clinical factors that affect health, including family and home life, education, employment, and food insecurity, according to a new AHIMA survey.
Clinical documentation and ICD-10-CM coding terminology for neonatal conditions do not always match. Review documentation requirements and ICD-10-CM coding guidelines for reporting common neonatal diagnoses, as well as advice for querying pediatric healthcare providers.
Cerebrovascular accidents (CVA) are the fifth-leading cause of death and a leading cause of disability in the U.S., according to the Centers for Disease Control and Prevention. Review ICD-10-CM coding for CVA and ICD-10-PCS coding for surgical interventions used to open blocked arteries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Chronic obstructive pulmonary disease (COPD) was the sixth-leading cause of death in the U.S. in 2020 with 152,657 deaths, according to the Centers for Disease Control and Prevention. Read up on ICD-10-CM coding for different types of COPD including emphysema and chronic bronchitis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Findings from a recent medical record review published by JAMA Network Open show that physical assaults are often miscoded as accidents. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for specific details about an injury or health event.
Postoperative mortality rates among Medicare beneficiaries are associated the characteristics of patients’ neighborhoods and the hospitals where they received treatment, according to a study published in JAMA Network Open in January.
Q: A 4-year-old managing lissencephaly, hypotonia, and dysphagia with aspiration of secretions presents with fever and tachypnea. A chest x-ray shows right lower lobe infiltrates. Would it be appropriate to query the provider to confirm a diagnosis of pneumonia?
Jorde Spitler, RN, CDI manager at Dayton Children’s Hospital, describes key considerations for documentation review, querying, and ICD-10-CM coding in a pediatric acute care setting.
Q: What ICD-10-PCS codes would be used to report Stage 1 of a metatarsal resection involving Excision of nonviable tissue for diagnostic purposes and partial detachment of the fifth metatarsal?
Adhere to ICD-10-PCS guidance for reporting multiple procedures and procedural components when coding for wound debridement and skin grafting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Robotic and computer-assisted surgical procedures are still considered new technology despite having been used in the U.S. for many years. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBG , unpacks ICD-10-PCS coding for surgeries performed using specialized software and robotic technology.
Laura Roberts, BSN, RN, CCDS , describes how to perform internal reviews that target Patient Safety Indicators, hospital-acquired conditions, and other quality indicators.
The Office of Inspector General (OIG) recently released its annual report detailing its list of top unimplemented recommendations for 2022. The agency recommends that CMS increase scrutiny of inpatient hospital claims for severe malnutrition and other diagnoses that are vulnerable to upcoding.
Coding and CDI professionals should understand disease processes for common inpatient diagnoses. Ronald Singell, RN, BSN, CCDS , writes about clinical indicators of disease for diabetic ketoacidosis, gastrointestinal hemorrhage, and sequential organ failure.
Pneumonia is a common infection of the lungs that can be life-threatening. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM/PCS coding for this infectious disease and its treatment.
Obesity has grown into a global epidemic with significant social and economic consequences. Review ICD-10-CM coding for obesity and other weight-related conditions, and ICD-10-PCS coding for surgical interventions used to maintain a healthy weight. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
If a urinary tract infection is left untreated, it can spread to other organs and cause sepsis and septic shock. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down ICD-10-CM coding for this life-threatening diagnosis.
A retrospective medical record review published in JAMA Network Open in December found that nearly one-third of intentional firearm injuries resulting in emergency department admissions were inaccurately coded in ICD-10-CM as accidents.
Auditors see assignment of certain MS-DRGs as a red flag and most often will pull these encounters for review. Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , describes these MS-DRGs and offers advice for ensuring accurate reporting of a principal diagnosis.
Stacy Reck, MBA, RHIA, CDIP , and Ashley Wells, MN, RN, CMSRN, CCDS , describe common reasons for clinical validity denials and strategies they use to defend against them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Paraneoplastic syndrome is a rare condition that results from an immune system response to a neoplasm. In this article, Sarah Nehring, RHIA, CCS, CCDS , breaks down ICD-10-CM/PCS coding for paraneoplastic syndrome of the nervous system.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , outlines benefits that come with being a physician advisor and how coding and CDI professionals can reiterate these to physicians who are interested in taking on this role.
CMS recently released Medicare Claims Processing Transmittal 11685 revising language to make three revenue codes for inpatient hospital services allowable for payment under Medicare Part B and adding COVID-19 to its list of preventive services.
Review key policy updates introduced in the 2023 IPPS final rule, including an increase in operating payments, changes to New Technology Add-on Payment designations, MS-DRG updates, and introduction of a birthing-friendly hospital designation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
While laser interstitial thermal therapy (LITT) is not new, the expansion of its use for diagnoses beyond brain tumors can help a new patient population. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how LITT is documented and reported in ICD-10-PCS.
The 2023 ICD-10-CM Official Guidelines for Coding and Reporting include new reporting guidance for neoplasms, care complications, social determinants of health, and more. Review significant updates to the guidelines, which took effect October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The average patient length of stay in hospitals has increased by 19.2% in 2022 compared to 2019 levels, the American Hospital Association said, citing data from Strata Decision Technology. For patients awaiting discharge to post-acute care settings, the increase is nearly 24%.
Healthcare professionals often struggle to define the role of CDI in their organization. Marlene Goodwin-Esola, MSN, RN-C, CV , clarifies the role of CDI specialists and professionals in related disciplines who contribute to documentation improvement efforts.
