QUESTION: We are a nondialysis facility, so when a patient is in observation for some other reason and must undergo hemodialysis, we report code G0257 (unscheduled or emergency dialysis treatments for an ESRD [end stage renal disease] patient in a hospital outpatient department that is not certified as an ESRD facility). But how should we code peritoneal dialysis when a patient is in observation or inpatient for other problems? I have received three different codes from different coders. I cannot really find any information on this anywhere.
CMS added modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within three days or one day) to the Integrates Outpatient Code Editor (I/OCE) as part of the January updates detailed in Transmittal 2370 .
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. In this month’s column, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, addresses the anatomy of the respiratory system.
When the American Medical Association (AMA) made it clear back in November that it wanted to delay the transition to ICD-10-CM/PCS, the first thing that came to mind was ... are you kidding me?...
Here are the top 10 reasons you should attend the JustCoding Virtual Summit: ICD-10-CM and ICD-10-PCS February 29-March2. 10. October 1, 2013 is getting closer all the time Remember when CMS...
Just when you thought you had your RAC processes in place, more changes appear on the horizon. CMS wasn't shy about making changes to the Medicare RAC program in 2011. For example, the second half of the year saw demand letters shift to become the responsibility of Medicare Administrative Contractors (MAC)—a change that went into effect January 3, 2012. Joseph Zebrowitz, MD, and Debbie Mackaman, RHIA, CHCO, comment on this change as well as other updates, including the RAC Statement of Work, the Medicaid RAC final rule, and the new pre-bill demonstration program.
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
Coders can find the largest number of new codes in the pathology and laboratory section of the 2012 CPT® Manual . The AMA added a total of 103 new codes, 101 of which denote Tier 1 and Tier 2 molecular path-ology procedures.
Q We're struggling with nursing documentation of stop times for IV infusions (e.g., piggybacks and hydration). The nurses also inconsistently document a patient's return to the unit from diagnostics. We know that CMS now allows us to use average times for common services, and we're interested in considering this approach at my organization. Can you share additional specifics?
Self-administered drugs present a significant issue for coders, especially when considering how they may or may not be covered by Medicare Part B. In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting.
In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.
A coder can be misled when coding directly from an encoder, and heavy dependence on one can ultimately affect a coder’s skill set. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, CCDS, explains that a critical limitation of encoders is that they cannot physically reason. This inability to deduce often contributes to inaccurate ICD-9-CM code assignment at the expense of clinical accuracy in the reporting of disease processes, not to mention potential reimbursement and measures of continuity of care post-hospitalization.
QUESTION: A physician admits a 30-year-old male with lower abdominal pain. A CT scan showed consistency with perforated appendicitis. However, the patient had an appendectomy 10 months prior. The physician documents "appendiceal stump syndrome." How should I code this case?
In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
The task of assigning the appropriate present on admission (POA) indicator for various conditions is still fraught with a number of challenges—many of which stem from problems coders have in obtaining clear, explicit physician documentation. Colleen Stukenberg, MSN, RN, CCDS, CMSRN, and Donna D. Wilson, RHIA, CCS, CCDS, discuss how gleaning the necessary details from the records can be a daunting task in and of itself, and then inconsistencies among various physicians makes assigning POA indicators that much harder.
The January issue of Medicare Quarterly Provider Compliance Newsletter (volume 2, issue 2) addressed a number of recovery audit findings, including ambulance services separately payable during an inpatient hospital stay, diseases and disorders of the circulatory system, and minor surgery and other treatment billed as inpatient stay.
The only thing we have to fear is fear itself, according to Franklin D. Roosevelt. We certainly shouldn’t fear the transition to ICD-10-CM/PCS. Unfortunately, however, it seems to be a common...
Physicians use devices all the time during procedures. For example, they may place a temporary catheter in a patient, insert a drug-eluting stent, or insert a central line. So when do you report a...
Coders will need more information to correctly assign fracture codes in ICD-10-CM, but don’t fear. Most of that information is already in the medical record. Robert S. Gold, MD, Sandy Nicholson, MA, RHIA, and Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, walk through what you need to know to code fractures in ICD-10-CM
We hear about physician engagement across and throughout all healthcare settings almost daily, so it’s nothing new. But it's important for the upcoming transition to ICD-10-CM/PCS. Gloryanne Bryant, RHIA, RHIT, CCS, CCDS, offers suggestions for how to get your physicians engaged in the change.
As hospitals develop more intensive training programs for ICD-10-CM/PCS, coordinators may want to consider how different learning styles will impact the effectiveness of these training sessions. Education has to work for everyone and one size does not necessarily fit all. Victoria Weinert, RHIT, CCS and Lora Ma explain how to get everyone moving in the same direction and prevent coders from going rogue.
