Don’t let rumor steer you away from the goal of being ready for ICD-10-CM/PCS implementation. By now, everyone has heard that CMS plans to issue a proposed rule with a new ICD-10-CM/PCS...
Even though this kink (the possible implementation delay) has been presented to everyone, I think we need to remember that the likelihood of continuing status quo for a lengthy amount of time using...
So CMS may or may not change the October 1, 2013 implementation date for ICD-10-CM/PCS. We’re still waiting to hear more from CMS and the Department of Health and Human Services. While we’re waiting...
Physician queries are considered communications between coding (or coding-related) professionals and physicians to clarify or increase specificity in the documentation to ensure good clinical...
QUESTION: We have a question in regards to hydration that we are trying to figure out. Does the physician specifically have to state in his or her documentation that the IV is for hydration purposes or can a coder figure it out through critical thinking and using the process of hierarchal injection/infusion coding when reading the record? For example, X IV fluids are being used for an antibiotic and after the antibiotic, the IV fluids continue at 125/hr for hydration. Does the physician need to document "for hydration"? Our physicians do not want to write that. Do you have any good advice on this?
Drug delivery implants are designed to provide active pharmaceuticals to a targeted area in into the patient’s body for a certain length of time site. Lori-Lynne Webb, CPC, CCS-P, CCP, COBGC, CHDA, provides what coders need to understand to correctly report drug delivery implant codes and what the physician must document.
In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting. Kimberly Anderwood Hoy, JD, CPC, and Valerie Rinkle, MPA, offer some tips and suggestions for reporting self-administered drugs and determining when the drug is integral to the service.
The transition to ICD-10-CM/PCS has not been cancelled, just delayed. And we’re not even sure for how long. Some industry experts offer their thoughts on what organizations should do while we wait...
It’s no longer a mere possibility; HHS has confirmed its intent to delay the ICD-10 compliance deadline, according to its latest press release . “We have heard from many in the provider community who...
After years of repeatedly saying the implementation date for ICD-10-CM/PCS wasn’t changing, the Department of Health and Human Services (HHS) and CMS are rethinking their stance. HHS Secretary...
A patient comes in with displaced fracture of base of second metacarpal bone of his right hand. The physician treats the patient and sends him home. The coder would report ICD-10-CM code S62.310A for...
CMS is looking at the timeline for ICD-10 implementation, acting administrator Marilyn Tavenner told attendees at the American Medical Association (AMA) National Advocacy Conference in Washington, DC...
A great storyteller understands that it’s all in the details. Perhaps it’s the back-story about a particular character or maybe it’s the little facts peppered throughout the tale, but it’s the details that convey the essence of the story. Likewise, some ICD-10-CM injury codes tell only part of a patient’s story. Lolita M. Jones, RHIA, CCS, and Donna M. Smith, RHIA, discuss how to report associated injuries and complications and also talk about why it’s so important to have a firm grasp on anatomy and physiology to ensure accurate coding.
The American Hospital Association does not plan to “convert” past issues of Coding Clinic for ICD-10-CM/PCS. Lynne Spryszak, RN, CCDS, CPC, discusses why this decision has caused concern among coders and clinical documentation improvement specialists, who for years have relied on the guidance published in Coding Clinic to assist with coding complicated diagnoses or procedures.
CMS issued Transmittal 1039 in the One-Time Notification Manual on February 3, which provides guidance on reporting claims submissions and date span requirements for 33X Type of Bill, which pertains to Home Health Agencies, containing ICD-10 codes with dates of discharge on or after October 1, 2013.
Big news regarding the ICD-10-CM/PCS implementation timeline came out this morning during the American Medical Association (AMA) National Advocacy Conference in Washington, DC. Per CMS acting...
Inpatient coders currently can default to “not otherwise specified” (NOS) codes in ICD-9-CM Volume 3, but they won’t have that option as frequently in ICD-10-PCS. Coders report NOS codes when the...
What’s in a name? That which we call a rose by any other name would smell as sweet. At least Shakespeare says so. And that has what to do with coding in ICD-10-PCS you might ask. Well, you won’t find...
Outpatient coders are getting very familiar with combination codes when it comes to procedure coding, thanks to the AMA. Coders have been seeing more and more combined procedures in recent years in...
CMS added modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within three days or one day) to the Integrates Outpatient Code Editor (I/OCE) as part of the January updates detailed in Transmittal 2370 .
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, JustCoding will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. In this month’s column, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, addresses the anatomy of the respiratory system.
To code chemotherapy properly, coders need to understand what the clinical staff actually does for the patient via complete and accurate documentation. Chemotherapy and other injections and infusion present some unique challenges in part because clinical staff members are focused more on patient care than documentation requirements. Paula Lewis-Patterson, BSN, MSN, NEA-BC, and Jugna Shah, MPH, discuss the challenges of compiling complete chemotherapy documentation.
