Rules governing code assignment often don’t make sense to those coming from the clinical side, such as CDI. In truth, they often confound professionals with years of inpatient coding experience, too. And most CDI and coding professionals have a list of frustrations when it comes to translating clinical documentation into ICD-10 codes.
Training new inpatient coders and CDI staff is a big job that often takes several months to conclude, but the end of orientation doesn’t mean that staff members never have to undergo education ever again. As most are keenly aware, the ground is always moving under our feet. From new regulations, to coding guideline changes, to new clinical definitions, education never truly ends.
In the current healthcare climate the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. Review medical necessity guidance from CMS and learn how to prevent repeated denials due to improper documentation of medical necessity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Can you bill CPT codes 76981 (ultrasound, elastography; parenchyma [e.g., organ]) and 76982 (ultrasound, elastography; first target lesion) at the same time as CPT codes for liver and breast ultrasounds?
A recent study conducted by physician researchers at Stanford University highlights the challenges of CPT code-based patient classification and subsequent outcome analysis for colorectal procedures.
CMS has downgraded the supervision requirements for services performed by radiologist assistants working in medical practices, imaging centers, and radiology offices. Read about these 2019 changes to ensure accurate documentation and reporting for radiology services.
The beginning of a new year typically brings new resolutions to deal with weight-related issues. Shelley C. Safian, PhD, RHIA, HCISPP , writes about ICD-10-CM coding for common weight-related diagnoses such as obesity and anorexia, and CPT coding for interventions used to treat them.
Q: I would like to add encephalopathy due to urinary tract infection to our quick coding tips, but our CDI specialists disagree on how this condition should be coded and want us to query for metabolic encephalopathy. How should this condition ultimately be reported?
The mechanics of the concurrent coding process can cause headaches for both CDI and coding professionals. Plus, one could argue that CDI’s presence itself limits the number of necessary post-discharge clarifications without the process of concurrent inpatient coding. This article reviews ways that CDI programs can get involved with this process and work collaboratively with coders.
Adriane Martin, DO, FACOS, CCDS, reviews Coding Clinic’s Third and Fourth Quarter 2018 advice including reporting for coronary artery bypass grafting, drainage of an abscess in the submandibular space, and diabetes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Average hospital costs and mortality rates are significantly higher for patients diagnosed with sepsis after hospital admission when compared with patients diagnosed prior to admission, according to a retrospective analysis recently published in Critical Care Medicine.
This article reviews HCPro’s 2018 coding productivity survey and reviews data on factors that have affected coder productivity, remote coders, and collaboration between coders and CDI specialists, including charts coded per hour and coding accuracy standards.
It is evident with the complexity of this diagnosis (and the complexity of updated criteria) that even the most seasoned inpatient coder should review malnutrition coding guidelines and criteria frequently to ensure compliant reporting.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews common CPT and ICD-10-CM coding and documentation errors, such as unbundling, inappropriate modifier usage, and missing information, to help coders reduce their risk from audits.
The ICD-10-CM Manual was recently updated with new codes for peritonitis in association with acute appendicitis and the CPT Manual now includes new codes for gastrostomy tube replacements. Familiarize yourself with these changes to ensure accurate reporting of digestive diagnoses and treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Findings show that pathologist involvement in the review and verification of CPT codes may reduce the need for code modifications at the time of sign-out auditing, according to the recent study published in the Archives of Pathology and Laboratory Medicine.
Even on a small scale, the implementation of an outpatient clinical documentation improvement (CDI) program can be overwhelming. Review advice from CDI specialists on developing successful outpatient CDI programs that facilitate accurate coding and billing.
The brain is the most complex component of the central nervous system, consisting of approximately 100 billion neurons that communicate via an exponentially larger number of synapses. Individual areas of the brain have specialized functions that work in conjunction and regulate voluntary and involuntary body functions.
Q: A physician documented that a pregnant patient is obese, and the patient’s chart has a listed body mass index (BMI) score. Can we assign an ICD-10-CM BMI code in this instance or should this never be done for an obstetrics patient?
