Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, defines abnormal pregnancies and explains how to determine the appropriateCPT ® , ICD-9-CM, and ICD-10-CM codes.
Providers have one last chance to volunteer for ICD-10 end-to-end testing, with CMS extending the deadline to sign up for the July testing period through May 22.
Coding Clinic won't be updating its ICD-9-CM guidance for ICD-10-CM, but that doesn't mean none of the previous answers will be applicable in the new code set. Nelly Leon-Chisen, RHIA, Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, and Anita Rapier, RHIT, CCS, review various tricky coding situations that can be resolved now, ahead of implementation.
Coding and guideline changes in ICD-10-CM for neurological conditions may require coders to learn new terms and look for additional information in documentation. Caren J. Swartz, CPC, CPMA, CPC-I, CIC, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, explain the changes for hemiplegia, hydrocephalus, and meningitis and how to find the proper code.
Our friends at the Association of Clinical Documentation Improvement Specialists are putting the final touches on their conference preparations. They have sent off the final shipment to San Antonio (...
We love surveys, especially about ICD-10. Seriously, how many ICD-10 surveys have you been asked to fill out in the past year alone? It’s very easy to look at survey results and think things look...
An automated Recovery Auditor review of discharge status codes identified improper payments, according to the Medicare Quarterly Compliance Newsletter . However, CMS did not report the prevalence of the errors.
PSI 7 evaluates the hospital’s risk-adjusted rate of central venous catheter-related bloodstream infections. Shannon Newell, RHIA, CCS, Steve Weichhand , and Sean Johnson explain inclusions, exclusions, and risk adjustment factors for this measure.
As coders have prepared for ICD-10-CM, they have raised questions about how to select the correct seventh character. Nelly Leon-Chisen, RHIA, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, offer tips for determining the correct seventh character.
Coders and clinical documentation improvement specialists need to pay attention to what conditions are considered CCs and MCCs, as well as sequencing rules which could affect MS-DRGs. Laurie L. Prescott, MSN, RN, CCDS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, and William E. Haik, MD, FCCP, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, discuss some common CCs and MCCs.
If nothing else, Rep. Ted Poe, R-Texas, is consistent. He again introduced legislation to kill ICD-10. (The bill is H.R.2126 if you are interested.) Poe has tried this trick before. He introduced an...
In case getting allergic rhinitis from your dog wasn’t bad enough, a Colorado man contracted the plague from his pit bul l. And then he may have passed it on to another person. Person-to-person...
And the flowers bring pollen. Achoo! Allergies are a fact of life for millions of Americans—approximately 30% of adults and 40% of children suffer from allergies, according to the American College of...
CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.
CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.
The policies that CMS publishes each year in the OPPS proposed rule don't always come as a surprise. Sometimes, CMS will announce its future intent in a previous rule in order to notify providers about data it is looking at or requesting comments on.
Many coders rely on the AHA's Coding Clinic advice to resolve sticky situations with ICD-9-CM coding. However, AHA will not be transitioning its current guidance to ICD-10-CM. Instead, in January 2014, AHA began focusing solely on ICD-10-CM questions to help clear up confusion prior to implementation.
PSI 15 measures the hospital's risk-adjusted rate of accidental punctures and lacerations. PSI 15 has the highest weight in the PSI 90 composite under both the Hospital-Acquired Condition Program and the Hospital Value Based Purchasing Program. Coders and CDI specialists can improve performance for PSI 15 by ensuring complete documentation and correct ICD-9-CM code assignment for PSI 15?pertinent inclusions, exclusions, and risk adjustment variables.
When CMS introduced the -X{EPSU} modifiers in August 2014 to be used in specific instances to replace modifier -59 (distinct procedural service), the agency encouraged "rapid migration" to the new modifiers.
This month’s issue features the second article in a series of PSI 90, PSI 15. In addition, we highlight similarities and differences in coding poisonings and adverse events in ICD-9-CM and ICD-10-CM. Sharme Brodie highlights some of the top questions about ICD-10 answered by Coding Clinic and Robert S. Gold, MD, reviews how to identify conflicting documentation.
Our friends at the Association of Clinical Documentation Improvement Specialists hold their annual conference next month in San Antonio , Texas. And like everything in Texas, it’s going to be BIG ...
You learn something new every day. Today’s new fact: you can be a professional video game player. I’m not sure why that surprises me. After all, video games have come a long way from the Atari and...
