Sepsis and systemic inflammatory response syndrome are historically difficult to document and report in ICD-10-CM. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , breaks down sepsis definitions and outlines a process for query creation.
Determining the most specific ICD-10-PCS code for a procedural service can be tricky given that there are 34 character values and over 78,000 ICD-10-PCS codes for 2022. This article breaks down potentially confusing ICD-10-PCS guidelines for obstetric and cardiovascular procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Twenty-five percent of hospitalized Medicare patients experience patient harm, and 43% of those harm events could have been prevented, according to a recent Office of Inspector General (OIG) report.
Hospital coders must be able to determine the reason for an admission and to differentiate conditions present on admission (POA) from those that develop during an inpatient stay. Learn how to effectively decipher documentation to identify the principal diagnosis and conditions that were POA.
A handful of new ICD-10-CM/PCS codes took effect April 1. Read up on the updates and CMS’ process for implementing code changes biannually. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders in acute care facilities must be comfortable assigning ICD-10-CM/PCS codes for abortions. Sarah Nehring, BS, RHIT, CCS, CCDS , breaks down ICD-10-CM/PCS codes for spontaneous and induced abortions and related complications.
In an industry that changes both quickly and frequently, keeping staff educated is important not only for your healthcare system, but for your employees’ professional growth. Catherine Sheika, BSN, RN, CCDS, writes about coding and team-building games that make even the driest topics more engaging.
Peoples Health Network received an estimated $3.3 million in overpayments between 2015 and 2016 for incorrectly billing ICD-10-CM codes from high-risk groups, according to a recent audit by the Office of Inspector General (OIG).
Cranial diagnoses present with varied symptoms and require an individualized approach to treatment. Brush up on documentation and ICD-10-CM/PCS coding for neuroendoscopy, posterior fossa decompression, and embolectomy/thrombectomy procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding a chart with a sepsis diagnosis requires careful attention to detail. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews sepsis documentation, ICD-10-CM coding requirements, and quality measures for public reporting.
Hospitals have made avoiding and managing denials a top priority, but for many, their best efforts have yet to turn the tide. Take steps to address compliance concerns and reduce denial rates.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting , introducing new codes and guidance for reporting dementia, head injuries, and long-term drug therapy.
Correct present on admission (POA) identification and use of POA indicators is important, as these indicators directly affect how insurance providers and patients are billed. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down POA reporting requirements and payment implications.
Q: What clinical criteria should coders use to support ICD-10-CM code assignment for upcoming 2023 dementia codes in category F02 (dementia in other diseases classified elsewhere)?
CMS recently released the fiscal year (FY) 2023 ICD-10-PCS code set and ICD-10-PCS Official Guidelines for Coding and Reporting . The ICD-10-PCS update includes several new codes for Destruction and Occlusion, and a new guideline for Detachment procedures of the extremities.
Inpatient coding for brain surgery can be challenging as many approaches, techniques, and devices may be used to treat cranial abnormalities. Read up on reporting requirements and ICD-10-CM/PCS coding for craniotomies and deep brain stimulation (DBS). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Various ICD-10-CM/PCS and CPT codes may be used to report hospital services for the diagnosis and treatment of COVID-19. Review Q&As on appropriate coding for COVID-19 laboratory testing, comorbidities, and treatments.
The establishment of mandatory sepsis protocols at all hospitals in New York state is estimated to have saved more than 16,000 lives between 2015 and 2019, according to End Sepsis.
Approximately 37.3 million Americans have diabetes, and nearly 20% of them don’t know they have it, according to the Centers for Disease Control and Prevention. Review the signs and symptoms of diabetes and guidelines for reporting the condition in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Items eligible for CMS’ New Technology Add-on Payment (NTAP) often yield high reimbursement but are prone to charging, coding, and billing errors. Learn about the NTAP designation and its impact on coding and billing processes.
A cesarean section is typically performed when complications from pregnancy make a traditional vaginal birth difficult. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for common labor and delivery complications, and ICD-10-PCS coding for cesarean deliveries.
Revenue leakage can be caused by a number of factors including late filings, inconsistent documentation, and inaccurate coding. Fran Jurcak, MSN, RN, CCDS, CCDS-O , describes proactive strategies that coding professionals can use to address mid-revenue cycle leakage.
Hospitalists coded a significantly higher proportion of Medicare beneficiaries as high severity compared to non-hospitalists, according to a study published in the Journal of the American Medical Association Health Forum .
Aspiration pneumonia is a lung infection caused by inhaled oral or gastric contents. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , breaks down documentation and ICD-10-CM coding requirements for aspiration pneumonia.
CMS is proposing to hit pause on major changes to MS-DRG designations while considering numerous changes to quality reporting and value programs, according to the fiscal year 2023 IPPS proposed rule. Read up on CMS’ proposed updates, which will impact inpatient hospitals beginning October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding managers should not assume that they can review every coding guideline, Coding Clinic , or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Inpatient coders must be familiar with different types of denials such as those due to clinical validity concerns. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , outlines components of a clinical validation denial and tools used to craft a clinical validation appeal.
CMS released the fiscal year (FY) 2023 IPPS proposed rule on April 18, 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 advancing health equity and improving maternal health outcomes.
Reviewing a sample of claims for clinical validity and coding accuracy can seem like a daunting task. Kaitlin Loos, RN, BSN, CDI auditor, and Molly Siebert, RHIA, CCDS, CDI specialist, describe their individualized review processes.
A recent audit conducted by the Office of Inspector General (OIG) projected that hospitals received $47.8 million in net overpayments from January 2018 through July 2019 for Medicare Part A claims that did not meet national requirements or contractor specifications for bariatric surgery.
Monitoring coding accuracy enables coding managers to spot error trends that could result in claim denials. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , describes two methods used to calculate coding accuracy based on a sample of claims.
Nancy Treacy, MPH, RHIA, CDIP, CCS , describes her team’s experience implementing a streamlined audit process and offers advice to help others do the same. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Mechanical ventilation is a life-saving intervention used for acutely ill patients who cannot breathe on their own. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , evaluates medical terminology used to describe mechanical ventilation and breaks down ICD-10-PCS coding for this procedure.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , describes how to use Office of Inspector General audit reports to identify areas at risk for noncompliance and how to organize targeted internal reviews.
CMS recently released three ICD-10-PCS codes, effective April 1, for the administration of fostamatinib (Tavalisse®)—an oral spleen tyrosine kinase inhibitor used to treat adults with low platelet count due to chronic immune thrombocytopenia.
It is estimated that as many as 1 in 500 adults may suffer from a cardiomyopathy, according to the Centers for Disease Control and Prevention. Review documentation considerations and ICD-10-CM coding for different types of cardiomyopathies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Patients are often admitted for acute conditions and experience additional issues affecting their care and treatment plan during the encounter. Ashayla Stephens, MHA, RHIA, CCS , and Audrey Howard, RHIA , describe the process of validating multiple diagnoses documented within the health record. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The primary purpose of CDI work is to review medical records to increase the accuracy and specificity of provider documentation. Review the primary responsibilities of a CDI specialist including documentation review, querying, and physician education.
A recent audit conducted by the Office of Inspector General (OIG) found that Tufts Health Plan Inc. (Tufts) received at least $3.7 million of net overpayments from 2015 to 2016 for incorrectly submitting selected high-risk diagnosis codes.
Physician documentation of heart failure must specify the type and severity of the illness to apply the most accurate code. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , breaks down clinical documentation and ICD-10-CM coding for four types of heart failure.
