The 2021 update to the ICD-10-CM code set introduced 43 new codes to Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. Review new codes for sickle-cell diseases, hemolytic anemias, and cytokine release syndrome. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, HCISPP , writes about CPT coding for total hip arthroplasty and autologous chondrocyte implantation: two orthopedic procedures that were recently removed from the inpatient-only (IPO) list for 2021.
Although the HIM department plays a key role in the revenue cycle, too often it’s placed in a reactive position, limiting the department’s effectiveness. The HIM department can wind up locked in a cycle of cleaning up claims without being empowered to apply process improvements that would reduce errors and facilitate corrections.
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?
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.
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.
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.
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.
Clinical indicators for certain conditions or treatments frequently require greater completeness or specificity in ICD-10-CM, for which concurrent or retrospective query is often required.
This article details 2021 updates to CPT® codes for medicine services including several new codes for continuous electrocardiogram (ECG) recordings and auditory-evoked potentials (AEP), as well as American Medical Association (AMA)-approved CPT codes for COVID-19 immunizations.
Section 1862 (l) and Section 1869 (f)(2)(B) of the Social Security Act (the Act) sets forth general procedures to develop and evaluate Medicare coverage determinations that are either adopted nationally by CMS or created and applied locally by a Medicare Administrative Contractor (MAC) within the MAC’s own jurisdictional boundaries.
Hospital coding for pregnancy-related services requires a detailed understanding of the CPT® global obstetric (OB) package and ICD-10-CM coding guidelines for maternal care management. This article details hospital coding for pregnancy and delivery complications and procedures used to treat them.
Our coding experts answer questions about reporting strokes and seizures in ICD-10-CM without pre-existing disorders, revenue cycle education for clinical staff, and more.
CMS recently announced that it will take steps to increase hospital capacity by allowing care to be provided to patients outside a traditional, inpatient hospital setting amid a rising number of COVID-19 hospitalizations.
Sarah Nehring, RHIT, CCS, CCDS, reviews several new COVID-19-related ICD-10-CM and ICD-10-PCS codes recently released by CMS that will become effective January 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Is there ICD-10-CM sequencing guidance for a patient who had a hemorrhagic stroke and then a seizure without a pre-existing seizure disorder? Would it be appropriate to report epilepsy, and are there any inclusion terms we should be aware of?
Julian Everett, RN, BSN, CDIP, details COVID-19’s recent impact on our healthcare system including healthcare spending, health disparities, and the future of the system among COVID-19. Everett also assesses ICD-10-CM reporting for these disparities and social determinants of health.
The calendar year 2021 Medicare Physician Fee Schedule (MPFS) final rule will have a significant impact on physician health systems. Review the implications of updated coding and payment policies that will boost payment for certain E/M services and cut the Medicare conversion factor by 10.2%.
The Medicine chapter of the CPT Manual covers a wide variety of services applicable to multiple specialties. Review calendar year 2021 updates to CPT® codes for medicine services including new codes for continuous electrocardiogram recordings and auditory-evoked potentials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Audit defense is a key strategy in protecting earned revenue and ensuring coding and billing compliance. Read about auditing trends during the COVID-19 public health emergency and internal processes that organizations are using to track audit activity.
Sydni Johnson, RN, BSN, CCDS , and Denice Piwowar, BSN, RN, CCDS , detail some basics of clinical validation and how to request supporting indicators of a documented diagnosis without questioning the provider’s judgment.
CMS recently announced 27 new ICD-10-CM and ICD-10-PCS codes, along with corresponding MS-DRG assignment, for diagnoses and procedures related to COVID-19. These new codes will become effective for discharges on or after January 1.
Emmel Golden, MD, FCCP, CCDS , reviews three recent studies detailing sepsis trends in the U.S. and writes that now is a great time to shed light on how important complete, precise documentation and coding are to understanding the sepsis health challenges we face as a country.
Q: What are the benefits to having coders review charts for appropriate capture of CCs and MCCs, and how can our coding team get started in this process?
Clinical indicators for certain conditions frequently require greater specificity in ICD-10-CM for which a query is often required. This article takes a closer look at clinical indicators and ICD-10-CM reporting for transient ischemic attack (TIA) and underlying causes and consequences. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hospital coding for pregnancy-related services requires a detailed understanding of the CPT® global obstetric (OB) package and ICD-10-CM coding guidelines for maternal care management. This article details hospital coding for pregnancy and delivery complications and procedures used to treat them. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Laura Evans, CPC, reviews 2021 E/M coding for outpatient encounters based on provider documentation of medical decision-making (MDM). She breaks down the four levels of problems addressed and describes the types of conditions that would fall into each category.
Q: When might it be appropriate to report computer-aided mapping of the cervix uteri using 2021 CPT add-on code 57465 (computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect)?
CMS' new final rule prepares for vaccine coverage for Medicare, Medicaid, and commercial insurers without any out-of-pocket costs. CMS will pay for any coronavirus vaccine that receives FDA authorization either through an Emergency Use Authorization or via a license under a Biologics License Application.
