In Major Diagnostic Category 1, Diseases and Disorders of the Nervous System, which covers MS-DRGs 020-103, CMS made changes to the classification of the diagnoses of functional quadriplegia and precerebral occlusion or transient ischemic attack with the use of a thrombolytic, as well as for the insertion of a responsive neurostimulator system. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
On Wednesday, August 2, CMS released the fiscal year 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , reviews coding guidelines, signs, and symptoms of gastroparesis and helps coders avoid tricky guidance that can lead to reporting errors. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our team had a recent case that involved a small midline episiotomy which extended to a second-degree laceration which was repaired with 3-0 vicryl rapide sutures. Would we code the episiotomy and repair or just the repair, and why?
Crystal Stalter, CDIP, CCS-P, CPC, writes that with the release of the 2018 IPPS final rule, hospitals around the country are poring over it to see what impact the changes might bring to their case-mix index, quality initiatives, and overall reimbursement. In the midst of this are coders and CDI specialists who need to be kept abreast of these changes.
James S. Kennedy, MD, CCS, CDIP, CCDS, says that with the news codes available October 1, coders will face significant changes in documentation and coding practices. He discusses some of the additional new codes, including type 2 diabetes mellitus with ketoacidosis and pulmonary hypertension.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that coding for skin cancers requires understanding the guidelines as well as knowledge of how the conditions are classified in the ICD-10-CM manual. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP , explains how ICD-10-CM addresses kidney illness and advises on how to ensure documentation and coding integrity through certain challenges including risk-adjustment methodologies and functional versus anatomic diagnoses.
According to a study published in Annals of Emergency Medicine, researchers studying emergency department (ED) visits found that electronic sepsis alert implementation increased ED sepsis detection from 83% to 96%.
In June, CMS released the 2018 ICD-10-PCS Official Guidelines for Coding and Reporting which include various revisions from the 2017 guidelines. These changes come on the heels of the 2018 IPPS proposed rule and recently released ICD-10-PCS codes.
James S. Kennedy, MD, CCS, CDIP, writes that while you might have thought you’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the compliance risks and opportunities with a new risk-adjustment method: Hierarchical Condition Categories.
Q: At my institution, all of our congestive heart failure exacerbations get at least one chest x-ray. Is that enough “diagnostic testing” to code the secondary condition in accordance to Coding Clinic ?
Daniel E. Catalano, MD, FACOG, says that from the CDI perspective, the ability to communicate pediatric severity of illness is complicated by the fact that pediatricians have a lexicon that is not well captured in ICD-10-CM. This, he writes, is especially true for pediatric cardiology.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS , explains that as a coding manager, whether your inpatient team is on-site, off-site, or remote, creating the appropriate environment and selecting proper locations are key to any successful team. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Beginning and sustaining a remote CDI program can be a challenge for even seasoned professionals. Traditionally, CDI specialists put in varying amounts of face-to-face time with the physicians. Ideally, that in-person interaction makes the physicians more open to CDI efforts. However, many remote CDI programs and individual specialists have found creative ways around this face-to-face time.
On June 13, CMS released the final 2018 ICD-10-PCS codes that will become effective October 1. These changes come on the heels of April’s IPPS proposed rule.
Q: I can't distinguish between "code first" and "in diseases classified elsewhere.” Both are used with manifestations and both can't be sequenced as principal diagnosis and both need etiology codes, so what is the difference?
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , takes a look at scleroderma diagnoses and helps coders to breakdown the disease components and treatment to better identify it in documentation and improve coding. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Laura Legg, RHIT, CCS, CDIP, writes that coders will benefit from digging deeper into the meanings of the new fiscal year 2018 ICD-10-PCS cardiovascular code descriptions to be able to fully comprehend and use them.
Q: We use an electronic system at our hospital, and find it is difficult to query a physician since we all have our own processes. Would you recommend having a set format for a query that is used electronically?