The Office of Inspector General (OIG) has been conducting a series of studies about adverse events in various healthcare settings since 2008 and will be publishing more of its corresponding reports throughout 2019, the OIG said in a statement.
Assigning the appropriate ICD-10-PCS code for spinal procedures can be a challenge for inpatient coders as they need to correctly identify each character of the seven-character code. In this article, Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS , offers coding tips for reporting spinal surgery cases in ICD-10-PCS and examines the correct use of each character. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently made several updates in its latest version of its Hierarchical Condition Category (HCC) list, including revisions to the mental health and chronic kidney disease categories. And, while HCCs may not be a common review focus for inpatient coders and CDI professionals, capturing HCCs for these conditions is paramount for accurate reporting and reimbursement.
Adriane Martin, DO, FACOS, CCDS, writes that with the complexity of malnutrition—and the complexity of updated criteria—even the most seasoned inpatient coder should review ICD-10-CM malnutrition coding guidelines and criteria frequently to ensure compliant reporting.
Establishing an outpatient CDI program can have substantial benefits. Recently, an outpatient CDI review project demonstrated there were many documentation improvement opportunities at a large family practice/internal medicine physician clinic.
The 2019 CPT code update includes 19 code additions and three revisions to the cardiovascular section of the CPT Manual. These changes reflect advances in surgical treatment for cardiovascular conditions such as heart failure and aortic stenosis.
A preliminary study found that a new point-of-care troponin assay safely ruled out acute myocardial infarction (AMI) in a large proportion of patients with symptoms suggestive of acute coronary syndrome, according to the report published in the Journal of the American Medical Association.
The original DRG system aimed to categorize similar patients with theoretically similar treatments and charges based on the patient’s principal diagnosis and up to eight secondary diagnoses. As time has gone by this system has expanded and become more complicated, making it essential for inpatient coders to understand to ensure accurate reporting and facility reimbursement.
Q: Considering the fiscal year 2019 update to the ICD-10-PCS Official Guidelines for Coding and Reporting for Transfer procedures, how should we now report a pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure in ICD-10-PCS?
Sepsis has been notoriously hard to report in ICD-10-CM, which means coders should not only fully understand coding guidance and guidelines for sepsis, but they should also have a thorough knowledge of its clinical aspects as well. Cesar M. Limjoco, MD , breaks down these clinical aspects and sheds light on the various sepsis definitions coders have encountered over the years.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes that while reporting mental illness is on the radar for outpatient coders, inpatient coders should be up to date with these diagnoses as well. Capturing this data in the inpatient setting not only substantiates reimbursement, it is also used to identify national trends for tracking and understanding these serious conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hospitals should get their compliance strategies in top shape before the end of the year. CMS released the fiscal year (FY) 2019 IPPS final rule with significant reductions to reporting requirements for quality initiatives, updates to payment rates, changes to CC/MCC designations, and revisions to various MS-DRGs. CMS also finalized the requirement for hospitals to post their chargemaster online, effective January 1, 2019.
Findings from a retrospective cohort study published in the American Journal of Emergency Medicine suggest that, on average, EDs may report higher-level E/M services for incarcerated individuals when compared to the general population.
Take cues from the revised NCCI Policy Manual for Medicare Services to polish your coding and billing efforts in 2019 and avoid common infractions tied to modifier -50 (bilateral procedure).
Reporting and billing hospital observation services can be confusing, particularly when the observation stay lasts more than one day. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about CPT coding for observation services based on time and the key components of the history, exam, and medical decision making of a patient.
A variety of therapeutic services can be used to treat patients suffering from debilitating mental health conditions. Clear up confusion surrounding CPT coding for these initial office visits, psychiatric diagnostic evaluations, and psychotherapy visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS, review the recently published “Global Leadership Initiative on Malnutrition (GLIM) Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community” and help coders apply this criteria in ICD-10-CM.