Dave Fee, MBA, identifies updates to CMS' programming logic for comprehensive APCs and provides a step-by-step approach to determine whether a complexity adjustment will be applied.
Primary care providers see patients for a wide variety of conditions, meaning coders in those settings may have to learn many of the new concepts and terms in ICD-10-CM. Annie Boynton, BS, RHIT, CPCO, CCS, CPC, CCS-P, COC, CPC-P, CPC-I, and Rhonda Buckholtz, CPC, CPC-I, CPMA, CRC, CHPSE, CGSC, CENTC, COBGC, CPEDC, discuss three common conditions seen in these settings and what information coders will need to look for in documentation to code them in ICD-10-CM.
A Recovery Auditor automated review of claims for cardiovascular nuclear medicine procedures found potential incorrect billing due to lack of medical necessity, according to the latest Medicare Quarterly Compliance Newsletter.
Q: We are trying to verify whether we should bill for two units of the CPT® code when the provider performs a service with and without magnetic resonance angiography (MRA), such as an MRA of the abdomen, with or without contrast material (code 74185). The description of the MRA CPT codes say "with or without," not with and without for billing all non-Medicare payers. We realize for Medicare we are to use HCPCS codes C8900-C8902.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, reviewsCPT® coding for interrupted pregnancies, while also highlighting changes coders can expect for related diagnoses in ICD-10-CM.
You may recall that Steve’s super streak at the Vegas craps table ended with a torn right ulnar collateral ligament. On the recommendation of his primary care physician, Steve consulted an orthopedic...
You know us and the staff at the Acme ED, Fix ‘Em Up Clinic, and the Stitch ‘EM Up Hospital. Now, we want to get to know a little bit about you, our readers. Please complete this short survey to tell...
When providers use different definitions for the same disease, confusion and chaos result. Trey La Charité, MD , discusses how coding and clinical documentation improvement specialists can clear up the situation.
Heart failure is the intrinsic inability of the heart to supply target organs with sufficient nutrient flow to function normally. Robert S. Gold, MD, and Gloryanne Bryant, RHIA, RHIT, CCS, CDIP, CCDS, review the clinical and coding guidelines for heart failure.
Q: A patient came to the ED with shortness of breath (SOB). The admitting diagnosis was possible acute coronary syndrome (ACS) due to SOB and elevated troponin levels. The ACS was ruled out. Elevated troponin levels were assumed to be due to chronic renal failure (CRF), and no reason was given for SOB. Before discharge, the patient was noted with an elevated temperature and found to have a urinary tract infection (UTI). All treatment was directed at the UTI, and the doctor noted the discharge diagnosis as the UTI. What would be the principal diagnosis in this case?
PSI 15 measures the hospital’s risk-adjusted rate of accidental punctures and lacerations. Shannon Newell, RHIA, CCS, Steve Weichhand , and Sean Johnson explain inclusions, exclusions, and risk adjustment factors for this measure.
I spent the weekend reading the 2016 Inpatient Prospective Payment System (IPPS) proposed rule. Not the most thrilling reading ever (government-ese should be classified as a foreign language). I did...
Last week, Steve spent some serious time at the craps table in Las Vegas. He was on a real roll with those dice, racking up a 14-hour winning streak. However, on that last throw, something went very...
The endless last-minute patches for the Sustainable Growth Rate (SGR) are almost history. Late last night, the Senate overwhelmingly passed H.R. 2, which repeals the SGR. The House overwhelmingly...
A Comprehensive Error Rate Testing (CERT) study of transcatheter aortic valve replacement/implantation (TAVR/TAVI) services found that approximately one third of the claims received improper payments, mostly due to insufficient documentation, according to the latest Medicare Quarterly Compliance Newsletter.
Peggy Blue, MPH, CPC, CCS-P, CEMC, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, review code changes in the 2015 CPT® Manual's Medicine section, including newly available products and services.
Reporting procedures for the skin can require a variety of documented details, such as location, severity, and size. John David Rosdeutscher, MD, and Gloria Miller, CPC, CPMA, CPPM, explainwhich details coder should look forto accurately report excisions, closures, and other wound care services.
Q: If a patient is given Reglan ® intravenously at 12:20, 13:00, and 13:20, would this be considered an IV push because the clinician did not document a stop time?
CMS is asking for some social media help in support of ICD-10. The agency is planning a social media rally to encourage the healthcare community to get ready for the ICD-10 transition. You can sign...