Modifiers provide a means by which a physician or facility can flag a service that has been altered by a special circumstance but has not changed in definition or code. Break down CPT guidelines for reporting hospital modifiers -25, -50, -59, -LT, and RT.
One concern CDI professionals and inpatient coders say they struggle with is physician engagement and education. Without an engaged physician staff, CDI and coding efforts will languish with unanswered queries and subpar documentation practices.
I received a note from Diane Matysik, a CDI supervisor for Ascension Health in Duluth, Minnesota, who asked a question near and dear to my emergency department (ED) heart: If a patient suffers an out-of-hospital cardiac arrest and is resuscitated before arrival in the ED, should the scenario be described with an ICD-10-CM Z code?
The HIM department plays a critical role in the revenue cycle, but it’s often placed in a reactive position, limiting its effectiveness. Learn how to improve operations by enhancing the HIM department’s involvement across the revenue cycle.
Q: We have an elderly patient admitted to our hospital who is also presenting with osteoarthritis (OA) of the right knee. How can we determine primary versus secondary OA, and how would it be reported in ICD-10-CM?
The Office of Inspector General (OIG) recently announced it plans to audit hospital inpatient claims. According to the report, the OIG wants to determine if inpatient claims with short lengths of stay were incorrectly billed as inpatient when they should have been billed as outpatient or outpatient with observation.
Sarah A. Nehring, RHIT, CCS, CCDS, details ICD-10-CM reporting and clinical indicators for hepatic fibrosis, cirrhosis, and complications caused by cirrhosis such as ascites and spontaneous bacterial peritonitis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alicia Kutzer, Esq., LL.M., M.H.A , reviews CMS’ Interim Final Rule with Request for Comments (IFC) concerning coverage, billing, and payment for COVID-19 vaccines and therapeutics. This guidance is imperative for inpatient hospitals to evaluate to ensure proper documentation and reimbursement.
ICD-10-CM coding for genitourinary conditions requires careful attention to detail. Learn about genitourinary structures and their functions as well as new ICD-10-CM codes for glomerulonephritis, chronic kidney disease, and granulomatous mastitis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A multi-organizational collaborative is proving further evidence of the growing interest in behavioral health integration with primary care. Read about organizational efforts to improve collaboration between primary care and mental health providers and enhance billing for behavioral health services.
The American Medical Association (AMA) on November 10 announced a handful of new CPT codes for reporting COVID-19 vaccine products and immunization administration.
Sarah Nehring, RHIT, CCS, CCDS , details three significant changes to the ICD-10-CM tabular list Excludes notes that may prove valuable to hospitals in fiscal year (FY) 2021, including updates to Excludes notes for encephalopathy, toxic encephalopathy, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, writes that the better the CDI policies and procedures, the better CDI and inpatient coding departments can work efficiently together to achieve proper documentation, coding, and reimbursement.
Up to now, public health data collection has been mainly focused on adult COVID-19 patients, but we are beginning to see data indicating that COVID-19 is impacting children’s health as well. With more of the spotlight on pediatric COVID-19 diagnoses, it’s important to ensure proper documentation to help improve data collection.
Incorrect acute stroke diagnosis codes reported by Medicare providers resulted in millions of dollars in increased payments to Medicare Advantage organizations, according to a recent Office of Inspector General (OIG) report.
Q: Our coding team is having trouble understanding the different types of chronic respiratory failure (CRF) and knowing when to suspect its presence when it’s not specifically documented by our physicians. Can you please help us with this?
CMS on October 28 released an interim final rule that ensures physician reimbursement for the administration of a COVID-19 vaccine and outpatient hospital reimbursement for COVID-19 drug services provided at the same time as a comprehensive APC service.
The COVID-19 public health emergency has not made it easy, but coders and medical practice staff have a lot to be proud of this year. Review key findings from a medical practice salary survey, including data to support medical staff pay increases and expanded job responsibilities.
Public comments on 2021 Medicare Physician Fee Schedule (MPFS) proposed rule offer insight into the policy preferences of the medical practice industry. Familiarize yourself with controversial proposed policies to restrict telehealth billing and reduce payment rates for audio-only E/M services.
Q: What place of service codes and modifiers should be reported on physician claims for wound care services performed via telehealth during the COVID-19 public health emergency?
Modifiers provide a means by which a physician or facility can flag a service that has been altered by a special circumstance but has not changed in definition or code. Break down CPT guidelines for reporting hospital modifiers -25, -50, -59, -LT, and RT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Our coding experts answer questions about chart audit focus areas, reporting separately payable E/M services with modifier -25, physician billing via telehealth, and more.
As we continue seeing an influx of novel coronavirus (COVID-19) cases, there is no better time for inpatient coders to review ICD-10-PCS reporting for extracorporeal membranous oxygenation (ECMO) procedures. Hopefully these procedures are only necessary in rare circumstances for those COVID-19 inpatients.
The fiscal year (FY) 2021 ICD-10-CM code set includes 26 new codes for nervous system conditions such as cerebellar ataxia, Dravet syndrome, and cerebrospinal fluid (CSF) leaks. This article details these code changes and associated updates to the ICD-10-CM Official Guidelines for Coding and Reporting , which went into effect last month.
