About 1% of children in the U.S. suffer from chronic malnutrition, according to John Hopkin’s Medicine. In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, breaks down ICD-10-CM coding and documentation requirements for malnutrition.
Allen Frady, RN, BSN, CCS, CRC, CCDS, describes steps that coding and clinical documentation integrity managers can take to improve quality metrics and hold staff accountable for reporting errors.
Billing for high-level inpatient stays increased over a six-year period sparking concerns by the government about upcoding, according to a recent report from the Office of Inspector General (OIG).
Cheryl Manchenton, RN, BSN, Beth Wolf, MD, CCDS, CPC, and Audrey Howard, RHIA, review ICD-10-CM coding for cytokine release syndrome, sepsis, and multisystem inflammatory syndrome. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2x4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)?
Medicare auditors have identified failure to document time as a key flaw in claims for advance care planning (ACP), and the Office of Inspector General plans to conduct an audit of these services. Read up on documentation requirements and CPT coding for ACP to prevent claim denials.
Physician and non-physician practitioners may benefit from reviewing documentation requirements and HCPCS Level II codes for knee orthoses, according to a recent Medicare Quarterly Compliance Newsletter .
Approximately 34.2 million Americans, or 10.5% of the U.S. population, were diagnosed with diabetes in 2018, according to the Centers for Disease Control and Prevention. Review signs and symptoms of diabetes mellitus types 1 and 2 and ICD-10-CM coding for these conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Corneal dystrophies are a group of genetic, often progressive, eye disorders that alter functioning of the cornea. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for corneal dystrophies and CPT coding for procedures used to treat them.
Regular monitoring and internal auditing are critical to ensure compliance throughout the revenue cycle and protect revenue integrity. Consider the different strategies that can be applied to documentation and chart audits, coding audits, and more.
The most impactful overhaul to the E/M coding and documentation guidelines in 25 years went live January 1. The updated guidelines eliminate medical history and physical examination as required elements for reporting E/M codes 99202-99215. E/M coding for outpatient visits is now based on documentation of medical decision-making (MDM) or time spent on the encounter.
Let’s face it: Our organizations are under tremendous scrutiny. As the healthcare dollar shrinks, all payers strive to minimize patient care expenses to maintain profit margins.
It’s common to see CDI job listings that require applicants to be registered nurses. Often an RN credential is not listed as being “preferred,” but required. There are risks, however, with only seeking candidates from this one background.
Ischemic heart disease has a multifactorial etiology and can be prevented from developing in populations primordially and in individuals at high risk by primary prevention.
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures.
Strokes are complicated, which is why it is important for inpatient coders to be familiar with the brain’s anatomy and the clinical concepts of a stroke in order to report the most accurate ICD-10-CM codes.
The American Medical Association’s (AMA) CPT Editorial Panel at its February meeting approved technical corrections to the E/M coding guidelines for outpatient visits. The corrections were uploaded to the AMA website on March 9 and go into effect retroactively from January 1.
Refresh your knowledge of dysphagia, esophagitis, gastroesophageal reflux disease, and Barrett’s esophagus, and review guidance for reporting these conditions in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The mid-revenue cycle is rife with possibilities to lose earned, appropriate revenue. Learn how to identify common weaknesses and deploy coding and technology to avoid revenue loss.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, CCDS-O , analyzes complex E/M coding guidance for selecting an outpatient visit level on the basis of medical decision-making (MDM).
Q: We have a patient admitted for COVID-19 who is now showing signs of cytokine release syndrome (CRS). Can you give our team more information on symptoms or clinical indicators for CRS as well as any ICD-10-CM coding advice?
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM codes for immunodeficiencies are CCs for inpatient admissions and can impact severity of illness and risk of mortality calculations, which is why they are important for coders to frequently review. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In part one of this two-part series, Allen Frady, RN, BSN, CCS, CRC, CCDS, gives tips to CDI and coding teams on how to help improve healthcare quality scores by reviewing CMS star rating calculations, department challenges, physician education, and more.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and the rules governing their assignment in order to ensure proper reimbursement. Part two of this two-part series will review HACs in particular as part one focused on present on admission indicators.
COVID-19 patients who were hospitalized as inpatients cost significantly more than those treated in an outpatient setting, according to data from the Blue Cross and Blue Shield Association.
Supporting accurate Hierarchical Condition Category (HCC) capture is essential to success under the growing number of risk-adjusted payment models. With their strong knowledge of coding and documentation guidelines and insight into emerging trends, coders are a key part of that strategy.
CMS recently added six codes to the list of services that may be reported with HCPCS modifier -CS (cost-sharing), which requires Medicare to cover beneficiary cost-sharing during office visits and other encounters for the duration of the COVID-19 public health emergency.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, CCDS-O, analyzes confusing E/M guidelines for time-based visits and prolonged services provided before or after a face-to face encounter.
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to a study recently published in the Journal of Clinical Endocrinology & Metabolism , 55% of Black patients with both COVID-19 and Type 1 diabetes also presented with diabetic ketoacidosis.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, says with recent audit activity and the Office of Inspector General’s continued scrutiny of malnutrition diagnoses, it’s important to dig into the coding and documentation requirements for this tricky diagnosis, particularly in the case of COVID-19 patients.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and present on admission (POA) indicators and the rules governing their assignment in order to ensure proper reimbursement. Part one of a two-part series will review POA indicators in particular.
Q: We had a patient admitted with a negative COVID-19 test, but after being retested the patient had a positive COVID-19 result. Should we query the provider whether COVID-19 was POA?
Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ , write that since acute respiratory distress syndrome (ARDS) is included as a common respiratory manifestation of COVID-19 in the ICD-10-CM Official Guidelines for Coding and Reporting , it is essential to understand the syndrome for accurate and complete inpatient reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Arthroscopic surgical procedures involve the insertion of a small scope into the interior of a joint, allowing the physician to view the joint without making a large incision through the skin. Review CPT coding for arthroscopic procedures of the hip and knee joints.
CPT neurology codes describe advanced techniques to evaluate and treat conditions of the brain, spinal cord, and nerves. This article details CPT coding for three procedural services used to assess neurological symptoms: electroencephalogram, electromyography, and auditory-evoked potentials testing.
Though the adoption of outpatient CDI has been growing steadily over the years, it’s not always easy to prove the return on investment for such efforts.
Our coding experts answer questions about CPT documentation and coding for psychotherapy services, ICD-10-CM reporting for knee injuries, conducting chargemaster audits, and more.
In 2005, the International Pediatric Sepsis Consensus Conference published definitions for sepsis, severe sepsis, and septic shock. Sepsis among children is defined as systemic inflammatory response syndrome (SIRS) associated with suspected or proven infection.
Facilities that are not leveraging CDI efforts for denials management and tracking denials as a key performance indicator (KPI) should consider doing so. Denials are the framework for identifying gaps in provider documentation and are a surefire approach to tailoring physician education that is meaningful.
Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. It’s more important than ever as the COVID-19 pandemic continues to drain hospital resources, but with HIM departments already stretched thin, it’s also more difficult than ever.
