During the January injections and infusions audio conference, Jugna Shah, MPH, president and founder of Nimitt Consulting in Washington, D.C., and Valerie A. Rinkle, MPA, associate director with Navigant Consulting in Seattle, reviewed these scenarios.
Healthcare providers are used to regularly changing guidelines and regulations that drastically alter their processes for coding and billing. Despite few guideline changes since 2008, drug administration still frequently causes confusion because of all the necessary factors to properly document, code, and bill the services.
In this month's issue, we explain how prepare for ICD-10-PCS' surgical challenges, detail changes made by Recovery Auditors, review changes to codes and MS-DRGs, and discuss why documentation improvement is important for more than just reimbursement. Dr. Gold reveals why coding from memory is not recommended and our coding experts answer your questions.
Physicians are never going to like receiving queries from coders and CDI specialists. They really won't like all the queries they will receive after the transition to ICD-10.
The Cooperating Parties made the last regular update to the ICD-9-CM codes October 1, 2011, but they are still adding codes for new technologies each year. The updates are considerably smaller than the regular updates, but coders still need to be aware of them.
Ah, Black Friday, when shoppers go doorbusting for deals and then head to the Fix ‘Em Up Clinic for repairs. Today’s first wounded bargain hunter, Stephanie, comes in complaining of pain in her left...
Farmer Brown came in today to see Dr. Gobbler for some injuries sustained when he tried to prepare his Thanksgiving main course. It seems Farmer Brown’s turkey wasn’t interested in joining him as...
Q: When a procedure is performed by laparoscopy, but only a code for the open approach is listed, do you use the unlisted procedure code? For example, the physician documented: laparoscopic pyloromyotomy, hypertrophic pyloric stenosis. We used CPT ® code 43520-22 (pyloromyotomy, cutting of pyloric muscle, Fredet-Ramstedt type operation, with the increased procedural services modifier) but the coding department corrected with 43659 (unlisted laparoscopy procedure, stomach). We are a pediatric surgical practice. I feel because the procedures are very common and performed often, our revenue will drop by using unidentified procedure codes, but I want to code them correctly.
ICD-10-CM codes may look unfamiliar, but many concepts are the same as those in ICD-9-CM, with a few notable changes. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC , look at some of the new conventions and guidelines for ICD-10-CM.
Coding for acute and chronic pain will not change greatly in ICD-10-CM, though coders will have some new options at their disposal. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , discusses some common pain diagnoses and how they will translate from ICD-9-CM.
CMS recently released five online resources to aid providers in their ICD-10 implementation efforts. Although CMS designed some of these resources with providers in mind, much of the information is applicable to hospitals, payers, and vendors as well.
You may remember that the American Medical Association (AMA) has been pushing for an end to ICD-10 since 2012. During its recent House of Delegates meeting, the AMA reinforced its position that ICD-...
Conquest, War, Famine, and Death have nothing on the Four Horsemen of the ICD-10 Apocalypse: Accuracy Documentation Productivity Reimbursement How do you tame these terrors? With planning and...
A feral flock of wild turkeys has invaded New York City. Seriously. And with them, they bring all sorts ofcode-ready diseases and mishaps. First, turkeys can transmit fun infections such as...
CMS created a mini tempest in June when announced it would not conduct end-to-end testing for ICD-10. CMS has not reversed that decision, but will require MAC to conduct front-end testing in March...
Some hospitals are incorrectly reporting lymphoma and leukemia MS-DRGs for patients who are admitted and treated for anemia and dehydration, according to the Medicare Quarterly Provider Compliance Newsletter .
When an error occurs in coding, sometimes the coders miscodes a record, but in others, the documentation is deficient, leading to incorrect code assignment. Joy Strong, PMP, Donielle Bailey, RHIA, and Jill M. Young, CPC, CEDC, CIMC, discuss how good documentation and accurate coding go hand in hand.
Coders may find assigning codes for sepsis somewhat easier in ICD-10-CM, but they will still face some challenges. Ann Barta, MSA, RHIA, CDIP , and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CCDS, detail how to report sepsis in ICD-10-CM.
