Keeping up with coding changes in the circulatory system chapter in the ICD-10-CM manual is an ongoing process. Almost every fiscal year coders are met with new codes for myocardial infarctions (MI), changes to congestive heart failure codes, and updates to the guidelines for reporting cerebrovascular diseases.
This summary, organized by major diagnostic category (MDC), highlights some of the changes to the IPPS proposed rule affecting MS-DRG and ICD-10-CM/PCS code assignment.
Acute kidney injury (AKI) and acute tubular necrosis (ATN) remain targets for both coding and clinical validation. Over the years, we’ve gleaned valuable insights from appealing hundreds of coding and clinical validation denials for AKI and ATN.
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.
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.
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.
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.
CMS recently released quarterly updates to the OPPS and Integrated Outpatient Code Editor (I/OCE), effective July 1. Judith Kares, JD , summarizes key coding and billing policy updates, including changes to APCs, status indicators, revenue code changes, and more.
The skin maintains homeostasis by generating new tissue in response disease or damage. Sometimes, however, surgical interventions are used lessen the severity of the wound and prevent infection. Review integumentary system anatomy and CPT coding for removals and repairs used to facilitate wound healing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A clinician documented "combination Type 1 and Type 2, diabetes mellitus in poor control." This condition is sometimes called Type 1.5 diabetes. What is the correct ICD-10-CM code assignment for Type 1.5 diabetes?
The July 2019 quarterly update to the OPPS, released by CMS in late May, announces an effective date of July 1 for 20 CPT Category III codes and revises status indicators for CPT codes used to report imaging by magnetocardiography.
The use of ultrasound at the bedside, or within the office practice, has become more common in provider-based clinic settings. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , details documentation requirements and CPT and ICD-10-CM coding for diagnostic ultrasound services.
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 .
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.
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.
Learn how ICD-10-CM coding accuracy, specificity, and compliance impacts provider performance in each of the four performance categories under the Merit-based Incentive Payment System (MIPS). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A physician orders a comprehensive metabolic panel and a quantitative blood sample to measure blood glucose level. How would a coder report these services using CPT codes, and what modifier would he or she use to indicate that the blood sample was performed separately from the panel?
CMS released Transmittal 4313 on May 24 describing changes that will be implemented in the July 2019 quarterly update to the OPPS. These changes included several new HCPCS codes for reporting certain drugs and biologicals.
A May report from the Office of Inspector General (OIG) found that some physician practices were at the root of basic coding errors that caused federal overpayments. Although the Essence audit was small, the findings have significant implications for physician coders.
Because lower extremity diagnoses are often associated with issues in other parts of the body, assessing the severity of a patient’s podiatric condition can be challenging. Shelley Safian, PhD, RHIA, HCISPP, COC, CPC-I , reviews physician E/M coding for patients seeking treatment for foot and lower leg problems.
If you only bill using the CMS-1500 claim form, then you’ve probably never seen a revenue code. But if you need to bill for facilities, you know revenue codes play an important communicative role between providers and insurers. UB-04 claim forms sent to an insurance company without a revenue code associated with each charge will be rejected.
Having taken on more diverse responsibilities, many providers regard medical coding as a necessary evil; their primary focus is caring for their patients. Although many physicians select codes for the work they perform, they rely on specialized coding and auditing professionals to review their documentation and reporting for accuracy.
Valerie Rinkle, MPA, CHRI, covers important proposals found in the fiscal year (FY) 2020 IPPS proposed rule, including coding updates, new technology payment changes, and increases to low wage index hospitals.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that accurate ICD-10-CM/PCS coding for the heart improves data quality, which in turn is used for statistics and tracking trends, so it is imperative to ensure the disease process is captured correctly.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, presents a review of MS-DRG basics to ensure that inpatient coders have a thorough understanding of MS-DRGs’ intricacies, thus perfecting assignment and reimbursement accuracy.
At the beginnings of inpatient coding and CDI, we had books like DRG Expert and Excel-based programs for MS-DRG selections. More than 10 years later, vendors are offering web-based technologies that use artificial intelligence and machine learning to make us even more productive in both coding and CDI. The real question, however, is how we can best leverage those technologies.
With the addition of the two new telehealth service codes for 2019, providers now have 98 CMS-approved telehealth services to report. Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I , describes the two newest telehealth HCPCS codes and breaks down 2019 billing regulations surrounding telehealth.
Q: A patient presents to the ED seeking treatment for impacted cerumen affecting both ear canals. How would you report a bilateral cerumen removal using CPT codes?
