CMS recently published One Time Notification Transmittal 2259 and MLN Matters 11168 , which outline changes to the processing of NCCI procedure-to-procedure edits associated with modifiers -59 and -X{EPSU}. Read about these updates and how they will impact CPT coding and for select surgical procedures.
According to the U.S. Department of Health and Human Services, endometriosis affects 11% of women between the ages of 15 and 44. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about diagnosing and treating endometriosis as well as ICD-10-CM and CPT coding for the condition.
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. Review expert advice on accurate documentation and coding for outpatient ED visits and for developing detailed E/M guidelines. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laurie L. Prescott, MSN, RN, CCDS, CDIP , details the basics of ICD-10-CM/PCS for newer inpatient coders including a review of the ICD-10-CM seventh-character extension, placeholder use, and ICD-10-PCS root operations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We had a patient with hemorrhagic cystitis. Our preprocedural plan was a cystoscopy with a bladder biopsy and cauterization. How should this be reported in ICD-10-PCS? We are having trouble choosing between Control or another root operation, and we are getting different MS-DRGs depending how the procedure is reported.
A recent study showed that CMS’ Hospital Readmissions Reduction Program (HRRP) may be causing an increase in the 30-day mortality rate for certain conditions. Now, a second study published by Health Affairs claims that the reductions in readmission rates are themselves “illusory or overstated.”
The benefits outweigh the difficulties when it comes to retrospective reviews. How do you get started with this new venture? Like many aspects of CDI, there are many ways to approach the problem. This article details these approaches, including how to enhance coder and CDI collaboration for these reviews.
Not many clinical conditions cause more consternation for inpatient coders and CDI specialists than acute and chronic respiratory failure. In this article, William E. Haik, MD, FCCP, CDIP, details acute and chronic respiratory failure and the critical elements in the health record that validate their reporting.
If we look at each element of a coding audit, we can see the benefits these coding reviews provide. Every healthcare organization and hospital should invest in routine, internal coding audits. The alternative is waiting until the payer conducts an audit, denies a claim, and incurs costs for the organization.
Coding for knee arthroscopies can be challenging, especially when procedures are performed in multiple compartments of the same knee. Read about anatomy and coding details required to accurately report these procedures.
Many outpatient CDI professionals stepped into their roles blind—not knowing where to begin or how to tell if they were successful. However, as programs mature, they need to be able to track their progress for a number of reasons, including focusing physician education and justifying continued funding from organizational leadership.
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
As an inherited blood disorder, sickle cell disease is passed from parent to child. Children with sickle cell disease often have two defective hemoglobin S genes , one from each parent. However, various forms of sickle cell disorder also occur when a person inherits one hemoglobin S gene (sickle cell gene) from one parent and a different type (other than the S type) of defective hemoglobin gene from the other parent. All of these forms have distinct ICD-10-CM diagnosis codes, making reporting complex.
In 2013 the “ Guidelines for Achieving a Compliant Query Practice ,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. Since that time this brief has been updated twice: once in 2016 and most recently in 2019 .
Consider the story of a patient—say, a pneumonia patient—whose treatment cost a lot of money. The hospital’s reimbursement for that care, however, was less than the cost of providing it. Now say someone looked at that case and how complex it was, and then saw that the reimbursement only paid for half the cost of caring for that patient. That’s how CDI was born.
CMS recently released Transmittal 4246 , revising language in Chapter 13 of the Medicare Claims Processing Manual regarding the billing of E/M codes on the same date of service as superficial radiation treatment delivery.
CMS added new guidance to the CPT Manual to clarify imaging documentation for codes that include both procedural and imaging guidance. This article outlines these regulatory changes and implications for outpatient coders and providers.
Prostate cancer is the second most common form of cancer in American men, according to the American Cancer Society. Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I , writes about CPT coding for rectal exams and a new prostate specific antigen (PSA) immunoassay test used to detect early indications of prostate cancer, as well as ICD-10-CM codes used to support medical necessity for these services.
