In part two of this two-part series, Audrey Howard, RHIA, covers fiscal year (FY) 2022 updates to ICD-10-PCS reporting for spinal procedures, specificity updates to the ICD-10-CM official coding guidelines, and modified MS-DRG logic for type 2 myocardial infarctions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Surviving Sepsis Campaign recently released a 2021 update to guidelines for the care of patients with sepsis. The updated guidelines emphasize the difficulties with treating patients who are experiencing long-term effects of sepsis.
Hospitals often put significant thought, time, and energy into hiring new team members, and while coding and CDI managers can have the best possible staff, if they don’t feel appreciated, the odds of them staying with the company long term are low.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down a clinical scenario and corresponding query so inpatient coders and CDI specialists can better work to ensure proper reporting and reimbursement for diagnoses related to acute tubular necrosis (ATN).
In part one of this two-part series, Audrey Howard, RHIA, covers fiscal year (FY) 2022 updates to ICD-10-CM reporting for non-ischemic myocardial injury and traumatic brain compression and herniation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Howard Rodenberg, MD, MPH, CCDS, writes that it only takes one or two inappropriate queries to a provider for the process to seem burdensome to them. To avoid this scenario, Rodenberg proposes three questions to consider once you’ve decided a query is in order.
In this article, we will take a closer look at clinical indicators for acute myocardial infarction, congestive heart failure, and arrythmias. Frequently reviewing clinical indicators for complicated diagnoses such as these will ensure both proper ICD-10-CM reporting and reimbursement.
Q: Our coding team has been having trouble reporting post-operative complications due to vague physician documentation. What language might you suggest that physicians use to clarify that the complication is indeed due to surgery?
It’s not unusual for CDI and inpatient coding teams to cite physician education and engagement as one of their top struggles in the field. In this article, read how the CDI team at Avera Health System turned to their query data to craft a focused education program and meet their physicians on the same page.
Sarah Nehring, RHIT, CCS, CCDS, writes that in light of the fiscal year 2022 ICD-10-CM update to encephalopathy, now is a good time for inpatient coders to review common forms of encephalopathy and its reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released the FY 2022 IPPS final rule, which finalized updates to quality programs including the Hospital-Acquired Condition Reduction Program, the Hospital Readmissions Reduction Program, and the Hospital Value-Based Purchasing Program.
CMS generally took the path of least resistance and cushioned the ongoing impact of the COVID-19 pandemic in the fiscal year (FY) 2022 IPPS final rule. Effective October 1, the final rule covers payment rate updates, new technology add-on payments, and changes to MS-DRG rate setting and groupings.
Through examples given within the wound care setting, Bobbie Starkey, RHIT, CCS-P , shows the importance of documentation and ICD-10-CM reporting to support hierarchical condition category (HCC) capture within the inpatient coding sphere. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released the fiscal year (FY) 2022 IPPS final rule, which repealed the MS-DRG relative weight methodology finalized in the FY 2021 IPPS final rule.
Q: We have a patient admitted for heart failure who is also being treated for latent autoimmune diabetes of adulthood (LADA). What is LADA and how would it be reported in ICD-10-CM?
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, writes that CDI professionals and inpatient coders need to pay attention to the definitions and clinical indicators of acute kidney injury (AKI) to ensure proper ICD-10-CM reporting and reimbursement.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, reviews how critical thinking is important within the CDI and coding realm in order to enhance review accuracy and query rates and to help loosen reliance on technological tools such as encoders.
Judith L. Kares, JD, details pertinant changes found in the fiscal year (FY) 2022 IPPS final rule, including payment rate updates and the repeal of the MS-DRG relative weight (RW) methodology.
Dawn Valdez, RN, LNC, CDIP, CCDS, says that the clinical indicators used to validate sepsis can also have other possible etiologies that could be equally responsible for the clinical indicators that are present—these are known as competing diagnoses.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM/PCS reporting for the cardiac system is complex and requires frequent review in order to report the most accurate codes. In this article, Nehring covers ICD-10-CM/PCS coding and clinical indicators for cardiogenic shock, intra-aortic balloon pumps, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We recently had a patient admitted with severe acute meningitis causing respiratory decompensation. A diagnostic lumbar puncture and mechanical ventilation were both performed during the inpatient stay. Which of these two procedures would be the principal procedure?
The Office of Inspector General (OIG) recently released its fiscal year (FY) 2020 Healthcare Fraud and Abuse Control Program report. During FY 2020, the federal government won or negotiated more than $1.8 billion in healthcare fraud judgments and settlements, according to the report.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes that inpatient coding for pacemaker Insertions can be confusing to both novice and experienced coders. Because of this, it’s important for all inpatient coders to regularly review ICD-10-PCS reporting for these procedures. 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 (FY) 2022 IPPS final rule on Monday, August 2, which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.
