In this issue, we explain how to code CABG in ICD-10-PCS, review sepsis clinical criteria and ICD-9 coding guidelines, and review the changes to physician certification finalized in the OPPS final rule. Robert S. Gold, MD, highlights areas of concern for respiratory conditions in ICD-10-CM.
Beginning January 1, 2015, physicians will no longer need to provide certification for an inpatient admission unless the admission is expected to last for at least 20 days or the case is an outlier.
The ICD-10 implementation delay mandated by Congress this spring granted providers an extra year to prepare their coders and clinicians on the requirements of the new code set, but a recent survey has found some organizations heading in the wrong direction.
With quarterly code updates and other regulatory changes from CMS throughout the year, the chargemaster coordinator has to constantly monitor the healthcare landscape, but the final few months of the year remain the most challenging.
We’ve survived the holiday feast and decided to skip the doorbusting to head out and visit the cute and fluffy animals at the Anytown Zoo. Of course, no outing would be complete without some injuries...
Tom Turkey has come in to the Stitch ‘Em Up Hospital for a little work before Thanksgiving. Dr. Carver is going to first take out Tom’s guts, then replace them with stuffing. How would we code Tom’s...
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the endocrine system and how to code for conditions affecting it.
Q: We have a patient diagnosed with neuropathy due to poorly controlled insulin-dependent Type 1 diabetes mellitus. What should we report in ICD-10-CM?
AHIMA is calling for coders, billers, and providers to contact Congress to ask for no additional delays to ICD-10 after physician groups have recently started to advocate for members to petition Congress to introduce a new, two-year implementation delay to push the compliance date to October 1, 2017.
The majority of providers either stopped or slowed their ICD-10 preparations as a result of the latest implementation delay, but now providers have less than a year to become ready. CMS' Denesecia Green and Stacey Shagena offer advice on how providers can create an action plan to be ready by October 1, 2015—even if they haven't started yet.
In its November issue, the Journal of AHIMA published an article citing significantly lower costs for physician practices to transition to ICD-10 than the numbers supplied by Nachimson Advisors in a...
Oh, that Jose Canseco. Such a kidder. Turns out, his claim that his finger fell off during a poker game was a joke. He did actually shoot part of it off “cleaning” his gun and did indeed have it...
Coders often talk about guidelines and coding conventions, but what about ethics? Robert S. Gold, MD , discusses the value of following ethical coding standards.
Malnutrition is at its most basic level any nutritional imbalance and it is often underdiagnosed. James S. Kennedy, MD, CCS, William E. Haik, MD, FCCP, CDIP, and Mindy Hamilton, RD, LD , explain the clinical indicators and coding basics for malnutrition.
Providers gauge the severity of an acute brain injury using the Glasgow Coma Scale, and in ICD-10-CM, coders will be able to code this score. Kim Carr, RHIT, CCS, CDIP, CCDS , and Gretchen Young-Charles, RHIA, explain how to code the coma scale in ICD-10-CM.
Q: We have a problem getting our physicians to understand what we are querying for chronic respiratory failure when a patient is on home oxygen continuously with documented supplementary oxygen of less than 90%, or arterial blood gas with hypoxemia. The physicians tell us chronic obstructive pulmonary disease (COPD) is chronic respiratory failure by definition. Can you help us clarify this situation or give us some tips on how to educate our physicians?
Baseball fans may remember Jose Canseco as part of the Oakland A’s slugging duo, the Bash Brothers. He made a lot of money hitting the ball very, very far. I hope he saved some for his medical bills...
As healthcare professionals, we’re all familiar to some degree with HIPAA. You know, the law that makes it illegal to release protected health information, among other things. Hospital employees have...
One of the biggest stumbling blocks for ICD-10 implementation by small physician practices was the estimated cost of the transition. Those costs may not be as high as originally estimated, according...
Ever play with a Magic 8 Ball? (If not, there’s an app for that.) Ask it a question, shake it up, and get an answer. Usually something vague (and vaguely ominous) like, “Reply hazy try again.” Asking...
CMS finalized a new data collection requirement for services performed in off-campus, provider-based clinics in the 2015 OPPS final rule , which was released October 31.
Q: I work in a large, provider-based orthopedic clinic with a rheumatology department that has many patients who are very ill with several comorbid conditions. Does the physician need to document every comorbid condition that impacts his or her medical decision making for each encounter? Do we need to code every comorbidity each time in order to meet hierarchical condition category (HCC) requirements?
Nearly 30% of Medicare patients are enrolled in Medicare Advantage (MA) programs, which come with specific coding and documentation challenges. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, and Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, highlight key requirements for reporting diagnoses that map to Hierarchical Condition Category codes, the basis of MA plans.
