The Office of the Inspector General (OIG) stated in its recent publication, “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm,” that a series of reports examining adverse events in hospitals shows that for the hospitals it surveyed, the incident reporting systems only tracked approximately 14% of incidents.
Times are changing, and, most likely, so are the jobs of your health information management (HIM) staff members. In some cases, there's a sudden addition of responsibilities, such as the implementation of the recovery audit contractor program. In other cases, the increased use of technology triggers a shift. If these changes aren't managed appropriately, you may end up with declines in performance, careless errors, low productivity, or diminished quality. Elizabeth Layman, PhD, RHIA, CCS, FAHIMA, shares her approach to HIM department and job restructuring.
The goals of coding should always be ensuring data accuracy and capturing a patient's true clinical picture. Knowing the intent of an ICD-9-CM code is crucial. However, coding guidelines and official coding guidance sometimes conflict with these goals, putting coders between a rock and a hard place. Robert S. Gold, MD, examines cardiomyopathy, a disease that affects the heart muscle, as an example of a diagnosis that is frequently misreported due to inaccurate guidance.
Computer-assisted coding (CAC) is a hot topic these days. Many industry experts claim that CAC is the wave of the future—that its accuracy has been proven, and that humans cannot match its productivity. With CAC, elements such as fatigue, stress, and inexperience are no longer factors that can negatively affect code assignment. Many articles and vendors sing its praises. However, is it really all that? Robert S. Gold, MD, and Lori Cushing, RHIT, CCS, discuss some relevant concepts.
While working on various projects related to ICD-10-PCS, I have discovered many areas where I think coders are going to struggle because the rules either go against the way we code now in ICD-9-CM...
The ultimate goal of fetal surveillance is to prevent fetal death. Part of this process is a fetal non-stress test (FNST), the monitoring of the fetal heart rate in response to fetal movement. Lori-Lynne A. Webb, CHDA, CCS-P, CCP, CPC, COBGC, details what the FNST includes and how to code for it.
The AMA added a total of 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. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, and Christi Sarasin, CCS, CCDS, CPC-H, FCS, highlight the significant changes for 2012.
QUESTION: The 2012 CPT ® Manual includes the typical time physicians spend at the bedside and on the patient’s hospital floor or unit for initial observation care codes 99218, 99219, and 99220. Do these codes only apply when the counseling and/or coordination of care support the respective 30/50/70 minutes of time? Do you know if CMS has published any new guidelines related to these times?
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator procedures at the standardized inpatient rate as part of the calendar year 2012 Outpatient Prospective Payment System final rule. In addition, CMS finalized several changes regarding payments for 11 cancer centers, drug payment calculations, and physician supervision. Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, explain the changes facilities will see in 2012.
CMS added four new J codes for reporting drugs and biologicals that previously did not have specific codes available as part of the 2012 Outpatient Prospective Payment System updates ( Transmittal 2376 ).
The 2012 ICD-10-CM updates include significant narrative changes for primary malignant neoplasms overlapping site boundaries and malignant neoplasm of ectopic tissue, as well as smaller narrative...
When Jim Brown, FHFMA, RHIA, CCS, started working at Jefferson Regional Medical Center in early November 2010, he quickly realized that there were a number of opportunities to improve their health information management operations and efficiencies. In this article, Brown shares strategies and tips for how he and his management team were able to identify areas that needed improvement and reduce department expenses and come in 9.5% ($149K) under budget for the end of fiscal year 2011.
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS finalized for fiscal year (FY) 2012. However, it’s critical that providers also examine how these changes directly affect MS-DRG assignment. Robert Gold, MD, examines a number of these changes, including MS-DRG assignment related to cardiac-specific comorbidities, autologous bone marrow transplants, excisional debridement, and thoracic aneurysm repair.
QUESTION: A patient had an aneurysm at arteriovenous (AV) fistula, and the physician excluded the aneurysm between two clamps, ends oversewn, and excised the aneurysm. The physician used a tunneler to tunnel an 8 mm Flixine graft from the arterial to the venous side, and two end-to-side anastomoses were then performed at the vein and arterial end. Should we report code 39.42 (revision of AV shunt for renal dialysis) with code 38.63 (other excision of vessel), or code 38.43 (resection of vessel with replacement), or another code(s)?
Medicare Advantage plans rely on the Hierarchical Condition Categories (HCC) system for reimbursement. HCC payments are linked to the individual health risk profiles for the members in the plan. MA Plans use ICD-9-CM codes as the primary indicators of each member’s health status. Therefore, it is essential for MA plans to make sure that providers capture the complete diagnostic profile of patients through accurate and complete physician coding. Holly J. Cassano, CPC, explains why coders need to have a complete understanding of the HCC process and risk adjustment, as well as the effects on the provider, the member, the MA plan, and overall reimbursement.
Although the New Year marked the deadline for Version 5010 compliance, CMS recently reminded providers that it will not exercise enforcement until April 1, 2012. Despite the 90-day discretionary period, CMS urged providers that they should complete the transition to Version 5010 as soon as possible. This extension will not have any effect on the implementation date for ICD-10-CM/PCS, which remains set for October 1, 2013.
