CMS released its latest MLN Quarterly Provider Compliance Newsletter, volume 2, issue 4 in July. The newsletter addresses common billing and coding errors, with the latest issue addressing frequently cited Recovery Auditors and Comprehensive Error Rate Testing (CERT) findings.
Coding for physician services doesn’t always match coding for facility services, which can cause problems for coders who code records for both. ED E/M is one area where different rules come into play.
QUESTION: I'd like to address our coders' questions on how to code poisoning due to bath salts. Internet research has led me to many different options: codes 977.8 (other specified drug/medicinal), 970.89 (other CNS stimulant), 969.70 (psychostimulant, unspecified), among others. What would you suggest? There don't seem to be any guidelines out there and the coding for this seems to be all over the place.
Physicians often use the acronyms IBS (which should indicate irritable bowel syndrome) and IBD (which should indicate inflammatory bowel disease) interchangeably even though they represent completely different conditions with different treatment and prognoses.
Learn about documentation and principal diagnoses, coders and EHR implementation, clarifying IBS and IBD for accurate code assignment, and ICD-10 fracture codes.
In this month's issue, our coding experts answer questions about how to differentiate between modifiers -52, -73, -74, coding for negative pressure wound therapy, and billing the technical component of pathology services.
In this month's issue, we unravel confusion surrounding use of modifier -59, explain the difference between NCCI and MUE coding edits, discuss building E/M ED visit level, review the updates to the I/OCE, and answer reader questions.
A lack of funding shouldn't prevent you from getting creative in your morale-boosting celebrations, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, and Nicolet Araujo, RHIA. So when your staff members are around, this time of year can be a great time to boost their morale with summer outings and special staff recognition for jobs well done.
What happens in Vegas might stay in Vegas, but when things go wrong in Atlantic City, people end up at Fix ‘Em Up Clinic. Today, we have several bachelor party victims who made the clinic their first...
Why hello there, Mr. Coyote. Long time, no see. Are you still chasing that roadrunner? You are? Well, you are certainly persistent, I’ll give you that. So what brings you into the Acme Clinic today?...
The American Osteopathic Association (AOA) House of Delegates has joined the American Medical Association’s (AMA) crusade to crush ICD-10 implementation. Back in November 2011, the AMA’s House of...
Cross-training coders has definitive short-term advantages, such as enhancing staff coverage during holidays and vacations and increasing the department's ability to handle periods of fluctuation in certain bill types. But coding managers might not realize that these benefits can also help hospitals with long-term preparation for ICD-10. Angie Comfort, RHIT, CCS, and Rose T. Dunn, MBA, RHIA, CPA, FACHE, explain the benefits of cross training coders as ICD-10 approaches.
Many coders can quickly quote the code for diabetes mellitus in ICD-9-CM (code 250.00) when the physician only documents diabetes mellitus. But what will coders need in the documentation for diabetes mellitus in ICD-10-CM? Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Jill Young, CPC, CEDC, CIMC, and Donna Smith, RHIT, dissect the differences in coding for diabetes mellitus in ICD-9-CM and ICD-10-CM.
The National Center for Health Statistics, the Centers for Disease Control and Prevention (CDC), and CMS have posted updated files for ICD-10-CM for 2013.
Over the weekend, Matt decided to grill up dinner, which sounds at first like a good idea. He started with chicken, then added some vegetables, unfortunately including some cherry tomatoes. While he...
Epilepsy affects nearly 3 million Americans and 50 million people worldwide, so you may see some of these patients come through your facility or practice. In ICD-9-CM, you find many of the epilepsy...
The National Center for Health Statistics, the Centers for Disease Control and Prevention, and CMS have posted some updated files for ICD-10-CM for 2013. The following files are available for...
I grew up in Western Pennsylvania coal country, where coal mines at one time were prevalent and back in the day, you could smell the hydrogen sulphide (at least according to my mother). A lot of the...
The digestion process is complex and there’s a lot that can go wrong. Thankfully, Robert S. Gold, MD, unravels the topic of mechanical and paralytic ileuses in this week’s article.
