Most fracture cases originate in the ED, so orthopedic coders must understand the various scenarios that may arise based on the patient’s condition and the intent of the performing clinician. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS published a summary of its fourth quarter 2023 HCPCS Level II code update application decisions, including 36 additions, four revisions, and 18 deletions.
Teresa Seville, RHIT, CCS , explains that a thorough review of code updates must include analysis of the addenda, including index, tabular notes, guidelines, and committee meeting highlights.
TaraJo Vaught, MSN, RN, CCDS , shines a light on the crucial roles played by coding and CDI specialists, compares their respective realms, and offers insights for transitioning between them.
Teresa Seville, RHIT, CCS, explains that a thorough review of ICD-10 updates must include analysis of the addenda, including the index, tabular notes, guidelines, and committee meeting highlights.
Alysia Minott, CCS, CIRCC, CDIP, explains anatomic and documentation details coding professionals need to know to report cardiac and interventional radiology procedures.
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC , analyzes various types of postprocedural complications, such as respiratory failure, infection, ileus, shock, and offers direction on how to report them.
Our experts answer questions about conflicting payer and MAC guidance, identifying CPT/HCPCS services and supplies that are not separately reportable, and more.
Diane Pittman, CPC, CPMA, CRC, CCD-O, and April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O, explain how reporting ICD-10-CM social determinants of health, their context, and coder feedback can influence natural language understanding.
While certifications specific to CDI are by no means a requirement to get into the CDI field, they have grown to become a rite of passage for many CDI professionals.
Q: Can a “yes/no” query be sent based on this documentation to confirm yes, there is a postoperative hematoma, no, there is not a postoperative hematoma, or other?
Nancy Reading, RN, CPC, CPC-P , explains how employing clinical and coding criteria for assigning or auditing ICD-10-CM codes for malnutrition can have a significant impact on reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CCS , defines the Diagnosis, Etiology, Evidence, Plan (DEEP) methodology to identify and instill good habits for provider documentation.
The AHA responded with potential provider concerns to the government’s recent request for information (RFI) as it prepares for the potential transition from ICD-10 to ICD-11 for morbidity coding.
April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O , and Will Morriss, CCS, CCDS-O , describe how artificial intelligence (AI) has impacted providers, coders, and the healthcare industry.
Diane Pittman, CPC, CPMA, CRC, CCD-O, and April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O , explain how reporting ICD-10-CM social determinants of health, their context, and coder feedback can influence natural language understanding.
For accurate CPT and ICD-10-CM coding of fractures, coders will need to identify many pieces of information, including location and type. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Marlene Goodwin-Esola, MSN, RN-BC , recounts her personal journey with heart disease, undergoing cardiac catheterization, and offers her viewpoint on being on the other side of a coding chart.
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC , explains the differing definitions of “complication” for providers vs. coders, reviews types of complications, and codes an intraoperative laceration case study.
2024 ICD-10-CM code changes pertaining to acute appendicitis and small intestinal bacterial overgrowth give coders the opportunity to report these conditions with greater accuracy and specificity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Michael Malohifo’ou, RN, MBA, PhD , explains how excessive use of emergency departments can result in unfavorable outcomes . He also assesses the complicated relationships between EDs, social determinants of health ICD-10-CM coding, and mental and behavioral health CPT services.
Q: What terms need to be included in physician documentation to code in ICD-10-CM whether the patient’s migraine is chronic, intractable, or with status migrainosus?
This Q&A with Nancy Enos, FACMPE, CPC-I, CPMA, CEMC , covers independent historians, independent interpretations, discussion with external physicians, risk, and billing for separate E/M visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julia Kyles, CPC , reviews the 2024 First Quarter National Correct Coding Initiative (NCCI) code update, which included 929 new procedure-to-procedure edit pairs.
CMS posted its 2024 Therapy Code List and Dispositions on December 28. This list indicates whether therapy services, as distinguished by HCPCS Level II and CPT codes, are recognized under CMS as “sometimes therapy” or “always therapy.”
Michael Malohifo’ou, RN, MBA, PhD, explains how excessive use of emergency departments can result in unfavorable outcomes . He also assesses the complicated relationships between EDs, social determinants of health ICD-10-CM coding, and mental and behavioral health CPT services.
April Russell, MBA, CPC, CPC-P, COC, CRC, CCDS-O, and Will Morriss, CCS, CCDS-O, describe how artificial intelligence (AI) has impacted providers, coders, and the healthcare industry.
Professional development in CDI is a multifaceted and continuous journey, demanding integration of specific knowledge, continuous learning, and adaptability.
A scan of healthcare news sources or the Office of Inspector General work plan often finds psychiatry and mental health practices under scrutiny. Laurie Bouzarelos, MHA, CPC, reviews revenue cycle functions, provider contracting/credentialing, and coding and documentation tips to avoid denials.
The 2024 ICD-10-CM update added 36 codes to the now nearly 400 codes in category M80.- (osteoporosis with current pathological fracture). The additional codes add further specificity for pelvis fractures due to age-related osteoporosis.
Amanda Vincent, MBA, CCS, CPC, CCDS, CRC, explains the differing definitions of “complication” for providers vs. coders, reviews types of complications, and codes an intraoperative laceration case study.