Clinical queries serve a definitive purpose when documentation in the medical record is ambiguous, inconsistent, lacking specificity, or contradictory. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, explains why documentation improvement initiatives and heightened coder awareness of the need to query can be an asset or liability.
Q: What recommendation would you give to the coder when the clinical indicators in the chart do not support sepsis but it’s in the final diagnostic statement?
The majority of respondents in our recent (unscientific) JustCoding poll identified physician documentation as their biggest concern heading into the ICD-10 transition. No one should be surprised by...
Coding for podiatry services requires an extensive understanding of complex anatomy and regulations. Lynn M. Anderanin, CPC, CPC-I, COSC , AAPC Certified ICD-10-CM instructor, AHIMA Approved ICD-10-CM trainer, reviews what steps coders can make to ensure complete documentation for podiatry services that are facing increasing audits.
ICD-10-CM codes may look completely different, but many of the coding steps remain the same. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD; Julia Palmer, MBA, RHIA, CCS ; and Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, FAHIMA, CDIP, AHIMA-approved ICD-10-CM/PCS trainer explain how to code for neoplasms in ICD-10 and which changes to note.
The 2014 IPPS Final Rule was supposed to be implemented with enforcement beginning October 1, but one of its most controversial aspects has seen another delay in enforcement, with major healthcare trade groups seeking more.
Q: We recently had a situation where a patient had come in to have his port re-assessed. He had been complaining of the port being difficult to access. Preliminary x-ray showed the port accessed, with great blood return. Patient has an allergy to IV contrast, so we just flushed the port, and did not give the contrast. The port remained accessed. How do we code this? Do we use 36598 (contrast injection[s] for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report) with a modifier -52 (reduced services)? The other option is a modifier -73 (discontinued outpatient procedure prior to anesthesia administration) or -74 (discontinued outpatient procedure after anesthesia administration). However we have no documentation regarding anesthesia, and I'm not sure the patient would even get anesthesia for a procedure such as this.
Mr. Jack O. Lantern underwent some significant surgery at Stitch ‘Em Hospital back on October 16. Dr. Carver removed Jack’s liver, stomach, large intestine, small intestine, appendix, and gall...
Which tasks have you completed on your ICD-10 implementation list? We want to know. Our sister publication , Medical Records Briefing, is conducting a benchmarking survey on ICD-10 implementation,...
Initially, we thought that outpatient coders didn’t have to learn to code in ICD-10-PCS. They would still use CPT® codes to report physician services in the outpatient world. Now it looks like that...
A wound is an injury to living tissue caused by a cut, blow, or other external or internal factor. Robert S. Gold, MD , and Gloria Miller, CPC, CPMA , review anatomy and documentation for wounds and explain how to code for wound care in ICD-9 and ICD-10.
Physicians believe they are providing quality care, which gives them high job satisfaction. However, the problems associated with using electronic health records decreased that satisfaction, according to a recent RAND survey.
The ICD-10 implementation will result in a slowdown at every level of coding. Elaine O’Bleness, MBA, RHIA, CHP, Migdalia Hernandez, RHIT, Kimberly Carr, RHIT, CCS, CDIP, and Rachel Chebeleu, MBA, RHIA, provide suggestions on how to minimize that productivity decline.
Recovery Auditors are data mining for sepsis MS-DRGs and then focusing in on those with a short length of stay. Robert S. Gold, MD, and Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, provide tips for correct sepsis coding to avoid auditor takebacks.
Coders select E/M levels based on criteria developed by their organization. CMS has proposed a significant change to E/M coding-replacing the current 20 E/M levels for new patients, existing patients, and ED visits with three G codes-but that change would only apply to Medicare patients and only to the facility side.
In this month's issue, we explain how coders will report sepsis in ICD-10-CM, go beyond pressure ulcers for coding wound care, review the importance of PEPPER, and reveal how to uncover and correct documentation deficiencies before ICD-10 implementation. Dr. Robert Gold introduces you to SIRS and our coding experts answer your questions.
