Julian Everett, RN, BSN, CDIP , says that 2020 should be the year when more CDI programs and inpatient coding teams ponder the idea of expanding into reviewing obstetrics. In this article, Everett details key areas to consider when starting these reviews, including hiring staff that have experience in obstetrics, conducting case sample assessments, and providing education on coding guidelines.
While the premise for quality programs is largely the same across the board, there are many programs and measures that fall under the “quality” banner. From readmissions to present on admission (POA) and patient safety indicators (PSI), CDI programs have a myriad of potential options in terms of record review focus.
In 2017, roughly 48 million incident cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported, according to a study published in The Lancet . According to the study, this represents 19.7% of all global deaths.
Sarah Nehring, CCS, CCDS , writes that because of the complexity and frequency of ischemic stroke admissions, inpatient coders should review clinical criteria and ICD-10-CM reporting regularly for this diagnosis to ensure accurate coding and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published Special Edition MLN Matters article 20004 regarding changes to new technology add-on payments (NTAP) under the IPPS that are meant to increase access to innovative antibiotics for hospital inpatients.
The ICD-10-PCS Official Guidelines for Coding and Reporting were updated for 2020 to include guidelines for coding brachytherapy performed in the inpatient setting. Sarah Nehring, CCS, CCDS , details these changes and how they will impact ICD-10-PCS reporting for permanent and temporary brachytherapy.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes about conflicting documentation and how coders and clinical documentation integrity specialists can resolve inconsistencies in provider documentation to prevent claim denials.
Lung cancer is the leading cause of cancer death, making up almost 25% of all cancer deaths in the U.S., according to the American Cancer Society. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O , reviews ICD-10-CM and ICD-10-PCS coding for common types of cancer. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to the Centers for Disease Control and Prevention, flu season is underway for most of the United States, and the activity level is expected to increase over the next several weeks. In this article, Adriane Martin, DO, FACOS, CCDS, reviews inpatient ICD-10-CM reporting for the flu and its potential complications.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, analyzes pertinent guidelines and coding dilemmas found within Chapter 1 of the ICD-10-CM Manual: Certain Infectious and Parasitic Diseases. Commeree covers instructional note guidance and other chapter specific guidance for diagnoses such as sepsis and HIV. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We are finding that physician documentation is lacking for vaping-related lung injuries at our hospital, making it hard to report the condition accurately. What can our coding team do to remedy this situation, and how do we accurately report vaping-related lung injuries in ICD-10-CM?
With the increased focus on clinical validation denials, more and more CDI professionals are finding themselves involved in the appeals-writing process and may initially feel a bit overwhelmed by the magnitude of the job. This article is part two of the two-part series covering best practices and appeal advice for those on the frontlines.
Ninety percent of hospital and inpatient organization leaders are considering outsourcing both clinical and non-clinical functions to achieve cost-efficiencies and succeed in value-based care models, according to a recent Black Book survey.
Julian Everett, RN, BSN, CDIP , reviews the background of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) and says that even though the report is only made available through quality or chief financial departments, it is imperative CDI and coding staff have a seat at the table when discussing areas for improvement at a facility.
Q: Our coding department was told there were changes made for fiscal year (FY) 2020 when it comes to reporting healed/healing pressure ulcers and pressure-induced deep tissue damage. Can you explain any recent updates?
With the increased focus on clinical validation denials, more and more CDI professionals are finding themselves involved in the appeals-writing process and may initially feel a bit overwhelmed by the magnitude of the job. This article will provide you with best practices and appeal advice for those on the frontlines.
Sarah Nehring, CCS, CCDS , writes that CDI and coding professionals must understand the guidelines for coding myocardial infarctions (MI) as well as the clinical difference between type 1 MIs and type 2 MIs so they can be clinically validated, queried, and reported effectively to avoid negative reimbursement ramifications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: I’ve heard conflicting information about reporting uncertain diagnoses. Do the ICD-10-CM diagnoses need to be documented in the discharge summary/final progress note or can they be coded from an earlier progress note?
One strategy for handling the confluence of confusion surrounding frequent criteria changes comes in developing a set of organizationwide clinical criteria for targeted, high-risk/high-volume diagnoses. This article discusses others’ experiences in developing standardized clinical indicators and guidelines at their facilities.
Medicare made $54.4 million in improper payments to acute care hospitals for post-acute transfers that did not comply with Medicare’s policies, according to a recent report from the Office of Inspector General (OIG).
