And a chilly one it is. It’s also the day after the Super Bowl, which means patients with a variety of injuries arrived at the Fix ‘Em Up Clinic today. First is Phil, who is convinced he is a...
Many coders and CDI specialists memorized previous Official Guidelines for Coding and Reporting , Coding Clinic for ICD-9-CM and do not have to give them a lot of forethought before applying correctly to their day-to-day reviews. Although many of the Official Guidelines for Coding and Reporting remain the same in ICD-10, none of Coding Clinic's previous advice can be applied to the new code set. Without years of new Coding Clinic advice under their belts, it may take some time before the staff exhibits the same ease when applying ICD-10-CM/PCS codes to the documentation provided.
Since portions of the reproductive system use some of the same structures as the urinary system, including the urethra, codes for conditions involving both male and female reproductive systems appear in Chapter 14 of ICD-10-CM, Diseases of the Genitourinary System.
Coding professionals may inappropriately assign codes from parts of the medical record where the doctors, early in the workup of a complex patient, were describing differential diagnoses in their evaluation of the patient. Robert S. Gold, MD, discusses whether coders should report every diagnosis mentioned in a patient’s chart.
Coding tells a patient's story, based on the narrative the physician provides in his or her documentation. Accurately painting a picture of the patient's severity of illness (SOI) and risk of mortality (ROM) is essential for good patient care, and it is becoming increasingly important for quality measures and payment.
In this month’s issue, we examine how coders and CDI specialists look at chest pain, review the most recent Coding Clinic advice on ICD-10-PCS , and explain how querying can lead to a more accurate representation of a patient’s severity of illness and risk of mortality. Robert S. Gold, MD, discusses whether coders should report every diagnosis mentioned in a patient’s chart.
As new and more effective treatment options are created and evaluated, AMA must update the CPT® Manual to add and revise codes that allow providers to accurately report the work they performed. The 2015 updates include more than 500 changes, including more than 250 new codes that impact nearly every section. In the 2015 CPT Manual, only the integumentary and respiratory system sections remain unchanged.
In December 2014, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment (HOP Panel) website outlining the hospital outpatient therapeutic services that were recently evaluated for a change in supervision levels. The three-page document contains a chart that includes the HCPCS code, the level of supervision required for coverage, and the effective dates of the changes for various services.
Coronary artery disease (CAD) develops when the arteries that supply the blood to the heart muscles become hardened and narrowed due to a buildup of cholesterol and other materials, such as plaque, on their inner wall. It's also called atherosclerosis.
Our sister website JustCoding.com recently published its 2014 Coder Salary Survey. Since many of our readers responded to the survey, we would like to share some of the results with you.
We’re into dig out mode here in Anytown and apparently, not everyone got the memo about proper snow shoveling techniques. Richard came into the Fix ‘Em Up Clinic complaining of intense pain in his...
A hiatus from Recovery Auditor scrutiny may have allowed HIM professionals to focus on other issues, but Laura Legg, RHIT, CCS, explores why HIM departments need to gear up for Recovery Auditors’ return.
In order to identify patients with a CC or MCC, coders need to know when to report additional diagnoses. William E. Haik, MD, FCCP, CDIP, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, discuss when to report a secondary diagnosis.
Physician documentation for the use of osteogenic stimulators for nonunion of fractures is often insufficient for Medicare coverage, according to Comprehensive Error Rate Testing (CERT) results .
Q: When atelectasis is noted on an ancillary test such as a CT scan of the abdomen or chest x-ray, can nursing documentation of turning, coughing, and deep breathing be considered an intervention that qualifies as one of the criteria to meet a secondary diagnosis?
Accurately painting a picture of the patient's severity of illness (SOI) and risk of mortality (ROM) is essential for good patient care, and it is becoming increasingly important for quality measures and reimbursement. Sara Baine, MSN-Ed, CCDS, and Rhonda Peppers, RN, BS, CCDS , explain the importance of accurately reporting conditions that affect SOI and ROM.
Here in Anytown we are getting blasted by a big winter storm, which means we’re also seeing lots of patients with storm-related injuries at the Fix ‘Em Up Clinic. Doug came into the clinic...
We can choose from 31 root operations in the ICD-10-PCS Medical and Surgical section, but biopsy isn’t one of them. So which root operation do we use when a physician performs a biopsy? The answer is...
Some diseases can cross between species, which can presents a significant problem. Just think back to how quickly avian flu spread starting in 2003. It turns out that diseases have been crossing that...
CMS made incorrect payments to hospitals for established patient clinic visits estimated at approximately $4.6 million in 2012, according to a recent Office of Inspector General (OIG) audit.
Blood tests are a common diagnostic tool for providers trying to determine a patient's condition. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the components of blood, detailing key terms and conditions coders should know to prepare for ICD-10-CM.
