Q: A patient presents with a sore throat, and the physician states “Sore throat; differential diagnoses include streptococcal sore throat, tonsillitis, postnasal drip.” If the physician doesn’t rule out any of the differential diagnoses, should the coder query for clarification or simply choose one of the differential diagnoses?
Thirty-day readmissions for heart failure, heart attack, and pneumonia occur most frequently for reasons other than the cause of the initial hospitalization, according to a study published in the January 23 issue of the Journal of the American Medical Association (JAMA).
Coders are under constant stress and pressure. They must remain incredibly focused and pay attention to detail regularly. Lois E. Mazza, CPC, discusses why coders need to think about their health.
Physician documentation must reflect severity of illness and risk of mortality for all patients. Robert S. Gold, MD, and Valerie Bica, BSN, RN, CPN, explain why pediatric patients require special attention in terms of clinical documentation improvement specialists.
CMS recently announced it will rename the ICD-9-CM Coordination and Maintenance Committee the ICD-10 Coordination and Maintenance Committee effective with the March 2014 committee meeting. This...
Documentation opportunities abound in ICD-10-CM Chapter 13 (musculoskeletal system). The official ICD-10-CM Coding Guidelines provide us with plenty of instructions. The guidelines include...
ICD-10-PCS includes specific guidelines for coding spinal fusion procedures, including guidelines for selecting the body part value. The body part for a spinal vertebral joint(s) rendered immobile by...
CMS is making a significant change to the Medically Unlikely Edits by changing the edits from line item edits to date of service edits. The change will become effective April 1.
As more patients are being impacted by noncoverage of self-administered drugs, coders and billers need to know when and how to report drugs and drug administration services. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, discuss the differences in how drugs are paid under Medicare Part A and Part B.
CMS defines self-administered drugs as drugs patients would normally take on their own. In general, Medicare will not pay for self-administered drugs during an outpatient encounter or for drugs considered integral to a procedure. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, explain how to determine whether a drug is integral, self-administered, or both.
Genetic screening is often used to detect abnormal genes or possible fetal anomalies during antepartum care. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews some of the most common genetic tests and what diagnosis codes to report.
Q: The rule our institution has followed with respect to HCPCS coded medications without a local coverage determination (LCD) is to limit prescribing to the FDA-approved indications. The question that arises is how closely do the physicians need to follow the package insert? For example, the drug basiliximab does not have an LCD and the FDA indication is: For acute kidney transplant rejection prophylaxis when used as part of an immunosuppressive regimen that includes cyclosporine and corticosteroids. Generally, physicians performing transplants at our institution do not use steroids or cyclosporine. They use tacrolimus, sirolimus, mycophenolate mofetil, and/or mycophenolate sodium. If the physician performs a transplant without cyclosporine or steroids, do we need to have the patient sign an advanced beneficiary notice?
Recently, I attended a large ICD-10 planning meeting. Attendees came from four different states and covered nine hospitals. There were coding, clinical documentation improvement (CDI), and revenue...
It’s Valentine’s Day and love is in the air. So are Cupid’s arrows. Does ICD-10-CM include a code for assault by Cupid’s arrow? Not quite. The arrow itself would leave a puncture wound (probably), so...
One of AHIMA’s long-time goals is to empower HIM professionals to be heavily involved in the ICD-10 overhaul and perhaps even leading the transition in their facility.
The FY 2013 ICD-10-CM Official Guidelines for Coding and Reporting probably look very familiar to coders. Lorraine Began, CPC, CPC-I, CCS-P, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, reveal the similarities and differences between the guidelines for ICD-10-CM and ICD-9-CM.
MS-DRGs won’t change much in the first year after the transition to ICD-10, but hospitals still need to understand the details of the transition. Janice Bonazelli and Dwan Thomas Flowers, MBA, RHIA, CCS, explain how to use the draft ICD-10 MS-DRG Definitions Manual to prepare for MS-DRGs in ICD-10.
ICD-10-PCS differs significantly from ICD-9-CM procedure coding, but fortunately, the Cooperating Parties are providing plenty of guidelines. Laura Legg, RHIT, CCS, discusses some of the key ICD-10-PCS guidelines and why coders should learn them.
The Workgroup for Electronic Data Interchange (WEDI) is conducting an ICD-10 readiness survey through February 20. WEDI and CMS will use the survey results to measure the: Progress of ICD-10...
