Learn how the ICD-10 delay will affect coders, why you shouldn't fear ICD-10 implementation, why you should review pregnancy coding guidelines, and how to motivate your coding staff.
Happy Monday! I hope you had a great weekend because it’s time to dive into coding for today’s visitors to the Fix ‘Em Up Clinic. Our first patient, nine-year-old Chris, arrived with a really nasty...
A surgeon performs an open reduction of right tibia fracture for an inpatient. Which ICD-10-PCS root operation should be reported? In this case, it’s fairly easy: reposition. In a reposition...
ICD-10-CM and ICD-10-PCS contain a significant number of new codes, which shouldn’t be news to anyone at this point. Most of the codes are longer than the current ICD-9-CM codes, which could increase...
Each year the number of quality measures being used for public reporting across provider settings increases. Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, and Linda Hyde, RHIA, explain why organizations that have not started to evaluate the impact ICD-10 will have on their quality measure data should start now.
QUESTION: How will we be able to code for procedures such as Billroth procedures, Roux-en-Y anastomoses, and Whipple’s procedure when eponyms won’t be used in ICD-10-PCS?
HHS’ proposed rule announcing a one-year delay of the implementation of ICD-10-CM/PCS was printed in the April 17 edition of the Federal Register . If HHS finalizes the delay, ICD-10-CM/PCS would become effective October 1, 2014.
The additions and revisions to the ICD-10-CM Official Guidelines for Coding and Reporting in 2012 include some new information that coders should be aware of in preparation for ICD-10-CM/PCS implementation. Sandy Nicholson, MA, RHIA, and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, explore some of the biggest guideline changes.
Unfortunately, ICD-10-PCS is not very comparable to the current ICD-9-CM volume 3 codes inpatient coders currently use. But coders shouldn’t despair, according to Sandy Nicholson, MA, RHIA, Jennifer Avery, CCS, CPC-H, CPC, CPC-I and Robert S. Gold, MD —ICD-10-PC coding may even be fun once coders get the hang of it.
[caption id="attachment_2698" align="alignright" width="150" caption="Hey, look, it's a friend of Wile E.!"] [/caption] Wile E. Coyote is back in the Acme ED, this time with a broken arm, leg, pelvis...
Not all of the ICD-10-PCS root operations are complicated or confusing. Take reattachment for example. The root operation is pretty much what you would expect. The official definition of reattachment...
As charges become more specific to provide additional concrete and transparent cost data, providers must consider what procedures they routinely provide to patients and what procedures are specifically related to the patient's condition. Denise Williams, RN, CPC-H, and Kimberly Anderwood Hoy, JD, CPC, reveal tips for determining when to separately bill for ancillary bedside services provided to inpatients.
A physician or clinical provider of care may have a completely different understanding, interpretation, and definition of medical necessity than the patient or a third-party insurance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, explains the differences in the definition and application of the term medical necessity.
To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report. But simply having an OP report isn’t enough. Coders also must be able to read the OP report and pick out the important information. Lynn Pegram, CPC, CEMC,CPC-I, CGSC, breaks down the OP report to help coders find the information they need.
QUESTION: I would like to know the correct codes to use when a patient comes into the ER after smoking synthetic marijuana and has symptoms of palpitations, seizure, or anxiety. Some physicians document ingestion, while others document abuse. What is the proper way to code considering we do not have a specific code for this new drug on the market?
A one-year delay in ICD-10-CM/PCS isn’t a slam dunk. “We’re recommending it, but it’s not [guaranteed],” said Denise Buenning, group director CMS Office of E-Health Standards and Services. Buenning...
After HHS proposed year-long delay of ICD-10, questions emerged regarding the current ICD-9-CM code freeze. CMS confirmed that the code freeze will hold until ICD-10-CM/PCS is implemented regardless...
Don’t trust the squirrels in the park. They may look cute and friendly, but they are really covert operatives on a mission to steal your food. [caption id="attachment_2676" align="alignright" width="...
Do you suffer from triskaidekaphobia, paraskevidekatriaphobia or friggatriskaidekaphobia? In other words are you afraid of the number 13 or Friday the 13 th ? More importantly, can you code for those...
If you're going to spend time and resources to conduct a coding audit, you certainly want to ensure effective and informative results. Joe Rivet, CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHC, and Julie Daube, BS, RHIT, CCS, CCS-P, discuss how factors such as timing, senior-level buy in, risk areas, a defined scope, and a commitment to follow-through can help make the coding audit a valuable tool in your organization.
QUESTION: For a healing traumatic finger amputation with concern but no diagnosis of infection at the amputation site (the physician prescribed Bactrim), is it correct to assign code V54.89 (other orthopedic aftercare) and ICD-9-CM code 886.x (traumatic amputation of finger)?
CMS has posted a summary report from the discussion of procedure codes at the ICD-9-CM Coordination and Maintenance Committee meeting held March 5. The agenda addressed only a small number of code requests due to the implementation of the partial code freeze.
As you run down your mental to-do list for the rest of the afternoon, you realize you're double-booked for multiple meetings, and you're having trouble prioritizing because your phone keeps buzzing with new e-mail notifications. If you're a health information management (HIM) director, this scenario likely repeats day in and day out. Luckily Monica Pappas, RHIA, Patti Reisinger, RHIT, CCS, and Tesa Topley, RHIA, provide tips and strategies for HIM directors to help manage all that they juggle, and prevent stress from getting out of control.