At a Senate Committee on Finance hearing on May 8, physician groups urged Congress to work with CMS to improve the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) by establishing new performance measures and providing greater financial incentives for participating providers.
The month of May is designated Skin Cancer Awareness Month by the American Academy of Dermatology. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D , writes about ICD-10-CM/CPT coding for common types of skin cancer and their treatments.
Diagnosis coding for skin ulcers can be particularly confusing as different kinds of ulcers have their own etiology and associated ICD-10-CM code. Review ICD-10-CM coding and reporting for venous, pressure, and diabetic skin ulcers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our department has been having trouble reporting comas in ICD-10-CM. Are there any tools we can use to help us report these diagnoses more accurately?
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.
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.
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.
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.
The spread of acute flaccid myelitis (AFM), a serious, paralysis-inducing syndrome, is beginning to alarm epidemiologists who have yet to identify its cause. Recognize the first signs of AFM and learn how to report the condition using ICD-10-CM codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS’ recently released fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule includes 273 proposed ICD-10-CM code additions mainly affecting reporting for legal interventions, orbital roof fractures, and pressure-induced deep tissue damage. The code changes, if finalized, will take effect October 1, 2019.
Q: I was recently informed that providers use cellular-based tissue products to treat ulcers when a patient fails to respond to more conservative treatment options. What constitutes a failed response to treatment and how would this be documented?
Anthem announced that it may reject claims that contain a subsequent E/M service that’s linked to the same diagnosis as an earlier E/M encounter. Learn what Anthem’s modifier -25 policy means for providers and physician coders.
The role of the coder has transitioned over the past few years to one that is more auditing-heavy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , describes how to effectively perform internal audits and educate providers on coding best practices.
Reduced and discontinued service modifiers indicate to the payer when service is either less than the HCPCS code indicates (reduced) or the procedure was stopped before completion (discontinued).
Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, writes about E/M code changes implemented this year and changes for implementation over the next two years.
A query is a communication tool or process used to clarify documentation in the health record for documentation integrity and accurate code assignment for an individual encounter in any healthcare setting.
The first quarter of 2019 has ended. Do you know what that means? Unfortunately, it means that income taxes were due in April. But luckily for inpatient coders and CDI professionals, it also means that we have new Coding Clinic guidance to take our minds off our taxes.
Health records are data-rich, and more stakeholders are looking to dip into them for increasingly diverse purposes such as population health and value-based care programs.
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?
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.
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.
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.
Hospital/physician practice integration has contributed to an increase in chemotherapy drug treatment and injection administration spending under Medicare, according to a study recently published in Health Economics.
The most commonly reported CPT codes are getting a much-needed makeover. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS , writes about E/M code changes implemented this year and changes for implementation over the next two years.
Q: The American Medical Association added three new CPT codes for skin biopsies, effective January 1. What are the new biopsy codes and CPT guidelines for reporting them?
The endocrine system is an intricate collection of hormone-producing glands that help to control mood, metabolism, tissue function, and sexual development. This article breaks down endocrine anatomy and ICD-10-CM guidelines for reporting diabetes mellitus and Cushing’s disease. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Providers will find significant leeway in how they can report advance care planning (ACP) services for physicians given CMS’ open-ended coding requirements. Review potentially confusing CPT time rules and other obstacles that may be holding back providers from engaging in ACP services.
The beginning of the year is a time to go back to basics—or even, in some cases, to start over. Revisiting information on how to conduct a medical record review may, at first glance, feel like a basic or beginner topic. But medical record review is an important subject for all CDI professionals, and even coders, to consider.
Q: Which ICD-10-PCS code should be reported for an incision and drainage of a perianal abscess of the left buttocks? We are confused about which body part value should be captured since the physician documented both “perianal” and “left buttocks.”
Kay Piper, RHIA, CDIP, CCS, details the process of submitting ICD-10-CM codes to the ICD-10 Coordination and Maintenance Committee meeting by sharing the experience a medical coding educator and a CDI physician adviser had when submitting a proposal for the March 2018 meeting.
Keeping up with changing coding guidance adds to the complexity of reporting digestive procedures. In this article, Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , reviews ICD-10-PCS reporting for common digestive procedures including the Whipple procedure and lysis of adhesions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Researchers analyzed reports and clinical data from a community hospital for malnourished patients and concluded that of the 1,817 records for malnourished adult patients examined, 1,171 (64.4%) of them were not coded for malnutrition, according to the study published in the Journal of the Academy of Nutrition and Dietetics.
