CMS and auditors are increasing scrutiny of CCs and MCCs. William E. Haik, MD, FCCP, CDIP, provides tips that coders can use to look for clinical evidence in the record before querying for these targeted conditions.
Although coders and billers don’t play a role in determining whether condition code 44 is appropriate, they certainly ensure correct billing of the code. Deborah K. Hale, CCS, CCDS, and John Zelem, MD, FACS, review the requirements for condition code 44 and when coders should report it.
Under a new ruling, CMS allows full Part B payment for inpatient stays that a contractor denies because it deems them to be not reasonable and necessary. David Danek and Ann Marshall, both from CMS, explain how the rebilling works under the ruling and what will be different under a simultaneously released proposed rule.
The increasing complexity of the healthcare reimbursement system, quality initiatives, and the transition to ICD-10-CM/PCS put clinical documentation improvement programs in the spotlight . Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, discusses the importance of documentation improvement specialists.
Q: A surgeon’s dictated report for a right hip hemiarthroplasty states the following: Of note, while drilling one of our transosseous suture holes with a 2.0 mm drill bit, the end of the drill bit broke off inside of the trochanter. It seemed to be quite deep into the bone and was not retrievable. As such, it was left in place. Should we report 998.4 (foreign body accidentally left during a procedure) for this case?
The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
DRGs for procedures unrelated to the principal diagnosis should occur rarely. Robert S. Gold, MD, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain when it is appropriate to report an unrelated DRG.
Distinguishing between clinical and coding significance is often confusing. Joel Moorhead, MD, PhD, CPC, discusses how coders should differentiate between the two.
Three out of four providers have completed only 25% or less of their ICD-10-CM/PCS conversion process, according to an ICD-10 snapshot survey conducted by the Aloft Group in February. However, CMS and others are busy helping to ensure that providers and payers are ready for the transition to ICD-10-CM/PCS.
Change is consistently a part of HIM and coding. Rules, regulations, and codes change yearly and sometimes quarterly. Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, reveals why the switch to ICD-10 is different from the annual changes coders are used to and how coders and organizations can prepare.
Many organizations are concerned about the expected drop in coder productivity after the transition to ICD-10. Angie Comfort, RHIT, CDIP, CCS, discusses the pros and cons of using computer-assisted coding to help offset those productivity losses.
Choosing the correct root operation may be one of the most challenging aspects of ICD-10-PCS. Sandra Macica, MS, RHIA, CCS, and Kristi Stanton, RHIT, CCS, CPC, define some of the root operations in the surgical section of ICD-10-PCS and explain when to report them.
Q: Using the ICD-10-CM guidelines for the seventh character extensions for fracture codes, how should I identify each of the following? Avascular necrosis following fracture Cast change or removal Emergency treatment Evaluation and management by a new physician Follow-up visits following fracture treatment Infection on open fracture site Malunion of fracture Nonunion of fracture Medication adjustment Patient delayed seeking treatment for the fracture or nonunion Removal of external of internal fixation device Surgical treatment
The OIG is taking a closer look at mechanical ventilation, according to its FY 2013 Work Plan. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explain why your facility should do the same.
Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the four Recovery Auditors in FY 2013 first quarter (October 2012–December 2012), according to the most recent release of improper payment statistics .
Coded data is incredibly important to a wide range of people. Bill Rudman, PhD, RHIA, Roxanne Andrews, PhD, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Susan Beever, RHIT, CCS, reveal how accurate coding aids research and law enforcement and improves quality of care.