The House of Representatives recently passed a bill that would impact supervision levels for certain outpatient services. Debbie Mackaman, RHIA, CPCO , reviews the impact of the legislation and which provider types and services it would affect.
You may have noticed that the ICD-10 manuals have the word “draft” splashed all over them. (If you have an actual paper ICD-10 manual that is. The PDFs don’t include the word draft.) I had someone...
Welcome to OR 13 at the Stitch ‘Em Up Hospital, where Dr. Hack N. Slash is preparing for today’s procedure. And what is today’s procedure? Dr. Slash is performing a cut down and suturing of a...
ICD-10-CM is similar to ICD-9-CM, but coders need to watch out for differences which could lead to incorrect coding. Nelly Leon-Chisen, RHIA, Gretchen Young-Charles, RHIA, and Sarah A. Serling, CPC, CPC-H, CPC-I, CEMC, CCS-P, CCS , discuss possible pitfalls for coding myocardial infarctions, neoplasms, and external causes in ICD-10-CM.
Beginning January 1, 2015, physicians will no longer need to provide certification for an inpatient admission unless the admission is expected to last for 20 days or longer or the case is an outlier.
Coders need to understand the different approaches for procedures in ICD-10-PCS because they're required and the new system does not include default or unspecified options. Laura Legg, RHIT, CCS, Nena Scott, MS, RHIA, CCS, CCS-P, and Gretchen Young-Charles, RHIA, explain the different approaches and address gray areas for selecting the most appropriate character.
Many physicians remain reluctant to admit when a complication occurs as the direct result of the medical care they provide. Trey La Charité, MD , reviews hypothetical situations to help illustrate how coders and clinical documentation improvement specialists can handle complications.
Q: The primary physician documented subacute cerebral infarction and I am wondering whether I should code this to a new cerebral vascular accident (CVA) or not, since the term “subacute” doesn’t really fall anywhere.
Gerri Walk, senior manager of technical training for HRS in Baltimore, had the absolute best reason for learning to code in ICD-10. During the 2013 AHIMA National Conference in Atlanta, Gerri...
Many coders rely on the advice in the American Hospital Association (AHA)'s Coding Clinic to resolve sticky situations with ICD-9-CM coding. However, the AHA will not be transitioning its current guidance to ICD-10-CM. Instead, in January, it began focusing solely on ICD-10-CM questions to help clear up confusion prior to implementation.
Editor's note: With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, we will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. This month's column addresses the anatomy of the thoracic cage.
Even before ICD-10-CM was delayed until October 1, 2015, the quality of physician documentation to accommodate the new code set was a top concern for the healthcare industry.
In this month's issue, we explain the clinical and coding aspects of malnutrition, review the possible approaches in ICD-10-PCS, and discuss Coding Clinic clarifications for ICD-10. Robert S. Gold reveals when to report a transbronchoscopic lung biopsy.
ICD-10-PCS codes consist of seven characters, each of which identifies a unique, specific piece of information. For most of the codes in the Medical and Surgical section, each character represents the same information every time.
Physicians use a lot of shortcuts and abbreviations. Some of them may even make it to the official abbreviation list at a hospital. Some don't. Even if they do, some physicians will use the wrong term.
Editor's note: Jugna Shah, MPH, president and founder of Nimitt Consulting, writes a bimonthly column for Briefings on APCs, commenting on the latest policies and regulations and analyzing their impact on providers.
Even before ICD-10-CM was delayed until October 1, 2015, the quality of physician documentation to accommodate the new code set was a top concern for the healthcare industry.
Malnutrition is at its most basic level any nutritional imbalance. While it can be overnutrition, such as being overweight, obese, or morbidly obese, providers more commonly equate malnutrition with undernutrition, which is a continuum of inadequate intake, impaired absorption, altered transport, and altered nutrient utilization.
Ghosties and ghoulies and long-legged beasties are parading through the Fix ‘Em Up Clinic. It must be Halloween and the staff Halloween party. Even the best planned Halloween party can go astray (...
Once upon a midnight dreary, as I labored on a query To send to the doc whose documentation was a source of constant woe As I nodded, nearly napping (that darn G47.411 again) Suddenly there came a...
Ewww, I don’t think so. Your feet stink. What could be causing that foul odor to emanate from your feet? The most common cause is sweat. Just sniff your old gym sneakers and you’ll see what I mean...
Steven Espinosa , CCS , AHIMA-approved ICD-10-CM/PCS trainer, and Denise Williams, RN, CPC-H, outline the anatomy of the upper gastrointestinal system and how anatomical details, along with the provider's approach and intent, help determine the proper procedure code.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. Review the anatomy of the thoracic cage and coding concepts in ICD-10-CM related to coding diagnoses of this region.
