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...
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)?
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.
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.
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.
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...
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.
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?
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.
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.
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.
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...
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.
Robert S. Gold, MD, gives coding guidance on primary cardiomyopathy, SIRS, sepsis, acute respiratory distress syndrome, and conditions during the perinatal period.
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.
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.
Most of the odd ICD-10-CM codes, the ones that make us laugh or roll our eyes, live in Chapter 20 (External causes of mortality). Here you will find such gems as: X32, exposure to sunlight (which...
When coding for neoplasms in ICD-10-CM, coders will notice some differences in clinical documentation and sequencing. ICD-10-CM and ICD-9-CM coding for neoplams share some similarities, but ICD-10-CM...
When I first heard that the American Medical Association (AMA) is still fighting against ICD-10 implementation, I thought, “Seriously?” and rolled my eyes. In case you haven’t heard, the AMA’s House...
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, JustCoding 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 shoulder.
Organizations looking for real-world examples of ICD-10 education can check out the plan created by Ginger Boyle, MD, of Spartanburg Regional Healthcare System in South Carolina.
External cause codes in ICD-10-CM are intended to provide data for injury research and evaluation of injury prevention strategies. Some are humorous and some are confusing. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, explains how and when to use these codes.
If you’re worried about getting your physicians trained for ICD-10, you’re not alone. Thea Campbell, MBA, RHIA, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Donna Smith, RHIA, and Sue Belley , MEd, RHIA, CPHQ, offer tips and strategies to educate physicians about the new code sets.
Black Friday marks the beginning of the holiday shopping season—and the holiday injury season at Fix ‘Em Up Clinic. Patients started showing up shortly after the stores opened this morning with...
Over the river and through the woods to the Fix ‘Em Up Clinic we go. Not exactly where our patients want to spend Thanksgiving (and neither do we), but we’re here to coding their holiday mishaps...
Do you find yourself wondering how you will ever learn everything to be ready for the ICD-10-CM/PCS compliance deadline? Does it feel overwhelming with how busy you are? The answer: Keep Calm and...
Q: Should we query for the specific pulmonary exacerbation of cystic fibrosis (CF)? Coding Clinic states that the exacerbation of CF should be listed first.
So many coding topics to audit, yet so few staff members to perform those audits. Julie Daube, BS, RHIT, CCS, CCS-P, reveals steps you can take to resolve this dilemma and determine which areas to audit in 2013.
Maternal fetal medicine procedures highlight the differences between ICD-9-CM procedure codes and ICD-10-PCS codes and can serve as a foundation for understanding ICD-10-PCS. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, demonstrates how coding for fetal thoracentesis will change after the switch to ICD-10.
Hospitals are overturning Recovery Auditor denials nearly 75% of the time, according to recent RACTrac data. That’s why the American Hospital Association adamantly supports a new proposed bill—the Medicare Audit Improvement Act of 2012 —aimed at holding Recovery Auditors accountable for inappropriate denials.
Every few years, the AHA publishes guidance in Coding Clinic that can significantly affect inpatient coders, such as guidance published in the Second Quarter 2012 on neoplasm coding. Randy Wagner, BSN, RN, CCS, and Paul Dickson, MD, CCS, CPC, review the new guidance and how to use the TNM cancer staging system.
How many of you are worried about getting physicians on board with the ICD-10 transition? We all know physicians are busy people. So how do you get them engaged in learning about the increased...
You need enthusiasm and a desire to keeping learning to tackle the monumental task of learning ICD-10-PCS. In authoring an ICD-10 CM/PCS education program 10 hours per work I learn something new...
In order to accurately code physician and provider services, coders must know and understand the place of service (POS) codes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, details the specific POS codes and how to appropriately report them.
Q: What CPT ® code best describes the Bier block procedure? We are toiling over this and the most recent CPT Assistant says to use 64999 (unlisted procedure, nervous system). But the article referenced is from 2004. We just want to make sure there is nothing more recent.
Quite a few campers took advantage of the nice weather this weekend to make one last trip into the woods before winter. Unfortunately, some of them ended up in Fix ‘Em Up Clinic as a result of their...
Do you know what you don’t know about ICD-10? Do you know where your knowledge gaps are? Unfortunately, the answer is probably no. More than half of the people who responded to our completely...
Wile E. Coyote may bill himself as a Super Genius, but based on his last visit to the ACME ED, I think that’s overstating things a bit. What landed Wile E. back in the ED, you ask? Another...
Ethical dilemmas can creep in at any time during a coder’s average workday. However, one might be hard pressed to find a coder who will openly acknowledge this. Brad Hart, MBA, MS, CMPE, CPC, COBGC, and Kathy DeVault, RHIA, CCS, CCS-P, explore how coders can and should handle ethical dilemmas.
