The fall 2021 Leapfrog Hospital Safety Grade report has been released, assigning grades to 2,901 hospitals. The grades come from hospitals’ performance on over 30 evidence-based measures of patient safety. For the first time, a new grading factor for post-operative sepsis, blood leakage, and kidney injury were included in those measures.
Q: We recently had a patient with a history of diabetes admitted with gangrene of the left second toe. Can you review any guidance related to ICD-10-CM coding and documentation for a case like this?
Anneleah Williams-Bridges, MS, MBCA, RHIA, CCS, CCS-P, CCDS, RH-CBS, LIA, says that until recently, many organizations have solely used their coding and CDI resources to strengthen the capture of CCs/MCCs, severity of illness/risk of mortality scores, and MS-DRG validation; however, facilities that are not leveraging these teams for denials management and tracking denials as a key performance indicator should consider doing so.
Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, CEMC, MHP, writes that in order to ensure proper coding, documentation, and reimbursement, it’s great practice to have inpatient coding and CDI teams review querying procedures yearly. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding and CDI programs can take many approaches to manage denials, whether they focus on physician documentation education, have a team member dedicated to writing appeals, or anything in between.
Coding for conditions complicating pregnancy and delivery can be challenging, given the number of factors that influence maternal and fetal health. This article details ICD-10-CM coding for cervical incompetence, in vitro fertilization (IVF), and postpartum care complications.
We would fail to see ourselves completely if we didn’t consider external views as well, so for this article, we’ll be looking at CDI-focused works from the medical literature.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
The 2022 CPT code set includes 249 new codes that went into effect January 1. Review new CPT codes for spinal decompressions, cataract removals, auditory implantations, and more.
Most risk adjustment models use ICD-10-CM codes to identify patients who are considered “risky” by healthcare insurance companies. The process of risk adjustment is used to predict costs linked to care delivery and quality reporting, which is why thorough knowledge of risk adjustment is important for hospitals to ensure proper quality reporting.
Sarah A. Nehring, RHIT, CCS, CCDS , writes that with new COVID-19 codes coming in April 2022, now is a good time to review these updates as well as an ICD-10-CM code that was previously released in an April update: electronic cigarette, or vaping, product use-associated lung injury (EVALI). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We recently had a patient admitted after a vertebral body tether procedure for scoliosis. Were there any changes to the fiscal year 2022 ICD-10-PCS codes for procedures related to this?
The Office of Inspector General (OIG) recently released the 2021 version of its annual publication on unimplemented recommendations, which lists overpayments from incorrectly assigned severe malnutrition diagnosis codes as a top concern.
Many physicians are not entirely aware of the denials landscape and their involvement in it is often something that they never anticipated. Educating physicians on their role in coding denials is important as it will help ensure proper reimbursement. Part one of this two-part series discusses how to make time for proactive education.
Patient safety and quality of care are forerunning concerns for organizations today. Not only do we want to ensure our patients are receiving high-quality care, we want to ensure care is safe and effective. We need to examine how and when we evaluate that quality of care, however, in order to remain ethical and compliant.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Shelley C. Safian, PhD, RHIA, CCS-P, COC , breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
Tackling reporting errors early on is an essential component of denials management. Leyna Belcher, MSN, RN, CCDS, CCDS-O , describes strategies that coding and billing professionals can employ to reduce claim denials and increase the success rate of appeals.
Q: Effective January 1, CPT codes 94625 and 94626 will replace HCPCS code G0424 for pulmonary rehabilitation. Will these new CPT codes have the same reporting requirements as G0424?
Between January 2019 and August 2020, CMS overpaid physicians an estimated $9.5 million in unallowable Medicare payments associated with facet joint denervation procedures, according to a recent Office of Inspector General (OIG) report.
Inpatient coders and CDI specialists are usually familiar with ICD-10-CM coding for diabetes mellitus and Cushing’s syndrome. However, they may need a refresher on ICD-10-CM coding for less common endocrine disorders. This article breaks down endocrine anatomy and physiology, and ICD-10-CM coding for thyroid, parathyroid, adrenal, and pineal irregularities.
According to Deanne Wilk, BSN, RN, CCDS, CDIP, CCDS-O, CCS, patient safety and quality of care are forerunning concerns for organizations today, and hospitals need to examine how and when they evaluate that quality of care in order to remain ethical and compliant.
CMS and the Centers for Disease Control and Prevention recently released new ICD-10-CM/PCS codes related to vaccines and treatments for COVID-19. These new ICD-10-CM/PCS codes are effective April 1, 2022.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , writes that one diagnosis in particular that can take extra effort to understand is acute kidney injury (AKI). Frequently reviewing coding and CDI challenges related to AKI will ensure proper coding and reimbursement.
Sarah Nehring, RHIT, CCS, CCDS, says ICD-10-CM reporting for diabetes can be complex, that’s why it’s important for inpatient coders to regularly review reporting requirements for this diagnosis and associated complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders and CDI professionals should be active in the rule-making process for the IPPS, as their specific skills and knowledge can make a large impact on what appears in the final rule.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks CPT coding for breast biopsies, mastectomies, lymph node excisions, breast reconstructions, and other procedures used to prevent and treat breast cancer.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Effective January 1, CMS is expanding coverage for the use of telehealth technology to include the delivery of mental health services in underserved areas.
Due to the drug ivermectin’s uptick in misuse for treating COVID-19, Susan Belley, MEd, RHIA, CPHQ, reviews ICD-10-CM reporting for poisonings, adverse and toxic effects, and underdosing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Our facility has been seeing more denials lately for acute respiratory distress syndrome (ARDS), especially when both respiratory failure and ARDS are documented in the same record. How should ARDS be reported in ICD-10-CM, and which MS-DRG does this diagnosis group to?
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down acute respiratory distress syndrome (ARDS) and sepsis criteria and reviews documentation and querying for these diagnoses through a case study.
According to a recent audit performed by the Office of Inspector General (OIG), Coventry Health Care of Missouri Inc. received nearly half a million dollars in overpayments from 2014 through 2016 for incorrectly submitting diagnosis codes from high-risk groups.
All inpatient coding and CDI professionals, whether new to the field or industry veterans, should be familiar with the American Hospital Association’s Coding Clinic . This article reviews the steps to take and the importance of submitting coding questions.
CMS recently released the 2022 Medicare Physician Fee Schedule (MPFS) and OPPS final rules, revising E/M coding guidelines for split visit services, retaining Category 3 telehealth codes through 2023, and increasing monetary penalties for hospital price transparency noncompliance.
Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for mammography, breast ultrasound, and breast magnetic resonance imaging for cancer screening and diagnosis.
Four new CPT codes for principal care management services take effect January 1, 2022. Review documentation requirements and billing edits that will affect reporting of these new codes.
Read up on documentation requirements and CPT coding for psychiatric diagnostic evaluations and psychotherapy services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
