Facilities may be reluctant to charge for bedside services beyond the room rate because they fear double-dipping. Kimberly Anderwood Hoy, JC, CPC, and William L. Malm, ND, RN, CMAS, discuss what CMS does—and doesn’t—say about charging for ancillary services .
Q: Some of our providers see patients in our local nursing facilities. When these patients are admitted to our hospital, must we retain this documentation in our own records?
These days, the healthcare industry is all about the numbers, especially as pay-for-performance becomes more common. Lawrence L. Sanders, Jr., MD, MBA, and Simone R. Gravesande, RN, BSN , review how APR-DRGs work and why all coders should understand them.
E codes are important in a variety of settings. Pamela L. Owens, PhD, Kathy Vermoch, MPH, Leslie Prellwitz, MBA, CCS, CCS-P, and Suzanne Rogers, RHIA, CCS, CCDS, explain the importance of reporting E codes and why every facility should have an internal coding policy that includes E codes.
Q: What advice can you offer for sequencing pulmonary edema and congestive heart failure when both appear to meet the definition of principal diagnosis?
Hospitals continue to report dramatic increases in Recovery Auditor (RA) activity, according to the latest RAC Trac survey results released June 4. The survey found that the number of medical record requests for survey respondents has increased by 53% in comparison to the cumulative total reported in the third quarter of 2012.
The ideal approach to ICD-10-CM/PCS preparation is capitalizing on the synergistic partnership between clinical documentation improvement and coding professionals. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, discusses how organizations can use this dynamic to improve preparations for ICD-10.
Coders may be surprised by the expansion and reorganization of codes for diabetes in ICD-10-CM. Pamela Rand, RD, LDN, Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, and Laura Legg, RHIT, CCS, discuss the differences between coding diabetes in ICD-9-CM and ICD-10-CM.
CMS has uploaded the latest version of the ICD-10-PCS codes that coders will use for reporting inpatient procedures beginning October 1, 2014. The new files also include the 2014 ICD-10-PCS Official Guidelines for Coding and Reporting .
In ICD-10-PCS, root operations precisely identify the purpose, intent, or objective of a procedure. Cynthia L. Stewart, CPC, CPC-H, CPMA, CPC-I, CCS-P, highlights the specific—and often subtle—differences in the definitions of ICD-10-PCS root operations.
Q: How will I report the initial insertion of a dual-chamber pacemaker device in ICD-10-PCS? The physician inserted two leads—one into the atrium and one into the ventricle–using a percutaneous approach into the patient’s chest.
Any ICD-10-CM/PCS to-do list wouldn’t be complete without the task of reviewing and revising query templates. Cheryl Robbins, RHIT, CCS, Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, and Sandra L. Macica, MS, RHIA, CCS, provide tips for updating queries for ICD-10.
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.
The accuracy and completeness of coded data can potentially affect physicians more as the healthcare industry becomes increasingly transparent to consumers. William E. Haik, MD, FCCP, CDIP, Timothy Brundage, MD, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Cathy Testerman, CCS, EMT, and Donna Walker-Thomas, MBA, RHIA, CPC, CMA, review how coded data relates to physician profiling and offer tips for engaging physicians in documentation improvement.
CMS not only redefines inpatient status in the 2014 IPPS proposed rule, but it also discusses the ‘why’ and ‘how’ physicians should document the defining characteristic of all admissions: medical necessity. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain how the proposals could impact inpatient admissions.
CMS has had a couple of busy months releasing various FY 2014 proposed rules. On May 1, CMS issued its proposed rule for skilled nursing facilities (SNF) . On May 2, the agency issued its proposed rule for inpatient rehabilitation facilities (IRF) . The two rules come in the wake of the IPPS proposed rule issued April 26.
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.
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.