Coders who are preparing for the upcoming transition to ICD-10-CM should note some significant changes to the coding guidelines for glaucoma coding as part of the 2012 updates to the ICD-10-CM Official Guidelines for Coding and Reporting .
When you hear the word 'transplant', what do you think of first? Many people probably think of organ transplants. If you’re one of those people, you’re all set for the ICD-10-PCS root operation...
Have you heard that not all payers will be ready for the ICD-10-CM/PCS coding system on October 1, 2013? What a headache, huh? All payers were required to be ANSI X12 Version 5010 compliant by...
QUESTION: I have a question regarding the coding of a computer-assisted fluoroscopy. Consider the following documentation: Use and interpretation of intraoperative fluoroscopy. After positioning the patient, the posterior lumbar area was prepped and draped in the standard sterile fashion. The prior incision was marked with a marking pen. C-arm fluoroscopy was used to map an incision extending from the tip of the spinous process of L2 to that of L5. After performing a time-out, this incision was infiltrated with local anesthetic and incised with a 10-blade scalpel. Dissection proceeded through the subcutaneous fat using Bovie monopolar cautery. Self-retaining retractors were applied. Dissection then proceeded in the midline through the avascular plane through the lumbodorsal fascia and musculature using the Bovie. Self-retaining retractors were deepened. Would you assign a procedure code for the fluoroscopy for this inpatient procedure or would it just be inclusive in the procedure? There seems to be confusion when comparing this procedure in an inpatient setting vs. an outpatient setting.
The Office of the Inspector General (OIG) stated in its recent publication, “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm,” that a series of reports examining adverse events in hospitals shows that for the hospitals it surveyed, the incident reporting systems only tracked approximately 14% of incidents.
The goals of coding should always be ensuring data accuracy and capturing a patient's true clinical picture. Knowing the intent of an ICD-9-CM code is crucial. However, coding guidelines and official coding guidance sometimes conflict with these goals, putting coders between a rock and a hard place. Robert S. Gold, MD, examines cardiomyopathy, a disease that affects the heart muscle, as an example of a diagnosis that is frequently misreported due to inaccurate guidance.
Computer-assisted coding (CAC) is a hot topic these days. Many industry experts claim that CAC is the wave of the future—that its accuracy has been proven, and that humans cannot match its productivity. With CAC, elements such as fatigue, stress, and inexperience are no longer factors that can negatively affect code assignment. Many articles and vendors sing its praises. However, is it really all that? Robert S. Gold, MD, and Lori Cushing, RHIT, CCS, discuss some relevant concepts.
Times are changing, and, most likely, so are the jobs of your health information management (HIM) staff members. In some cases, there's a sudden addition of responsibilities, such as the implementation of the recovery audit contractor program. In other cases, the increased use of technology triggers a shift. If these changes aren't managed appropriately, you may end up with declines in performance, careless errors, low productivity, or diminished quality. Elizabeth Layman, PhD, RHIA, CCS, FAHIMA, shares her approach to HIM department and job restructuring.
While working on various projects related to ICD-10-PCS, I have discovered many areas where I think coders are going to struggle because the rules either go against the way we code now in ICD-9-CM...
The ultimate goal of fetal surveillance is to prevent fetal death. Part of this process is a fetal non-stress test (FNST), the monitoring of the fetal heart rate in response to fetal movement. Lori-Lynne A. Webb, CHDA, CCS-P, CCP, CPC, COBGC, details what the FNST includes and how to code for it.
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator procedures at the standardized inpatient rate as part of the calendar year 2012 Outpatient Prospective Payment System final rule. In addition, CMS finalized several changes regarding payments for 11 cancer centers, drug payment calculations, and physician supervision. Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, explain the changes facilities will see in 2012.
The AMA added a total of 60 new codes throughout the surgery section of the 2012 CPT ® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, and Christi Sarasin, CCS, CCDS, CPC-H, FCS, highlight the significant changes for 2012.
CMS added four new J codes for reporting drugs and biologicals that previously did not have specific codes available as part of the 2012 Outpatient Prospective Payment System updates ( Transmittal 2376 ).
QUESTION: The 2012 CPT ® Manual includes the typical time physicians spend at the bedside and on the patient’s hospital floor or unit for initial observation care codes 99218, 99219, and 99220. Do these codes only apply when the counseling and/or coordination of care support the respective 30/50/70 minutes of time? Do you know if CMS has published any new guidelines related to these times?
The 2012 ICD-10-CM updates include significant narrative changes for primary malignant neoplasms overlapping site boundaries and malignant neoplasm of ectopic tissue, as well as smaller narrative...
