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.
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...
Modifiers are sometimes essential to ensure proper payment, but choosing the correct one can be tricky. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS; Katherine Abel, CPC, CPMA, CEMC, CPC-I; and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, discusssome confusing modifiers and how to use them accurately.
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?
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.
Last week, we looked at some strange causes of death in the ancient world and their associated ICD-10-CM codes. Let’s fast-forward to some odd Dark Ages deaths and see if we can code them. Some...
Death smiles at us all. All a man can do is smile back. (Kudos if you know I appropriated that from the movie Gladiator .) History is full of weird circumstances and odd injuries that lead to death...
CMS has been releasing ICD-10 National Coverage Determination (NCD) “omnibus” transmittals since September 2012, which gives providers some information about CMS’ coverage policies moving forward...
The 2014 IPPS Final Rule contains two significant changes that will impact coders: the 2-midnight inpatient presumption and the Part A to Part B rebilling. Marc Tucker, DO, FACOS, FAPWCA, MBA, and Kimberly Anderwood Hoy Baker, JD, CPC, review the key provisions of these changes.
Q: A patient undergoes placement of a MediPort ® to receive chemotherapy for lung cancer. What principal diagnosis should we report? Should we report V58.81 (fitting and adjustment of vascular catheter) or 162.9 (malignant neoplasm of bronchus and lung unspecified)?
Health information exchange between hospitals and other providers has risen by 41% between 2008 and 2012, according to research published in Health Affairs from the Office of the National Coordinator for Health Information Technology (ONC).
No one is perfect, including coders. Mistakes aren’t necessarily a reflection on one’s abilities or attention to detail. James S. Kennedy, MD, CCS, and Laura Legg, RHIT, CCS, highlight some common problem areas and provide tips for compliance.
Unlike ICD-10-CM, ICD-10-PCS does not include unspecified codes. Thus, clinicians may see an increased number of queries on procedures post-implementation. Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, explains why facilities should review documentation for inpatient procedures now.
With the ICD-10 compliance date looming, can we find some fun in it all? We can play Coding “Jeopardy” as a fun learning tool, but if ICD-10 were a game, what game would it be? Some might liken it to...
Labor Day might mark the unofficial end of summer, but sadly, it's not the end of barbecue mishaps at the Fix 'Em Up Clinic. Matt, who last year survived flaming tomato napalm, decided to grill up...
Inpatient coders are used to assigning a present-on-admission (POA) indicator in ICD-9-CM. They will need to continue to assign POA indicators in ICD-10-CM. The POA indicators remain the same, but...
After a cerebrovascular accident (CVA, also known as stroke), a patient may suffer additional health problems, lasting after the event has passed. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, compares coding for these lasting effects, known as sequela, in ICD-9-CM and ICD-10-CM.
Q: We have a patient with documented age-related osteoporosis. She bent over to pick up a newspaper from a table and fractured a vertebrae. Should we code the fracture as pathologic or traumatic?
CMS’ Pat Brooks, RHIA, senior technical advisor, Hospital and Ambulatory Policy Group, and AHIMA’s Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, reviewed basic ICD-10 information during a CMS National Provider Call August 22.
When it comes to ICD-10-CM/PCS, coders may be the hardest and most directly hit employees. Laura A. Shaffer, PhD, and Monica Lenahan, CCS, explain how hospitals may be lagging behind in terms of actually managing the change for these individuals.
The 2014 OPPS proposed rule is shorter than normal at 718 pages, but the proposed changes are significant and probably the most sweeping changes since the inception of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting.
When it comes to ICD-10-CM/PCS, coders may be the hardest and most directly hit employees. Yet some experts say that aside from technical training, hospitals may be lagging behind in terms of actually managing the change for these individuals.
E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G-codes.
Our experts answer questions about billing vasectomy and sperm analysis , coding for ED visit when the patient is admitted for surgery, billing glucose reading before a PET scan, documentation required for the functional limitation codes, and appropriate reporting of observation.
As meticulous as a coder may be, he or she is bound to make a mistake at some point in his or her career. After all, nobody is perfect. Mistakes aren't necessarily a reflection on one's abilities or attention to detail. Coders know that physician documentation often makes the job much more difficult. Add stringent productivity standards to that, and you've got a potential recipe for disaster.