Laura Legg, RHIT, RHIA, CCS, CDIP, takes a look at some common questions asked about MS-DRG optimization and reviews how inpatient coding and documentation plays a large role in the process.
Karen, a 67-year-old patient with a history of hypertension, diabetes, and tobacco use, presents to her primary care physician with complaints of pain in her right buttock and thigh when she walks from her house to her mailbox. She is then admitted as an inpatient for surgery.
Members of the Medicare Payment Advisory Commission (MedPAC) asked the U.S. Department of Health and Human Services to create national coding guidelines for ED visits by 2022, following an April 4 meeting.
Yvette DeVay, MHA, CPC, CPMA, CIC, CPC-I, writes that in the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list, effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status.
Vestibular migraine is a common visual and neurological disorder that can be difficult to diagnose as symptoms of the disorder resemble those of other conditions such as vestibular neuritis and Meniere’s disorder. In this article, Debbie Jones, CPC , reviews clinical indications of vestibular migraine disorder and CPT coding for diagnostic tests used to assess vestibular functioning.
A spinal fusion is a major surgery used to fuse together two or more vertebrae so they can heal into a single bone. This article breaks down spinal anatomy and simplifies CPT and NCCI guidance for reporting spinal fusions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Assigning the appropriate ICD-10-PCS code for spinal procedures can be a challenge for inpatient coders, as they need to correctly assign the entirety of a seven-character ICD-10-PCS code.
Cheryl Manchenton, RN, explains CMS’ Hospital-Acquired Condition Reduction Program (HACRP) and says inpatient coding professionals can play a significant role in HACRP success by understanding the basis for hospital-acquired condition scores and ensuring that documentation and coding accurately and fully captures patient conditions and complications.
Sepsis is a leading cause of death in U.S. hospitals, but in most of cases, sepsis alone may not be the true cause of the majority of inpatient, septic hospital deaths, according to recent research published by the Journal of the American Medical Association.
Q: I know that the tumor, nodes, and metastasis (TNM) staging system can be used for ICD-10-CM coding purposes, but I’ve never used it before. As an inpatient coding professional, should I know how this system works and how to apply it?
A transcatheter aortic valve replacement (TAVR) is an interventional cardiology procedure that has proven to be an important life-saving cardiac intervention frequently seen by inpatient coders. In this article, Stephen Houlahan, RN, MSN, MBA, CCDS, reviews TAVR history, clinical background, and documentation and reimbursement methodologies to ensure proper education and compliance for facilities.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, writes that proper reporting and documentation of chronic obstructive pulmonary disease (COPD) will help ensure accurate MS-DRG assignment and strengthen cases during inpatient audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders often wonder how to define realistic productivity benchmarks. Different facilities establish the responsibilities and expectations of their coding teams, so productivity standards are not uniform.Coders often wonder how to define realistic productivity benchmarks. Different facilities establish the responsibilities and expectations of their coding teams, so productivity standards are not uniform.
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. In addition, because ED coding encompasses professional and facility billing, they may need to scour provider documentation to determine the correct E/M service level for both bill types.
Telehealth services are likely to promote health, wellness, and disease management, providing an avenue to offer efficient, high-quality care while supporting value-based care in a cost-effective manner. Although the benefit of telehealth is obvious and its value is continually highlighted by CMS, it appears the services are underutilized.
Providers will find significant leeway in how they can approach and report advance care planning services for physicians given CMS’ open-ended coding requirements, which should push the already strong growth of the codes to new heights.
Wound care coding is frequently a target of payer and Office of Inspector General audits. This article provides coders with step-by-step instructions for interpreting provider documentation and assigning CPT codes for excisional, selective, and non-selective debridement, based on the depth of the tissue removed and the total surface area debrided. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS introduced seven new HCPCS codes and granted pass-through payment status to four separately payable drugs and biologicals in the April 2019 OPPS quarterly update.
As outpatient clinical documentation improvement (CDI) programs mature, CDI professionals need to be able to track their progress to ensure the program’s success. Learn how to develop CDI tracking tools to successfully capture coding and billing metrics and justify a CDI program’s effectiveness.
Anemia is the most common blood disorder, affecting more than 3 million Americans per year, according to the National Heart, Lung, and Blood Institute. In this article, Joel Moorhead, MD, PhD, CPC , reviews documentation and ICD-10-CM coding for anemia.
With March declared National Endometriosis Awareness Month, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, details endometriosis-related procedure reporting for inpatient coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