I’m always fascinated by new medical research and information about diseases I’ve never heard of. They also make great fodder for this blog. I recently came across an article on REM sleep behavior...
Fifteen-month-old Finn is back at the Fix ‘Em Up Clinic today to see Dr. Spock. Finn is currently suffering from a fever, reduced appetite, and sore throat, according to his mom Melissa. Finn just...
As we continue to move closer to ICD-10 implementation (still set for October 1, 2015), I keep finding more reasons why we need better documentation. I am not trying to pick on physicians (really),...
The seventh character in an ICD-10-CM code represents either the fetus (for pregnancy codes), or the encounter (for injuries and burns). Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, Gretchen Young-Charles, RHIA, and Nelly Leon-Chisen, RHIA, review guidelines for correct seventh character selection.
In ICD-10-CM, coders will use a seventh character, not an aftercare code, to identify follow-up treatment for an injury. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, C-DAM, Kristi Pollard, RHIT, CCS, CPC, CIRCC, and Anita Rapier, RHIT, CCS, explain how aftercare coding will change in ICD-10-CM.
The 2014 ICD-10 implementation delay negatively impacted ICD-10 preparations, according to the Workgroup for Electronic Data Interchange (WEDI) February 2015 readiness survey .
Ruth and Gary thought it would be great fun to give their nieces Amanda and Rachel some peeps for Easter. Amanda and Rachel thought they were getting marshmallow treats (so did their parents) so it...
No joke this time. We have six months left until ICD-10 implementation. That’s a good news/bad news proposition. The good news is that all of the hard work we’ve put into training and implementation...
Even through ICD-9-CM and ICD-10-CM/PCS are currently under a code freeze, c oders and CDI specialists still need to pay attention to what conditions are considered CCs and MCCs, as well as sequencing rules which could affect MS-DRGs.
In this month’s issue, we review some key CCs and MCCs, provide a high-level overview of PSI 90, and discuss how coding aftercare will change in ICD-10-CM, Robert S. Gold, MD, discusses hypertension in its various forms.
Each year, the AMA updates the Vaccines, Toxoids section of the Medicine chapter in the CPT ® Manual to add or revise descriptions of newly available products. In 2015, the AMA added two new product codes (90651, 90630) and revised four (90654, 90721, 90723, and 90734).
Patient Safety Indicator 90 evaluates hospital performance for defined in-hospital complications and adverse events. Find out more about how clinical documentation and coding can affect this measure in the first of a four-part series.
Mental health disorders are common in the United States, with an estimated 19% of Americans 18 or older suffering from a diagnosable mental disorder, according to a 2012 survey from the National Institute of Mental Health (NIMH).
One of the great things about healthcare and medicine is you can always learn something new. Today’s odd but true condition is exploding head syndrome. (I love the Internet.) If you have ever...
Jeff went on vacation to Hawaii three weeks ago to enjoy some sun, sand, and surfing. He came back with some cool photos and a broken ankle. Apparently, the parking lot at the beach did him in even...
Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries. Laura Legg, RHIT, CCS, AHIMA-approved ICD-10-CM/PCS trainer, Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA, and Sara Clark, RHIA, MLS, AHIMA-approved ICD-10-CM/PCS trainer, explain how coders will report PTCA in ICD-10-PCS.
A complication basically refers to an unexpected result, outcome, or event. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Cheryl Ericson, MS, RN, CCDS, CDIP, and Trey La Charité, MD , detail when to report a complication and highlight the differences in complication coding between ICD-9-CM and ICD-10-CM.
The physician documented “encephalopathy” in the progress note of a patient who was admitted with a cerebrovascular accident (CVA) and/or possible seizures. James S. Kennedy , MD, CCS, CDIP, discusses what to consider when determining whether to code the encephalopathy.
CMS Transmittal 3217 , effective April 1, will allow inpatient-only procedures to be included on inpatient claims, similar to other outpatient services included in the three-day window.
Poor Wendy. Shortly before Christmas, she stubbed her toe, really hard. However, no bruise appeared and her toe didn’t swell up, so she thought nothing of it. Three weeks later, she stretched her...
You have one more chance to participate in CMS’ end-to-end testing. The agency is currently looking for approximately 850 volunteers for the June 1-5 testing week. You can volunteer on your MAC’s...
Cardiovascular coding can be challenging even without the introduction of new codes and concepts in ICD-10-CM. Laura Legg, RHIT, CCS, and Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, review the anatomy of the cardiovascular system and highlight some of the key changes in ICD-10-CM.