When is a mammogram a screening procedure and when does it qualify as a diagnostic test? Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, outlines the differences between the two and what to look for in the documentation.
Q: Do any general guidelines exist for queries on outpatient services? We are beginning the process of developing such a query system for our hospital outpatient services and clinical documentation team.
Coders aren’t the only ones who run into problems due to a lack of complete physician documentation. Lack of sufficient documentation also causes problems for audit review of submitted claims, which in turn leads to delays in payment, according to the October 2014 Medicare Quarterly Provider Compliance Newsletter .
When coders run into a tough coding question, they often look for guidance in the AHA’s Coding Clinic . Coding Clinic is a resource, but it’s not always the final word. The AHA publishes Coding...
Poor Mr. Frank N. Stein. He just coughed up a lung. Literally. While it is possible to survive on one lung, it’s generally not recommended, so Frank is here at the Stitch ‘Em Up Hospital to get a new...
If I hear one more person poke fun at ICD-10-CM code V97.33XD (sucked into a jet engine, subsequent encounter), I am going to develop a very strong case of R45.850. (That’s homicidal ideation in case...
When a physician closes off varices, coders must determine the location and method the physician used to correctly build an ICD-10-PCS code. Nena Scott, MSEd, RHIA, CCS, CCS-P, and Gretchen Young-Charles, RHIA, review the components of different procedures for closing off varices and how to code those procedures in ICD-10-PCS.
A large number of the code additions in ICD-10-CM appear in the musculoskeletal section. While fractures account for some of those changes, coders also need to understand how coding for other orthopedic conditions will change in ICD-10-CM. Kristi Stanton, RHIT, CCS, CPC, CIRCC, and Kim Carr, RHIT, CCS, CDIP, CCDS, discuss ICD-10-CM coding for sprains, strains, and dislocations.
Most, but not all, guidelines in ICD-10-CM match up to those in ICD-9-CM. S helley C. Safian, PhD, CCS-P, CPC-H, CPC -I, AHIMA-approved ICD-10-CM/PCS trainer, highlights some of the main guideline differences for coders to learn before the transition to ICD-10-CM.
Q: How specific does the physician have to be for the location of the acute myocardial infarction (MI) in ICD-10-CM? We don’t do catheterizations at my facility .
If you are a fan of American Horror Story (I’m not) or carnival sideshows (again, not my thing, but I’m not judging), you’ve seen some odd creatures. Maybe you’ve wondered if they are real. After all...
You’ve probably heard that you need to beef up your clinical knowledge for ICD-10-CM and ICD-10-PCS coding. And you’re probably wondering when you have time to do that. We’re here to help. We’ve...
Jeff, an 18-year-old male, came into the Fix ‘Em Up Clinic with complete left oculomotor palsy. Jeff stated he had a severe, throbbing headache around his eye yesterday. He took some aspirin and went...
Saturday marks the 165th anniversary of the death of Edgar Allan Poe, but sadly, we’re still not sure of the cause of Poe’s demise. We do, however, have plenty of theories. First is the popular “he...
Today we’re going to look at a real-life injury, but I will say up front that I don’t have all of the information about this particular patient’s injuries. F1 racecar driver Jules Bianchi was...
The four Cooperating Parties released the 2015 ICD-10-CM guidelines and, in the process, deleted a guideline that affects inpatient coding. Both the Centers for Disease Control and Prevention and CMS posted the new guidelines on their websites.
Clinical auditors are often not able to translate from ICD-9 to CPT ® to determine a procedure is inpatient-only, which leads to denials. Kimberly A.H. Baker, JD, CPC, and Beverly Cunningham, MS, RN, reveal common causes of denials and what hospitals can do to overturn incorrect denials.
Q: My colleagues and I continually wrestle with this question: Must all diagnoses on an inpatient chart be listed in the discharge summary for them to be coded?
The Workgroup for Electronic Data Interchange’s (WEDI) most recent survey on ICD-10 readiness included a particularly alarming (at least to me) statistic: Approximately 25% of the 324 providers who...
We’re still living under a code freeze as we (eagerly) await ICD-10 implementation. However, the four Cooperating Parties are still tweaking the ICD-10-CM guidelines. Both the Centers for Disease...
I don’t know about you, but I’m starting to feel a little like Chicken Little, yelling, “ICD-10 is coming!” instead of “The sky is falling!” And we’re all probably being met with the same polite (or...
The October update to the OPPS and Integrated Outpatient Code Editor (I/OCE) includes a payment correction, in addition to new HCPCS codes and other changes. Dave Fee, MBA, reviews CMS' changes and details the retroactive payment correction.