Howard Rodenberg, MD, MPH, CCDS, and Lynn Shay, CPHQ , say that making sense of varying COVID-19 case-mix index metrics is an important endeavor that will sometimes require a bit of DIY. In this article, they explain how they were able to unscramble their departments’ COVID-19 case-mix index data.
In this article, Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, reviews Coding Clinic , Second Quarter 2021, advice for reporting encephalopathy, a laparoscopic salpingo-oophorectomy, and more.
A recent study highlighted growing evidence that patients of all ages can develop type 1 diabetes after an acute COVID-19 infection. In this article, Susan Belley, RHIA, CPHQ, and Audrey Howard, RHIA, evaluate these findings as well as ICD-10-CM reporting for the two conditions.
Q: Would telemetry and the continuation of home medications be considered continued care for a myocardial infarction (MI) or treatment when reporting in ICD-10-CM? Would this meet the definition of a secondary diagnosis?
The fiscal year (FY) 2022 ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, both effective October 1, were recently released by the Centers for Disease Control and Prevention and CMS, respectively.
Sarah Nehring, RHIT, CCS, CCDS , reviews ICD-10-CM reporting and clinical criteria for various types of heart failure including diastolic, systolic, hypertensive, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, writes that organizations that aren’t reviewing all in-hospital mortality cases are missing some tremendous opportunities to improve reimbursement and documentation.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2022 ICD-10-CM code set which includes 159 new, 20 revised, and 32 deleted ICD-10-CM codes. CMS also released the finalized ICD-10-PCS codes for FY 2022, which includes 191 new, 62 revised, and 107 deleted ICD-10-PCS codes. The code changes take effect October 1, 2021.
Q: Per Coding Clinic, Second Quarter 2017, when a spinal fusion is performed without bone grafting it cannot be coded to the root operation Fusion in ICD-10-PCS. Is this advice still accurate?
Judith L. Kares, JD, reviews potential updates found in the fiscal year (FY) 2022 IPPS proposed rule that pertain to quality programs for inpatient hospitals and changes to address existing inequities in the delivery of these services.
Pediatric record reviews require a different skill set than those in the traditional adult acute care space. Often, those reviewing these specialized charts are islands within their overall CDI or coding department, acting as the sole pediatric chart reviewer. This article sheds light on how some have perfected these reviews within their department.
Shelley C. Safian, PhD, RHIA, CCS-P, writes that inpatient Removals of a device from a lower bone may be performed less frequently than other procedures, which creates a need for more education on reporting ICD-10-PCS codes from table 0QP. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , summarizes findings from recent Office of Inspector General audits that highlight improper billing of high-level inpatient stays. He also outlines steps hospitals can take to prevent billing errors due to upcoding.
Howard Rodenberg, MD, MPH, CCDS , describes how internal reviews can be used to identify repeated coding errors and prevent payment penalties due to Patient Safety Indicators (PSI) and hospital-acquired conditions (HAC).
Medicare Recovery Auditors will review claims submitted by inpatient psychiatric facilities to ensure that billed services are medically reasonable and necessary, according to a recent Medicare Quarterly Provider Compliance Newsletter.
Approximately 1.5% of the general population sees a primary care physician each year for treatment of chest pain symptoms, according to Family Practice . In this article, Sarah Nehring, RHIT, CCS, CCDS , breaks down potentially confusing ICD-10-CM coding guidelines for chest pain and angina. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A recent Office of Inspector General audit estimates that Medicare improperly paid inpatient hospitals $267 million over a two-year period for transfer services incorrectly billed as discharges. Judith Kares, JD , analyzes documentation and billing rules for acute and post-acute transfers.
The Office of Inspector General (OIG) recently performed a compliance audit of specific diagnosis codes billed by Anthem Community Insurance Company Inc. to CMS and found that the company submitted unsupported diagnosis codes for 123 of the 203 enrollee-years.
Approximately 185,000 amputations occur in the U.S. each year, according to the Amputee Coalition. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down documentation and ICD-10-PCS coding for amputations of the upper and lower extremities. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS offers hospitals some breathing room to recover from the effects of the COVID-19 pandemic in the 2022 IPPS proposed rule. Review proposed updates to complication/comorbidity (CC) and major CC classifications, and a proposed new MS-DRG rate-setting method aimed at alleviating hospital burden.