Q: Our electronic health record system only provides for a "yes/no" choice under smoker. How can we capture the additional details necessary for an ICD-10-CM code assignment?
Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, and Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, look at frequently diagnosed mental disordersand note changes for reporting them in ICD-10-CM.
Providers who want to volunteer to participate in CMS' final round of ICD-10 end-to-end testing have until April 17 to sign up through their Medicare Administrative Contractor's (MAC) website.
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, discusses how to code for burns and corrosions in ICD-10-CM, which requires at least three codes to indicate the site and severity, extent, and external causes.
Liam spent this St. Patrick’s Day on a fruitless quest for a pot of gold. He powered up for his quest by having a few glasses of green Guinness beer for breakfast. Turns out it’s not a good idea to...
Poor Wile E. Coyote is headed for surgery. As you might recall, Wile E. suffered a subdural hematoma following a collision with a cliff on Friday the 13th. Dr. Frankenbean decided to try conservative...
Poor Wile E. Coyote, Friday the 13 th has not been kind to our favorite super genius. Wile E. arrived at the Acme ED decidedly the worse for wear after his latest encounter with a certain speedy bird...
ICD-9-CM and ICD-10-CM differentiate between acute and chronic meniscus tears. Kristi Pollard, RHIT, CCS, CPC, CIRCC , and Gretchen Young-Charles, RHIA, review how to code these injuries in both systems.
Clinical documentation improvement (CDI) specialists must understand CMS pay-for-performance measures in order to improve data quality . Shannon Newell, RHIA, CCC, AHIMA-approved ICD-10-CM/PCS trainer, Steve Weichhand, and Sean Johnson explain how Patient Safety Indicator 90 is measured and what role CDI specialists play in capturing data for this measure.
Myths and misinformation about query practices still remain. Cheryl Ericson, MS, RN, CCDS, William E. Haik, MD, FCCP, CDIP, CDIP, and Nelly Leon-Chisen, RHIA, provide a refresher on how and when to query physicians.
Q: How should the diagnosis of urinary tract infection (UTI) and encephalopathy be sequenced, specifically which diagnosis should be the principal? If physician documentation indicates that the patient came in with confusion, can encephalopathy be assigned as the principal diagnosis if it is due to the UTI and no other contributing issues are present?
Three university hospitals saw a doubling of Recovery Auditor audit activity from 2010–2011 to 2012–2013, and a nearly three-fold increase in overpayment determinations, according to a new study in the Journal of Hospital Medicine.
Melissa took her four nephews sledding over the weekend to the boys’ delight. They had a great time. Aunt Melissa, however, didn’t escape the adventure unscathed. While descending the (not really)...
We want physicians to be very clear in their documentation about what’s wrong with the patient and what the physician did to make that patient better. Our friends over at the Association of Clinical...
A new article in the Journal of the American Medical Association (JAMA) Psychiatry shows a strong link between genetics and autism. That’s not an unusual or completely unexpected outcome. Scientists...
Just when we were starting to feel really good about ICD-10’s chances of being implemented, AHIMA has learned that Chairman of the House Rules Committee Pete Sessions, R-Texas, is looking to draft...
Physician coders won't be able to just report the CPT ® code that best describes the procedure for some digestive system services in 2015. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, explain why some payers, including CMS, may require new G codes for certain procedures and how the G codes map to related CPT codes.
Coders may be familiar with the term "fetal distress" in physician documentation, but its lack of specificity can limit code selection. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, explains what coders can look for in documentation to report the most accurate ICD-9-CM and ICD-10-CMfetal status codes.
Q: I have a question regarding a National Correct Coding Initiative (NCCI) edit. I reported CPT ® code 80053 (comprehensive metabolic panel) and 84132 (potassium; serum, plasma or whole blood), resulting in an NCCI conflict. This code pair does allow modifier -59 (distinct procedural service) to be appended to one of the codes to be paid for both tests. Does it matter if we append modifier -59 to the primary code or the secondary?\ In my case, sometimes the secondary code is already dropped into the system and now the edit is asking me to append the modifier. Can I add modifier -59 to 80053 whether it's the primary code or not?
The musculoskeletal and nervous system sections of the 2015 CPT Manual include dozens of new and revised codes to accommodate the latest technologies and procedures. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Peggy Blue, MPH, CPC, CCS-P, CEMC, review the codes and highlight important instructional notes in the guidelines.
