If ICD-10-CM/PCS is used to its full potential, it will provide greater detail and a more accurate depiction of patient severity. This level of detail is expected to provide more information about the relationship between a provider’s performance and the patient’s condition.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes that understanding the epidemiology of HIV, its manifestations, and its stages are important when reviewing the medical record for ICD-10-CM coding, and interpreting provider documentation and understanding the coding guidelines are of the upmost importance for proper sequencing.
James S. Kennedy, MD, CCS, CCDS, CDIP, interprets the various guidance given in Coding Clinic , Fourth Quarter 2017, including pre-bill audits and denials based on clinical criteria, and chronic obstructive pulmonary disease with exacerbated asthma.
Q: What would be the ideal way to code a case where a patient has ongoing encephalopathy after a subdural hematoma multiple years ago? I keep seeing documentation as a brain injury with ongoing encephalopathy, but is there a way to improve on this?
Jocelyn E. Murray, RN, CCDS, reviews the similarities and differences between CDI audits and coding compliance audits and says it’s our collective responsibility to provide the insight that defines the two specialties and the critical efforts both bring to the table.
Upon reviewing 2,145 inpatient claims at 25 providers, the Office of Inspector General (OIG) found that all but one claim incorrectly included the ICD-9-CM diagnosis code for kwashiorkor (260). This resulted in overpayments in excess of $6 million, according to the OIG report .
The first week of December was National Influenza Vaccination Week, a week highlighting the importance of continuing flu vaccination, particularly through the holiday season. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes about CPT coding for vaccinations and immunization administration.
Q: Our coding department has been reviewing the AHIMA Standards of Ethical Coding but were interested in learning more about standard seven. I didn’t realize that continuing education credits help with ethical coding.
The improper payment rate for hospital outpatient services was 5.4%, accounting for 7.5% of the Medicare Fee-For-Service improper payment rate, according to 2016 Medicare Fee-for-Service Improper Payments Report.
When faced with a claim denial, providers need to understand what is being denied and when an appeal is appropriate. This article outlines basic steps providers need to take before composing an appeal for a claim denial and helpful tips for successfully navigating through the appeals process.
Updates to the 2018 CPT Manual , set to go into effect January 1, include several additions, revisions, and deletions to E/M and anesthesia procedural code sets. Familiarize yourself with these coding changes to aid in accurate reporting and prevent disruptions to the claims process. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Recent findings support the possibility that the Hospital Readmissions Reduction Program has had the unintended consequence of increased mortality in patients hospitalized with heart failure, says a study published by JAMA .
Q: Can acute respiratory failure be used as the principal diagnosis rather than ICD-10-CM code I46.9 (cardiac arrest, cause unspecified) when both are present on admission?
Sharme Brodie, RN, CCDS, reviews the most recent Coding Clinic guidance, which touches on common coding conundrums from subjects such as clostridium difficile, diabetes with ketoacidosis, myocardial infarction, pulmonary hypertension, and more.
More than 13 million Americans have bladder incontinence, and women are twice more likely than men to have it, according to the Agency for Healthcare Research and Quality. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, reviews ICD-10-CM/PCS coding for the bladder and writes that with so many Americans affected, knowledge of proper coding of bladder diagnoses and procedures is important.
Creating a query can be complicated, and there are a number of continued training tactics that prove successful for the coder when trying to improve upon physician query practices. This article takes a look at how improving a coder’s knowledge of principal and secondary diagnosis selection can produce a more effective physician query. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Coding for respiratory conditions can be challenging, given the structural complexity of the upper and lower respiratory tracts. Refresh your knowledge of respiratory anatomy to aid in the accurate reporting of common respiratory diagnoses such as emphysema, asthma, and chronic bronchitis. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Providers will no longer be required to append modifier -GT (via interactive audio and video) to professional telehealth claims, effective January 1, 2018, according to a policy CMS finalized in the 2018 Medicare Physician Fee Schedule (MPFS) final rule.
HCCs aren’t new, but for many organizations, their impact hasn’t been apparent until recently. Organizations must educate staff on HCCs to ensure success under reimbursement methodologies such as the Quality Payment Program and Merit-based Incentive Payment System reimbursement.
