After years of consideration, CMS introduced extensive changes for modifier -59 (distinct procedural service) for 2015. Jugna Shah, MPH , explains these changes and when to use the new modifiers instead of modifier -59.
CMS accepted 76% of all national ICD-10 test claims submitted during its November 2014 ICD-10 acknowledgement testing week. More than 500 providers, suppliers, billing companies, and clearinghouses participated in the tests, which identified no issues with Medicare's system.
CMS expanded packaging and finalized Comprehensive APCs in the 2015 OPPS final rule. Jugna Shah, MPH, and Valerie Rinkle, MPA, analyze the changes and the potential impact on providers.
Ready to test your ICD-10 systems with CMS? The agency is currently accepting applications for its second end-to-end ICD-10 testing week, scheduled for April 26-May 1. Each MAC (and Common Electronic...
In this month’s issue, we explain how to code for non-coronary bypass procedures in ICD-10-PCS, reveal when it is appropriate to bill for ancillary bedside procedures, and review Coding Clinic advice for ICD-10. Robert S. Gold, MD, discusses how and when coders should ask for additional documentation.
Inpatient coding professionals are used to DRG systems where all of the diagnoses and procedures map to a single DRG. So they may not look for additional procedures and services to report outside of that DRG.
Coronary artery bypass graft (CABG) procedures are not the only ones coders will report using the root operation Bypass in ICD-10-PCS. Surgeons can create bypasses in other vessels of the body.
As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment system, financial impact analysis of changes, departmental budgeting, and forecasting has become more complicated each year.
In a concerted effort to move healthcare payments to a system of "quality over quantity," CMS finalized policies that greatly expanded packaging for outpatient providers in the 2015 OPPS final rule. It also introduced complexity adjustments with comprehensive APCs (C-APCs).
CMS proposed that a new HCPCS modifier be appended to every code for a service furnished in a hospital's off-campus provider-based department on both the CMS-1500 claim form for physicians' services and the UB-04 form (CMS Form 1450) for hospital outpatient services in the 2015 OPPS proposed rule. Despite many detailed comments opposing this change, no consensus emerged; therefore, CMS is moving forward with implementing a slightly modified policy.
Despite all the uncertainty surrounding the implementation of ICD-10-CM/PCS, the Cooperating Parties (i.e., the American Hospital Association, AHIMA, CMS, and the National Center for Healthcare Statistics) nevertheless decided that the farewell issue of Coding Clinic for ICD-9-CM (which was published in the first quarter of 2014) will remain the farewell issue.
We’ve come to the end of another year filled with ICD-10 in the spotlight, for good and bad reasons. First the bad—we’re still waiting to implement ICD-10. We thought we were all set for October 1,...
On the 12th day of Christmas my true love gave to me 12 drummers drumming and the noise is unbelievable. I’ve got a migraine. I didn’t see any lights or odd visual disturbances beforehand, so this is...
Q: If the physician does not perform a formal myelography and just administers an injection before the patient goes straight for computed tomography (CT), which CPT ® code would we report in 2015? The 2015 combination codes are for use when the same radiologist or physician who performs the injection reads his or her own study.
With the ICD-10 implementation date set for October 1, 2015, CMS has continued its efforts to provide education and information to help organizations prepare for the change. Recently, CMS published a recording of its Transitioning to ICD-10 Provider Call and a new Coding for ICD-10-CM video to YouTube.
We've compiled the numbers from the latest JustCoding Salary Survey and now you can see how you compare to the average coder in terms of salary, experience, and other factors. Monica Lenahan, CCS, and Susan E. Garrison, CHCA, CHCAS, CHC, CCS-P, CPC, CPC-H , analyze the results and discuss the future of coder salary and responsibilities.
In part two of a series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews ICD-10-CM Z codes, explaining how and when to use them and how they differ from ICD-9-CM V codes.
On the 11th day of Christmas my true love gave to me 11 pipers piping. You know that saying about being careful what you wish for? It’s very true. I jokingly told my true love we needed musicians for...
On the 10th day of Christmas my true love gave to me 10 lords a-leaping. My house isn’t big enough for all of these dancers. Several of them mistimed their leaps and collided midair and they’re down...
On the ninth day of Christmas my true love gave to me nine ladies dancing. Um, ladies, this isn’t Radio City Music Hall. Please watch where you’re kicking. Don’t look now, but Great Aunt Edna has...
On the eighth day of Christmas my true love gave to me eight maids a-milking. Why, exactly, has a herd of cows taken up residence in my backyard, True Love? What are we going to do with them and more...
CMS Transmittal 547 changes the audit timeframe for complex reviews from 60 to 30 days for some MAC and Recovery Auditor reviews. The change could significantly affect the volume and timeliness of complex reviews for providers. The transmittal becomes effective February 24, 2015.