Over and over, one gets frustrated that professional coders are told that they are smart and educated and know about anatomy, physiology, and pharmacology, and then the same people turn around and say, "You code what the doctor documented and it's not up to you to question the physician."
All pressure ulcers are wounds, but not all wounds are pressure ulcers. A wound is an injury to living tissue caused by a cut, blow, or other external or internal factor. Wounds usually break or cut the skin.
Our experts answer questions about followup visits in the ED, skin substitutes, flu vaccines, osteoporosis and fractures in ICD-10-CM, ICD-10-CM external cause code, modifier for discontinued cardioversion, and modifier -25
With some major changes in look and form-but generally adhering to existing guidelines-coding for neoplasms serves as a microcosm of the changes providers will face when the transition to ICD-10-CM occurs October 1, 2014.
Coders may find assigning codes for sepsis somewhat easier in ICD-10-CM, but they will still face some challenges. The first of those challenges, and probably the biggest, centers on physician documentation.
In this month's issue, we review ICD-10-CM guidelines, illustrate how neoplasm coding will and won't change in ICD-10-CM, identify elements for appropriate ED E/M level selection, and answer your coding questions.
How well could you code in ICD-10 using your current physician documentation? Do your physicians document the specificity and detail coders need to select the correct ICD-10-PCS code? Do your physicians document laterality, which coders will need for many ICD-10-CM codes?
ICD-10-CM implementation is less than a year away and coders should be starting their ICD-10-CM code training if they haven't already. Coders don't need to learn the specific codes right now, but they should be familiar with some of the conventions and guidelines in ICD-10-CM.
If you're not already actively using your hospital's PEPPER (Program for Evaluating Payment Patterns Electronic Report), you're missing out on a lot of valuable data.
Poor Mr. Frank N. Stein, he’s literally falling to pieces. Not to worry, though, Dr. Shelly at the Stich ‘Em Up Hospital will have him back together in no time. Frank’s most obvious problem is that...
Our sister publication , Medical Records Briefing, is conducting a benchmarking survey on ICD-10 implementation, and we would appreciate your input. Please take a few moments to complete this survey...
Coder productivity was a hot topic of conversation during the AHIMA pre-conference in Atlanta October 26-27. We all know coders will be less productive initially after the transition to ICD-10. The...
Greetings from Atlanta! I spent the weekend collecting all kinds of tips and information about ICD-10 during the AHIMA Conference pre-conference sessions. These are just a few of the best tidbits...
The ICD-10-PCS Official Guidelines for Coding and Reporting address four specific circumstances when coders will report multiple procedures. Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and Mark N. Dominesey, MBA, RN, CCDS, CDIP, HIT Pro-CP, explain the guidelines and how they differ from the current ICD-9-CM guidelines.
Approach is the fifth character in the ICD-10-PCS code. Laura Legg, RHIT, CCS, AHIMA-approved ICD-10 CM/PCS trainer , reviews the seven approaches used in ICD-10-PCS.
Coders will use an ICD-10-PCS table to build a code for a hip or knee replacement. As with any procedure, coders must first determine the root operation. Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P, CDIP, and Wanda L. Cidor, guide you through coding for these procedures.
Jacob comes into the Fix ‘Em Up Clinic with a hairy problem—namely too much hair. He’s covered in it, head to tail, I mean toe. He also reports a strange urge to howl at the moon and a severe allergy...
Sitting hunched in front of a computer can be a bad thing. Aside from missing all of the splendid fall foliage, you could also be straining your neck muscles and causing yourself plenty of pain. So...
Mr. Jack O. Lantern is here at Stich ‘Em Up Hospital to have his guts removed. Dr. Carver begins by removing a section of Jack’s skull, then begins to remove Jack’s guts. How would we code this...
Small and mid-sized hospitals are increasing their ICD-10 training for staff, according to a recent Health Revenue Assurance Associates (HRAA) survey of 200 healthcare professionals. However, many still lag behind CMS’ timeline for dual coding and other implementation aspects.