Michael Lonski, Ph.D., a licensed psychologist, was sentenced to 27 months of imprisonment and three years of supervised release for conducting $2.6 million in Medicare and Medicaid fraud, the Department of Justice announced December 19.
This Q&A is part of an interview with Nancy Enos, FACMPE, CPC-I, CPMA, CEMC , covering physician CPT E/M reporting and medical decision-making. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A physician debrides a hyperkeratotic lesion on a patient’s left foot, second toe. During the same encounter, he performs a debridement of the five toenails. Which CPT codes and modifiers would be reported for this procedure?
A scan of healthcare news sources or the Office of Inspector General work plan often finds psychiatry and mental health practices under scrutiny . Laurie Bouzarelos, MHA, CPC , reviews revenue cycle functions, provider contracting/credentialing, and coding and documentation tips to avoid denials.
Providers can receive additional revenue when they check a patient for social determinants of health, but the service requires patient selection, a standardized tool, and follow up. Julia Kyles, CPC, explains how practices can report this service with a new HCPCS code for 2024.
The 2024 ICD-10-CM update added 36 codes to the now nearly 400 codes in category M80.- (osteoporosis with current pathological fracture). The additional codes add further specificity for pelvis fractures due to age-related osteoporosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a broad federal law that establishes the basic privacy and security protections that coders are required to follow.
A recent ProPublica article found that nearly 30,000 Medicare patients may have received atherectomy procedures prematurely or unnecessarily, resulting in millions of dollars in reimbursement.
Medical necessity is the foundation for justifying the need for services. It provides the reason for the diagnostic test or therapeutic services. Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI , reviews the fundamentals of medical necessity and explains its importance.
The National Correct Coding Initiative released the 2024 NCCI Policy Manual in early December, which will be effective January 1. This article covers the changes—both big and small. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released its January 2024 HCPCS Level II code update December 7, outlining 344 new and 74 discontinued codes. The code changes will become effective January 1, 2024.
Q: A patient underwent a diagnostic nasal endoscopy at 10 a.m. At 7 p.m., the patient developed an epistaxis and the physician had to use some complex cauterizing techniques to control the nosebleed. How would the physician’s services in this scenario be reported?
Traversing the different rules within cardiac and interventional radiology reporting is a challenge. Alysia Minott, CCS, CIRCC, CDIP , explains anatomic and documentation details coding professionals need to know to report these procedures.
Julia Kyles, CPC , contrasts 2024 CPT guidance and CMS’ 2024 Medicare Physician Fee Schedule (MPFS) final rule for changes to office visits, prolonged services, and split/shared services.
The healthcare setting can feel like a courtroom in the denials and appeals arena. By assessing the effort that goes into an appeal and the difference that comes out of them, coders and CDI specialists may find that the chasm between clarifying a patient record and defending it isn’t as wide as they think.
U.S. government civil healthcare fraud settlements exceeded $1.6 billion in 2022, according to the recently released 2022 Health Care Fraud and Abuse Control Program Annual Report.
Anemia describes a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient. Review the types of anemia, diagnostic criteria, treatment, and ICD-10-CM coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Spinal surgery for hospital coders can be very challenging if they do not know the rules for assigning the correct ICD-10-PCS codes. Nancy Reading, RN, CPC, CPC-P , reviews spinal anatomy and surgical approaches, and offers tips on how to select the most appropriate characters in ICD-10-PCS.
The National Correct Coding Initiative released the 2024 NCCI Policy Manual in early December, which will be effective January 1. This article covers the changes—both big and small.
Part B physicians will have to prepare for a net 3.4% payment decrease across services in 2024, according to the 2024 Medicare Physician Fee Schedule final rule, which covers numerous operational areas for medical groups, including new coverage opportunities and billing revisions to coding and compliance updates.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a broad federal law that establishes the basic privacy and security protections that coders are required to follow.
Our experts answer questions about finding the right assessment tool for reporting social determinants of health, choosing CPT modifiers for same-day services, and more.
After years of working to engage providers and get them on board with CDI efforts, every seasoned CDI professional knows there’s no one-size-fits-all solution.
Anemia describes a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient. Review the types of anemia, diagnostic criteria, treatment, and ICD-10-CM coding.
The 2024 OPPS final rule details changes to price transparency compliance, reimbursement changes and, updates to numerous other hospital programs. Additionally, CMS is moving forward with its proposals to address unlawful payment reductions to 340B drug reimbursement.
Debbie Jones, CPC, CCA , examines the cause, prognosis, and treatment options for desmoid tumors, in addition to reviewing the ICD-10-CM codes designed to identify them with specificity. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medical coding practices can vary widely between countries, with different code sets, regulations, and policies governing the process. However, there are some commonalities when comparing medical coding in the U.S. to other countries, which this article explores.
Q: I’ve heard some facilities are beginning to incorporate ICD-11, even though it is not yet implemented in the U.S. How can coders help their providers transition to ICD-11?
