During CMS’ two-day Coordination and Maintenance Committee meeting March 5 and 6, various stakeholders presented ICD-10-PCS proposals for consideration for future ICD-10-PCS code updates.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, reviews the clinical validation of acute congestive heart failure (CHF) exacerbation and shares his hospital’s coding and documentation strategy to help in appeal battles.
Adriane Martin, DO, FACOS, CCDS, details the updates found in the 2019 ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice” and writes that thorough knowledge of query guidelines is essential for inpatient coders and staying abreast of these guideline updates is crucial.
The second day of the ICD-10 Coordination and Maintenance Committee meeting, led by CMS and the Centers for Disease Control and Prevention’s National Center for Health Statistics, on March 5-6 focused largely on proposed ICD-10-CM code changes for mental health and musculoskeletal conditions.
CMS recently published One Time Notification Transmittal 2259 and MLN Matters 11168 , which outline changes to the processing of NCCI procedure-to-procedure edits associated with modifiers -59 and -X{EPSU}. Read about these updates and how they will impact CPT coding and for select surgical procedures.
According to the U.S. Department of Health and Human Services, endometriosis affects 11% of women between the ages of 15 and 44. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about diagnosing and treating endometriosis as well as ICD-10-CM and CPT coding for the condition.
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. Review expert advice on accurate documentation and coding for outpatient ED visits and for developing detailed E/M guidelines. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laurie L. Prescott, MSN, RN, CCDS, CDIP , details the basics of ICD-10-CM/PCS for newer inpatient coders including a review of the ICD-10-CM seventh-character extension, placeholder use, and ICD-10-PCS root operations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We had a patient with hemorrhagic cystitis. Our preprocedural plan was a cystoscopy with a bladder biopsy and cauterization. How should this be reported in ICD-10-PCS? We are having trouble choosing between Control or another root operation, and we are getting different MS-DRGs depending how the procedure is reported.
A recent study showed that CMS’ Hospital Readmissions Reduction Program (HRRP) may be causing an increase in the 30-day mortality rate for certain conditions. Now, a second study published by Health Affairs claims that the reductions in readmission rates are themselves “illusory or overstated.”
The benefits outweigh the difficulties when it comes to retrospective reviews. How do you get started with this new venture? Like many aspects of CDI, there are many ways to approach the problem. This article details these approaches, including how to enhance coder and CDI collaboration for these reviews.
Not many clinical conditions cause more consternation for inpatient coders and CDI specialists than acute and chronic respiratory failure. In this article, William E. Haik, MD, FCCP, CDIP, details acute and chronic respiratory failure and the critical elements in the health record that validate their reporting.
If we look at each element of a coding audit, we can see the benefits these coding reviews provide. Every healthcare organization and hospital should invest in routine, internal coding audits. The alternative is waiting until the payer conducts an audit, denies a claim, and incurs costs for the organization.
Coding for knee arthroscopies can be challenging, especially when procedures are performed in multiple compartments of the same knee. Read about anatomy and coding details required to accurately report these procedures.
Many outpatient CDI professionals stepped into their roles blind—not knowing where to begin or how to tell if they were successful. However, as programs mature, they need to be able to track their progress for a number of reasons, including focusing physician education and justifying continued funding from organizational leadership.
In the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status
As an inherited blood disorder, sickle cell disease is passed from parent to child. Children with sickle cell disease often have two defective hemoglobin S genes , one from each parent. However, various forms of sickle cell disorder also occur when a person inherits one hemoglobin S gene (sickle cell gene) from one parent and a different type (other than the S type) of defective hemoglobin gene from the other parent. All of these forms have distinct ICD-10-CM diagnosis codes, making reporting complex.
In 2013 the “ Guidelines for Achieving a Compliant Query Practice ,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. Since that time this brief has been updated twice: once in 2016 and most recently in 2019 .