In today’s virtual environment, with its focus on flexible schedules, organizing an inpatient coding team requires consideration of time zones, team member skills, volume of work, and claim-processing schedules. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP , writes that if a payer has criteria that differs from that of the provider or the facility, Recovery Auditors can deny ICD-10-CM/PCS codes they deem not to fit these criteria. Kennedy gives solutions for coding compliance for conditions such as sepsis, coma, and encephalopathy.
A recent study piloted by CHEST Journal found that surveillance-based clinical data, such as electronic health records, offered more reliable estimates of septic shock trends than coded records.
Sharme Brodie, RN, CCDS, reviews 2017 First and Second Quarter Coding Clinic advice, which includes sequencing chronic obstructive pulmonary disease with other respiratory diagnoses and body mass index reporting instructions.
On April 14, CMS released the fiscal year 2018 IPPS proposed rule, which included a proposal for the discontinuation of the CardioMEMS heart failure monitoring system add-on payment.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes about how understanding the different forms of viral hepatitis and alcoholic hepatitis, as well as their effects on the liver, help to clarify coding assignment. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP, helps coders and CDI specialists process important aspects of Coding Clinic’s First Quarter 2017 guidance such as the sequencing of pneumonia in the setting of chronic obstructive pulmonary disease.
Cheryl Ericson, MS, RN, CCDS, CDIP, explains why so many CDI departments are expanding their review processes to include consideration of how CMS quality measures are affected by claims data.
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?
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.
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.
On Friday, April 14, CMS released the fiscal year 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-PCS and ICD-10-CM code proposals.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, discusses the reporting of alcoholism, its key documentation details, and its effect on MS-DRGs in ICD-10. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Query practices have changed a lot over the years. With so many shifts, coders and clinical documentation specialists may need to take a step back and take stock of the changes they’ve worked through, reassessing current practices against industry recommendations and shoring up policies to prevent well-known pitfalls.
Ghazal Irfan, RHIA, writes about healthcare’s shift from fee-for-service to pay-for-performance, volume-based care to value-based reimbursement, and case-mix index to outcome measures, and how your facility can achieve compliant coding practices among these changes.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , writes about hemophilia and how this condition is important for inpatient coders to understand since incorrect reporting can affect MS-DRG assignment.
Q: Can you please help me determine the query opportunities and code assignment/sequencing argument related to a patient who was admitted with pneumonia, congestive heart failure, acute respiratory failure, and encephalopathy?
Clinical documentation improvement (CDI) specialists bridge the gap between physicians and coders. This article takes a look at the benefits of CDI and coding collaboration, and how CDI specialists can address coding hot topics at their own facilities.
Erica E. Remer, MD, FACEP, CCDS , comments on a recent Coding Clinic that has garnered a lot of questions on inpatient obstetrics coding and gives advice on how she thinks this new guidance is flawed. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Written comments on upcoming ICD-10-CM/PCS code changes presented during the ICD-10 Coordination and Maintenance Committee meeting in March are due Friday, April 7.
Since the physician doesn't need to document a specific root operation, coders cannot rely solely on the terms the physician uses; thus it is important for each coder to fully understand each definition. This article takes a look at the root operations Drainage, Extirpation, and Fragmentation. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
James S. Kennedy, MD, CCS, CDIP , reviews recent coding audits at that Northside Medical Center of Youngstown, Ohio, and Vidant Medical Center of Greenville, North Carolina, and gives readers tips on how to better prepare their facilities through these examples.
Q: One of my coworkers thought we needed the phrase “unable to clinically determine” as an option on every multiple-choice query we send. My take on it is that if we have “other” with an option for free text, that would cover us for compliance. Further, I thought it was inappropriate to include this option in some cases, as it may offer an option that is preventing me from obtaining the detail and specificity I need.
On March 8, CMS released eight frequently asked questions (FAQ) related to the Medicare Outpatient Observation Notice (MOON). The FAQs reinforce that psychiatric hospitals must comply with the Notice of Observation Treatment and Implication for Care Eligibility Act and MOON.