Inpatient coders may query to achieve clarity within the medical record and allow for accurate ICD-10-CM/PCS reporting. This article will cover when to query, how to format a query, and review ICD-10-PCS code anatomy to ensure a well-rounded and precise query is submitted. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Safety-net hospitals may not have adequate resources to comply with federal and state sepsis quality improvement standards required of acute care hospitals, according to a recent study published in the Journal of Critical Care .
As of December 4, nearly 2,300 cases of lung injury related to vaping have been reported, according to the Centers for Disease Control and Prevention. In this article, Adriane Martin, DO, FACOS, CCDS , covers guidance, clinical indicators, and ICD-10-CM reporting for vaping-related lung injury.
According to Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, updating diagnosis codes has been integral to the evolution of our healthcare system. In this article, she reviews the background and basics of ICD-11 in preparation for future implementation of the code set. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Physicians at our hospital use the terms bacteremia and sepsis interchangeably despite each having distinct ICD-10-CM codes. How should we address this issue, and what should we do when we need to query?
Since the implementation of ICD-10-CM/PCS, thousands of additional codes have been added to clarify aspects of certain conditions or procedures. This, on top of yearly code updates, has had a large impact on coder productivity. In this article, let’s take a look at some recent productivity statistics gathered by First Class Solutions Inc. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Brett Hoggard, MD, writes that the healthcare industry continues to transition toward a value-based, pay-for-performance system, but there’s still confusion surrounding different quality and value programs.
Rachelle Musselman, BSN, RN; Jorde Spitler, BSN, RN; Daniel Lantis, BSN, RN; Joseph E. Ross, MD; and Thomas A. Taghon, DO, MHA, review their experience with implementing pediatric heart failure criteria at Dayton Children’s Hospital.
Q: When a diabetic patient has arteriosclerotic peripheral artery disease (PAD), should an additional ICD-10-CM code be assigned from subcategory I70.2- (atherosclerosis of native arteries of extremities) to describe the affected vessel and laterality?
Coders need a solid understanding of complex anatomical terminology and ICD-10-CM coding guidelines to select the most specific codes for trauma and injuries. This article breaks down inpatient diagnosis coding for superficial injuries, fractures, and burns. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julian Everett, RN, BSN, CDIP, writes that early recognition of sepsis in pediatric patients, along with accurate reporting, is vital to the future of healthcare. With the goal of improving patient outcomes through documentation, Everett outlines her experience in providing documentation education to physicians.
CMS recently published an update to the fiscal year (FY) 2020 IPPS final rule. This update corrects certain technical and typographical errors and contains corrections to the final payment factors. In this article, Judith Kares, JD , gives a summary of these key updates and related guidance.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews the basics of reporting with ICD-10-PCS including how to use the ICD-10-PCS manual, decipher root operation guidelines, and identify the principal procedure in physician documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
While “myocardial ischemia” is a familiar term to CDI professionals and inpatient coders, the term “myocardial injury” does not share the same widespread recognition. In this article, Adriane Martin, DO, FACOS, CCDS , deciphers the clinical criteria and reporting guidelines for capturing myocardial injuries and demand ischemia.
During the September ICD-10-CM Coordination and Maintenance Committee meeting, the Centers for Disease Control and Prevention (CDC) released a proposal to add, delete, and revise various ICD-10-CM codes for reporting sepsis.
In part two of this two-part series, Sharme Brodie, RN, CCDS , reviews the recent guidance from Coding Clinic , Second Quarter 2019, including systemic inflammatory response syndrome, partial hip replacements, and more.
Q: We had a patient with Type 2 diabetes who was admitted for hypoglycemia with metabolic encephalopathy. The patient also had stage 2 chronic kidney disease (CKD) and a diagnosis of hypertension (HTN). Which ICD-10-CM codes should we assign for this patient’s encounter?
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews how to report the stage and type of various skin ulcers, the fiscal year (FY) 2020 guideline updates for pressure ulcers, and common terminology traps inpatient coders can get tripped up by.
With much of the coding workforce working remotely, the inpatient coding manager must implement some control mechanisms to ensure the distractions at home are not interfering with the quality and quantity of work expected from the staff. In this article Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, gives suggestions on the various ways to monitor your remote coding staff, including tips for conducting coding reviews. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our coding team saw that there is a new section for radiation therapy in the FY 2020 ICD-10-PCS Official Guidelines for Coding and Reporting . Can you explain the recent changes made to this section?
Q: We recently had a patient who was admitted with sepsis and the physician documented sepsis, a urinary tract infection (UTI) related to a chronic Foley catheter, and pneumonia. Can we report sepsis first instead of the complication code, or is the complication always first?