As more health systems have been forced to reckon with the undeniable impacts of socioeconomic status on health outcomes, CDI and coding practices have followed in kind. Analyze recent developments with reimbursement and ICD-10-CM coding for social determinants of health (SDOH).
The Journal of the American Medical Association recently released a study that analyzed social determinants of health and other conditions associated with lower-limb amputation in the U.S.’ most populated areas. The study found that several factors corresponded with an increased risk of amputation.
As important changes are coming for physician E/M reporting in 2024, coders should note the changes for reporting telemedicine services, split or shared visits, multiple visits, and hospital or observation care same day admission and discharge. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2024 OPPS final rule details changes to price transparency compliance, reimbursement changes and, updates to numerous other hospital programs. Additionally, CMS is moving forward with its proposals to address unlawful payment reductions to 340B drug reimbursement.
Part B providers will have to prepare for a net 3.4% payment decrease across services in 2024, according to the 2024 Medicare Physician Fee Schedule final rule. The rule covers numerous operational areas for medical groups, including new coverage opportunities and billing revisions to coding and compliance updates.
A recent Office of Inspector General audit of inpatient and outpatient Medicare claims estimated that nearly 20% of cases including codes for abuse or neglect were not reported to law enforcement.
Q: What advice can you give pertaining to clinical documentation requirements to properly report CPT codes for vaginal deliveries after cesarean (VBAC) procedures?
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews the clinical definition and types of postpartum hemorrhage, the intrauterine treatment devices used to treat it, and relevant ICD-10-PCS coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM, delves into the ethical standards, best practices, and importance of accurate health record documentation in regard to heart failure by drawing insights from authoritative sources within the industry.
Q: How would a coder report a coronary artery bypass graft complicated by ineffective external cardiac device insertion, subsequent removal, and intra-aortic balloon pump placement?
Children diagnosed with acute respiratory distress syndrome (ARDS) had a readmission rate of 27.8% in the first year after discharge, with half of those readmissions occurring within two months, according to a recent study in JAMA Network Open.
Colder weather is approaching, which brings an increase in respiratory infections. Shelley C. Safian, PhD, RHIA, CCS-P, COC, COC-I, clarifies the pathogenic causes of pneumonia, specifically those with recent additions to ICD-10-CM, and those with antibiotic resistance. She also reviews how to report treatment methods in ICD-10-PCS.
Niki Crawford, CCS-P, CPC, RCC, CCP-AS, CCP, QMC, describes a new addition to the Category III CPT code set with add-on code 0715T. She summarizes the procedure, reviews the associated technology, and gives coding tips and a clinical example.
2024 CPT manuals contain several changes related to integrated peripheral and spinal neurostimulator systems. The seven code additions, four code revisions, and new guidelines clarify when coders should use permanent procedure codes from the nervous system chapter vs. a Category III code.
Medical coding practices can vary widely between countries, with different code sets, regulations, and policies governing the process. However, there are some commonalities when comparing medical coding in the U.S. to other countries, which this article explores.
Our experts answer questions about CPT reporting for use of a Jada intrauterine device after delivery, ICD-10-CM coding for other thrombophilia with atrial fibrillation, and more.
CMS recently published a summary of its third quarter 2023 HCPCS Level II code update application decisions, accepting 51 of 61 submissions. There were also 10 codes that will be discontinued and one code whose definition will be revised. The additional codes mostly consist of injections and skin substitutes.
Q: One of our providers used a Jada device on a patient post-delivery, but I cannot find the corresponding CPT code. What is the CPT code for Jada device use?
For certain preventive services, coders must clarify when they become diagnostic services, which is why modifiers -GG, -PT, and -33 exist. Brush up on Medicare policies and CPT codes associated with these modifiers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
2024 CPT manuals contain several changes related to integrated peripheral and spinal neurostimulator systems. The seven code additions, four code revisions, and new guidelines clarify when coders should use permanent procedure codes from the nervous system chapter vs. a Category III code.
The decision for an emergency clinician to report fracture or dislocation care CPT codes with an E/M code can have significant reimbursement ramifications. Hamilton Lempert, MD, FACEP, CEDC, explains the complexities of reporting this care and covers details coders should watch out for in documentation.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews the clinical definition and types of postpartum hemorrhage, the intrauterine treatment devices used to treat it, and relevant ICD-10-PCS coding.
Does the data collected by your healthcare system truly represent the patient you are caring for? Andrew B. Maigur, MD, CHCQM-PHYADV, CMPC, writes about how documentation is critical to capturing data for accurate coding and quality metric reporting.
Hamilton Lempert, MD, FACEP, CEDC, writes about the complexities of reporting and billing for certain ED services, as well as what coders should watch out for in documentation.
Despite sepsis being the leading cause of hospital readmissions and in-hospital deaths in the U.S., its extensive history of clinical definitions and criteria can cause confusion for even the most experienced coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CDI departments have long been involved with the denials management process. As with any expansion of CDI responsibility, those looking to venture into a new area can glean valuable knowledge from those already on the cutting edge.
Approximately 33% of patients who experienced a first-time atrial fibrillation (AF) episode while hospitalized for noncardiac reasons had additional AF episodes up to one year after being discharged, according to a study recently published in the Annals of Internal Medicine .