Packaging still causes confusion amongst healthcare providers and the number of packaged services will greatly expand if CMS finalizes certain parts of the 2014 OPPS proposed rule. Valerie A. Rinkle, MPA, and Kimberly Anderwood Hoy Baker, JD, CPC , discuss what changes could come in 2014 and how to avoid common packaging errors.
Some of the most sweeping changes in OPPS history were proposed in the 2014 rule, including new packaging rules, quality measures, and changes to evaluation and management. Jugna Shah, MPH, and Dave Fee, MBA, look at some of the changes and how they could impact providers.
Q: The patient has had a previous bilateral mastectomy and is now coming in for a revision of bilateral areola with a dermal fat graft to the left nipple and excision of excessive skin and subcutaneous tissue from both breasts. This would be CPT ® code 19380 (revision of reconstructed breast) with modifier -50 (bilateral procedure) and 19350-50 (nipple/areola reconstruction) for both procedures. I cannot locate information that tells me if the nipple revision on the reconstructed breast is part of the 19380 or can be separately coded with 19350.
New CPT ® codes introduced for 2014 will give healthcare providers new ways to report pain management services and treatments. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer , reviews some of the codes, including new evaluation and management and Category II codes.
Welcome to the Middle Ages, when your chance of dying from the plague is around 50-50. The bubonic plague likely wiped out 75-200 million people in Europe in the 14 th century alone. For the...
My brain is fried. Keeping up with all of the mandates and changes in healthcare is exhausting. So is learning the new ICD-10 codes. Maybe I’m just tired because it’s Wednesday. What does ICD-10-CM...
CDI specialists shouldn’t focus on reimbursement, yet the reality is that improved documentation often does lead to higher payments for the hospital. Darice Grzybowski, MA, RHIA, FAHIMA, and Jon Elion, MD, offer tips on how CDI programs can mitigate ethical quandaries and demonstrate best practice.
Physicians often use different terms interchangeably when documenting sepsis. Robert Gold, MD , and Gloryanne Bryant, RHIA, RHIT, CCS, CDIP, CCDS, define the different terms and review when to query for additional clarification.
Although ICD-10-CM resolves some problematic areas of coding, it isn't a panacea. Robert S. Gold, MD reviews how respiratory insufficiency will continue to challenge coders.
In order for coders to report ICD-9-CM procedure code 96.72 (continuous invasive mechanical ventilation for 96 consecutive hours or more), the provider must document that the patient received more than 96 hours of continuous ventilation. A recent OIG report found that 96% of claims incorrectly included code 96.72 between 2009 and 2011.
People are creatures of habit. Some of them are good, some not so good. Coders, too, are creatures of habit. We know certain codes without having to look them up. (Anyone know the code for...
Jeanne L. Plouffe, CPC, CGSC , and Jennifer Avery, CCS, CPC-H, CPC, CPC-I , review procedures performed on the gallbladder and how to determine the correct ICD-9-CM diagnosis codes.
Like the skin, dermatology coding has several layers. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, says that coders need to pay attention to the type of procedure, site, size, and more in order to accurately report each encounter.
With less than a year until ICD-10 implementation, many facilities have yet to even begin training. A recent Association of Clinical Documentation Improvement Specialists survey shows how far along facilities are and their concerns as October 1, 2014, nears.
The implementation of ICD-10-CM will bring more specificity to coding, which will mean more data for facilities. Michael Gallagher, MD, MBA, MPH, and Andrea Clark, RHIA, CCS, CPC-H, look at how to handle that data and its benefits for providers and patients.
By this time next year, we will be using ICD-10 codes. Where are you in your transition? What have you accomplished? What’s left on the to-do list? Here’s a better question: will you be ready? It...
CMS released its FY 2014 IPPS final rule in August, and with it comes a whole slew of changes for inpatient hospitals. Set aside a good amount of time to scroll through the 2,000-plus page document. Yes, that's right: There are more than 2,000 pages of information to absorb before the rule goes into effect on October 1, 2013.
ICD codes are the ultimate source of information for the healthcare industry. Coders in every setting-inpatient, outpatient, and physician services-report the exact same ICD codes to describe a patient's condition.
