Post-traumatic stress disorder isn’t only reported for military personnel. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, writes about when PTSD may be reported and which diagnosis and procedures codes should be included.
Per CPT, modifier -52 is used when a service or procedure is partially reduced or eliminated at the provider's discretion. Such a situation is identified by using the service's usual HCPCS/CPT code and adding modifier -52, signifying that the service is reduced.
Some interesting tidbits of information can be gleaned from the most recent release of the AHA Coding Clinic for ICD-10-CM/PCS to help coders as they work in the new code set.
Perhaps recognizing the massive undertaking for coding and HIM departments in 2015 with the implementation of ICD-10, the latest CPT® update includes a relatively small 367 changes for 2016.
To charge or not to charge--that is the question. Determining whether a hospital can charge for certain services and procedures provided at a patient's bedside is a task often fraught with confusion and uncertainty.
Approximately 800 hospitals across the country that perform inpatient total hip and knee joint replacements will be required to participate in the latest value-based payment initiative launched by CMS, the Comprehensive Care for Joint Replacement (CJR) model, which becomes effective April 1.
The new ICD-10 system and its inherent errors, especially in ICD-10-PCS, has provided fertile ground for honest errors. But for this article, I'm going to talk about the other side of the coin, where new codes or descriptions of codes come out, often with inadequate definitions or directions, and people make up reasons to try to rook the system and bilk Medicare?that is, until enough caregivers get caught or advice comes out to squelch the "experts" who want to help you get denials by the hundreds or get hassled by Recovery Auditors.
Q: I was reviewing a case with one of our clinical documentation improvement (CDI) specialists this morning. The following clinical indicators documented in the chart are elevated cardiac enzymes, shock, and demand ischemia. Cardiology documented “elevated cardiac enzymes in setting of shock representing a Type 2 injury.” Also documented in another note is “demand ischemia.” Should the CDI specialist query for more information?
Even before ICD-10, unclear definitions for certain diagnoses and procedures led to confusion for coders trying to interpret physician documentation. Robert S. Gold, MD, writes about conditions in the new code set that could lead to potential risks for providers.
A decrease in staff productivity has been the top challenge for providers after ICD-10 was implemented, but relatively few organizations have seen a significant decrease, according to a recent survey from Navicure.
Laurie L. Prescott, RN, MSN, CCDS, CDIP, looks at the definitions for primary, principal, and secondary diagnoses and how to determine them from provider documentation.
Denials are on the rise for certain diagnoses, procedures, and regulations. Sarah C. Mendiola, Esq., LPN, CPC, outlines steps providers can take to reduce denials by focusing on certain documentation details.
The improper payment rate for oxygen equipment and supplies to the Medicare program was 62.1% with projected improper payments of approximately $952 million during the 2014 reporting period, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the January 2016 issue of the Medicare Quarterly Compliance Newsletter.
Hospital coders can choose multiple modifiers to apply to a procedure code if the service was discontinued. Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, provides an overview of these codes and in which instances to use them.
CMS audits for meaningful use could mean collecting information across the coding and HIM departments. David Holtzman, JD, CIPP, and Darice Grzybowski, MA, RHIA, FAHIMA, review what auditors could request and how to prepare your facility.
The government recently approved changes for physician payment systems. Is your clinical documentation improvement (CDI) team ready to tackle these challenges? More importantly, are your physicians ready?