As the task of query creation is becoming more prevalent in coding departments, reviewing essential query requirements is a must for all inpatient coders. This article covers these essential requirements including the growing adoption of electronic medical records, when to query, and pointers for submitting queries to physicians. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS and the Office of Inspector General (OIG) claims to have identified unspecified upcoding in hospital billing—either accidentally or intentionally reporting higher severity codes than supported by documentation to increase payment. Because of this, these entities will conduct a two-part study to assess inpatient hospital billing, according to the OIG.
Sarah Humbert, RHIA, and Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, explore three scenarios for onboarding new inpatient coders and provide valuable advice to prepare them for success.
Data in CDI reports should demonstrate the depth of work performed as well as productivity elements. I want to share my experience of personalizing data fields in our CDI software to fully demonstrate our CDI team’s impact beyond moving the MS-DRG.
The AMA updated the cardiovascular section of the 2019 CPT Manual to reflect advances in surgical treatment for cardiovascular conditions such as heart failure and aortic stenosis. Read about new and revised codes for the implantation and removal of leadless pacemakers, cardiac rhythm monitors, and other surgical devices commonly used to treat chronic heart conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2019 CPT code update will impact reporting for dermatologic biopsies. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , reviews updated reporting guidance and CPT codes for these common types of biopsies.
CMS hit the brakes on making imminent changes to the oft-used E/M code set that’s tied to billions of dollars in medical practice revenue. Review updates to E/M payment and documentation requirements effective January 1 and the extensive changes planned for implementation in 2021 under the 2019 Medicare Physician Fee Schedule final rule.
This month, we are pleased to introduce Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , Director of HIM/Coding at HCPro in Middleton, MA.
CMS recently released the 2019 NCCI Policy Manual for Medicare Services , which includes updates to payment policies and coding methodologies effective January 1, 2019. The changes impact billing and reporting for spinal arthrodesis procedures and laboratory services.
Osteoarthritis is the most common joint disorder in the United States and is one of the leading causes of chronic pain and disability, according to the National Institutes of Health (NIH).
Along with E/M changes for 2019 and beyond , the 2019 Medicare Physician Fee Schedule final rule contains a plethora of regulations impacting reimbursement, including new modifiers for therapists.
Despite facing potential lawsuits and political opposition, CMS finalized some of its most controversial proposals in the 2019 OPPS final rule by implementing several site-neutral payment policies and 340B drug payment reductions.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, writes that by reviewing common electronic health record (EHR) challenges, a CDI program can formulate appropriate mitigation strategies to minimize potential negatives of the system.
For patients who suffer from frequent symptoms of gastroesophageal reflux disease (GERD), the provider may have to increase to prescription strength medications and possibly consider surgical intervention for severe cases. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, reviews ICD-10-CM/PCS coding for these GERD diagnoses and procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Among patients ages 65 years and older, the rate of opioid-related hospitalizations increased more than the rate of nonopioid-related hospitalizations between 2010 and 2015, according to the recent statistical brief published by the Healthcare Cost and Utilization Project.
Adriane Martin, DO, FACOS, CCDS, explains the confusion behind the various sepsis definitions and provides guidance to coders when reporting sepsis in ICD-10-CM.
It’s true that most CDI specialists are not coders, and coding a record isn’t our specific focus. To complete our given mission, however, we must understand the process and the guidance related to code assignment. The focus of provider education is to assist in translating “coder speak” to “medical speak” and vice versa.
Outpatient procedures involving anesthesia should be reported using five-digit CPT codes as well as applicable hospital modifiers. Review types of anesthesia administration and documentation elements required for accurate code assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Findings from an Office of Inspector General (OIG) audit show that Novitas Solutions Inc. overpaid hospitals for intensity-modulated radiation therapy (IMRT) services provided to nearly all sampled Medicare beneficiaries over a 30-month period, resulting in overpayments of at least $7.2 million.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
Beginning in 2018, total knee arthroplasty (TKA) was removed from the Inpatient Only List and assigned a comprehensive APC payment. Outpatient coders need to ensure they are assigning the correct CPT codes for TKA to reduce their hospital’s risk of audits.
