CMS rescinded Transmittal 2607 and replaced it with Transmittal 2636 to update the add-on code edit file to include a change in the list of primary codes for CPT add-on code 90785 (interactive complexity).
One of the major changes to the 2013 CPT ® Manual is the replacement of the term "physician" with "physician or other qualified healthcare professional" in a wide range of codes. Marie Mindeman and Andrea Clark, RHIA, CCS, CPC-H, discuss how this change affects code assignment.
Interventional radiology cases are often complex with confusing coding rules, especially for radiologic supervision and interpretation. Stacie L. Buck, RHIA, CCS-P, RCC, CIC, and Karna W. Morrow, CPC, RCC, CCS-P, lead you through the maze of coding these procedures.
Q: A patient went to the operating room under anesthesia for cataract extraction and repair of retinal detachment of the same eye. The surgeon successfully removed the cataract. The surgeon then accessed the back of the eye to begin to repair the detachment. After reviewing the condition of this eye area, the surgeon determined that the eye was in such bad shape it could not be saved, so the detachment was not repaired and surgery was ended. The patient was under anesthesia and the retinal detachment repair procedure was begun (although barely) but then cancelled. Should we report this procedure since the facility incurred expenses for the surgical attempt at repair?
As part of the 2013 OPPS Final Rule, CMS made major changes to how it will reimburse facilities for separately payable drugs and how it will calculate APC relative weights. Jugna Shah, MPH, and Valerie Rinkle, MPA, review the most significant changes in the final rule.
It’s Groundhog Day…over and over in the comedy Groundhog Day. Poor Phil Connors (played by Bill Murray) does his best to escape the never-ending cycle by killing himself in some creative ways. It’s...
We’re all thinking about documentation specificity needs in ICD-10-CM/PCS as we prepare of the October 1, 2014 compliance deadline. Increased communication between physicians and coders is paramount...
The ICD-9-CM guidelines state that it's unusual for two or more diagnoses to meet the definition of principal diagnosis. However, coders know this isn't exactly true, as the scenario tends to occur frequently.
In November 2011, the FDA approved transcatheter aortic valve replacement (TAVR) to treat aortic valve stenosis for those patients who are not candidates for traditional open-heart surgery. This procedure is also referred to as a transcatheter aortic valve implantation (TAVI).
In times of increased auditor scrutiny, it's important for coders to remind themselves of their strengths. Assigning the POA indicator is one of them, according to an OIG report released in November 2012.
Physicians and other providers practice in many different areas within a hospital. To accurately code physician and provider services, coders must know and understand the place of service (POS) codes.
As Lucile Packard Children's Hospital in Palo Alto, Calif., implemented its EHR, the dreaded problem of copy and paste documentation began to rear its ugly head.
In this month's issue, we review the overhaul of CPT's psychiatry section and new codes for cardiology procedures, examine CPT's new provider neutrality language, and examine place of service codes.
One of the major changes to the 2013 CPT Manual is the replacement of the term "physician" with "physician or other qualified healthcare professional" (QHP) in a wide range of codes.
As Lucile Packard Children's Hospital in Palo Alto, Calif., implemented its EHR, the dreaded problem of copy and paste documentation began to rear its ugly head.
Underdosing is a new coding concept in ICD-10-CM and it has its own column in the table of drugs. Underdosing can be accidental (patient forgot to take the medication) or intentional (patient chose...
The FY 2013 Office of Inspector General (OIG) Work Plan includes plenty of new additions that might interest inpatient hospitals. Sara Kay Wheeler, Kimberly Anderwood Hoy, JD, CPC, Monica Lenahan, CCS, and William E. Haik, MD, FCCP, CDIP, review those new additions and offer tips for dealing with OIG scrutiny.
Coders should avoid reporting signs and symptoms as the principal diagnosis when possible. However, that’s not always possible. William E. Haik, MD, FCCP, CDIP, reviews the ICD-9-CM principal diagnosis selection guidelines and when coders should report signs and symptoms as the principal diagnosis.
Electronic health records (EHR) provide opportunities for more efficient and effective care, yet they also provide coding and documentation challenges. Jill M. Young, CPC, CEDC, CIMC, explains what coders need to be wary of when coding from an EHR.
If you’re curious about whether something you’ve heard or read about the Recovery Auditor program is true, be sure to check out new information published on the CMS Web site. The agency released a document that addresses 14 common myths about the program.
Q: One of our orthopedic surgeons started to perform spinal fusions percutaneously. CPT ® provides instruction on how to code this procedure; however, these are inpatient surgeries, so we need an ICD-9-CM code. We’re leaning toward code 81.00 (spinal fusion unspecified). Do you think this is the correct code?