Q: A patient was in a hyperbaric oxygen chamber for eight minutes and the physician had to abort the treatment because the patient was feeling anxious. Which HCPCS/CPT ® code should the hospital bill: HCPCS code C1300 (hyperbaric oxygen under pressure, full body chamber, per 30 minute interval) or an E/M code? Which code should the supervising physician bill: CPT code 99183 (physician or other qualified healthcare professional attendance and supervision of hyperbaric oxygen therapy, per session) or an E/M code?
In its latest survey of the healthcare industry's ICD-10 readiness, the Workgroup for Electronic Data Interchange (WEDI) found that this year's delay negatively impacted provider progress, with two-thirds reporting slowing down or putting implementation initiatives on hold as a result.
CMS has instructed MACs to reprocess claims and providers to reimburse beneficiaries due to a miscalculated copayment for stereotactic radiosurgery, according to the October update to the OPPS and Integrated Outpatient Code Editor (I/OCE).
Evaluation and management services continue to be a major target for auditors. In the second part of a series, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about frequently targeted areas providers can review in order to protect against audits.
In this issue, we review coding for sprains, strains, and dislocations in ICD-10-CM, exmine how to audit for denials of inpatient only procedures, and offer tips for identify documentation shortcomings. Robert S. Gold, MD, discusses how to handle situations when what the physician says he or she did is not what the physician actually did.
CMS designates a certain set of procedures as inpatient-only, meaning it will only reimburse facilities for these procedures when they are performed in the inpatient setting. Inpatient-only procedures present numerous problems for hospitals.
Changes to the codes for musculoskeletal injuries goes beyond just increased codes for fractures. Find out how to code for sprains, strains, and disclocations in ICD-10-CM.
Coding for endovascular revascularization requires following a unique hierarchy and specific guidelines. Caren J. Swartz, CPC-I, CPC-H, CPMA, CPB , and Denise Williams, RN, CPC-H , look at the anatomy of the lower body and the necessary documentation to report these services.
Editor's note: Andrea Clark-Rubinowitz, RHIA, CCS, CPCH , has more than 30 years of experience working with healthcare professionals, information systems, hospital coding, and operational and compliance training. She founded and led Healthcare Revenue Assurance Associates from 2001 to 2014. Contact her at 954-465-0968 or aclark5678@gmail.com .
CMS officially declared October 1, 2015, the new ICD-10 implementation date with the publication of a final rule, "Administrative Simplification: Change to the Compliance Date for the ICD-10-CM and ICD-10-PCS Medical Data Code Sets," in the August 4 Federal Register .
CMS officially declared October 1, 2015, the new ICD-10 implementation date with the publication of a final rule, "Administrative Simplification: Change to the Compliance Date for the ICD-10-CM and ICD-10-PCS Medical Data Code Sets," in the August 4 Federal Register .
Coders and clinical documentation improvement (CDI) specialists have different perspectives and priorities even on common diagnoses. HCPro boot camp instructors Shannon E. McCall, RHIA, CCS, CCS-P,...
With flu season just around the corner (hey, where did summer go?), Melissa took her 4-year-old son Andrew to Dr. Spock, the pediatrician, for his flu shot Wednesday. With a minimum of fuss (and a...
Q: Is it okay to code a diagnosis if the physician documents two diagnoses using the phrase “versus” between them? For example, the patient arrives with abdominal pain and the physician orders labs and other tests, but they all come back normal. In the discharge note, the physician documents “abdominal pain, gastroenteritis versus irritable bowel syndrome (IBS).” When I first started as a CDI specialist I was told we could not use diagnoses when "versus” was stated, and that we had to query for clarification.
If coders choose the wrong root operation in ICD-10-PCS, they will arrive at an incorrect code. Nena Scott, MSEd, RHIA, CCS, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer, Gretchen Young-Charles, RHIA, Anita Rapier, RHIT, CCS, and Nelly Leon-Chisen, RHIA, discuss some of the root operation clarifications offered by Coding Clinic .
ICD-10 implementation and coding present plenty of challenges, especially when it comes to ICD-10-PCS. Sue Bowman, RHIA, CCS, and Donna Smith, RHIA, clear up some misconceptions about ICD-10 implementation and use.
Not feeling well? The problem could be in your small intestine. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, reviews common conditions related to the small intestine.
Recovery Auditors have uncovered incorrect secondary diagnoses in patients who underwent amputations for musculoskeletal and circulatory system disorders. CMS revealed the findings in its Quarterly Compliance Newsletter .
Some days I swear I have the attention span of a hyperactive hummingbird or Dug the talking dog from the movie “Up.” Maybe what I really have is attention deficit disorder (ADD). How would you code...