QUESTION: A patient is admitted with pneumonia and atrial fibrillation and both are present on admission. The patient receives antibiotics for the pneumonia and a pacemaker during the stay, but undergoes no other procedures. Does the procedure automatically make ICD-9-CM code 427.31 for the atrial fibrillation the principal diagnosis?
New clinical guidelines for malnutrition could help alleviate compliance challenges associated with coding the condition, which has never had universally accepted clinical criteria. Jane White, James S. Kennedy, MD, CCS, CDIP, and Alice Zentner, RHIA, describe the new guidelines and what coders need to know about malnutrition coding.
The thought of learning ICD-10 is intimidating for many coders, but does it need to be? Robert S. Gold, MD, and Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explain why coders may not need to fear the transition quite as much as they think.
In late May, CMS released nationwide a new short-term (ST) acute care Program for Evaluating Payment Patterns Electronic Report (PEPPER). The ST PEPPER provides short-term acute care hospital (STACH) statistical data for the most recent 12 federal fiscal quarters, ending with the first quarter of fiscal year 2012.
We’re having a heat wave, a tropical heat wave, here at Anytown, which means the Fix ‘Em Up Clinic is seeing plenty of heat-related illnesses. Meredith, our first patient, comes in complaining of a...
In ICD-10-PCS, coders will only report a device when the device remains in the patient after the procedure. If it’s removed, it’s not a device and your sixth character will be Z. For many procedures...
Does even the mere thought of coding in ICD-10-CM give you a pounding headache? Well, you’re in luck. ICD-10-CM has plenty of codes for reporting that headache. In order to code for a headache, we...
Pain is an expected component of injuries, illnesses, and surgical procedures. In some instances, however, the patient's pain is unexpected or is worse than predicted. Sometimes, the pain can last well beyond the time it should have resolved. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, and Susan E. Garrison, CHCA, CHCAS, CHC, PCS, FCS, CCS-P, CPAR, CPC, CPC-H, provide tips and guidance to help coders accurately report pain management diagnoses and procedures.
CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS) proposed rule , released July 6. One has to do with how CMS proposes to calculate APC relative weights and the other with the reimbursement level for separately payable drugs and biologicals without pass-through status.
Coders can run into two types of edits that may require them to append modifier -59 (distinct procedural service) to override: National Correct Coding Initiative (NCCI) edits and medically unlikely edits (MUE). Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, explain the differences between the edits and how to correctly determine when to override the edit.
QUESTION: Our laboratory medical director sent out a notification to our medical staff, patient care departments, and order entry personnel that a physician order that read “CBC” or “CBC with differential” would be completed as a CBC with automated or manual differential and coded using CPT ® code 85025 (blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count] and automated differential WBC count). Should we code 85025 when the order just reads CBC and when we do a manual differential with the CBC?
An anesthesia provider faces plenty of challenges: cancelled anesthesia, failed medical direction, monitored anesthesia care, time issues, invasive line placement rules, and start/stop times. Judy A. Wilson, CPC, CPC-H, CPCO, CPC-P, CANPC, CPC-I, CMRS, reviews some of the common challenges coders face when reporting anesthesia services.
One advantage to using ICD-10-PCS is increased specificity. Coders will find increased specificity for the procedure, approach, device, and even anatomical region or body system. In the Medical and...
The eyes are the windows to the soul, but even the best windows can get cloudy or scratched or suffer some other type of trauma. Suppose a patient comes in with cloudy vision. The patient could be...
ICD-10-CM coronary artery disease and myocardial infarction codes will undoubtedly differ from their ICD-9-CM counterparts in some ways, but some aspects will remain the same.
In this month's issue, we examine pain management diagnosis and procedure coding, reveal how to differentiate between types of wounds when coding, explain how to read an operative report, and address your coding questions.
A physician can debride a wound to remove dead, damaged, or infected tissue so the remaining healthy tissue can better heal. Coders need to look for specific information in the documentation of wound debridement.