Now is the best time to consider the clinical documentation initiatives you need to implement in 2013. The preparation for ICD-10 has documentation needs first and foremost on everyone’s mind. Start...
ICD-10-PCS is vastly different from the ICD-9-CM procedure codes inpatient coders currently use. By now, you probably know that ICD-10-PCS codes must be seven characters in length. The letters I and...
On January 9, the American Medical Association sent out a notification of errata in the 2014 CPT ® Manual . The AMA followed with a January 16 correction saying the errata file is for the 2013 CPT Manual .
The use of dual coding is frequently discussed and debated as a way to prepare for the transition to ICD-10. Donna Smith, RHIA, Thea Campbell, MBA, RHIA, Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, and Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, evaluate the pros and cons of dual coding.
Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P, CDIP, senior manager at Blue and Company in Indianapolis, an industry expert on ICD-10, provides preparation tips and action steps for ICD-10 implementation.
ICD-10-CM includes separate chapters for diseases of the eye and diseases of the ear, a change from ICD-9-CM, where both diseases are included in the nervous system codes. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how the ICD-10-CM codes for diseases of the eyes and ears are similar to and different from ICD-9-CM codes.
I am back to my ICD-10 blog following a long illness. It is great to be back! Why is it that a date ending in 2013 seems so much closer to October 2014? Others must feel this way because there seems...
Anytown got hit with some significant snowfall, which lead to some interesting injuries at the Fix ‘Em Up Clinic. Dave came in complaining of back pain after spending two hours shoveling his driveway...
Cold and flu season is in full swing, so I thought it might be a good time to look at coding for influencza in ICD-10-CM. If you look up influenza in the ICD-9-CM index, you might think we currently...
Leading queries are frequently a topic of discussion among coding and clinical documentation improvement professionals. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, explains how to determine what constitutes a leading query and how to craft compliant queries.
MLN Matters ® article SE1236, which discusses documenting medical necessity for major joint replacements, may be aimed at physicians, but Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, and Lynn Marlow, BS, RHIT, CCS, explain how it also applies to hospitals and coders.
Physicians, especially ED physicians, need to start paying attention to how their documentation affects the facility. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Bernadette Larson, CPMA, discuss how documentation in the ED affects medical necessity and inpatient coding.
Q: I’ve heard that queries differ between critical access and short-term acute care hospital settings. Is this true, and if so, where can I find more information?
National Government Services, under contract with CMS, will host a series of listening sessions about lessons learned from the Version 5010 upgrade to prepare providers, vendors, and payers for the transition to ICD-10-CM/PCS.
A sequela is the residual effect (condition produced) after the acute phase of an illness or injury ends. ICD-10-CM includes codes specifically designed to report sequela, such as I69.953 (hemiplegia...
Being a Jedi knight is hard work. And it’s dangerous, especially when your father is out to kill you and your friend gets encased in carbonite. Intrepid coders that we are, we will brave the frozen...
Coding for stent placement procedures will look very different in 2013. The American Medical Association deleted the two CPT ® codes used to report nondrug-eluting intracoronary stent placement procedures.
Coders will find plenty of changes throughout the musculoskeletal, respiratory, and cardiac sections of the CPT® Manual for 2013, as well as guidelines changes, deletions, and editorial revisions. Andrea Clark, RHIA, CCS, CPC-H, Georgeann Edford, RN, MBA, CCS-P, and Marie Mindeman walk through some of the major changes for 2013.
CMS announced changes to reporting therapy services—the biggest operational change for 2013—in the Medicare Physician Fee Schedule final rule instead of the OPPS final rule. Jugna Shah, MPH, and Valerie Rinkle, MPA, explain the changes to therapy reporting and molecular pathology coding.
The American Medical Association completely overhauled the CPT ® Manual’s psychiatry subsection for 2013. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains the new codes and guidelines associated with psychiatric services.
Q: How should we bill for the physician in the following situation? A patient who has end-stage renal disease (ESRD) comes into a hospital’s emergency department (ED) with an emergent condition (dialysis access clotted or chest pain that is ruled out), but misses his or her dialysis treatment. Part of the treatment is dialysis performed in the ED or as an outpatient. The hospital bills G0257 (unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility) as per CY 2003 OPPS Final Rule guidelines and Pub 100-04, Chapter 4, section 200.2
So far, we’ve covered three different ICD-10-PCS guidelines for multiple procedures. We’ve looked at how to report multiple procedures involving: Same root operation, different body parts as defined...
Happy 2013! We survived the Mayan apocalypse and received a one-year extension on ICD-10 implementation (which according to some people is more of an apocalyptic event than 12-21-12). Where do your...