During the last year, the buzz from the health information management (HIM) and coding community has consistently reflected that, as a whole, the industry continues to feel the strain of tight budgets and squeeze of limited resources, especially with the approach of ICD-10 implementation. Coders reacted to the effects this has had on their compensation levels in the 2011 JustCoding Coder Salary Survey, the results of which are also discussed.
And the new proposed ICD-10-CM/PCS implementation date is (drum roll, please)…October 1, 2014. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the new date as part...
When a physician moves a body part to a new place without disrupting its vascular and nervous supply, coders will code to root operation Transfer in ICD-10-PCS. The root operation is indicated by the...
My feet are killing me. I wonder what the problem is. Let’s see what it could be and how we would code it in ICD-10-CM. I got a new pair of shoes, so maybe the problem is a blister. That should be...
Several years ago, a pharmaceutical company came under fire because its sales reps were pushing the company’s drugs using Tigger and Eeyore, two popular characters from the "Winnie the Pooh" series...
Our coding experts answer your questions about molecular pathology codes, HCPCS codes for drugs that aren’t separately payable under OPPS, deducting push time from infusions, CPT initial observation codes, and diabetes coding in ICD-10-CM.
Editor’s note: To help coders prepare for the upcoming transition to ICD-10-CM, we will provide occasional articles about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. This month’s column addresses digestive system.
The transition to ICD-10-CM is coming. The only question is when. Despite the delay, coders and other HIM professionals must continue to prepare for the transition.
Coders and billers may not completely understand how to charge for inpatient supplies. One misconception is that the room rate incorporates all supplies used for every inpatient. Another misconception is that payers will not separately pay for inpatient supplies.
This month's issue feautres articles on separately charging for inpatient supplies, an introduction to ICD-10-CM, anatomy of the digestive system, and our coding Q&A.
Learn about coding and medical necessity, planning internal coding audits, potential Medicaid RAC target areas, physician queries, and physician documentation and ICD-10-PCS.
Coding isn't just about reading documentation and selecting codes based on certain words. It's about processing information and assessing whether the codes reported accurately depict the clinical picture and medical necessity for an admission.
The Medicaid RAC program kicked off January 1, and experts say that although the program got off to a slow start, activity will likely ramp up in the next few months.
Spring is in the air and Anytown just held its combined Spring Festival and Easter egg hunt. I’m sad to say things did not go smoothly, judging by the number of patients in the Fix ‘Em Up outpatient...
When a physician completely closes the orifice or lumen of a tubular body part, coders will look to the root operation occlusion in ICD-10-PCS. The orifice can be a natural orifice or an artificially...
These days, documentation improvement and compliance are at the forefront of coders' minds. In some cases, coders are led completely astray by bad data and physician documentation that isn't entirely accurate. Robert S. Gold, MD, emphasizes that it’s important for coders to always look at the larger clinical picture in the medical record—not just a documented laboratory result or change in vital sign. Gold applies this philosophy and examines a number of conditions, including anemia, acute kidney injury, congestive heart failure, and myocardial infarction.
QUESTION: We are having a discussion about how to code when the studies section of the history and physical (H&P) indicates that the chest x-ray showed atelectasis or that an electrocardiogram showed right bundle branch block with anterior fascicular block. Some of us believe that it’s okay to code the diagnosis (i.e., atelectasis) if the provider states that the testing “showed” the diagnosis, whereas others believe we cannot code the diagnosis as it is a lab/testing result, and the provider could just be reading the results onto his or her H&P dictation. I realize you cannot go to the testing result itself and code from it directly. However, I argue that it would be okay to code for it because the provider is using this information to make decisions about care, testing, and procedures, and he or she indicates the testing results in the H&P body. What are your thoughts?
How does medical necessity get “overlooked” on the physician side as well as the inpatient side? Case managers, utilization review staff, physician advisors, CDI specialists, and coders, each carry out specific duties and responsibilities when reviewing medical records. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, CCDS, examines contributing factors and takes a closer look at guidelines Trailblazer Health recently issued defining specific joint replacement (DRG 470) documentation that both hospitals and physicians should follow to support medical necessity.
CMS released in February a fact sheet, “Global Surgery,” which contains information regarding the components of a global surgery package, including guidance about billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.
Coders are constantly analyzing documentation for clues and details that may indicate the need for a physician query. For example, coders should watch for clinical evidence that points to a condition that the physician may not have explicitly documented. Coders also need to be wary of reporting conditions without accounting for context or other clinical indicators in the documentation. William E. Haik, MD, CDIP, explains how this can lead to inappropriate reporting of an MCC, for example, that the overall clinical picture does not support.
"What's in a name? That which we call a rose by any other name would smell as sweet." [caption id="attachment_2635" align="alignright" width="150" caption="It's Pandemonium!"] [/caption] Ah, dear...
Poor Wile E. Coyote ® . He just came into the Acme ED with a skull fracture caused by a falling boulder. It seems the Roadrunner ® got away again. Dr. Frankenbean documents a closed fracture of the...
The Department of Health & Human Services (HHS) may do more harm than good by delaying ICD-10-CM/PCS implementation, according to survey, Industry Reaction to Potential Delay of ICD-10 ,...