Does the patient really have sepsis? Experts say coders often struggle with this question because physicians don't sufficiently document clinical indicators.
Our experts answer questions about NCCI edits for injections, modifier -25, modifier -59, laminotomy with insertion of Coflex distraction device, billing mammogram for needle placement, and auditing electronic orders.
Despite its apparently straightforward definition in the CPT ® Manual , modifier -59 (distinct procedural service) can be deceptively difficult to append properly.
In this month’s issue, we provide tips for wrapping your hands around data analytics before the transition to ICD-10-CM, review the October updates to the I/OCE, and discuss the correct use of modifier -59. In addition, our experts answer your coding questions.
Each physician may have his or her own way of describing a stroke. However, consistent terminology leads to accurate data to describe the care provided as well as the mortality, length of stay, and cost statistics.
CMS released its FY 2014 IPPS final rule in August, and with it comes a whole slew of changes for inpatient hospitals. Set aside a good amount of time to scroll through the 2,000-plus page document. Yes, that's right: There are more than 2,000 pages of information to absorb before the rule goes into effect on October 1, 2013.
CMS added modifier -AO (provider declined alt payment method) and new HCPCS codes to the I/OCE as part of the October 2013 quarterly update found in Transmittal 2763.
CMS announced that it is postponing the eHealth Provider Webinar on ICD-10 compliance that was scheduled for October 1. CMS has not announced a reschedule date.
My head is going to explode. This is seriously epic, end of the world pain. It’s a 20 on the pain scale. It wouldn’t be so bad if I didn’t also feel like I was going to throw up. And the light is...
The best way to decrease denials or increase overturn rates begins with a compliant concurrent review of documentation. Marilyn S. Palmer, DO, and Jonathan G. Wiik, MSHA, MBA, review common Recovery Audit targets and provide tips for successfully appealing denials.
Q: A patient presents with altered mental status/encephalopathy due to a urinary tract infection (UTI). The patient has a history of dementia. The final diagnosis is encephalopathy due to UTI. Should we code the encephalopathy as a secondary diagnosis because it’s an MCC and not always a symptom of a UTI?
Hospitals are being incorrectly reimbursed for preadmission testing that occurs within the three days prior to admission, according to Recovery Audit findings.
ICD-10-CM and ICD-10-PCS present different challenges, but both will require better documentation. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Kathy DeVault, RHIA, CCS, CCS-P, Donielle Bailey , and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, discuss some of the areas where coders will need more information to code in ICD-10.
Acute kidney injury (AKI) is an abrupt decrease in kidney function that includes—but is not limited to—acute renal failure. Garry L. Huff, MD, CCS, CCDS , and Brandy Kline, RHIA, CCS, CCS-P, CCDS , explain the clinical indicators of AKI and offers tips for composing queries.
Ears are moving up in ICD-10-CM. In ICD-9-CM, they have to share space with the eyes. In ICD-10-CM, they get their own chapter. They also get a lot more codes. Fortunately, many of those additional...
We have just a little over a year remaining until ICD-10 implementation. How well do you know your ICD-10-PCS codes? ICD-10-CM shares a lot of similarities with ICD-9-CM. Sadly, ICD-9-CM procedure...
Coding may not be brain surgery, but understanding brain anatomy can greatly help coders when reporting head injuries or disorders. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews some major components of brain anatomy and the impact of ICD-10-CM on coding for some common diagnoses.
Some providers are billing only add-on codes without their respective primary codes, resulting in overpayments, according to CMS. Add-on codes billed without their primary codes are considered an overpayment, with one exception.
CMS’ proposed 2014 OPPS rule is set to introduce many changes, such as more packaged services, including lab tests and add-on codes. Jugna Shah, MPH; Dave Fee, MBA; Kimberly Anderwood Hoy, JD, CPC; and Valerie A. Rinkle, MPA, offer their insight on what effect these changes could have for providers.
Q: A patient comes into the ED with chest pain. An EKG (CPT® code 93005) is performed. The patient goes directly to the catheterization lab for catheterization (code 93454). Is a modifier appropriate for the EKG?
