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.
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 .
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).
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.
Coding Clinic , Fourth Quarter 2017, which became effective October 1, has interesting morsels affecting ICD-10-CM/PCS documentation and coding compliance.
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.
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.
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.
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.
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 .
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
CMS recently released the 2018 IPPS final rule, which featured 2,916 of its now-annual ICD-10-PCS code additions, deletions, and revisions. This article reviews changes to ICD-10-PCS codes including the addition of short-term device characters and various table updates. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
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.
Outpatient coding’s impact on reimbursement is evolving as healthcare continues its march toward value-based care. Kim Miller, CPC, CHC , and Kerri Wing, RN, MS , detail how coders play a central role in this shift.
With weeks remaining before the 2018 ICD-10-CM codes are implemented, it is important to review new codes—including myocardial infarction and ophthalmology codes--as well as changes to the coding guidelines and documentation requirements. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Can you explain where in the clinical documentation it would be acceptable to report from for hierarchical condition category purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one Medicare administrative contractor tightened up physician supervision requirements.
The 2018 updates to the CPT Manual released in early September feature a total of 314 code changes. New codes for E/M visits, genetic testing services, and endovascular repairs of aortic aneurysms are among the 172 additions.
The fiscal year 2018 IPPS final rule included updates to payment rates and quality initiatives, as well as an ample amount of code changes and updates to ICD-10-PCS non-OR to OR code designations.
James S. Kennedy, MD, CCS, CCDS, CDIP, details how Coding Clinic , Second Quarter 2017, did not disappoint in addressing clinical issues affecting those in coding compliance and instructing how to properly use the ICD-10-CM Index and Table .
Beginning or expanding a remote CDI program requires planning, and it might not be for everyone. But, with the right preparation, organizations can make the transition beneficial to all.
CMS recently released the 2018 IPPS final rule, with 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. This article reviews guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: If a patient is admitted for anemia related to a malignancy and is treated only for anemia, the principal diagnosis goes to the malignancy. Could you still code for the malignancy as the principal diagnosis if the patient was treated for other conditions at the same time?
You may be thinking that you’ve never heard of scleroderma. As a coder, we know to look at these big fancy words and break them down by their root words in order to get a clue of what we’re talking about.
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one MAC tightened up physician supervision requirements.
The new ICD-10-CM codes for FY 2018, effective October 1, represent significant changes in our documentation and coding practices. Let’s discuss some of these new codes and their potential impact upon your diagnostic decision-making and documentation.
In the 2018 OPPS proposed rule, CMS proposed a change to the current clinical laboratory date-of-service policies for molecular pathology tests and for Advanced Diagnostic Laboratory Tests.
One of the reasons that we all read Briefings in Coding Compliance Strategies is to maintain our competence and quality in coding and risk-adjustment principles as to anticipate how recovery auditors and accountability agents view our coded data. While a good compliance officer and attorney knows the law, the better one knows the law, the judge, and the jury.
The fiscal year (FY) 2018 IPPS final rule includes updates to payment rates and quality initiatives, but some of the most extensive changes pertain to MS-DRG classifications and relative weights.
CMS recently released the fiscal year (FY) 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
Don’t automatically presume a link between two conditions within a combination code in cases when a guideline requires that link to be explicitly documented, the latest version of the ICD-10-CM coding guidelines clarify.
Julia Hammerman, RHIA, CPHQ , and Sam Champagnie , explain how the newness and specificity of ICD-10 ushered in a stronger focus on clinical coding audits and how coding audit best practices shifted following implementation.
In Major Diagnostic Category 1, Diseases and Disorders of the Nervous System, which covers MS-DRGs 020-103, CMS made changes to the classification of the diagnoses of functional quadriplegia and precerebral occlusion or transient ischemic attack with the use of a thrombolytic, as well as for the insertion of a responsive neurostimulator system. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS , writes about congestive heart failure and covers symptoms, coding best practices, and treatment for the disease using new ICD-10 for 2018.
Q: What are some times when it might be acceptable for a provider to copy and paste medical information into an electronic health record and when is it absolutely not acceptable?
The 2018 OPPS proposed rule is one of the shortest—and latest—in recent memory, being released July 13 at only 663 pages, but it contains major proposed policy changes for the 340B drug discount program, incorporates new modifiers, and expands packaging to drug administration for the first time.
One of the most controversial changes to the 2017 ICD-10-CM guidelines was the contradictory guidance for the term “with,” and that issue is addressed in the 2018 version of the guidelines.
The words “endometriosis” and “endometrioma” look similar, but as Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes, these conditions vary greatly in terms of physiology and coding.
The urinary system might not be one of the body systems people are most eager to discuss, but learning the anatomy of the urinary system is key in coding certain procedures, especially in the surgical and interventional radiology specialties. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews coding guidelines, signs, and symptoms of gastroparesis and helps coders avoid tricky guidance that can lead to reporting errors. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Crystal Stalter, CDIP, CCS-P, CPC, writes that with the release of the 2018 IPPS final rule, hospitals around the country are poring over it to see what impact the changes might bring to their case-mix index, quality initiatives, and overall reimbursement. In the midst of this are coders and CDI specialists who need to be kept abreast of these changes.
James S. Kennedy, MD, CCS, CDIP, CCDS, says that with the news codes available October 1, coders will face significant changes in documentation and coding practices. He discusses some of the additional new codes, including type 2 diabetes mellitus with ketoacidosis and pulmonary hypertension.
On Wednesday, August 2, CMS released the fiscal year 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
Q: Our team had a recent case that involved a small midline episiotomy which extended to a second-degree laceration which was repaired with 3-0 vicryl rapide sutures. Would we code the episiotomy and repair or just the repair, and why?
Coding and billing for the transgender patient can be difficult even when society in general has become more aware of people who are transgender. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, covers some of the challenges coders may face when filing claims for transgender patients.
James S. Kennedy, MD, CCS, CDIP , discusses the new ICD-10-CM codes for FY 2018 and describes some of the changes that could be made to documentation and billing habits for these conditions.
The 2018 OPPS proposed rule included potential changes to certain radiology modifiers used by CMS to identify services for data collection as well as reimbursement.
In the outpatient world, physicians are accustomed to seeing services as the key to reimbursement, but diagnoses and outcomes will increasingly factor into reimbursement as healthcare shifts toward value-based care. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What are the applicable modifiers that can be used when a test fails for medical necessity or if an Advance Beneficiary Notice (ABN) has been signed?
Now that the fiscal year 2018 ICD-10-CM/PCS codes have been released , let’s consider some of the compliance pitfalls, booby traps, and opportunities that await coders when these new codes are implemented on October 1.
The Medicare Outpatient Observation Notice (MOON) finally went into effect after a bumpy start. The MOON was originally set to go into effect August 2016, but the draft version was only released for comment at the beginning of that month.
It’s that time of year again – when HIM directors, hospital administrators, and coding managers begin to wonder just how they will be affected come October 1.
CDI professionals recognize the effect comprehensive CDI programs have on both payment and profiling outcomes in all healthcare settings. As a result, many organizations are forging ahead to apply CDI beyond the walls of the traditional acute care setting.
The 2018 OPPS proposed rule includes potential changes to 340B drug discount payments, the inpatient-only list, packaging for low-level drug administration services, and more.
You may find significant changes to E/M reporting in the near future, including a pivot away from two key elements — history and physical exam — that largely determine a given level of service for your most common patient encounters.
CMS wants your thoughts on its 2018 OPPS proposed changes. In various places in the proposed rule, CMS specifically asks providers to comment on the proposals. You may submit comments to the agency until September 11, 2017.