Sarah Nehring, RHIT, CCS, CCDS , reviews documentation and ICD-10-CM guidance for reporting for toxic effects, adverse drug reactions, and underdosing of prescribed medications.
A spinal fusion, or surgery to permanently connect two or more vertebrae in the spine, is sometimes necessary to correct spinal deformities and instability. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down ICD-10-CM and ICD-10-PCS coding for fusion procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The evolution of the role of clinical documentation integrity (CDI) specialists and their impact on coders has changed the landscape of inpatient coding departments. Learn about how to effectively collaborate with CDI professionals when conducting physician queries.
The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.
Spinal fusion procedures are reported using two different ICD-10-PCS tables, depending on the location of the vertebrae fused. Sarah Nehring, RHIT, CCS, CCDS , breaks down ICD-10-PCS coding for spinal fusions based on details in the operative note.
Before assessing a coder’s work performance, a facility must set goals that define that success. Review quality improvement standards that facilities use to define coding success.
CMS released the fiscal year (FY) 2022 IPPS proposed rule on April 27, with proposals for the annual ICD-10-CM/PCS code update, the creation of new MS-DRGs, and increases to hospital payment rates.
Susan Belley, RHIA, CPHQ , and Audrey Howard, RHIA , analyze the frequently changing ICD-10-CM guidelines for reporting COVID-19 and related respiratory complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A Humana health plan in Florida collected nearly $200 million in Medicare overpayments in 2015 by improperly coding for high-severity Hierarchical Condition Category conditions, according to a recent audit from the Office of Inspector General (OIG).
Q: I’m having trouble determining how to report an acute myocardial infarction (MI) for subsequent admissions occurring within four weeks of the initial MI in ICD-10-CM. Can you walk me through the process?
Vaginal cuff dehiscence is a severe complication of a total hysterectomy. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about ICD-10-CM coding for vaginal cuff dehiscence and ICD-10-PCS coding for dehiscence repairs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Review quality reporting metrics such as length of stay and mortality indexes that you can use to assess patient outcomes and improve revenue cycle processes.
Encephalopathy is a general term used to describe any disease of the brain that alters its function or structure. Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , analyzes ICD-10-CM coding for toxic, metabolic, and hepatic encephalopathies.
Allen Frady, RN, BSN, CCS, CRC, CCDS, describes steps that coding and clinical documentation integrity managers can take to improve quality metrics and hold staff accountable for reporting errors.
About 1% of children in the U.S. suffer from chronic malnutrition, according to John Hopkin’s Medicine. In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, breaks down ICD-10-CM coding and documentation requirements for malnutrition.
Billing for high-level inpatient stays increased over a six-year period sparking concerns by the government about upcoding, according to a recent report from the Office of Inspector General (OIG).
Cheryl Manchenton, RN, BSN, Beth Wolf, MD, CCDS, CPC, and Audrey Howard, RHIA, review ICD-10-CM coding for cytokine release syndrome, sepsis, and multisystem inflammatory syndrome. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We have a patient admitted for COVID-19 who is now showing signs of cytokine release syndrome (CRS). Can you give our team more information on symptoms or clinical indicators for CRS as well as any ICD-10-CM coding advice?
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and the rules governing their assignment in order to ensure proper reimbursement. Part two of this two-part series will review HACs in particular as part one focused on present on admission indicators.
In part one of this two-part series, Allen Frady, RN, BSN, CCS, CRC, CCDS, gives tips to CDI and coding teams on how to help improve healthcare quality scores by reviewing CMS star rating calculations, department challenges, physician education, and more.
COVID-19 patients who were hospitalized as inpatients cost significantly more than those treated in an outpatient setting, according to data from the Blue Cross and Blue Shield Association.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM codes for immunodeficiencies are CCs for inpatient admissions and can impact severity of illness and risk of mortality calculations, which is why they are important for coders to frequently review. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to a study recently published in the Journal of Clinical Endocrinology & Metabolism , 55% of Black patients with both COVID-19 and Type 1 diabetes also presented with diabetic ketoacidosis.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, says with recent audit activity and the Office of Inspector General’s continued scrutiny of malnutrition diagnoses, it’s important to dig into the coding and documentation requirements for this tricky diagnosis, particularly in the case of COVID-19 patients.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and present on admission (POA) indicators and the rules governing their assignment in order to ensure proper reimbursement. Part one of a two-part series will review POA indicators in particular.
Q: We had a patient admitted with a negative COVID-19 test, but after being retested the patient had a positive COVID-19 result. Should we query the provider whether COVID-19 was POA?
Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ , write that since acute respiratory distress syndrome (ARDS) is included as a common respiratory manifestation of COVID-19 in the ICD-10-CM Official Guidelines for Coding and Reporting , it is essential to understand the syndrome for accurate and complete inpatient reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM reporting of sequelae generally requires two codes, but the codes assigned and the sequencing depend on whether the sequela is from a cerebrovascular accident, a traumatic injury, or an infection such as COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, RHIA, says inpatient coding professionals need to look for signs and symptoms supportive of sepsis in order to report the most accurate codes, which is why staying up to date on the ever-changing clinical criteria for sepsis is so important.
CMS is modifying its approach for presenting new technology add-on-payment-related ICD-10-PCS code requests that involve the administration of therapeutic agents for its March 9-10, 2021 ICD-10 Coordination and Maintenance Committee meeting.
Q: We are confused about which body part value in ICD-10-PCS should be captured for an incision and drainage (I&D) of a perianal abscess of the left buttocks because the physician documented both “perianal” and “left buttocks.”
Howard Rodenberg, MD, MPH, CCDS , writes that ensuring the social determinants of health are appropriately documented within the medical record allows CDI and coding teams to capture the hard data needed to demonstrate the interactions among race, gender, ethnicity, and other key socioeconomic indicators with healthcare costs, utilization, and outcomes.
The Office of Inspector General (OIG) recently released an audit report for Providence Medical Center that says some of the hospital’s inpatient records did not support the medical necessity for inpatient hospital services.
Inpatient coding professionals must have a clinical understanding of COVID-19 and the disease process in order to accurately sequence diagnoses, code etiology and manifestations, and assign present on admission (POA) indicators. In this article, Audrey Howard, RHIA , and Susan Belley, RHIA, CPHQ, focus on coding issues related to POA indicators for the hospitalized, inpatient COVID-19 population.
Q: When two conditions are both present on admission, both meet definition to be the principal diagnosis (PDX), and are “equally treated,” my understanding is that the condition does not have to be "equally treated" in the sense of duration/frequency. Can you provide the actual verbiage of the coding rule and explain?
Review clinical indicators and query opportunities for acute respiratory failure, respiratory failure due to surgical procedures, and ventilator MS-DRGs. Frequently reviewing clinical indicators for these complicated diagnoses will ensure both proper coding and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Was there an Excludes note change for subcategory G93.4- (other and unspecified encephalopathy) for fiscal year 2021? If so, how will it change any ICD-10-CM reporting and reimbursement for toxic encephalopathy and metabolic encephalopathy going forward?
Those afflicted with sickle-cell disease or sickle cell traits were more likely to experience severe COVID-19 illness and hospitalization, according to a recent study presented at the American Society of Hematology Annual Meeting and Exposition.
Sarah Nehring, RHIT, CCS, CCDS, writes that the ICD-10-PCS code set update for fiscal year 2021 included the creation of five new Fragmentation tables. For this article, Nehring will take a look at two vascular Fragmentation procedures: ultrasound-assisted thrombolysis (EKOS) and intravascular shockwave lithotripsy (IVL). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In a year of unprecedented disruption and uncertainty, coding productivity managed to hold steady, according to the results of HCPro’s 2020 Coding Productivity Survey. Review the survey results, which provide data on facility coding productivity, accuracy benchmarks, and more.
Both sepsis and malnutrition remain top denied diagnoses, and there is little sign of those denial rates slowing. This article is part two of a two-part series that zeros in on clinical validation and denial prevention for these two diagnoses.
Almost half of hospitals in the U.S will be getting lower payments for Medicare patients due to their readmissions history, according to a recent analysis reported in Kaiser Health News.
Q: Are there any newly implemented fiscal year 2021 ICD-10-CM codes for spontaneous cerebrospinal fluid leaks (CSF)? Can you review any background and possible new codes for this disorder?
Both sepsis and malnutrition remain top denied diagnoses, and there is little sign of those denial rates slowing. Part one of this two-part series will take a closer look at malnutrition and sepsis criteria challenges, while part two will zero in on clinical validation and denial prevention for these two diagnoses.
Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, looks at some of the new fiscal year (FY) 2021 ICD-10-CM codes and guidelines pertaining to COVID-19 and Chapter 1 of the ICD-10-CM manual: Certain infectious and parasitic diseases. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Review clinical indicators for various types of encephalopathies including toxic or metabolic encephalopathy, hypertensive encephalopathy, and hepatic encephalopathy. Frequently reviewing clinical indicators for these complicated diagnoses will ensure both proper coding and reimbursement.