In this month's issue, you will find in-depth anaylsis of the OPPS Final Rule and a discussion on how to properly set charges to avoid payment reductions. In addition, we continue our occassional series of ICD-10 anatomy refreshers with the eye and our experts answer your coding questions.
Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator (CRT-D) procedures at the standardized inpatient rate. The agency announced its decision as part of the CY 2012 OPPS final rule released November 1, 2011.
Our coding experts answer your questions about determining ED visit level, coding open reduction and internal fixation of a radius fracture, and coding image-guided minimally invasive lumbar decompression.
Learn about CMS' bundled payment initiative, computer-assisted coding, the need to scrutinize physician documentation, and new Medicaid rules, and save the Briefings on Coding Compliance Strategies 2011 Index for future reference.
Removal sounds like it should be an easy root operation in ICD-10-PCS. Removal means taking something out, right? Physicians remove things all the time—your appendix, a cyst, the toy your son stuck...
When a physician frees a body part from an abnormal physical constraint by cutting or by use of force, coders will use the root operation release (N) in ICD-10-PCS. Keep in mind, though, that you...
The Medicare Code Editor (MCE) is software that detects and reports errors in the coding on claims that are submitted for payment. All Part A inpatient discharges and transfers pass through the MCE...
In ICD-10-PCS, coders assign the root operation bypass (third character 1) when the surgeon’s objective in the procedure is to reroute the contents of a tubular body part. Bypass procedures includes...
In the medical and surgical section of ICD-10-PCS, character 5 refers to the approach or method used to reach or expose a body part during a procedure. As a result, coders will need to look for...
CMS recently posted a file that identified duplicate codes within the ICD-9-CM and ICD-10-CM systems. The list isn’t terribly extensive, but in this atmosphere of transitioning from one system to the...
Looking for the 2012 ICD-10-CM code updates? Want to see what's included in the final regular update before implementation? Check the CMS’ ICD-10-CM and GEMS website. CMS posted the 2012 ICD-10-CM:...
Get ready to say goodbye to Coding Clinic for ICD-9 , and hello to Coding Clinic for ICD-10 . The AHA will cease publication of its ICD-9 guidance, but is already planning for an ICD-10-CM/PCS...
For those who work in environments where codes from category V57 (care involving use of rehabilitation procedures) are a staple, you be surprised to learn that when it comes to ICD-10-CM, all V57...
Late effects are considered to be the residual effects after the acute phase of an illness, disease, or injury. Typically, late effects are considered chronic conditions and can result from the...
CMS’ Office of E-Health Standards and Services (OESS) won’t enforce compliance with the HIPAA 5010 transaction set until March 31, 2012, the agency announced November 17 . The 90-day delay will not...
The American Medical Association (AMA) House of Delegates voted to “work vigorously to stop implementation of ICD-10” during the closing session of its semi-annual policy-making meeting November 15...
Coders are sharpening their knowledge of anatomy and physiology and honing their ICD-10-CM/PCS skills. The HIM department is getting ready for the transition, but did you remember to explain it to...
I had the opportunity to attend the American Health Information Management Association convention this year in Salt Lake City, and I helped work in HCPro's exhibitor booth. As a former HIM director...
Will the new ICD-10-CM concept of using seventh character code extensions to identify initial encounters vs. subsequent encounters cause additional confusion in relation to professional services, for...
Representatives from the American Hospital Association (AHA), the American Health Information Management Association, and the Centers for Disease Control and Prevention will discuss ICD-10...
As I continue to learn more and work with ICD-10-PCS codes, I find myself questioning the ancillary service codes in ICD-10-PCS. In my experience as an inpatient facility coder, I know that there are...
Coders will use the root operation division when the physician plans to cut into, transect, or otherwise separate all or a portion of a body part. Do not use division if the physician plans to cut or...
2013 is right around the corner. Learn how to kick start your hospital-wide ICD-10 educational plans. During this live 90–minute audio conference, our expert speakers will walk you through two...
As an AHIMA ICD-10 certified trainer, I have been doing a lot of work on various ICD-10 projects. When it comes to working with the new coding system, I find myself wondering whether the first ICD-10...
Coders should focus on chest pain, among other areas, as part of a larger review of ICD-9-CM codes and in preparing for ICD-10-CM. Coding chest pain in ICD-9-CM requires the physician to document the...
5010. That’s the cool way of saying Version 5010 of the Accredited Standards Committee (ASC) X12. It is the next version of the HIPAA electronic transaction standards that providers and all HIPAA...
Coders will find they need more information to select the appropriate code in chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue [M00–M99]) of the ICD-10-CM Manual. Most of the...
Over the summer, I was in the process of going through the American Health Information Management Association Academy for ICD-10-CM for trainers. I had completed the online, self-paced part of the...
Another new term coders will need to know for ICD-10-PCS root operations is fragmentation. Fragmentation is breaking solid matter in the body into pieces. Note that in a fragmentation procedure, the...
When should a coder report multiple procedures performed during a single operative session in ICD-10-PCS? Look to the official guidelines for information. According to the guidelines, coders should...