CMS proposed sweeping changes in the 2014 OPPS proposed rule.In this issue, we examine the proposed changes to E/M codes, packaging, and device-dependent APCs. In addition, our experts answer your coding questions.
Do you ever feel like everything is on YouTube? In some cases, it’s more than you want to see, but the video site can be extremely helpful for coders who want to watch procedures. For example, search...
Paracelsus, the father of toxicology (among other things), once wrote: “Everything is poison, there is poison in everything. Only the dose makes a thing not a poison.” Cheery thought, right?...
Diagnostic conclusion statements don’t sufficiently capture the clinical context and medical necessity for inpatient admission. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, discusses the importance of clinical context and quality of clinical documentation in the medical record.
Q: Our facility has a question about how other hospitals address this scenario: Patient is discharged to home (discharge status code 01). No documentation exists in the medical record to support post-acute care. Several months later, our Medicare Administrative Contractor (MAC) notifies us that the patient indeed went to post-acute care after discharge. The MAC retracts our entire payment. We need to resubmit the claim with the correct discharge status code. We are reluctant to do so because nothing in the medical record supports the post-acute care provided. Are other hospitals amending the record? If so, which department is adding the amended note?
Does the DRG accurately depict the patient’s story? Does the length of stay and severity of illness correlate with what actually happened? Heather Taillon, RHIA, and Cheryl Collins, BS, RN, offer tips to selecting the correct principal diagnosis.
Ah, the dogs days of summer. An evil time when, according to the ancient Romans, the sea boils, dogs grow mad, and men contract, among other diseases, burning fevers, hysterics, and frenzies,...
In ICD-9-CM, we know not to code solely from the Alphabetic Index. After all, the code could have additional digits or excludes notes or other coding directions (such as “code first” or “use an...
Evaluation and management (E/M) coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G codes. Dave Fee, MBA, Peggy S. Blue, MPH, CCS-P, CPC, Jugna Shah, MPH, Kimberly Anderwood Hoy, JD, CPC, Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Valerie A. Rinkle discuss the possible impact if CMS finalizes its proposal.
Medical necessity establishes the foundation for evaluation and management (E/M) code selection and supports the need to services provided to the patient. Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-approved ICD-10-CM/PCS trainer, explain how to define, determine, and defend medical necessity for E/M codes.
One of the bigger challenges with the birth of the new ICD-10-CM coding system is the assignment of the letter O as the leading indicator for OB/GYN codes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS AHIMA-accredited trainer, delivers a comparative look at coding for OB/GYN coding in ICD-9-CM and ICD-10-CM.
CMS added three new HCPCS C codes and one G code to the integrated outpatient code editor (I/OCE) as part of the October quarterly update. The new codes are effective October 1.
Q: The patient comes in for a cardioversion, but the international normalized ratio results were unsatisfactory. The physicians canceled the cardioversion. Would modifier -73 (discontinued outpatient/hospital ambulatory surgery center procedure prior to the administration of anesthesia) be appropriate?
CMS added additional ICD-10 MLN educational resources to its website and will be hosting an ICD-10 National Provider Call August 22. The new MLN educational resources include two fact sheets and a...
It’s baby day at Fix ‘Em Up Clinic and Stitch ‘Em Up Hospital as we prepare to deliver new codes and guidelines for reporting pregnancy and delivery in ICD-10-CM and ICD-10-PCS. Our first patient,...
Q: Which ICD-10-CM external cause code should we report if a patient falls while on an escalator? This is the first time that the patient has been seen for such a fall.
At first glance, codes for insertion, removal, and revision of pacemakers look quite different in ICD-10-PCS. Kimberly J. Carr, RHIT, CCS, CDIP, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, compare and contrast pacemaker procedure coding in ICD-9-CM and ICD-10-PCS.
Complete capture of procedure codes in ICD-9-CM helps to ensure accurate translation to ICD-10-PCS. Donna M. Smith and Patricia L. Belluomini, RHIA, reveal coding errors—including omission of procedure codes—that make the translation process more challenging.
The 2014 draft ICD-10-PCS guidelines include a code for the usage of a robotic-assist device in surgery, something coders can currently report in ICD-9-CM. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , compares documentation requirements for coding robotic-assisted surgery in both ICD-9-CM and ICD-10-PCS.
First we saw the new ICD-10-PCS codes and guidelines in May, followed by the new ICD-10-CM codes in June and the ICD-10-CM guidelines in July. Now we have updated general equivalence mappings (GEMs)...