Outpatient coders and billers must be able to interpret potentially confusing documentation elements for drug administration services and know what to do when key elements, such as infusion time, are missing from an order. Review CMS guidance on the accurate reporting and billing of intravenous drug administration services for calendar year 2019. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released an MLN Matters article to inform hospitals and Medicare Administrator Contractors of new system changes, effective July 1, that ensure organ acquisition costs are not included in the IPPS payment calculation for claims that group to a non-transplant MS-DRG.
CDI professionals can improve documentation and data scores via a mortality review process. This article discusses the various types of mortality reviews and publicly reported data and gives tips on how to implement a successful mortality review process.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, explains that reporting sepsis has long been a challenge for many coders even with the continual release of Coding Clinics and guideline revisions. In this article, Rivet reviews common coding traps for this condition including reporting urosepsis, severe sepsis, and sepsis on admission.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, reviews ICD-10-CM/PCS cardiac coding for American Heart Month and writes that since accurate coding improves data quality for these conditions, which in turn is used for statistics and tracking trends, ensuring the disease process is captured correctly is imperative. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Hospital Association (AHA) and the U.S. Department of Health and Human Services (HHS) recently issued court-ordered briefs in which each defends its respective position in a federal 340B payment lawsuit. The case was brought against HHS by multiple hospital groups to reverse Medicare payment cuts for drugs purchased through CMS' 340B drug discount program.
Arthroscopic procedures allow surgeons to use minimally invasive arthroscopic techniques to treat conditions which previously required more intensive, open surgery. Learn about orthopedic anatomy and terminology and CPT guidelines for reporting arthroscopic hip and knee procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A physician performs a hemiarthroplasty for a hip fracture. Would this procedure be reported with CPT code 27125 (hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty])?
Review advice from experts on accurate documentation and CPT coding for chronic care management, knee injection services, and health and behavior assessments.
Using financial penalties to reduce hospital readmissions has been linked to a significant rise in post-discharge mortality for patients with heart failure and pneumonia, according to a recent study by the Journal of the American Medical Association.
Q: What is the difference between ICD-10-CM code I24.8 (other forms of acute ischemic heart disease) and code I21.A1 (myocardial infarction type 2)? In which situation would each of these codes be reported?
Julian Everett, BSN, RN, CDIP, details her experience reviewing pediatric mortality cases for the first time and gives tips on how the different revenue cycle departments can work together to improve their processes and outcomes.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, reviews Coding Clinic , Fourth Quarter 2018, advice surrounding body mass index reporting and how new advice conflicts with previous guidance. McCall also reviews payment methodologies and the official guideline updates for this condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Denise Wilson, RN, MS, RRT, and Karla Hiravi, RN, BSN, explore why coding and clinical denials for acute kidney injury (AKI) and acute tubular necrosis (ATN) are different and the importance of different appeal strategies.
It’s time to take down the lights and pack up the wrapping paper and bows until next year. What else is it time to do? It’s time to look at the 2018 Third and Fourth Quarter Coding Clinic advice to make sure it’s not overlooked as the new year comes into full swing. This article, although not a complete summary, will review Coding Clinic advice as it pertains to coding guidelines, impact on severity, and/or MS-DRG assignment.
Alzheimer’s disease is the most common form of dementia, with symptoms that include problems with memory, thinking, and behavior. Understanding Alzheimer’s disease and its symptoms is important to coders, as some of the entries in the ICD-10-CM Alphabetic Index can be confusing.
Pay close attention to new CPT documentation and coding guidance for reporting radiological imaging. For example, a new paragraph titled “Imaging Guidance” in both the surgery and medicine guidelines advises that even when imaging guidance or supervision are included in a surgical procedure code, you must still follow the radiology documentation requirements in the CPT manual.
In 2018, most organizations held the line on coder productivity, according to the results of sister publication HIM Briefings’ 2018 coding productivity survey.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. This does not reduce the payment for the drugs, so this is an informational modifier, but it is a mandatory modifier.
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.