CMS set the timer on transforming MS-DRGs in the recently released fiscal year (FY) 2021 IPPS final rule . The agency strongly signaled its wish to de-emphasize the role of the chargemaster and the cost-to-charge ratio (CCR) in MS-DRG rate setting and laid out a pathway to a methodology that would align traditional Medicare MS-DRG rates with Medicare Advantage (MA).
Q: CMS created a new MS-DRG for chimeric antigen receptor T-cell (CAR-T) therapies in the fiscal year (FY) 2021 IPPS final rule. Which ICD-10-PCS codes group to this new MS-DRG and does it qualify for an additional new technology add-on payment?
It’s more important than ever that organizations keep ahead of COVID-19 ICD-10-CM and MS-DRG audits and denials. The financial strain that many organizations are under makes it imperative that they minimize disruptions to revenue.
Sarah Nehring, CCS, CCDS, RHIT, writes that acute blood loss anemia can increase expected reimbursement, the expected length of stay, and the severity of illness for an encounter. For these reasons, she presents seven things coders wish providers knew about accurately documenting this condition.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, RHIA , examines the reporting for codes in Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, of the ICD-10-CM manual, which included infectious arthropathies, inflammatory polyarthropathies, osteoarthritis, and other joint disorders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The finalized fiscal year (FY) 2021 ICD-10-CM and ICD-10-PCS code sets were recently released in the FY 2021 IPPS final rule, introducing new, revised, and deleted codes for diagnostic and procedural services and accompanying guideline changes.
Encephalopathy affects nearly one in three novel coronavirus (COVID-19) patients, according to a recent study published in the Annals of Clinical and Translational Neurology.
Outpatient coding for behavioral health services can be tricky given number of conditions that influence mental wellbeing. Review potentially confusing CPT coding guidelines for psychiatric evaluations, E/M visit services, and 2021 updates to ICD-10-CM codes for behavioral health. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association (AMA) released two new CPT codes October 7 for reporting antigen tests that detect the novel coronavirus (COVID-19) and influenza.
In a recent National Correct Coding Initiative (NCCI) update, CMS rolled back many of the procedural edits that it temporarily extended in light of the novel coronavirus public health emergency. Read up on the changes, including 291,274 procedure-to-procedure edits, which took effect October 1.
Valerie A. Rinkle, MPA, CHRI , reviews what providers need to know about the latest payment model from CMS’ Centers for Medicare and Medicaid Innovation.
A few years ago, there was a change of attitude within seizure medicine that manifested itself as new terminology. The older term “pseudoseizure” was replaced by the phrase “psychogenic non-epileptogenic seizure.”
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews healthcare compliance as a whole, and says it is important to be aware of these healthcare compliance risks, especially in ICD-10-CM reporting.
According to Johns Hopkins Medicine, approximately 30% of patients with the novel coronavirus (COVID-19) have acute kidney injury (AKI). Because of this, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, details COVID-19-related AKI to ensure accurate documentation and appropriate queries.
Sarah Nehring, CCS, CCDS, RHIT, writes that although noted in the ICD-10-CM alphabetic index, cardiorenal syndrome is not always hypertensive heart and chronic kidney disease, which is why clinical knowledge for this condition is very important for proper ICD-10-CM reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to The Office of Inspector General’s (OIG) recent Work Plan update, it will be reviewing payments for COVID-19 discharges that grouped to the newly weighted COVID-19 MS-DRGs.
CMS released the fiscal year (FY) 2021 IPPS final rule on September 2. In this article, we will review key priorities for the coming FY, including a continuing emphasis on addressing disparities in reimbursement between urban and rural hospitals and expanding beneficiary access to cutting-edge technologies.
Review significant updates to the musculoskeletal chapter of the ICD-10-CM manual including 57 new codes and updated guidelines for reporting arthritis, temporomandibular joint disorders, osteoporosis, and osteochondrosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A patient with a history of hypertension sees a cardiologist for chest discomfort during exercise. The cardiologist completes an office visit and performs a cardiac stress test the same day. Would it be appropriate to report the visit using an E/M code with modifier -25?
Between 50-80% of pregnant women complain of back pain, according to the American College of Obstetricians and Gynecologists. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about ICD-10-CM documentation and coding for back pain during pregnancy.
On January 1, new patient office visit code 99201 will be deleted from the CPT code set and coders will find revised descriptors for E/M codes 99202-99205 and 99211-99215. Read about how these changes will impact E/M leveling, medical decision-making (MDM), and code selection for outpatient visits.
Baylor Scott & White-College Station didn't properly bill Medicare for supplemental outlier payments, according to a September Office of Inspector General (OIG) report. Reviewed claims contained errors due to overcharging and inaccurate coding, resulting in $189,276 in overpayments, said the report.
CMS recently released the fiscal year ( FY) 2021 IPPS final rule , which increased hospital payment rates, created new MS-DRGs, and finalized CC/MCC designations.
Our coding experts answer questions about reporting modifier -58 for physicians and facilities, developing a charge capture audit process, and interpreting the 2021 E/M guidelines.
