Knowing spinal anatomy provides the foundation necessary to assign codes both before and after the switch to ICD-10-CM. Shelley C. Safian, Kim Pollock, RN, MBA, CPC, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, guide coders through the anatomy and common coding situations in ICD-9-CM and ICD-10-CM.
The transition to ICD-10-CM is coming. The only question is when. Despite the possible delay, coders and other HIM professionals must continue to prepare for the transition. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Sandy Nicholson, MA, RHIA, Robert S. Gold, MD, Jennifer Avery, CCS, CPC-H, CPC, CPC-I, and Kim Felix, RHIA, CCS, provide information on how ICD-10-CM will—and will not—differ from ICD-9-CM.
The American Health Information Management Association (AHIMA) has urged CMS not to delay ICD-10-CM/PCS implementation in its February 23 letter to HHS Secretary Kathleen Sebelius . Meanwhile, the...
Who knew St. Patrick’s Day was such a dangerous holiday? Take a look around the Fix ‘Em Up Clinic and see for yourself. First, we have Bobby, who was looking for a four-leaf clover. Unfortunately, he...
The Office of E-Health Standards and Services (OESS) announced a second delay in the enforcement of HIPAA 5010, CMS announced March 15 . OESS announced the first enforcement delay November 17, 2011...
ICD-10-CM is full of oddly specific codes for causes of injuries. Some of them are funny (I’m talking to you, W61.43, pecked by turkey) and others are so strange that most coders will probably never...
Special Edition MLN Matters article #SE1210 , “Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders,” outlines recovery auditor findings upon completion of medical necessity reviews. In the article, which addresses documentation and billing for inpatients, recovery auditors concluded that providers had been admitting patients even for clinical situations for which outpatient observation services would have been appropriate.
What should inpatient coders remember about the three-day payment window requirements? Although it may seem counterintuitive, Debbie Mackaman, RHIA, CHCO, and Marion G. Kruse, RN, MBA, explain that inpatient coders need to be aware of certain outpatient services that they may need to include on inpatient claims, as well as when they need to alert billers to assign condition code 51.
When a provider notes a diagnosis on the hospital-acquired condition (HAC) list, coders must be diligent about looking throughout the rest of the chart to ensure documentation clearly indicates the presence of a HAC. For example, if the condition is a pressure ulcer, the condition may have been present on admission. Shelia Bullock, RN, BSN, MBA, CCM, CCDS, and Beverly Cunningham, MS, RN, address the importance of coder participation as members of hospital HAC committees and the development of best practices to ensure accurate HAC and HCAC reporting.
Physicians use a lot of shortcuts and abbreviations. Some of them may even make it onto the official abbreviation list at their hospital. Some don’t. And even if they did, some physicians will use the wrong term. Robert S. Gold, MD, discusses an example that was featured in the January Medicare Quarterly Provider Compliance Newsletter regarding proper identification and ICD-9-CM coding of a bronchoscopy with biopsy (TBB) vs. a bronchoscopic lung biopsy (TBLB).
QUESTION: Recently, reviewers have denied diagnostic code 584.9 (acute renal failure [ARF]) based on lab values. The diagnosis is well documented and treated by the attending physician, but reviewers are stating the lab values do not support the diagnosis of ARF. The lab values (creatinine/blood urea nitrogen) went from normal to abnormal, and we found no definitive standards for lab parameters to meet the definition of ARF. Following coding guidelines for reporting secondary diagnoses, the ARF was clinically evaluated, the patient received therapeutic and diagnostic procedures, and there was an extended length of stay/increased nursing care. As coders, we feel it is inappropriate to question the physician’s clinical judgment, and reporting the ARF as a secondary diagnosis is correct. Based on the documentation in the record, is it appropriate to code the ARF?
The ICD-10-PCS defines root operations excision and resection in a very similar way. Excision is cutting out or off, without replacement, a portion of a body part. Coders should report the qualifier...
Coders use ICD-9-CM E codes to describe the accident, circumstance, event, or specific agent that caused a patient’s injury. In ICD-10-CM, these codes will not be prefaced with the letter ‘E,’ and...
Can you begin to imagine how complex a piece of great literature would be if we had to include complete documentation of each medical incident? Or have to stop every time we have to develop physician...