To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report. But simply having the OP report isn't enough. Coders also must be able to read the report and pick out the important information.
New clinical guidelines for malnutrition could help alleviate compliance challenges associated with coding the condition, which has never had universally accepted clinical criteria.
Learn about ICD-10-CM coronary artery disease and myocardial infarction codes, three-day payment rule audits, malnutrition clinical guidelines, the causes of mechanical and paralytical ileuses, and the importance of documenting the history of present illness.
Our coding experts answer your questions about correct use of modifier –PD, coding infusions to correct low potassium levels, payment for HCPCS code J2354, appropriate reporting of IV push followed by infusion of the same drug, and the difference between modifiers –AS and -80.
Pain is an expected component of injuries, illnesses, and surgical procedures. Let's face it, breaking your leg hurts. In some instances, however, the patient's pain is unexpected or is worse than predicted. Sometimes, the pain can last well beyond the time it should have resolved.
As expected, not much has changed for 2013 with ICD-10-PCS codes. The updated code set is now available on the the CMS website . CMS confirmed in April that the code freeze will hold until ICD-10-CM/...
Remember when your grade school English teacher drilled the rule of punctuation into your head? Instead of an English lesson, consider this an ICD-10-CM punctuation lesson. Brackets are used in the...
Until HHS issues a clear and direct statement on a final ICD-10-CM/PCS implementation date, some healthcare entities will stop any progress to compliance with new ICD-10 requirements, according to...
CMS reassigned 10 codes to status indicator K (paid under OPPS; separate APC payment) as part of the July update to the Integrated Outpatient Code Editor .
QUESTION: The vendor for our cochlear implants has stated it’s standard to provide our operating suite with the cochlear device and two external speech processors. Should we report HCPCS Level II code L8614 (cochlear device, includes all internal and external components) for the one device and two external speech processors even though one processor is sent home with the patient? If so this means that we should charge the patient for the device and two processors as one price under revenue code 278.
Chronic kidney disease (CKD) is the permanent alteration in the kidney’s ability to perform filtration and reabsorption functions. Patients with CKD can come into an outpatient clinic or may be admitted as an inpatient, either for the CKD or some other condition. Debra Lawson, CPC, PCS, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, explain the ICD-9-CM and CPT ® coding for CKD.
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, we 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 eye.
Emergency Departments (EDs) see a wide range of illnesses and injuries, from minor to major, which may require critical care. Lois E. Mazza, CPC, details how critical care is defined, what elements providers must document, and under what circumstances critical care can be coded for ED patients.
Mother’s Day and Father’s Day have already passed (and Grandparents Day isn’t until September), but we still see plenty of babies (and grouchy parents) here at Fix ‘Em Up Clinic. Sativa brings in...
The ICD-10-CM makes a distinction between burns and corrosions. The burn codes are for thermal burns, except sunburns, that come from a heat source, such as a fire or hot appliance. You also report e...
Choosing a principal diagnosis can be tricky for coders. Luckily, Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, and Robert S. Gold, MD, help unravel the complexities of principal diagnosis selection.
QUESTION: A patient was exposed to shingles, for which a coder reported ICD-9-CM code V01.79 (exposure to other viral diseases, including HIV). This poses a problem for billing as code V01.79 is a confidential diagnosis, requiring special release of information from the patient and would remain on the insurance record. As an RN and certified coder, I believed code V01.71 (exposure to varicella) is the correct code because the varicella virus causes both chicken pox and shingles. However, I am being overridden by the chief business office. Which code is correct?
Medical necessity denials traditionally focus on high-dollar MS-DRGs, such as those for hip and knee replacements; other MS-DRGs may also soon become targets, such as inpatient wound care, according to Nelly Leon-Chisen, RHIA, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, CCDS. Krauss and Leon-Chisen discuss coverage determinations, excisional vs. nonexcisional debridement, debridement of multiple layers, and more.
Why do coders need to know about Value Based Purchasing, the Readmissions Reduction Program, and Hierarchical Condition Categories codes? Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explains why it all comes back to coding accuracy and complete documentation.