Each year, more than 2,000 Americans are diagnosed with mesothelioma— an aggressive and deadly type of cancer that develops in the lining of the lungs, abdomen, or heart. Debbie Jones CPC, CCA , writes about different types of mesothelioma and how they should be reported in ICD-10-CM.
CMS’ policy in the 2018 OPPS final rule to cut reimbursement for drugs purchased through the 340B drug discount program by nearly 30%, accounting for the decrease from average sales price plus 6% to minus 22.5%, is getting a lot of attention from the provider community—and with good reason.
CMS is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released in November.
It seems that the current buzz in the CDI and inpatient coding world is hierarchical condition categories (HCCs) and other health plan funding models. Everyone’s talking about HCCs for the inpatient, including AHIMA , ACDIS , and the AMA .
When asked to describe their job, many CDI professionals explain that they help physicians and coders paint an accurate picture of the care provided to patients. But how can CDI programs flip the canvas and dip their brushes to paint their own self-portrait?
Hiring top-notch inpatient coders: Is it good luck, great karma, or the power of prayer? Many coding managers say it takes all three to recruit high-quality, experienced medical record coders post-ICD-10.
In advance of ICD-10-CM/PCS, many institutions implemented computer-assisted coding (CAC) hoping to mitigate the anticipated productivity losses, but some research has confirmed my suspicions that there is an inverse relationship between coding productivity and accuracy.
Review vascular anatomy and terminology in order to aid in accurately assign codes for interventional radiology procedures such as angioplasties, atherectomies, and lower extremity revascularizations. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If only a central vein is treated when performing treatment for an arteriovenous fistula, is it correct to report CPT code 36901 since 36907 is an add-on code?
While the 2018 OPPS final rule may be controversial for its payment cuts to drugs purchased through the 340B drug discount program, it contains several provisions supported by hospitals and other stakeholders.
A new private payer rate-based Clinical Laboratory Fee Schedule (CLFS) system is estimated to drastically reduce Medicare Part B lab payments in 2018. Valerie A. Rinkle, MPA, details how this revision will impact providers in outpatient settings and payers tied to the Medicare CLFS.
November, a month associated with the pleasure of eating, is also Stomach Cancer Awareness Month. In this article, Yvette M DeVay, MHA, CPC, CPMA, CIC, CPC-I, describes signs and symptoms of stomach cancer, and outlines best practices when assigning diagnostic and procedural codes for this disease.
In advance of ICD-10-CM/PCS, many institutions implemented computer-assisted coding (CAC) hoping to mitigate anticipated productivity losses. Erica E. Remer, MD, FACEP, CCDS, highlights some of the pitfalls of CAC and provides techniques to improve accuracy. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Candace Blankenship, BSN, RN, CCDS, details the scoring weight of the new ICD-10-CM heart failure codes and looks at potential reimbursement discrepancies as none of the new heart failure codes have been assigned to a CC/MCC.
James S. Kennedy, MD, CCS, CDIP, CCDS, writes that in order to comply with CMS’ ever-changing metrics, it’s important for physicians to learn new techniques for better documentation so that ICD-10-CM/PCS codes can be reported more completely.
Within the span of two days last week, CMS released final rules for three comprehensive policies, which have important financial implications for hospitals, physicians, and medical professionals in 2018.
Ovarian cysts may develop at any point in a woman's life and frequently occur with other medical diseases. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, details best practices when assigning ICD-10-CM/CPT codes for ovarian cyst diagnoses and procedures.
In order to accurately code for complex diseases and procedures of the brain, spinal cord, and sense organs, coders need a basic understanding of nervous system functionality. This article provides detailed information on nervous system anatomy and terminology, common brain and nervous system disorders, and recently introduced 2018 ICD-10-CM codes related to nervous system conditions.
More and more, hospitals are experiencing a shift of services from inpatient to outpatient settings. In this article, Laura Jacquin, RN, MBA , describes common challenges healthcare workers face when providing comprehensive documentation for services across the care continuum.
Patient care continues to move from the inpatient setting to outpatient. With this change, the challenge of securing comprehensive documentation that articulates the services rendered and the patient care provided now needs to extend across the care continuum.