Thinking about exiting the coding profession before the transition to ICD-10? Laura Legg, RHIT, CCS, enjoys coding too much to give it up and offers some tips for how to prepare for the transition.
Coders can go a bit overboard when reporting CCs and MCCs. Cheryl Ericson, MS, RN, CCDS, CDIP, and Deborah K. Hale, CCS, CCDS, reveal the dangers of over-reporting CCs and MCCs and how to report them appropriately.
Although hospital infection rates continue to decline, Medicare payment penalties are not the cause, according to the New England Journal of Medicine article titled Effect of Nonpayment for Preventable Infections in U.S. Hospitals .
It’s All Saints Day (you know, the day after Halloween) and the waiting room at the Fix ‘Em Up Clinic is full of ghosties and ghoulies and long-legged beasties. I’m not sure if we have any things...
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 CDI specialists take on this role? Perhaps it might be a combination of the two.
In this month's issue, we unravel the complexities of billing for self-administered drugs, explain how to jump-start your ICD-10 transition plans, discuss changes to the I/OCE, and answer reader coding questions.
Because of the increase in the number and type of outpatient services provided, more patients are being impacted by noncoverage of self-administered drugs. Kimberly Hoy, JD, CPC, and Valerie Rinkle, MPA, explain why CMS sometimes--but not always--covers self-administered drugs.
Our coding experts answer your questions about how to determine the correct units for drugs, billing for fluoroscopy, therapy caps under OPPS, and payment for critical care and separately reported services
The ICD-10-CM/PCS delay may give coders more time to learn the new system, but what does this mean for organizations that have already begun to prepare?
Learn why continuing the momentum will facilitate your transition to ICD-10, how to establish a game plan for ICD-10 physician queries, how one hospital plans to use computer-assisted coding for ICD-10 preparation, why medical coding dilemmas require a proactive approach, and new information about coding metastatic neoplasms.
Every few years, the AHA publishes guidance in Coding Clinic that can significantly affect inpatient coders. Coding Clinic , Second Quarter 2012, includes such guidance.
The manager of clinical documentation integrity program/HIMS at a 300-bed academic medical center and pediatric specialty hospital has high hopes for computer-assisted coding (CAC). In particular, she anticipates that it will increase productivity and ease the transition from ICD-9-CM to ICD-10-CM/PCS.
Hurricane Sandy blasted the Mid-Atlantic region this week, causing plenty of destruction in its wake. We could undoubtedly spend a lot of time coding for the injuries people suffered as a result of...
Q: It appears that one requirement for using CPT ® codes 15002–15005 with application of negative pressure wound therapy (NPWT) is that the wound must be healing by primary intention. Can you explain this? We have never used these codes with preparation for vacuum assisted closure (VAC) placement, but it doesn't make sense, as NPWT is almost always used for wounds healing by secondary intention. Our physicians appreciate any clarification.
The rules for coding for facilities and physicians are basically the same for most services, but coders follow different rules for appending certain modifiers. Christi Sarasin, CCS, CCDS, CPC-H, FCS , Kimberly Anderwood Hoy, JD, CPC , and Peggy Blue, MPH, CPC, CCS-P, separate physician and facility rules for using modifiers -26, -TC, and -79.
Providers are beginning to see some translation of CMS’ National Coverage Determinations (NCD) for ICD-10 with the release of Transmittal R1122OTN and Medlearn Matters Article MM7818 .
Basing a coder’s successful completion of a coding audit only on coding accuracy overlooks importance of local coverage determinations (LCD) and national coverage determinations (NCDs). Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explains the role LCDs and NCDs play in determining practical day-to-day coding accuracy.
The CPT ® Editorial Panel revised its guidance for critical care codes to specifically state that, for hospital reporting purposes, critical care codes do not include specified ancillary services. Denise Williams, RN, CPC-H, and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, discuss how coders should code for critical care services and review which services are bundled into critical care.
Inpatient coders will face a big learning curve when it comes to ICD-10-PCS. It’s a completely different system with a lot more detail than ICD-9-CM Volume 3. The biggest potential problem could be...
Anytown hosted a national ICD-10 conference this week and some of the Fix ‘Em Up Clinic’s coders attended the sessions to learn all about the new coding system. The rest of us got to meet some of the...
ICD-10-CM code category J45.- includes new, more specific terms for asthma that may help improve data quality and lead to more effective research and treatments. Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, and Suzan Berman, CPC, CEMC, CEDC, detail the new terminology for asthma coding in ICD-10-CM.
Assess. Educate/train. Practice. Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, and Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, reveal how following those three steps can prepare you for ICD-10 implementation.
CMS has published two ICD-10-related Special Edition Medlearn Matters articles that may be of interest to providers and serve as tools to assist with implementation.
In ICD-9-CM, coders report specific codes to indicate a surgeon used robotic assistance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains how that will change in ICD-10-PCS.