The anatomical definition of a body part may not be the same as the ICD-10-PCS identification of a body part. Jennifer Avery, CCS, CPC-H, CPC, CPC-I, Nena Scott, MSEd, RHIA, CCS, CCS-P, and Gretchen Young-Charles, RHIA, explain the guidelines for selecting the appropriate body part and how body parts can affect root operation selection.
Q: If the physician writes septic shock instead of sepsis, do I need to query for sepsis? Is this an integral part of the diagnosis and sepsis would be the principal diagnosis, with septic shock a secondary diagnosis, making it an MCC?
In the first part of a two-part series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, discusses the use of Z codes in ICD-10-CM.
On the seventh day of Christmas my true love gave to me seven swans a-swimming. To be completely accurate, he took a group of us on a road trip to a pond where the swans swam in blissful ignorance of...
On the sixth day of Christmas my true love gave to me six geese a-laying. My favorite Uncle Ted was so excited about this gift that he rushed right over to relieve those geese of their eggs. Bad idea...
On the fifth day of Christmas my true love gave to me five golden rings. Hey wait, there are only four rings here. Where did the other one go? Oh no, little Andrew shoved it up his nose. Time to...
On the fourth day of Christmas my true love gave to me four calling birds. I’m starting to think he raided a pet shop. Or maybe he captured these in the park. He says they’re calling birds. They look...
On the third day of Christmas my true love gave to me, three French hens. Awesome, more birds. My house is starting to look like an aviary. I’m also not sure why my true love thought it necessary to...
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about how to reduce queries by highlighting the information providers need to document for the most common OB ultrasound procedures.
Recovery Auditors have identified improper payments for claims involving end-stage renal disease (ESRD) services when more than one monthly service was billed per month and per-day codes exceeded the limit, according to the latest Medicare Quarterly Provider Compliance Newsletter .
Q: I have a question regarding CPT ® code 99184 (initiation of selective head or total body hypothermia in critically ill neonate, includes appropriate patient selection by review of clinical, imaging, and laboratory data, confirmation of esophageal temperature probe location, evaluation of amplitude EEG, supervision of controlled hypothermia, and assessment of patient tolerance of cooling) in the 2015 CPT Manual . What if the neonate is in the hospital for several weeks? The total body hypothermia is performed, the baby improves, but remains in the hospital and then needs the procedure performed a second time. Can we report it a second time if several weeks have elapsed?
The added detail found in ICD-10-CM may require coders to brush up on their anatomy and physiology training to select the most appropriate codes. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews the anatomy of the male reproductive system and how coding for it will change in ICD-10-CM.
On the second day of Christmas my true love gave to me, two turtle doves. Hmm, you think he would have learned his lesson with the partridge. Apparently not. And apparently Mr. Whiskers isn’t hungry...
On the first day of Christmas, my true love gave to me, a partridge in a pear tree. How…nice. Fortunately, the tree is way too big for the living room (it also clashes with my real Christmas tree)...
Usually in this blog, I talk about ICD-10 implementation and coding from the coder or HIM point of view. But I wanted to share some suggestions from James S. Kennedy, MD, CCS, CDIP, president of...
Poor Finn. He’s heading for his first birthday, but he may not be in a partying mood. After Finn developed his fifth ear infection in six months, mom Melissa decided it was time to put tubes in his...
I’m almost afraid to read my email these days. It seems like every day brings a new group trying to delay ICD-10 or another piece of legislation that ICD-10 opponents might slip delay language into...
ICD-10-PCS will change the way coders count sites for coronary artery bypass graft (CABG) procedures. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Nena Scott, MS, RHIA, CCS, CCS-P, explain how coders will report CABG in ICD-10-PCS.
The advantages offered by ICD-10-CM can directly affect providers, patients, and third-parties alike. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, discusses this history of ICD-10-CM and the improvements the new system offers.
ICD-10-CM introduces new requirements for coding skull fractures and brain injuries. Kim Carr, RHIT, CCS, CDIP, CCDS , and Kristi Stanton, RHIT, CCS, CPC, CIRCC, explore how coding for these conditions changes in ICD-10-CM.
Q: We’ve heard that ICD-10-CM does not include a diagnosis code to show that a laparoscopic procedure was converted to an open procedure. How will we report this in ICD-10?
The endocrine system, which consists of many glands located throughout the body, is responsible for producing hormones and releasing chemicals into the bloodstream. These glands help maintain many important bodily functions, including metabolism, growth, and reproductive functions.
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.
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.
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.
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.
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...
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.
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.
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.
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?
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...
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?
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.
Coders often talk about guidelines and coding conventions, but what about ethics? Robert S. Gold, MD , discusses the value of following ethical coding standards.
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.
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.
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?
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...
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.
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.
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...
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.
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.
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.
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: 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.
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.
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.
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.
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...