In July, Utah pain doctor Jahan Imani, MD, and Intermountain Medical Management, P.C., entered into a nearly $400,000 settlement with the OIG to resolve allegations that Imani’s practice submitted false or fraudulent claims due to improper modifier use for payment by improperly using modifier -59 with HCPCS code G0431.
Q: If you have an acute exacerbation of chronic right heart failure (CHF) with a preserved ejection fraction (EF) above 55%, can you code it as heart failure (HF) with preserved EF? All the clinical symptoms exemplify right-sided heart failure (e.g., ascites, pronounced neck vein distension, swelling of ankles and feet).
Inpatient stays involving any opioid-related diagnosis increased by 14.1% after ICD-10-CM was implemented in 2015, according to a study recently published in Medical Care .
Crystal Stalter, CDIP, CCS-P, CPC, writes about the benefits of creating best practices at your facility and how they help avoid time lost and unnecessary delays in payment. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Cheryl Manchenton, RN, BSN, says that to achieve accurate quality rankings and value-based payments, efforts must extend far beyond coding and CDI to include clinical providers, quality specialists, and other healthcare professionals—and everyone must collaborate to achieve positive results.
Coding Clinic , Fourth Quarter 2017, which became effective October 1, has interesting morsels affecting ICD-10-CM/PCS documentation and coding compliance.
James S. Kennedy, MD, CCS, CDIP, CCDS, writes that now that the fiscal year 2018 IPPS final rule and the 2018 ICD-10-CM Official Guidelines for Coding and Reporting have been released, it’s important to review MS-DRG dynamics that warrant consideration in documentation and coding compliance.
Yes, I’ll admit it: I used to be one of those people. Before finding a great fit on a CDI dream team, I worked as a medical review examiner for a Medicare Administrative Contractor (MAC). During that time, I reviewed Part A claims for inpatient stays, therapy reviews, medications, and Recovery Auditor (RA) appeals—to name a few. Not only did I gain experience working with Medicare hospital claims, but I also got to see a little bit of how different facilities approach their denials.
According to the American Cancer Society, skin cancer is by far the most common type of cancer . Exposure to harmful ultraviolet (UV) rays from the sun without protection can cause skin cancer. UV rays can come from other sources as well, such as tanning beds and sun lamps. The number of skin cancer diagnoses has increased in the past few years.
The newness and specificity of ICD-10 has ushered in a stronger focus on clinical coding audits. From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind.
Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) added a requirement that will dramatically revise the Medicare Clinical Laboratory Fee Schedule (CLFS) effective January 1, 2018.
A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter .
The new ICD-10-CM codes for FY 2018, effective October 1, represent significant changes in some hospital documentation and coding practices. James S. Kennedy, MD, CCS, CDIP, CCDS , reviews some of the most significant revisions to the ICD-10-CM guidelines for 2018.
Documentation is crucial for the development of data reflecting the healthcare needs of domestic violence victims. Yvette DeVay, MHA, CPMA, CPC, CIC, CPC-I , explains how to properly screen for and code incidents of domestic violence.
Whether big or small, crooked or straight, the nose is a vital component of the human respiratory system. There will be extra focus on nasal anatomy in 2018, as the CPT® codes for nasal endoscopies were revised. Brush up on nasal anatomy to prepare for reporting these new codes. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Allen Frady, RN-BSN, CCDS, CCS, CRC, answers questions about the fiscal year 2018 IPPS final rule’s updates, additions, and deletions in hopes to help guide coders and clinical documentation improvement specialists through the implementation.
On October 4, CMS issued a notice in the Federal Register containing numerous corrections to the 2018 IPPS final rule, including significant recalculations of MS-DRG relative weights and all budget neutrality factors.
James S. Kennedy, MD, CCS, CCDS, CDIP , deciphers the new information given for functional quadriplegia, marasmus, kwashiorkor, and palliative care found in the various fiscal year 2018 ICD-10-CM guidance updates.
In 2017, an estimated 252,710 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS , details best practices when assigning ICD-10-CM/PCS codes for breast cancer diagnoses and procedures. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our vascular physician prescribes exercise to some of his patients who have peripheral artery disease and wants to provide the exercise program in the office because he wants to have these patients monitored closely for their response. Is there a way to get reimbursed for this?