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable), but instituted a six-month trial period. That grace period ended July 1. Denise Williams, RN, CPC-H, Dave Fee, MBA, and Debbie Mackaman, RHIA, CHCO, explain how to report these G codes and their related functional modifiers.
CMS has been gathering information about the use of observation services and short inpatient hospital stays because hospitals have been placing patients in observation for longer periods of time. CMS recently finalized a change that will substantially affect how hospitals bill for observation stays, long outpatient stays, and short inpatient stays.
Q: A clinician goes to a patient's home and does not perform an evaluation and management, but performs a catheter replacement. How should we code this encounter?
The AMA significantly changed how coders report cervicocerebral imaging in 2013. Andrea Clark, RHIA, CCS, CPC-H, and David Zielske, MD, CIRCC, CPC?H, CCC, CCS, RCC, discuss the changes and provide tips for coding these services.
Medical necessity is as simple as it sounds and it isn’t important just for inpatients. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the importance of establishing medical necessity for outpatient services.
Wile E. Coyote presented to the ACME ED this morning with more injuries suffered in his quest to catch the Roadrunner. You won’t believe what he tried this time. Wile E.’s plan involved dropping an...
Joint replacement surgery is nothing short of a miracle for those experiencing pain due to an arthritic or damaged joint. The surgery is performed not only on the hip and knee, but also on the ankle, foot, shoulder, elbow, or finger. Patients who have undergone this surgery often regain mobility and are able to live pain free.
Eight CPT ® codes for multianalyte assays with algorithmic analyses (MAAA) procedures are now classified as not covered under OPPS (status indicator E), retroactive to January 1, 2013. These codes are now subject to I/OCE edit 9.
In this month’s issue, we examine how coders can use General Equivalence Maps to find codes in ICD-10, explain the new therapy G-codes, review CMS’ updates to the I/OCE, discuss the importance of proper rate setting, and answer your coding questions.
In January 2013, CMS introduced 42 therapy functional reporting G codes (nonpayable). These G codes are to be reported in conjunction with therapy services (physical, occupational, and speech). CMS also introduced seven complexity/severity modifiers to be used with these G codes.
It took some time to break down the wall between coders and CDI specialists at New Hanover Regional Medical Center in Wilmington, N.C. However, that wall eventually crumbled. Linda Rhodes, RN, BSN, CCDS, manager of CDI, says an increased emphasis on communication and respect is what did the trick.
BCCS recently spoke with advisory board member Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, about the role of state HIM associations in ICD-10-CM/PCS coder education. The following is a summary of that conversation. Bryant serves as the president of the California Health Information Association (CHIA), which has approximately 5,000 members to date. For more information, visit http://californiahia.org .
Although ICD-10-CM resolves some problematic areas of coding, it isn't a panacea. Respiratory insufficiency is one diagnosis that will continue to challenge coders.
When Paul Belton, RHIA, MBA, JD, LLM, speaks about the culture at Sharp HealthCare in San Diego, you can hear the pride and enthusiasm swelling in his voice. Having served as the vice president of corporate compliance for the past 15 years, Belton has led the ongoing effort to ensure that all employees "do the right thing" at all times.
Providers setting charges based on an understanding of their costs is not a new concept, says Jugna Shah, MPH, president and founder of Nimitt Consulting. However, providers struggle with this or fail to do it correctly, and then stand to deteriorate their future payment rates since CMS relies on provider data to set payment rates not only for inpatient and outpatient services, but also for laboratory services.
For coders, the summer months can be some of the busiest, particularly for those working in areas that attract tourists. Linda Schwab Messmer, RHIT, CCS, and Lori-Lynne A. Webb, CPC, COBGC, CCS-P, CCP, CHDA, review ICD-9-CM codes for common summer injuries and ailments.
CMS and the Office of the National Coordinator for Health Information Technology recently hosted a listening session to gather industry feedback and concerns about health information technology adoption. Read some of the highlights of the session and comments from providers in the field.
The recent ACDIS 2013 ICD-10 Preparation Survey found that 48 % of respondents don’t plan to add coding staff members to meet the challenge of ICD-10 implementation. Meanwhile, 66 % of respondents said they don’t plan to hire additional clinical documentation improvement (CDI) staff.
