CMS released a change request April 28 which provides guidance for Medicare Administrative Contractors on how to ensure accurate program payment for moderate sedation services provided as part of screening colonoscopies.
Coding plays a large role in claims and therefore is a key factor in reimbursement compliance. As such, coders have a responsibility to be as accurate and up-to-date on coding practices as possible. Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , explores some of the organizations and regulatory bodies available to assist coders.
As physicians and society debate the rising incidence and devastating effects of opioid dependency, neonatal abstinence syndrome, and the use and abuse of other mood-altering chemicals, James Kennedy, MD, CCS, CDIP , explains how providers must partner together to define, diagnose, document, and report drug-related events so that ICD-10-CM-dependent administrative data can accurately measure its epidemiology, responses to treatment, and consequences.
Wound care can be messy, but reimbursement and billing for wound care does not need to be as troublesome if coding and documentation are done correctly. One of the bedrocks in billing for wound care is ensuring medical necessity, and there are a few tricks and standards to learn about medical necessity in order to stay compliant. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Ghazal Irfan, RHIA, writes that it’s pivotal that coders have a thorough and in-depth understanding of complex surgeries such as excisional debridements, along with comprehensive knowledge of relevant Coding Clinics and guidelines.
With new data feeding into DRGs, facilities can finally start to see the impact of coders reporting new ICD-10 specificity and if cases are going to the same DRG groups that they did in ICD-9-CM. One MS-DRG group falling into question this year is for acute ischemic stroke with use of thrombolytic agent. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We are currently coding a chart for an acute kidney injury which has the baseline serum creatinine and urine output missing from the chart. Is there something we can do before we have to query the physician?
Joel Moorhead, MD, PhD, CPC , explains that a patient with an atypical presentation, by definition, may have the disease but might not meet typical criteria for diagnosis; thus, the patient needs to be at the center of clinical validation.
Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
CMS released the fiscal year 2018 IPPS proposed rule in April, and with it came a bevy of new potential ICD-10-CM codes. The update includes a total of 406 proposed new, revised, and deleted codes to be implemented October 1, 2017.
All of us in ICD-10-CM/PCS coding compliance are facing a tsunami of denials from payers, Recovery Auditors, and Medicare quality improvement organizations. This is due to the auditors’ removal of ICD-10-CM codes based on provider documentation; auditors can perceive that a patient did not have clinical indicators supporting the presence of the documented condition.
Alcohol, as a legal substance for those 21 and older, is commonly seen as more benign than illicit drugs such as heroin and cocaine. However, alcohol can also physically harm the body in many ways. In ICD-10-CM, the categories related to alcohol fall under category F10.- (alcohol-related disorders).
Clinical documentation improvement (CDI) specialists, in theory, bridge the gap between physicians and coders. However, CDI and coding teams are often educated separately and work apart from each other.
One of the primary difficulties in achieving uniformity of code assignment is that, in some circumstances, selecting the principal diagnosis is believed to be up to the individual coder or CDI specialist. Let’s take a closer look at the 2017 ICD-10-CM Official Guidelines for Coding and Reporting to understand whether this is really the case.