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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Coding managers use risk assessments to measure their level of compliance with laws, regulations, and internal policies and procedures. Learn about the steps involved in E/M risk assessments and practices used to address E/M coding and billing errors.
The Food and Drug Administration (FDA) recently issued an emergency use authorization (EUA) for the combination treatment of bamlanivimab and etesevimab for COVID-19 patients at high risk for severe infection.
A vaginal cuff tear, also known as vaginal cuff dehiscence, is a severe complication of a hysterectomy . Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, writes about CPT coding for transvaginal and laparoscopic vaginal cuff repairs.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, RHIA, says inpatient coding professionals need to look for signs and symptoms supportive of sepsis in order to report the most accurate codes, which is why staying up to date on the ever-changing clinical criteria for sepsis is so important.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM reporting of sequelae generally requires two codes, but the codes assigned and the sequencing depend on whether the sequela is from a cerebrovascular accident, a traumatic injury, or an infection such as COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS is modifying its approach for presenting new technology add-on-payment-related ICD-10-PCS code requests that involve the administration of therapeutic agents for its March 9-10, 2021 ICD-10 Coordination and Maintenance Committee meeting.
Q: We are confused about which body part value in ICD-10-PCS should be captured for an incision and drainage (I&D) of a perianal abscess of the left buttocks because the physician documented both “perianal” and “left buttocks.”
ICD-10-CM reporting for genitourinary conditions requires careful attention to detail as many codes in this section of the manual are for conditions that involve multiple body structures and that present with a variety of symptoms.
Podiatrists are doctors devoted to the health and wellbeing of the feet, ankles, and lower extremities. Review common ICD-10-CM and CPT codes reported by podiatrists in facility settings.
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. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In its February MLN Connects newsletter, CMS reminds providers that HCPCS add-on code G2211 for visit complexity is a bundled service under the Medicare Physician Fee Schedule, meaning the application of this code will not result in additional payment for a billed E/M visit service.
Hospitals across the country marked the start of the new year by posting new and more detailed price information online. With the Hospital Price Transparency final rule, which became effective January 1, 2021, CMS completed the most ambitious chapter in its ongoing price transparency efforts.
Review clinical indicators and query opportunities for acute respiratory failure, respiratory failure due to surgical procedures, and ventilator MS-DRGs. Frequently reviewing clinical indicators for these complicated diagnoses will ensure both proper coding and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: When two conditions are both present on admission, both meet definition to be the principal diagnosis (PDX), and are “equally treated,” my understanding is that the condition does not have to be "equally treated" in the sense of duration/frequency. Can you provide the actual verbiage of the coding rule and explain?
Howard Rodenberg, MD, MPH, CCDS , writes that ensuring the social determinants of health are appropriately documented within the medical record allows CDI and coding teams to capture the hard data needed to demonstrate the interactions among race, gender, ethnicity, and other key socioeconomic indicators with healthcare costs, utilization, and outcomes.
Inpatient coding professionals must have a clinical understanding of COVID-19 and the disease process in order to accurately sequence diagnoses, code etiology and manifestations, and assign present on admission (POA) indicators. In this article, Audrey Howard, RHIA , and Susan Belley, RHIA, CPHQ, focus on coding issues related to POA indicators for the hospitalized, inpatient COVID-19 population.
The Office of Inspector General (OIG) recently released an audit report for Providence Medical Center that says some of the hospital’s inpatient records did not support the medical necessity for inpatient hospital services.
Malnutrition is notorious for its impact on hospital reimbursement. For example, in 2018 the Office of Inspector General (OIG) conducted an internal audit of the University of Wisconsin Hospitals and Clinics Authority. The audit revealed an overpayment of $9,569,586 for the billing of malnutrition.
Review coronary anatomy and CPT coding for aortic and iliac repairs, as well as selective procedures used to treat vascular occlusions in the lower extremities.
