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.