The October 2017 OPPS quarterly update introduced 12 new proprietary laboratory analysis CPT codes as well as a new modifier for a biosimilar biological product.
The best time to determine code edits is when the account is coded, meaning coding professionals play a key role in establishing overarching principles and best practices for edit management.
The 2018 update to the ICD-10-CM code set introduced a number of new gynecological codes, and Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about the significance and distinguishing details of the new codes.
Compliance is more than just abiding by coding guidelines and payer policy. Coding professionals must become familiar with ethical standards and federal regulations to avoid facing denials or federal penalties. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Mortality reviews pose a special challenge—not only does the CDI specialist need to know the ins and outs of severity of illness and risk of mortality, but the cases themselves are typically more complicated than an average hospital stay, making these essential reviews even more complex.
While the Affordable Care Act has led to fewer 30-day readmissions, this reduction in readmissions does not correlate with 30-day mortality rates, according to a recent JAMA study.
Now that the fiscal year 2018 ICD-10-CM/PCS codes have been implemented , James S. Kennedy, MD, CCS, CCDS, CDIP , reviews some of the compliance pitfalls that coders may encounter for diagnoses including Type 2 myocardial infarction, the pediatric Glasgow Coma Scale, and right heart failure.
Atrial fibrillation is the most common type of heart arrhythmia in the U.S. Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes that an understanding of ICD-10-CM coding and sequencing for this condition is key, but coders still need to navigate ICD-10-PCS codes to capture the surgical services performed at the facility. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
In August, CMS released the fiscal year (FY) 2018 IPPS final rule which featured updates to various quality initiatives, annual payment updates for inpatient services, and an extensive amount of now-annual ICD-10-PCS code additions, deletions, and revisions.
The 2018 update to the ICD-10-CM code set went into effect October 1, 2017, and features 728 total code changes, including 360 new, 142 deleted, and 226 revised codes.
Now that the fiscal year (FY) 2018 IPPS Final Rule , the 2018 ICD-10-CM Official Guidelines for Coding and Reporting , and Coding Clinic , Third Quarter 2017, have been released, let’s continue to process some interesting dynamics that warrant our consideration in documentation and coding compliance.
Appeal writing, like most things in a hospital, is a learned skill. Keeping things simple, both in terms of the arguments constructed and the language used in the letters themselves, will prevent you from creating horrific monstrosities out of minor gremlins.
If you have never participated in the ICD-10 Coordination and Maintenance proceedings, I highly suggest that you make it a goal for the future. I feel very maternal about some of the changes in ICD-10-CM which will be implemented October 1 because I participated in the formative meeting.
Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
As part of the October 2017 OPPS update, CMS will revise its policy on upper eyelid blepharoplasty and blepharoptosis repairs to allow physicians to receive payment for medically necessary blepharoptosis repairs when performed with cosmetic blepharoplasty.
The rise of clinical documentation improvement programs was a game changer for inpatient documentation. Now, the Quality Payment Program and similar systems are creating an opportunity for CDI to expand into the outpatient arena.
Atrial fibrillation is the most common type of heart arrhythmia in the U.S. Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, writes about common symptoms and treatments as well as proper ICD-10-CM coding for the condition.
Changes to the ICD-10-CM guidelines go into effect October 1, and coders will need to master knowledge of alterations to the general coding guidelines as well as new additions to guidelines on reporting diabetes, substance abuse, and myocardial infarctions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When it comes to conditions not related to hypertension, is it sufficient to attribute the diagnosis to another etiology or does the provider need to specifically document that the congestive heart failure (CHF) is not due to hypertension?
The Centers for Disease Control and Prevention (CDC), one of the Cooperating Parties responsible for the ICD-10-CM codes and guidelines, recently released a 2018 ICD-10-CM Official Guidelines for Coding and Reporting errata. Slight changes were made to the guidelines for diabetes, hypertension, and principal diagnosis selection.
The amount of energy it takes to stay up-to-date on all the relevant payment and coding updates can be overwhelming, and one relatively new solution to this conundrum is the addition of a CDI educator—an individual dedicated to the educational needs of the CDI team and, in some cases, even physicians.