Medicare Fee-For-Service (FFS) will accept only ASC X12 Version 5010 or NCPDP Telecom D.0 electronic transactions beginning on July 1, according to a CMS June 11 Medicare Fee-For-Service Provider Partnership Program e-newsletter.
Anytown High School held its commencement ceremony over the weekend and it turned out to be a memorable event for more than the usual reason. Class president Marina decided to wear a pair of really,...
When a physician performs a procedure designed to put in a device without doing anything else to a body part, coders will report ICD-10-PCS root operation insertion (third character H in the medical...
The ICD-10-CM Official Guidelines for Coding and Reporting now include guidelines for coding methicillin resistant Staphylococcus aureus (MRSA), so let’s look at how to code MRSA. The physician...
QUESTION: I've always coded labile hypertension with ICD-9-CM code 401.9 (unspecified essential hypertension) because I couldn't find a more specific one. My supervisor stated that I must use ICD-9-CM code 796.2 (elevated blood pressure reading without diagnosis of hypertension) because it means the patient's blood pressure was high without a history of hypertension. The physician's diagnosis is labile hypertension. What code would you use?
An absence of start and stop times is one of the more frequent challenges that coders face when reporting injections and infusions. Denise Williams, RN, CPC-H, and Jugna Shah, MPH, highlight some other challenges to help coders determine how to code for injections and infusions.
The Rh factor of positive and negative can lead to problems between a mother and the developing fetus, a condition known as mother-fetus incompatibility. In some cases, the mother must receive the Rho(D) immune globulin. Lori-Lynne A, Webb, COBGC, CPC, CCS-P, CCP, CHDA , explains the diagnostic and procedure coding options for Rho(D) immune globulin.
In coding, sometimes it really is brain surgery and coders need a strong understanding of the anatomy of the skull and brain in order to correctly report diagnoses and procedures. Cynthia Stewart, CPC, CPMA, CPC-H, CPC-I, discusses the anatomy of the brain and skull and guides coders through some brain surgery procedures.
ICD-10-CM includes some specific guidelines to help coders decide when to code for a current malignancy or a personal history of malignancy. The physician excises a primary malignancy but the patient...
Summer means sand and sun for many people, but a day at the beach can result in a visit to the Fix ‘Em Up Clinic. Danielle hit the beach, but forgot her sunscreen. As a result, she ended up with a...
CMS has issued both a National Coverage Determination (NCD) Transmittal 143 and Medicare Claims Processing Transmittal 2473 on the coverage of extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) in certain circumstances under clinical research studies.
QUESTION: Do you predict coder productivity will decline as a result of ICD-10? If so, what do you think the declines will be six months after implementation?
Many HIM directors and coding managers are aware of the decrease in productivity that is anticipated with the implementation of ICD-10. The concern is a valid one, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, who explains what’s ahead and how HIM professionals should prepare.
A lot of learning is ahead for coders and others who will need to learn how to code in ICD-10. There are changes all around, and OB coding is no exception. Lori-Lynne A, Webb, COBGC, CPC, CCS-P, CCP, CHDA, explains coding for OB ultrasounds, amniocentesis, MRIs, and other procedures in CPT ® , ICD-9, and ICD-10
By now, you may have heard that the ICD-10-CM codes are more specific than those used in the ICD-9-CM system, and fracture coding is one of the areas undergoing the most changes. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CPC-I, CCDS, discusses fracture coding in ICD-10 and some of the expected documentation challenges associated them.
Some ICD-10-PCS root operations encompass a wide range of procedures. Think biopsy, excision, and extraction. Others cover a much smaller range of possible procedures, including fusion. Coders will...
A patient comes in for a face lift or another cosmetic procedure. What root operation should you code the procedure to in ICD-10-PCS? The answer: alteration (third character 0). The goal of an...
Consider this scenario: A physician orders three hours of hydration as well as a one-hour therapeutic antibiotic infusion for a patient. A nurse documents the hydration start time as 10 a.m. and the antibiotic start time as 11 a.m. Neither provider documents a stop time. What should coders report?