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC, writes that one of the most interesting aspects of the ICD-10-CM code update for fiscal year (FY) 2020 was CMS’ proposal to change the severity assignment for many of these codes. In this article, Blue compares the severity changes that were suggested in the FY 2020 IPPS proposed rule with the designations that were actually finalized.
Sarah Nehring, CCS, CCDS, says that the last thing a query writer wants is to provoke a defensive response, but in the current healthcare environment, CDI specialists, clinical, and inpatient coding staff need to think defensively. In this article, Nehring outlines five items to remember when it comes to defendable queries, documentation, and coding.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, HCS-D, reviews the 2020 ICD-10-CM code changes for atrial fibrillation, as well as the clinical background and ICD-10-PCS reporting for related procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
ICD-10-CM/PCS coding for heart conditions such as aortic valve stenosis, heart failure, and atrial fibrillation requires an in-depth understanding of anatomical terminology and clinical indications. This article will review these three diagnoses to help ensure accurate reporting and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that the prevalence and complexity of prostate cancer is why it is so important for even inpatient coders to fully understand the diagnostic, treatment, and procedural aspects of this disease.
Q: We have a diabetic patient with chronic kidney disease and hypertension who was admitted for treatment of chronic kidney disease (an Insertion of an arteriovenous graft for dialysis). Which ICD-10-CM code should be sequenced as the principal diagnosis?
In August, U.S. District Judge David Ezra in Texas dismissed a case against Baylor Scott & White Health that alleged the organization falsely billed for millions in false claims for Medicare reimbursement.
CMS released the FY 2020 IPPS final rule on August 2, which finalized its decision on requests for new MS-DRG designations for chimeric antigen receptor T-cell (CAR-T) therapies. Upheld from the proposed rule, CMS denied these requests.
Regularly reviewing hospital-acquired conditions (HAC) and preparing for unanticipated reporting situations will ensure your facility can submit these with the utmost accuracy. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, helps coders better understand HACs by outlining the basics and giving tips for improving inpatient documentation and coding for these conditions.
Q: What would be reported as the principal diagnosis if a patient was admitted with both a urinary tract infection (UTI) and sepsis? What would be reported first if the patient developed a catheter-associated UTI with sepsis?
Cathy Farraher, RN, BSN, MBA, CCM, CCDS, writes that CDI professionals can work to reduce the incidence of physician query fatigue and gives recommendations to help improve provider response rate while reducing query frustration.
It’s that time of year when coders eagerly await the release of the new ICD-10-CM/PCS codes and guideline updates for the upcoming year. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, tackles the fiscal year (FY) 2020 IPPS final rule to highlight 2020 code set and guideline changes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A diabetic patient is diagnosed with a gangrenous decubitus ulcer of the left heel and admitted to the hospital for treatment. If the provider documents an association between diabetes and the decubitus ulcer, which condition should be sequenced as the principal diagnosis?
While it is essential to receive continuing education on ICD-10-CM/PCS code selection, it is also important to stay current with industry news. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , reviews inpatient reporting and guideline updates for fiscal year 2020. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Tamara Hicks, RN, BSN, MHA, CCS, CCS, ACM-RN, CCDS-O , explains how her organization implemented a CDI career ladder and why it’s an important step for hospitals looking to expand their coding and CDI departments.
CMS released the fiscal year (FY) 2020 IPPS final rule on August 2 with updates to payment rates and wage index values, changes to CC/MCC designations, and revisions to various MS-DRGs. Policy updates affect approximately 3,300 acute care hospitals and apply to discharges beginning October 1.
Allen Frady, RN, BSN, CCDS, CCS, CRC , reviews the answers to commonly asked questions pertaining to sepsis documentation to help coders and CDI specialists ensure accurate reporting of this condition.
Sepsis and systemic inflammatory response syndrome (SIRS) have historically been difficult to report due to changing terminology and continuous updates to ICD-10-CM coding guidelines. Review clinical terminology and complex guidelines to select the most specific codes for both conditions.
Adriane Martin, DO, FACOS, CCDS , describes key takeaways from Coding Clinic , Second Quarter 2019, including helpful advice on well-known coding challenges and their impact on severity and DRG assignment.
A retrospective billing study conducted by researchers at Mayo Clinic in Jacksonville, Florida, showed that pre-existing psychiatric comorbidities independently predicted elevated healthcare costs for a large population of patients treated with radiation at the institution.
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve. Review advice from experts on improving internal processes for dealing with commercial audits.