QUESTION: We are a nondialysis facility, so when a patient is in observation for some other reason and must undergo hemodialysis, we report code G0257 (unscheduled or emergency dialysis treatments for an ESRD [end stage renal disease] patient in a hospital outpatient department that is not certified as an ESRD facility). But how should we code peritoneal dialysis when a patient is in observation or inpatient for other problems? I have received three different codes from different coders. I cannot really find any information on this anywhere.
When the American Medical Association (AMA) made it clear back in November that it wanted to delay the transition to ICD-10-CM/PCS, the first thing that came to mind was ... are you kidding me?...
Here are the top 10 reasons you should attend the JustCoding Virtual Summit: ICD-10-CM and ICD-10-PCS February 29-March2. 10. October 1, 2013 is getting closer all the time Remember when CMS...
Self-administered drugs present a significant issue for coders, especially when considering how they may or may not be covered by Medicare Part B. In many instances, payers may consider a drug to be self-administered in some circumstances but not in others. As a result, coders must pay special attention to how these drugs are used within their setting.
In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
Just when you thought you had your RAC processes in place, more changes appear on the horizon. CMS wasn't shy about making changes to the Medicare RAC program in 2011. For example, the second half of the year saw demand letters shift to become the responsibility of Medicare Administrative Contractors (MAC)—a change that went into effect January 3, 2012. Joseph Zebrowitz, MD, and Debbie Mackaman, RHIA, CHCO, comment on this change as well as other updates, including the RAC Statement of Work, the Medicaid RAC final rule, and the new pre-bill demonstration program.
QUESTION: A physician admits a 30-year-old male with lower abdominal pain. A CT scan showed consistency with perforated appendicitis. However, the patient had an appendectomy 10 months prior. The physician documents "appendiceal stump syndrome." How should I code this case?
In total, the AMA added 60 new codes throughout the surgery section of the 2012 CPT® Manual , 18 of which appear in the cardiovascular and respiratory system subsections. The AMA also revised 86 codes and deleted 48 codes in the surgery section.
The task of assigning the appropriate present on admission (POA) indicator for various conditions is still fraught with a number of challenges—many of which stem from problems coders have in obtaining clear, explicit physician documentation. Colleen Stukenberg, MSN, RN, CCDS, CMSRN, and Donna D. Wilson, RHIA, CCS, CCDS, discuss how gleaning the necessary details from the records can be a daunting task in and of itself, and then inconsistencies among various physicians makes assigning POA indicators that much harder.
Coders can find the largest number of new codes in the pathology and laboratory section of the 2012 CPT® Manual . The AMA added a total of 103 new codes, 101 of which denote Tier 1 and Tier 2 molecular path-ology procedures.
The January issue of Medicare Quarterly Provider Compliance Newsletter (volume 2, issue 2) addressed a number of recovery audit findings, including ambulance services separately payable during an inpatient hospital stay, diseases and disorders of the circulatory system, and minor surgery and other treatment billed as inpatient stay.
Q We're struggling with nursing documentation of stop times for IV infusions (e.g., piggybacks and hydration). The nurses also inconsistently document a patient's return to the unit from diagnostics. We know that CMS now allows us to use average times for common services, and we're interested in considering this approach at my organization. Can you share additional specifics?
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
A coder can be misled when coding directly from an encoder, and heavy dependence on one can ultimately affect a coder’s skill set. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, CCDS, explains that a critical limitation of encoders is that they cannot physically reason. This inability to deduce often contributes to inaccurate ICD-9-CM code assignment at the expense of clinical accuracy in the reporting of disease processes, not to mention potential reimbursement and measures of continuity of care post-hospitalization.
The only thing we have to fear is fear itself, according to Franklin D. Roosevelt. We certainly shouldn’t fear the transition to ICD-10-CM/PCS. Unfortunately, however, it seems to be a common...
Physicians use devices all the time during procedures. For example, they may place a temporary catheter in a patient, insert a drug-eluting stent, or insert a central line. So when do you report a...
Coders who are preparing for the upcoming transition to ICD-10-CM should note some significant changes to the coding guidelines for glaucoma coding as part of the 2012 updates to the ICD-10-CM Official Guidelines for Coding and Reporting .
As hospitals develop more intensive training programs for ICD-10-CM/PCS, coordinators may want to consider how different learning styles will impact the effectiveness of these training sessions. Education has to work for everyone and one size does not necessarily fit all. Victoria Weinert, RHIT, CCS and Lora Ma explain how to get everyone moving in the same direction and prevent coders from going rogue.