After a six-month delay, the Recovery Auditor prepayment review demonstration program began in August 2012. The program continues through August 2015, at which point CMS will determine the potential for a national rollout.
Providers and coders seem to speak two different languages-clinical and coding. Providers already have issues parsing ICD-9-CM "coder speak," so how can you get them to understand ICD-10?
Upon quick glance, the FY 2013 ICD-10-CM Official Guidelines for Coding and Reporting probably look very familiar to coders. They're comparable in length to the ICD-9-CM guidelines. They also follow the same format.
Hospitals earned a big win with drug payments this year in the 2013 OPPS final rule, released November 1. CMS decided to finalize its proposal to follow the statute and reimburse facilities at the average sales price (ASP) plus 6%.
The biggest operational change for outpatient facilities for 2013 does not appear in the 2013 OPPS final rule. Instead, CMS announced changes to reporting therapy services in the 2013 Medicare Physician Fee Schedule (MPFS) final rule.
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) that could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates, says Jugna Shah, MPH, president of Nimitt Consulting based in Washington, D.C.
In this month's issue, we review the major changes to OPPS for 2013, discuss the potential impact of CMS' packaging clarification, examine therapy, molecular pathology changes, offer suggestions on how to begin teaching providers to speak ICD-10, and answer your coding questions.
After a six-month delay, the Recovery Auditor prepayment review demonstration program began in August 2012. The program continues through August 2015, at which point CMS will determine the potential for a national rollout.
The holiday presents have all been unwrapped, and while the children were (mostly) thrilled by their gifts, their parents aren’t as pleased with what happened once the kids started playing with them...
The AMA added new CPT ® codes to report transcatheter aortic valve replacement for 2013. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details these and other code changes for cardiology.
Coders will find significant changes in the medicine section of the 2013 CPT® Manual . Denise Williams, RN, CPC-H, and Georgeann Edford, RN, MBA, CCS-P, review the changes to nerve conduction studies, vaccine administration, ophthalmology, and allergy testing.
Q: Is nursing documentation of completion of physician-ordered procedures, such as splinting/strapping, Foley catheter insertion, etc., sufficient to assign a CPT ® code for billing the procedure on the facility side in the ED?
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) concerning packaged services. Jugna Shah, MPH, and Valerie Rinkle, MPA, explain how this clarification could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates.
CMS recently posted an updated version of the National Correct Coding Initiative (NCCI) manual to the CMS NCCI website . The manual includes changes identified in red text and will be effective with dates of service January 1, 2013.
‘Tis the day before Christmas and all are not well at North Pole Industries. Ernie the head elf has lost his grip, literally. Ernie, it seems, can’t hold on to the toys he’s building. When he goes to...
It’s the end of the world as we know it and the people in the Fix ‘Em Up Clinic waiting room don’t feel fine. Apparently some people really believed that today would be the end of the world and their...
Moderation is not a term usually associated with the holiday season, as you can see from the waiting room at Fix ‘Em Up Clinic. Clark spent two days stringing holiday lights over everything: his tree...
ICD-10-PCS introduces plenty of new concepts. One that could cause coder confusion involves how to report a procedure when the physician changes the approach. The ICD-10-PCS guidelines state: If...
Q: A patient has unintentionally failed to take a prescribed dosage of insulin due to his Alzheimer’s dementia (age-related debility), and is admitted for initial care with inadequately controlled Type 1 diabetes mellitus. Which ICD-10-CM code(s) should we assign?
In a recent CMS email to providers, the agency reminded hospitals that any department, form, template, or other information that uses ICD-9-CM codes today will need to accommodate ICD-10-CM/PCS codes as of October 1, 2014.
ICD-10-CM Chapter 19 codes for injury, poisoning, and certain other consequences of external causes (S00-T88) demonstrate the specificity inherent in the new coding system. Betsy Nicoletti, MS, CPC, and Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, dig into the details of codes for injuries and underdosing.
In order to assign the correct ICD-10-PCS code, coders will need to determine the correct root operation. Christina Benjamin, MA, RHIA, CCS, CCS-P, discusses the various root operations found in the medical and surgical section of ICD-10-PCS.
Nervous or worried about the upcoming transition to ICD-10-PCS? Don’t be. Charlotte Lane, RHIA, CCS, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, offer up tips to reduce your anxiety about the new coding system.
When you search the 2013 ICD-10-CM Official Guidelines for Coding and Reporting you will find chapter-specific guidelines for each chapter except for Chapters 3, 8, and 12. Chapter 1: Certain...
We’ve already discussed one of the multiple procedure guidelines in ICD-10-PCS, but we still have three more to go. And that’s not counting the guidelines that are not included in the multiple...