Recovery Auditors audit the MS-DRG, principle diagnosis, any secondary diagnoses, and any procedures that affect—or could affect—DRGs. Christina Benjamin, MA, RHIA, CCS, CCS-P, reveals the most important documentation pitfalls and coding guidelines challenges related to MS-DRGs under auditor scrutiny.
Summertime means beach time and unfortunately for some, Fix ‘Em Up Clinic time. First into the clinic today is Eric. After swimming in the ocean yesterday, Eric developed a pruritic, erythematous,...
Apparently not everyone believes CMS’ claim that it will not move the ICD-10 implementation date again, based on our (completely unscientific) poll on JustCoding. We asked readers whether they...
ICD-10-CM is all about specificity, right? The increased detail is one of the reasons the U.S. is (finally) moving to the new system. So true or false: you should never report a nonspecific code...
CMS’ July update to the Integrated Outpatient Code Editor features new codes, new APCs, and a new modifier. Dave Fee, MBA, explains the most noteworthy changes for this quarter.
Coders append modifiers to claims every day, but use some modifiers less frequently than others. Lori- Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, discusses the proper use of two less common modifiers, modifiers -62 and -66.
Coding debridement of ulcers requires that coders know the type, location, and depth of the ulcer and the treatment provided. Gloria Miller, CPC, and Robert S. Gold, MD, review the clinical and coding aspects of ulcer debridement.
The U.S Centers for Disease Control and Prevention recently posted the updated ICD-10-CM guidelines . Narrative changes in the guidelines appear in bold text and content that moved within the guidelines is underscored.
October 1, 2014, is a little more than 14 months away. Where do your ICD-10 implementation plans stand? Do you know what resources you’ll need for the transition or when you should providing training...
One of the big changes to coding glaucoma in ICD-10-CM is the addition of laterality to the codes. ICD-10-CM includes options for right, left, bilateral, and unspecified. ICD-10-CM also includes...
The demand for coding labor may increase as much as 20%–40% over the next two years, according to a recent report, The State of H.I.M.: A Study of the Impact of ICD-10, CDI, and CAC Initiatives Within the Health Information Management Community. Trust Healthcare Consulting Services, LLC, which published the report, surveyed more than 300 HIM professionals in all types of healthcare facilities in nearly every state. The majority of participants (84%) were HIM directors.
The clinical documentation specialist role is relatively new, but can be a great place for coders. Lois Mazza, CPC, reveals why coders should consider taking on this role.
Q: Some of our providers see patients in our local nursing facilities. When these patients are admitted to our hospital, must we retain this documentation in our own records?
Healthcare data continues to become the industry’s newest hot commodity. Ralph Wuebker, MD, MBA, and Yvonne Focke, RN, BSN, MBA, explain what information facilities can extract from PEPPER reports.
Facilities may be reluctant to charge for bedside services beyond the room rate because they fear double-dipping. Kimberly Anderwood Hoy, JC, CPC, and William L. Malm, ND, RN, CMAS, discuss what CMS does—and doesn’t—say about charging for ancillary services .
In late June, CMS and the Centers for Disease Control and Prevention (CDC) released the 2014 ICD-10-CM codes without the updated guidelines. Those guidelines are now available on the CDC website ...
When we talk about root operations in ICD-10-PCS, we often focus on the 31 root operations in the Medical and Surgical section of the manual. After all, we’re going to use those codes the most and...
Everyone likes to think physicians are infallible (especially physicians), but accidents do happen, even during surgery. In ICD-9-CM, we can choose between two possible codes for a hemorrhage (998.11...
ICD-10-CM coding for diabetes mellitus will look very different from the ICD-9-CM coding . Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-Approved ICD-10-CM/PCS Trainer, explains what coders need to know to code diabetes in ICD-10-CM.
Ancillary department staff may think they don’t need ICD-10 training, but they’re wrong. Lori Purcell, RHIA, CCS, and Kathy DeVault, RHIA, CCS, CCS-P, offer tips for preparing ancillary department staff for ICD-10-CM.
The upcoming transition to ICD-10 is a great opportunity to build relationships with physicians. Kathy DeVault, RHIA, CCS, CCS-P, Mark N. Dominesey, MBA, RN, CCDS, CDIP, HIT Pro-CP, and Ann Barta, MSA, RHIA, reveal how coders and clinicians can educate each other to make the ICD-10 transition smoother.