When pneumonia documentation is questioned, CDI specialists or coders should always query the provider. But reviewing the following clinical elements involving aspiration and pneumonias with your physician staff may help improve the documentation of complex pneumonias and avoid adverse determinations by external reviewers.
A new risk model provides a simple way to determine whether acute myocardial infarction (AMI) patients are at a high risk for hospital readmissions, says a study published in the Journal of the American Heart Association.
Q: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
Sharme Brodie, RN, CCDS, reviews recent guidance published in Coding Clinic , Third Quarter 2018, including advice on diabetes, acute myocardial infarctions (AMI), pressure ulcers, and more.
Crystal R. Stalter, CPC, CCS-P, CDIP, says that there is still confusion around documenting patient stays to show quality, especially in the inpatient realm. Is it really as simple as documenting conditions to their fullest specificity or does it involve a more complex approach?
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that understanding spinal anatomy, the reporting of detailed spinal diagnoses, and the selection of applicable procedure codes can ensure that these complicated claims are reimbursed correctly and in compliance with coding guidelines. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Like it or not, provider documentation is the foundation for everything done in medicine. Without it, nothing is accomplished. As healthcare reform progresses (and hospital reimbursement shrinks), the need for excellent provider documentation only increases.
Coders must have a solid understanding of complex terminology and CPT and ICD-10-CM coding guidelines to select the most specific codes for traumatic fractures and their treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This month we are pleased to introduce Deborah Clinard, CPC, who has 12 years of experience as a coder and who currently works as a practice manager at Women’s and Children’s Specialists, LLC in Nashville, Tennessee.
Q: A lung cancer patient presents to the infusion clinic to receive chemotherapy treatments. The patient receives a Carboplatin infusion, a Gezmar infusion, and an Anzemet intravenous push. Which CPT codes would be used to report these services?
CMS recently released both the calendar year (CY) 2019 Medicare Physician Fee Schedule and OPPS final rules last week, revising the payment structure for E/M office visits and expanding payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted, off-campus, provider-based departments.
The CMS risk adjustment model uses Hierarchical Condition Categories (HCC) to calculate risk scores based on ICD-10 diagnoses. Review HCC coding do’s and don’ts to help your facility manage risk effectively, enhance shared savings, and provide patient-centered care.
The death of one twin in utero complicates oversight of a multifetal pregnancy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews symptoms of vanishing twin syndrome and ICD-10-CM coding for continuing pregnancy after intrauterine death .
Remittance processing and appeals are integral parts of the revenue cycle. When facilities submit a claim to Medicare, the hope is that the claim will be paid in full and in a timely manner, but that does not always happen.
In the 2019 OPPS final rule, released November 2, CMS implemented several site-neutral payment policies, though the agency did delay or shelve other proposals due to stakeholder feedback.
Q: What’s the difference between an incomplete miscarriage, a septic miscarriage, and a missed miscarriage and how would surgical treatments for these conditions be reported using CPT codes?
CMS released Transmittal 836 on October 19, clarified language in Chapter 6 of the Medicare Program Integrity Manual regarding medical review of diagnostic laboratory tests.
Coding and documentation teams can replicate an organization’s overall denial avoidance and management program by scaling it to the scope of denials for which they are responsible. Lynette Kramer, MA, RHIA , outlines a four-step process that coding teams can use to monitor claim data and establish accountability for denials.
According to the National Center for Chronic Diseases Prevention and Health Promotion, an estimated 5.7 million adults throughout the U.S. have heart failure. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, writes about ICD-10-CM coding for heart failure diagnoses and CPT coding for procedures used to treat the disease.
The FY 2019 ICD-10-CM update includes 54 code additions, three deletions, and 87 revisions to Chapter 19 of the ICD-10-CM Manual , “Injuries, Poisonings, and Certain Other Consequences of External Causes.” Review updated codes and guidelines for reporting burns, infections and sepsis following a procedure, drug abuse, and human trafficking. 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 with a history of chronic heart failure (CHF) and end-stage renal disease (ESRD) who was admitted with volume overload due to acute kidney injury and dialysis noncompliance. How should we report this in ICD-10-CM?