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS finalized for fiscal year (FY) 2012. However, it’s critical that providers also examine how these changes directly affect MS-DRG assignment. Robert Gold, MD, examines a number of these changes, including MS-DRG assignment related to cardiac-specific comorbidities, autologous bone marrow transplants, excisional debridement, and thoracic aneurysm repair.
Medicare Advantage plans rely on the Hierarchical Condition Categories (HCC) system for reimbursement. HCC payments are linked to the individual health risk profiles for the members in the plan. MA Plans use ICD-9-CM codes as the primary indicators of each member’s health status. Therefore, it is essential for MA plans to make sure that providers capture the complete diagnostic profile of patients through accurate and complete physician coding. Holly J. Cassano, CPC, explains why coders need to have a complete understanding of the HCC process and risk adjustment, as well as the effects on the provider, the member, the MA plan, and overall reimbursement.
Although the New Year marked the deadline for Version 5010 compliance, CMS recently reminded providers that it will not exercise enforcement until April 1, 2012. Despite the 90-day discretionary period, CMS urged providers that they should complete the transition to Version 5010 as soon as possible. This extension will not have any effect on the implementation date for ICD-10-CM/PCS, which remains set for October 1, 2013.
When Jim Brown, FHFMA, RHIA, CCS, started working at Jefferson Regional Medical Center in early November 2010, he quickly realized that there were a number of opportunities to improve their health information management operations and efficiencies. In this article, Brown shares strategies and tips for how he and his management team were able to identify areas that needed improvement and reduce department expenses and come in 9.5% ($149K) under budget for the end of fiscal year 2011.
QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end. Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?
Learn about CMS' bundled payment initiative, computer-assisted coding, the need to scrutinize physician documentation, and new Medicaid rules, and save the Briefings on Coding Compliance Strategies 2011 Index for future reference.
Our coding experts answer your questions about determining ED visit level, coding open reduction and internal fixation of a radius fracture, and coding image-guided minimally invasive lumbar decompression.
In this month's issue, you will find in-depth anaylsis of the OPPS Final Rule and a discussion on how to properly set charges to avoid payment reductions. In addition, we continue our occassional series of ICD-10 anatomy refreshers with the eye and our experts answer your coding questions.
Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator (CRT-D) procedures at the standardized inpatient rate. The agency announced its decision as part of the CY 2012 OPPS final rule released November 1, 2011.
Removal sounds like it should be an easy root operation in ICD-10-PCS. Removal means taking something out, right? Physicians remove things all the time—your appendix, a cyst, the toy your son stuck...
When a physician frees a body part from an abnormal physical constraint by cutting or by use of force, coders will use the root operation release (N) in ICD-10-PCS. Keep in mind, though, that you...
The Medicare Code Editor (MCE) is software that detects and reports errors in the coding on claims that are submitted for payment. All Part A inpatient discharges and transfers pass through the MCE...
In ICD-10-PCS, coders assign the root operation bypass (third character 1) when the surgeon’s objective in the procedure is to reroute the contents of a tubular body part. Bypass procedures includes...
In the medical and surgical section of ICD-10-PCS, character 5 refers to the approach or method used to reach or expose a body part during a procedure. As a result, coders will need to look for...
CMS recently posted a file that identified duplicate codes within the ICD-9-CM and ICD-10-CM systems. The list isn’t terribly extensive, but in this atmosphere of transitioning from one system to the...
Looking for the 2012 ICD-10-CM code updates? Want to see what's included in the final regular update before implementation? Check the CMS’ ICD-10-CM and GEMS website. CMS posted the 2012 ICD-10-CM:...
Get ready to say goodbye to Coding Clinic for ICD-9 , and hello to Coding Clinic for ICD-10 . The AHA will cease publication of its ICD-9 guidance, but is already planning for an ICD-10-CM/PCS...
For those who work in environments where codes from category V57 (care involving use of rehabilitation procedures) are a staple, you be surprised to learn that when it comes to ICD-10-CM, all V57...
Late effects are considered to be the residual effects after the acute phase of an illness, disease, or injury. Typically, late effects are considered chronic conditions and can result from the...
CMS’ Office of E-Health Standards and Services (OESS) won’t enforce compliance with the HIPAA 5010 transaction set until March 31, 2012, the agency announced November 17 . The 90-day delay will not...
The American Medical Association (AMA) House of Delegates voted to “work vigorously to stop implementation of ICD-10” during the closing session of its semi-annual policy-making meeting November 15...
Coders are sharpening their knowledge of anatomy and physiology and honing their ICD-10-CM/PCS skills. The HIM department is getting ready for the transition, but did you remember to explain it to...
I had the opportunity to attend the American Health Information Management Association convention this year in Salt Lake City, and I helped work in HCPro's exhibitor booth. As a former HIM director...