The January update to the Integrated Outpatient Code editor generally includes a large number of changes and the January 2012 update is no exception. Dave Fee, MBA, highlights the most significant changes including the addition of modifier –PD, which he calls one of the real sleepers in this release.
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
Otolaryngology coding covers a wide range of procedures and four parts of the respiratory system—the ears, nose, sinuses, and throat (ENT). Stephanie Ellis, RN, CPC, and Kim Pollock, RN, MBA, CPC, explore some common ENT coding trouble spots.
Some of the ICD-10-PCS root operations are very similar—think excision (cutting out or off, without replacement, a portion of a body part) and resection (cutting out or off, without replacement, all...
In honor of Dr. Seuss' birthday, we present: Oh, the ICD-10-CM codes you’ll find Hit by a truck? Bit by a duck? There’s an ICD-10-CM code for that. Liver contused? Wrong substance infused? There’s an...
I love the National Public Radio (NPR) program, "Wait, Wait, Don't Tell me" (WWDTM), a fun look a the news. The program features a panel of amusing well-knowns who answer questions and try to win a...
As technology evolves, providers can perform more procedures at the patient's bedside than they ever could in the past. Previously, they could only perform these procedures in another department of the hospital, and they had to charge separately for them.
Cross-training coders has definitive short-term advantages, such as enhancing staff coverage during holidays and vacations and increasing the department's ability to handle periods of fluctuation in certain bill types, but these aren't the only benefits.
The respiratory system, responsible for inspiration (carrying oxygen into the body) and expiration (the expulsion of carbon dioxide), is composed of two tracts: the upper respiratory tract and the lower respiratory tract.
As technology evolves, providers can perform more procedures at the patient's bedside than they ever could in the past. Previously, they could only perform these procedures in another department of the hospital, and they had to charge separately for them.
ICD-10 will allow coders to report nonspecific, unspecified, or not otherwise specified (NOS) codes, but experts say doing so will be counterproductive because of the specificity inherent in the new system.
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) is now included in the I/OCE, according to January updates detailed in Transmittal 2370 .
Knowing when and how to query for all conditions is crucial; this couldn't be truer for CCs and MCCs, conditions that affect payment and help capture a patient's true clinical picture and complexity.
Learn about physician queries, PACT underpayments, the effects of bad data on coding, NOS codes and ICD-10-CM, coder cross-training, and CMS' prepayment and rebilling demonstrations.
Q Addendum B of the APC updates for 2012 indicates the new molecular pathology codes have status indicator E (noncovered service, not paid under OPPS). Our laboratory director said we should report these new codes in addition to the codes that are payable. Can you explain why?
Coders who keep in mind the injuries that define multiple significant trauma are more likely to identify these cases and assign DRGs based on this classification when present. Joel Moorhead, MD, PhD, CPC, and Beverly (Cross) Selby, RHIT, CCS, examine what defines multiple significant trauma and discuss the coding guidelines for these sometimes complicated cases.
Robert S. Gold, MD, discusses updates to the code definitions and exclusions for various lung diseases, such as pulmonary insufficiency and respiratory failure, and cautions coders about the potential for over-reporting conditions that patients don't have or for identifying conditions that do not meet the intent of the codes.
QUESTION: Can a patient have encephalopathy after surgery? For example, a patient becomes confused post-surgery and is transferred from the medical-surgical floor to the intensive care unit, where he or she receives high doses of pain medication via IV. However, the patient recovers well and the confusion disappears after the IV fluids and reduction in pain medication and oxygen. Would it be appropriate to query the physician regarding encephalopathy and its possible cause, or would this be a red flag for auditors? The situation did extend the patient’s length of stay by one day.
Trailblazer Health Enterprises, LLC, the Medicare administrative contractor (MAC) for Jurisdiction 4 (i.e., Colorado, New Mexico, Oklahoma, and Texas) stated in a February 21 notice that about 68% of reviewed claims billed with MS-DRG 470 (joint replacement or reattachment of lower extremity without MCC) resulted in denials. The MAC cited missing or insufficient documentation as the reason for 96% of these denials.
Even if you didn’t make a personal New Year's resolution, you should make a professional one: to be more conscientious when scrutinizing physician documentation. Experts say every coder should scrutinize physician documentation, especially with ICD-10-CM/PCS looming on the horizon. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Dinh Nguyen examine the role coders play in determining diagnosis quality and accuracy.
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...