Q: When would we use codes from ICD-10-CM category E13 (other specified diabetes mellitus)? If it's secondary diabetes but not due to an underlying condition or drug and is not chemically induced, what kind of diabetes could it be?
The switch to ICD-10-CM won't bring many changes in the codes for reporting genital prolapse, but understanding the nuances of the diagnoses is key for choosing the correct code. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, highlights terms to look for in documentation and provides a sample operative report to test your knowledge.
ICD-10 implementation requires organizational coordination from a variety of departments. Chloe Phillips, MHA, RHIA, and Kayce Dover, MSHI, RHIA, discuss how organizations can overcome challenges regarding staffing, productivity, and data analytics as they prepare for the change.
Every have one of those days when you feel like you’ll never be warm? I’m having one of those. One of the downsides to have a window cube is the cold seeps in with the sunshine. Or with the dreary...
In some cases, coding professionals can—and should—report ancillary services provided to inpatients. Denise Williams, RN, CPC-H, and Valerie A. Rinkle, MPA, explain when and how to bill for ancillary bedside services.
Auditors continue to scrutinize inpatient wound care services. Glenn Krauss,BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, reviews the importance of documenting medical necessity for these services.
The reason a patient comes in is to a facility not always the same as the reason the physician admitted the patient. Brush up on the guidelines for principal diagnosis selection.
The District of Columbia federal district court dismissed a lawsuit December 18, 2014, filed by the American Hospital Association (AHA) against HHS for excessive and inappropriate Recovery Auditor denials, according to AHA News. The AHA announced that it may appeal the court’s decision.
Oh, the joys of being an 8-year-old with a snow day. Joey spent the weekend playing in his newly built snow fort without a hat, scarf, or pair of sunglasses. Now he’s complaining of hot, tender,...
Well, it’s not quite the polar vortex of 2014, but it’s definitely polar bear weather out there. As in, polar bears are the only ones who appreciate this kind of cold. We’re starting to see some...
CMS accepted 76% of all national ICD-10 test claims submitted during its November 2014 ICD-10 acknowledgement testing week. More than 500 providers, suppliers, billing companies, and clearinghouses participated in the tests, which identified no issues with Medicare's system.
After years of consideration, CMS introduced extensive changes for modifier -59 (distinct procedural service) for 2015. Jugna Shah, MPH , explains these changes and when to use the new modifiers instead of modifier -59.
The nervous system consists of the brain, spinal cord, sensory organs, and other specialized cells throughout the body, and is involved in nearly every bodily function. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the anatomy of the nervous system and some guidelines changes for it in ICD-10-CM.
CMS expanded packaging and finalized Comprehensive APCs in the 2015 OPPS final rule. Jugna Shah, MPH, and Valerie Rinkle, MPA, analyze the changes and the potential impact on providers.
Ready to test your ICD-10 systems with CMS? The agency is currently accepting applications for its second end-to-end ICD-10 testing week, scheduled for April 26-May 1. Each MAC (and Common Electronic...
Despite all the uncertainty surrounding the implementation of ICD-10-CM/PCS, the Cooperating Parties (i.e., the American Hospital Association, AHIMA, CMS, and the National Center for Healthcare Statistics) nevertheless decided that the farewell issue of Coding Clinic for ICD-9-CM (which was published in the first quarter of 2014) will remain the farewell issue.
Coronary artery bypass graft (CABG) procedures are not the only ones coders will report using the root operation Bypass in ICD-10-PCS. Surgeons can create bypasses in other vessels of the body.
As CMS pushes the OPPS from a fee-for-service program toward more of a true prospective payment system, financial impact analysis of changes, departmental budgeting, and forecasting has become more complicated each year.
In this month’s issue, we explain how to code for non-coronary bypass procedures in ICD-10-PCS, reveal when it is appropriate to bill for ancillary bedside procedures, and review Coding Clinic advice for ICD-10. Robert S. Gold, MD, discusses how and when coders should ask for additional documentation.
Inpatient coding professionals are used to DRG systems where all of the diagnoses and procedures map to a single DRG. So they may not look for additional procedures and services to report outside of that DRG.
CMS proposed that a new HCPCS modifier be appended to every code for a service furnished in a hospital's off-campus provider-based department on both the CMS-1500 claim form for physicians' services and the UB-04 form (CMS Form 1450) for hospital outpatient services in the 2015 OPPS proposed rule. Despite many detailed comments opposing this change, no consensus emerged; therefore, CMS is moving forward with implementing a slightly modified policy.
In a concerted effort to move healthcare payments to a system of "quality over quantity," CMS finalized policies that greatly expanded packaging for outpatient providers in the 2015 OPPS final rule. It also introduced complexity adjustments with comprehensive APCs (C-APCs).