Getting physicians on board with the transition to ICD-10 won’t be easy, but CMS is trying to help. CMS will host a National Provider Call: Preparing Physicians for ICD-10 Implementation at 1:30 p.m...
Outpatient coders currently report procedures using CPT codes. That won’t change after the switch to ICD-10. However, some facilities currently require outpatient coders to also report procedures...
Accurate reporting of observation services depends on a lot of factors. Deborah K. Hale, CCS, CCDS, and Cheryl Staley, RHIA, CCS, walk though five case studies to explain the ins and outs of observation coding.
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.
QUESTION: I work for a gastrointestinal (GI) practice and I have a question regarding the correct sequence for adding diagnosis codes to a claim. I have advised our physicians and billers that the primary diagnosis code is always the reason for the visit. I am a little confused about the remaining diagnosis codes the physician will write down in no specific order. Billers will report codes in the order the physicians write down the diagnoses and not always the reason for the visit. For example, a patient is referred for a consult due to weight loss. The patient comes for the consult and the physicians may put down 787.29 (other dysphagia), 401.1 (benign hypertension), 783.21 (abnormal loss of weight), 787.99 (change in bowel habits) in this order and leave it up to the person entering the info to figure it out. I would report 783.21 first since that was the reason for the visit but then I’ve been putting the GI codes next and then anything else last. What is the correct sequence when adding diagnosis codes to a claim?
Hospital medicine is a specialty that provides inpatient services for patients admitted to the hospital. Hospitalists are often called on to consult in regards to and to follow medical problems that occur during hospitalization for surgery, psychiatric hospitalizations, and obstetrical patients. Lois E. Mazza, CPC, explains how to correctly report hospitalist services.
CMS proposed extending the delay on enforcement of physician supervision rules for critical access hospitals and small and rural hospitals with 100 or fewer beds for one final year as part of the 2013 OPPS proposed rule. Debbie Mackaman, RHIA, CHCO, and Jugna Shah, MPH, detail some of the more significant proposals for 2013.
Legendary Green Bay Packers coach Vince Lombardi once described the ideal linebacker as agile, hostile, and mobile. Sadly, some of our local linebackers are significantly less agile and somewhat...
The rugby players who come into the Fix ‘Em Up Clinic are a pretty tough group. They can shrug off broken ribs, downplay dislocations, and boast about bruises. They are no match for gnats, though...
We all know coder productivity will go down after the transition to ICD-10 and it may never rebound to current levels. The question is, how much will productivity decline? It could drop more than you...
Inpatient-only procedures are those that CMS has determined providers must perform on an inpatient basis. Kimberly Anderwood Hoy, JD, CPC, and Beverly Cunningham, MS, RN, unravel the complexities of coding for these procedures.
Provider documentation of inpatient wound care services may be confusing at best and completely lacking at worst. Coders end up trying to decipher exactly what procedure the provider performed. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, and Robert S. Gold, MD, offer tips to assist coders in choosing the correct code for inpatient wound care.
The HIM profession is constantly changing, but HIM professionals are still responsible for maintaining the integrity of the health records. Lou Ann Wiedemann, MS, RHIA, FAHIMA, CPEHR, explains why HIM professionals can—and should—also play a role in clinical documentation improvement (CDI).
The OIG estimates that Medicare Administrative Contractors paid $8.4 million in overpayments to inpatient rehabilitation facilities (IRFs) because IRF and Medicare payment controls did not adequately identify late submissions of patient assessment instruments.
Q: I have a question about coding transplant complications. My understanding is if the complication affects the transplanted organ, then coders should assign a code for the transplant complication itself. Is this correct? Consider the following physician documentation: Final A/P: Acute renal failure in patient with history of renal transplant. Should coders report 996.81 (complications of transplanted kidney) and 584.9 (acute kidney failure, unspecified)? Also consider this documentation: CHF in heart transplant patient . Should coders report 996.83 (complications of transplanted heart) and 428.0 (CHF, unspecified)?
News flash: The sky is NOT falling. You don’t need to press the panic button when you think about the transition to ICD-10. It’s time to prepare, practice, and plan. The transition will be a huge...
How tired are you of hearing the phrase “documentation, documentation, documentation” as you prepare for ICD-10? I have a new phrase that you’ll soon dread as well: “Practice, practice, practice.”...
Got an ICD-10 question? Answers are coming soon. ICD-10 implementation is still almost two years away, but the American Hospital Association’s Coding Clinic will add an ICD-10 section starting in the...
Hospitals and physician practices are used to being in competition with each other and maintaing a veil of secrecy over internal operations. Well, that’s not really limited to just healthcare, it...
Learn about the 2013 IPPS final rule, inpatient-on;y procedures, asthma terminology in ICD-10, computer-assisted coding, and body mass index calculation.