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, we 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 skull.
Inpatient hospitals will see CMS payment rates increase 2.3% in FY 2013 if the agency finalizes the change in the IPPS proposed rule released in April. CMS expects that in FY 2013, the documentation and coding adjustment will net an aggregate 0.2% increase. Other quality-of-care initiatives could reduce payments.
In this month's issue, we clear up confusion surrounding injections and infusions coding, provide an anatomy refresher for the skull, detail changes to the I/OCE for April, discuss the proposed implementation delay for ICD-10, and answer your coding questions.
Facilities can't bill for skin substitutes unless they also bill for a skin substitute application procedure on the same date, according to the April update to the I/OCE. If facilities don't comply with this practice, they won't receive payment for the skin substitute. The April update includes a list of eight procedure codes (CPT codes 15271-15278) and 27 specific skin graft materials.
Our coding experts answer your questions about payment for items in OPPS Addendum B and skin substitutes, incomplete documentation for IV infusions, coding for amputation of finger and aftercare, facility codes for peritoneal dialysis
Learn about the FY 2013 IPPS proposed rule, MAC prepayment reviews, tips for coding sepsis and SIRS, inpatient wound care coding challenges, acute respiratory failure CC/MCC status, and the importance of continuing ICD-10 preparations.
A writer paints a picture with words. The English language alone offers somewhere in the neighborhood of a quarter of a million words. But really how many does the average person use? According to...
Summer semi-officially arrived this week with Memorial Day and that means plenty of sun and sand related illnesses at the Fix ‘Em Up Clinic. Our first patient is Todd, who was trying to grill up the...
The guiding principle is the definitive methodology used for all risk adjustment medical record reviews. Successful Medicare Advantage (MA) plans focus on early disease detection, coordination of care, and accurate reporting of members’ chronic conditions by primary care physicians, retrospective and prospective pursuits to drive and improve health outcomes. Holly J. Cassano, CPC, guides coders through the principles of risk adjustment for MA plans.
QUESTION: When would you use the table labeled as not otherwise classified drugs at the end of the HCPCS Level II Table of Drugs and Biologicals? Many other drugs are not assigned a HCPCS code and are not in this table.
Cardiac catheterization is a common procedure performed to study cardiac function and anatomy and to determine if a patient is a candidate for intervention. Terry Fletcher, CPC, CCC, CEMS, CCS-P, CCS, CMSCS, CMC, and Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, explain how to code the different catheterization procedures.
Providers will soon be reimbursed by Medicare for a new, less-invasive aortic valve replacement procedure. Medicare Acting Administrator Marilyn Tavenner announced CMS’ decision to pay for transcatheter aortic valve replacement under specific conditions.
When a physician performs a procedure intended to narrow the diameter of a tubular body part or orifice, coders will select the root operation restriction in ICD-10-PCS. Restriction includes both...
Our Town Zoo hosted its annual black tie fundraiser and things got a little, well, wild as the patients at the Fix ‘Em Up Clinic prove. Tiffany made a fashion statement with a bright blue shimmering...
CMS released its latest MLN Medicare Quarterly Provider Compliance Newsletter in April. The newsletter features educational information for providers related to recent audit targets and findings.
Many physicians say that systemic inflammatory response syndrome (SIRS) criteria are insufficient and confusing at best, and don't indicate whether a patient is truly sick. Some patients may meet necessary criteria for SIRS and truly have sepsis or another severe diagnosis. Others, however, may meet two of four criteria but not actually have SIRS. Where does all of this information leave coders? Often between a rock and hard place. Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, and Robert S. Gold, MD, offer seven tips for coders who need to negotiate tricky sepsis coding.
QUESTION: Our pulmonologists are not comfortable documenting acute respiratory failure unless the patient is on a ventilator. Also, they rarely document chronic respiratory failure, even in chronic obstructive pulmonary disease (COPD) patients on continuous home oxygen. I’m trying to develop standard query forms for acute and chronic respiratory failure and am running into these obstacles. How do you recommend handling this problem?