PTSD is marked by persistent mental and emotional stress that occurs as a result of severe psychological shock. Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews symptoms of and ICD-10-CM coding for PTSD, as well as barriers to psychosocial treatment for the condition.
Adriane Martin, DO, FACOS, CCDS , writes about how to accurately capture and report social determinants of health to improve patient outcomes and decrease costs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS announced on June 21 that it updated the national coverage policy for transcatheter aortic valve replacement (TAVR), requiring covered hospitals and physicians to begin or maintain a TAVR program and adhere to updated volume requirements.
The fiscal year 2020 IPPS proposed rule includes nearly 1,500 CC/MCC designation changes, which impact MS-DRG groupings used to calculate pricing for inpatient hospital claims. Rhonda Butler, CCS, CCS-P , reviews noteworthy proposed changes to MS-DRG assignment for the coming fiscal year. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Treatment options for spinal conditions are varied and may include pain management with medications, injections, or surgical interventions. Adrienne Commeree , CPC, CPMA, CCS, CEMC, CPIP , breaks down spinal anatomy and ICD-10-PCS coding for spinal fusions and laminectomy procedures.
Correct documentation and coding are key to accurate reimbursement, but according to the Office of Inspector General, organizations aren’t hitting the mark on either when billing for inpatient rehabilitation facility (IRF) services.
CMS recently released the fiscal year (FY) 2020 ICD-10-PCS changes and Official Guidelines for Coding and Reporting for the procedural coding system which will affect discharges occurring from October 1, 2019, through September 30, 2020.
Patients who use oxygen at home for a primary respiratory condition typically present with some degree of respiratory failure. Howard Rodenberg, MD, MPH, CCDS , describes common documentation issues related to oxygen requirements for the diagnosis of acute respiratory failure.
Q: We have a patient who received a pancreas transplant for the treatment of diabetes. The patient was later admitted to the hospital for treatment of an unrelated kidney stone. Would it be appropriate to assign the ICD-10-CM code for diabetes as a chronic condition based on the patient’s medical history?
The estimated annual cost of sepsis readmissions is more than half the annual cost of all Medicare Hospital Readmissions Reduction Program conditions combined, according to a study published in CHEST Journal .
Diagnosis coding for neoplasms can be particularly challenging, as neoplasms are classified by site, behavior, and morphology. Review ICD-10-CM coding and guidelines for reporting solid organ tumors and cancers affecting the bone marrow and lymphatic system. 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 2020 IPPS proposed rule in April, which addressed various requests for MS-DRG designations, and in particular, the request for a new MS-DRG designation for chimeric antigen receptor T-cell (CAR-T) therapies that CMS subsequently denied.
Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that due to the frequency of diagnoses and treatments for breast cancer, it’s more important than ever for inpatient coders to make sure they are reporting these diagnoses and procedures with the utmost accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Adriane Martin, DO, FACOS, CCDS, reviews recent Coding Clinic, First Quarter 2019, advice, which includes guidance on reporting abdominal aortic aneurysm (AAA) repairs, spinal fusions, Whipple procedures, midline and central venous catheters, and more.
Sarah Nehring, CCS, CCDS, says that from the inpatient coding and CDI perspective, sepsis can be one of the trickiest diagnoses. In this article, she reviews 10 things coders wish physicians knew about sepsis documentation and coding.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews the background of MS-DRGs, as frequently revising MS-DRG basics will ensure that inpatient coders have a thorough understanding of the MS-DRG intricacies, thus perfecting overall assignment and reimbursement accuracy.
Adriane Martin, DO, FACOS, CCDS, writes that treatment of peripheral arterial disease (PAD) is variable and includes both medical and surgical therapy. Given the frequency of this condition, it is imperative that inpatient coding professionals have a clear understanding of the surgical treatment of PAD to avoid costly ICD-10-PCS errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If our physician only documents “uncontrolled diabetes” in an admitted patient’s chart, but I can see from the lab results in the record that the patient’s blood glucose levels are high, can I assign the ICD-10-CM code for diabetes with hyperglycemia?
Although computer-assisted coding and natural language processing software has improved many aspects of daily CDI work, the technology requires ongoing oversight to ensure efficacy and accuracy. Therefore, CDI professionals, and even inpatient coders, need to be aware of the software’s potential pitfalls within the CDI department and develop tactics to overcome them.
CMS released the fiscal year (FY) 2020 IPPS proposed rule Tuesday, April 23, which included the annual ICD-10-CM/PCS code update proposals, significant changes to CC/MCC and MS-DRG designations, and a proposed increase to hospital payment rates.