Five new CPT ® codes will be used to report services in two new evaluation and management categories: complex chronic care coordination services and transitional care management services. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details the codes and guidelines for these services.
As tempting as it might be to append modifier -59 (distinct procedural service) to a claim in order to get paid, doing so poses a huge compliance risk. Karna W. Morrow, CPC, RCC, CCS-P, Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS , Peggy Blue, MPH, CPC, CCS-P, and Kimberly Anderwood Hoy, JD, CPC, walk through five case studies to help coders chose the correct modifier.
Misusing modifier -25 (significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service) can be an expensive proposition. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, and Debbie Mackaman, RHIA, CHCO, explain how to determine when an E/M service is significant and separately identifiable.
Q: CPT ® code 85660 (sickling of RBC, reduction) has a medically unlikely edit of one unit. We test blood for transfusion for sickle cell before we provide it to a sickle cell patient. If we test three units of blood prior to administering the blood to the patient, which modifier is more appropriate: -59 (distinct procedural service) or -91 (repeat laboratory test)?
It’s the second week of deer camp and all the hunters are at Fix ‘Em Up Clinic. Moe came into the clinic with some serious frostbite. Apparently, he fell asleep in the latrine at the camp and spent...
The multiple procedure guidelines in ICD-10-PCS present possibilities for coder confusion. Several guidelines relate to the coding of multiple procedures, some under the heading of multiple...
Hospitals are approximately two months into the Fiscal Year (FY) 2013 Value-Based Purchasing (VBP) Program that began with Medicare fee-for-service discharges on or after October 1, 2012. The Hospital Readmission Reduction Program is also well underway. Deborah K. Hale, CCS, CCDS, and Susan Wallace, Med, RHIA, CCS, CDIP, CCDS, explain the important role coded data plays in these and many other quality-of-care-related initiatives.
Recovery Auditors have already begun prepayment audits of MS-DRG 312 (syncope and collapse). Laura Legg, RHIT, CCS, details how hospitals can ensure the appropriate assignment of MS-DRG 312.
Providers will continue to use the same definition of inpatient status that they already know. That’s because despite CMS’ consideration of various provider comments, the agency has not establish new criteria.
ICD-10-CM/PCS incorporates laterality, acuity, anatomical specificity, and a slew of additional combination and complication codes. Who will submit queries when this information is missing in a medical record? Will coders or clinical documentation improvement specialists take on this role? Cheryl Ericson, MS, RN, CCDS, CDI-P, and Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA, offer suggestions for determining who will submit queries.
Q: As a traveling consultant, I review many types of inpatient hospital records. As hospitals have implemented electronic health records (EHR), I’ve seen documentation worsen. The ability to cut and paste information in the record has compromised coding accuracy. It has also increased the volume of queries, which frustrates physicians. For example, a physician performs a history and physical (H&P) in his or her office one week prior to admitting a patient to the hospital. The first progress note in the EHR—as well as each subsequent progress note—includes the exact same documentation. This documentation, which continues for four days while the patient is in the hospital, is clearly based on the original H&P. Obviously, the documentation has been copied and pasted from one note to another. Even the patient’s vital signs remain exactly the same as they were in the physician’s office. Coders have no way of knowing whether physicians who treat the patient in the hospital agree with any test findings because residents simply cut and paste the results in each subsequent progress note. Residents claim that they do this solely for the attending physician’s convenience. Clinical documentation improvement (CDI) specialists don’t address the problem because they are more focused on determining the accuracy of the MS-DRG. Is there a solution that will keep physicians, coders, and CDI specialists all on the same page?
Penny arrived at the Stitch ‘Em Up Hospital with a benign growth on her thyroid gland (ICD-10-CM code D35). The growth isn’t causing any functional problems, so we don’t need to report any additional...
Misusing modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) can be an expensive proposition. Just ask Georgia Cancer Specialists I, a leading oncology practice in Atlanta.
Our coding experts answer your questions about observation orders, sequencing additional diagnoses, coding for wound care with no-cost skin substitute, and reporting cardiac rehabilitation and physical therapy together.
Robert S. Gold, MD, gives coding guidance on primary cardiomyopathy, SIRS, sepsis, acute respiratory distress syndrome, and conditions during the perinatal period.
In this month's issue, we review correct use of modifier -25, walk through observation case studies, discuss the pros and cons of dual coding in preparation for ICD-10, review the supervision decisions of the Hospital Outpatient Payment Panel and CMS, and answer your coding questions.
The Hospital Outpatient Payment Panel recommended CMS change the supervision requirements for 15 HCPCS and CPT codes during its second meeting this year in August. CMS released details of the meeting September 24.