Organizations may opt to measure productivity using several methods, such as number of charts coded per day or per month, based on their needs, service lines, and other considerations. Some organizations use different productivity metrics for specific settings or account types.
The American Medical Association (AMA) recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old.
Chapter 19 of ICD-10-CM includes codes for various types of injuries, poisonings, and other consequences of external causes. Review integumentary anatomy and ICD-10-CM coding for burns and superficial injuries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What is the difference between anterior and posterior approaches to spinal surgery, and when might a physician use a combined (anterior and posterior) approach?
State and federal prosecutors continue to extract sizable settlements from practices that allegedly submitted fraudulent claims for one type of service—urine drug tests (UDT). In this article, Julia Kyles, CPC , breaks down fraudulent coding and billing patterns for UDT services.
The 2022 ICD-10-CM manual includes new codes for thrombotic microangiopathy (TMA)—a rare clinical syndrome defined by the presence of hemolytic anemia, organ dysfunction, and low platelets. Read up on TMA pathophysiology and diagnosis coding.
One of the biggest components of a leader’s role is to track, trend, and report on the department’s performance. Learn strategies for balancing priorities and time constraints and presenting key performance indicators to leadership.
The Office of the Inspector General (OIG) recently announced it will conduct statewide reviews to determine whether hospitals complied with Medicaid billing requirements when assigning severe malnutrition diagnosis codes to inpatient hospital claims.
Q: Our coding team has been having trouble understanding how to correctly report diabetes mellitus (DM) “with” other conditions in ICD-10-CM. Can you provide some guidance on this issue?
Due to the complex nature of sepsis, some cases require querying the provider prior to assigning ICD-10-CM/PCS codes. Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , breaks down inpatient coding and querying for sepsis.
Computer-assisted coding (CAC) technology analyzes healthcare documentation and selects codes based on specific phrases and terms. Review the pros and cons of using this software to perform inpatient coding and billing functions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The CMS hierarchical condition category (CMS-HCC) methodology recognizes specific combinations of diseases as well as the effect of disease processes as related to different settings of care. These metrics are important to understand in order to ensure proper reimbursement, even within the inpatient coding and CDI sector.
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 ICD-10-CM documentation requirements for traumatic fractures to resolve the coding challenges.
CMS recently issued a new HCPCS code for the antiviral medication remdesivir when administered in the outpatient setting. The new code is a response to a statement from the National Institutes of Health regarding therapies for the COVID-19 omicron variant.
Review new CPT codes 98975-98981 for the monitoring of non-physiologic patient data such as musculoskeletal system status, respiratory system status, and medication adherence.
Coding for spinal diagnoses requires careful attention to detail. Take time to review spinal anatomy and ICD-10-CM coding for common diseases of the spinal column and paravertebral tissues. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
CMS recently released two ICD-10-PCS codes, effective April 1, to describe the introduction or infusion of therapeutics, including vaccines for COVID-19 treatment.
Q: I’ve been told that if there are clinical indicators to support that chronic kidney disease (CKD) is the etiology of a patient’s hypertension, an ICD-10-CM code from category I15.- (secondary hypertension) would be assigned. Since codes from category I12.- (hypertensive chronic kidney disease) also capture CKD with hypertension, what is the best code category to be reporting from?
ACDIS and AHIMA recently released a position paper detailing CDI technology standards. The paper covers information on the variety of technology solutions currently available, strategies to assess compliance with CDI and coding practice guidelines, and methods for creating synergy between CDI and coding departments and novel technology solutions.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes that it’s not unusual for an outpatient coder to advance their career by diving into inpatient coding. When deciding to learn about ICD-10-PCS, it’s important to first understand the basics and compare and contrast ICD-10-PCS and CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Inpatient coders know that clinical indicators for certain conditions frequently require greater completeness or specificity in ICD-10-CM for which a concurrent or retrospective query is often required. This article will review clinical indicators and query opportunities for common respiratory conditions such as pneumonia, respiratory failure, and asthma.
One of the biggest components of a leader’s role is to track, trend, and report on the department’s performance. Key performance indicators can range in complexity depending on the needs of the organization, but all are imperative for proving the success of a CDI or coding program.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for subsequent hospital visits and services provided on the day of discharge from inpatient status.
Review documentation requirements and CPT coding for radiology services including computed tomography and x-ray scans, breast mammography, and bone length studies.
Fundamentally, what makes outpatient CDI different from inpatient CDI? A multitude of similarities exist between inpatient CDI basics and reviews, but outpatient CDI has many different areas of opportunity.
Our experts answer questions about CPT coding catheterizations for congenital heart defects, the difference between approaches for spinal surgeries, and more.
Review documentation requirements and CPT coding for radiology services including computed tomography and x-ray scans, breast mammography, and bone length studies. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders continue to be in high demand, and given the importance of this function, evaluating coders’ performance is an essential task for revenue integrity. In this article, Lawrence A. Allen, MBA, CPC, CPMA, CEMA , makes the case for reevaluating coding performance.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include a new code for a third dose of Pfizer’s COVID-19 vaccine in children 5 through 11 years old.
Selecting the most specific E/M code for a physician-patient encounter can be tricky. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down facility documentation and E/M coding for office visits and initial hospital care.
Departmental silos are prevalent in the healthcare world and can lead to unvoiced frustrations and counterproductive work. This article reviews how different organizations have various approaches to breaking down these walls.
Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM, says that when reporting sepsis in ICD-10-CM, it’s important that evidence of sepsis is found throughout the body of a patient’s medical record. A clinical validity query may be necessary if the provider confirms the diagnosis of sepsis, but clinical evidence is lacking in the documentation.
The Centers for Disease Control and Prevention (CDC) recently released multiple addenda with new tabular and index instructions and updates to the ICD-10-CM Official Guidelines for Coding and Reporting to complement the updated ICD-10-CM code set to become effective April 1.
Q: If a physician documents a patient as HIV positive, should the ICD-10-CM code Z21 be reported? What about if they document the patient is HIV positive with an HIV-related illness—would that be reported with ICD-10-CM code B20?
Susan Belley, M.Ed., RHIA, CPHQ, and Audrey Howard, RHIA, write that a majority of inpatients during this omicron surge are admitted for reasons other than COVID-19 and are incidentally found to be COVID-19-positive—making this an opportune time to review ICD-10-CM reporting for COVID-19 as a secondary diagnosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medical practices in the U.S. are expanding treatment options for major depressive disorder to include transcranial magnetic stimulation (TMS). Laurie Bouzarelos, MHA, CPC, reviews the basics of TMS, types of providers who can deliver TMS, and ICD-10-CM/CPT coding for TMS delivery and management.
CMS recently released the 2022 National Correct Coding Initiative Policy Manual for Medicare Services . Julia Kyles, CPC , breaks down procedure-to-procedure and medically unlikely edits for a selection of new provider-based services.
Between 2016 and 2019, Medicare payments to laboratories for genetic tests quadrupled from $351 million to $1.41 billion. This sharp increase in spending on genetic testing is likely linked to excessive and fraudulent billing, according to a recent Office of Inspector General (OIG) report.
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.
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.
Many physicians are not entirely aware of the denials landscape and their involvement in it is often something they never anticipated. Educating physicians on their role in coding denials is important as it will help ensure proper reimbursement. Part two of this two-part series discusses involving physicians in administrative law judge appeals and monitoring success rates.
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?
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.