Will the new ICD-10-CM concept of using seventh character code extensions to identify initial encounters vs. subsequent encounters cause additional confusion in relation to professional services, for...
Representatives from the American Hospital Association (AHA), the American Health Information Management Association, and the Centers for Disease Control and Prevention will discuss ICD-10...
As I continue to learn more and work with ICD-10-PCS codes, I find myself questioning the ancillary service codes in ICD-10-PCS. In my experience as an inpatient facility coder, I know that there are...
Coders will use the root operation division when the physician plans to cut into, transect, or otherwise separate all or a portion of a body part. Do not use division if the physician plans to cut or...
2013 is right around the corner. Learn how to kick start your hospital-wide ICD-10 educational plans. During this live 90–minute audio conference, our expert speakers will walk you through two...
As an AHIMA ICD-10 certified trainer, I have been doing a lot of work on various ICD-10 projects. When it comes to working with the new coding system, I find myself wondering whether the first ICD-10...
Coders should focus on chest pain, among other areas, as part of a larger review of ICD-9-CM codes and in preparing for ICD-10-CM. Coding chest pain in ICD-9-CM requires the physician to document the...
5010. That’s the cool way of saying Version 5010 of the Accredited Standards Committee (ASC) X12. It is the next version of the HIPAA electronic transaction standards that providers and all HIPAA...
Coders will find they need more information to select the appropriate code in chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue [M00–M99]) of the ICD-10-CM Manual. Most of the...
Over the summer, I was in the process of going through the American Health Information Management Association Academy for ICD-10-CM for trainers. I had completed the online, self-paced part of the...
Another new term coders will need to know for ICD-10-PCS root operations is fragmentation. Fragmentation is breaking solid matter in the body into pieces. Note that in a fragmentation procedure, the...
When should a coder report multiple procedures performed during a single operative session in ICD-10-PCS? Look to the official guidelines for information. According to the guidelines, coders should...
These days it seems like a new ICD-10 tool is waiting for you around every corner. Be sure to periodically check different organization's websites, as many of them are constantly updating information...
Do you remember the Y2K scare? Vendors and information technology staff were entranced with making upgrades to computers and information systems months in advance to make sure that the internal...
Some of the removal root operations can easily be confused with other root operations that involve taking out solids, fluids, or gases from a body part (e.g., drainage, extirpation, and fragmentation...
The CDC updated the terminology used to describe asthma in ICD-10-CM to reflect the current clinical classification of asthma. In ICD-9-CM, asthma is described as extrinsic or intrinsic. In ICD-10-CM...
Given the many differences between the ICD-9-CM and ICD-10-CM/PCS system and the thousands of new codes that will be used, all skilled-nursing facility (SNF) and homecare agency staff members...
A step-by-step approach to code assignment is helpful when trying to understand the complexity of ICD-10-PCS. Step one: Determine the first character, which denotes the general category of the...
When I hear "YouTube," I think of video clips of babbling babies, stupid pet tricks, and “don’t try this at home” stunts. But did you know that CMS is now on YouTube? Who’d a thunk it! They even have...
I’m not really crazy about the title of this blog post, but that’s how the adage goes. Once you get used to something, like ICD-9-CM for example, change is met with resistance. I don’t want to think...
When we think of all of the steps we have to take to get ready for ICD-10 implementation, missing one step in the planning process could cause chaos in your facility. Don’t forget about 5010! Your...
If an excision involves cutting out a portion of a body part, and a resection involves cutting out all of a body part, what then is an extraction? According to the ICD-10-PCS guidelines, an...
Will physician documentation be specific enough so coders can select the most appropriate code in ICD-10-CM/PCS or will coders be defaulting to unspecified codes? For starters, don't dwell on details...
With ICD-10-PCS, coders will have 31 root operations to choose from and not all of them are clear cut. Start learning the root operations now to prepare you for the switch to ICD-10-PCS. The ICD-10-...
One of the things that has concerned me about ICD-10-CM is the lack of guidance regarding sequencing. Since the American Hospital Association announced that it would not be converting Coding Clinic...
If you haven’t already done so, now is a good time to look at your system capabilities and see what you need to update or upgrade before the transitions to HIPAA Version 5010 and ICD-10-CM/PCS. Start...
As a kid, do you remember playing the game where you sat round in a circle and one person whispered a phrase in the ear of the person sitting next to them, and that person passed it along until...
CMS created the following four podcasts based on the January 12 national provider call, “Preparing for ICD-10 Implementation in 2011:” Welcome and ICD-10 Overview Implementation Strategies for 2011...
So the transition to ICD-10-CM/PCS is still more than two years away, and it’s too early to start learning actual codes. But you can start reviewing some of the major concepts of ICD-10-CM/PCS with...