Consider the story of a patient—say, a pneumonia patient—whose treatment cost a lot of money. The hospital’s reimbursement for that care, however, was less than the cost of providing it. Now say someone looked at that case and how complex it was, and then saw that the reimbursement only paid for half the cost of caring for that patient. That’s how CDI was born.
CMS recently released Transmittal 4246 , revising language in Chapter 13 of the Medicare Claims Processing Manual regarding the billing of E/M codes on the same date of service as superficial radiation treatment delivery.
CMS added new guidance to the CPT Manual to clarify imaging documentation for codes that include both procedural and imaging guidance. This article outlines these regulatory changes and implications for outpatient coders and providers.
Prostate cancer is the second most common form of cancer in American men, according to the American Cancer Society. Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I , writes about CPT coding for rectal exams and a new prostate specific antigen (PSA) immunoassay test used to detect early indications of prostate cancer, as well as ICD-10-CM codes used to support medical necessity for these services.
Outpatient coders and billers must be able to interpret potentially confusing documentation elements for drug administration services and know what to do when key elements, such as infusion time, are missing from an order. Review CMS guidance on the accurate reporting and billing of intravenous drug administration services for calendar year 2019. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently released an MLN Matters article to inform hospitals and Medicare Administrator Contractors of new system changes, effective July 1, that ensure organ acquisition costs are not included in the IPPS payment calculation for claims that group to a non-transplant MS-DRG.
CDI professionals can improve documentation and data scores via a mortality review process. This article discusses the various types of mortality reviews and publicly reported data and gives tips on how to implement a successful mortality review process.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, explains that reporting sepsis has long been a challenge for many coders even with the continual release of Coding Clinics and guideline revisions. In this article, Rivet reviews common coding traps for this condition including reporting urosepsis, severe sepsis, and sepsis on admission.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, reviews ICD-10-CM/PCS cardiac coding for American Heart Month and writes that since accurate coding improves data quality for these conditions, which in turn is used for statistics and tracking trends, ensuring the disease process is captured correctly is imperative. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Hospital Association (AHA) and the U.S. Department of Health and Human Services (HHS) recently issued court-ordered briefs in which each defends its respective position in a federal 340B payment lawsuit. The case was brought against HHS by multiple hospital groups to reverse Medicare payment cuts for drugs purchased through CMS' 340B drug discount program.
Arthroscopic procedures allow surgeons to use minimally invasive arthroscopic techniques to treat conditions which previously required more intensive, open surgery. Learn about orthopedic anatomy and terminology and CPT guidelines for reporting arthroscopic hip and knee procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A physician performs a hemiarthroplasty for a hip fracture. Would this procedure be reported with CPT code 27125 (hemiarthroplasty, hip, partial [e.g., femoral stem prosthesis, bipolar arthroplasty])?
Review advice from experts on accurate documentation and CPT coding for chronic care management, knee injection services, and health and behavior assessments.
Using financial penalties to reduce hospital readmissions has been linked to a significant rise in post-discharge mortality for patients with heart failure and pneumonia, according to a recent study by the Journal of the American Medical Association.
Q: What is the difference between ICD-10-CM code I24.8 (other forms of acute ischemic heart disease) and code I21.A1 (myocardial infarction type 2)? In which situation would each of these codes be reported?
Julian Everett, BSN, RN, CDIP, details her experience reviewing pediatric mortality cases for the first time and gives tips on how the different revenue cycle departments can work together to improve their processes and outcomes.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, reviews Coding Clinic , Fourth Quarter 2018, advice surrounding body mass index reporting and how new advice conflicts with previous guidance. McCall also reviews payment methodologies and the official guideline updates for this condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Denise Wilson, RN, MS, RRT, and Karla Hiravi, RN, BSN, explore why coding and clinical denials for acute kidney injury (AKI) and acute tubular necrosis (ATN) are different and the importance of different appeal strategies.
It’s time to take down the lights and pack up the wrapping paper and bows until next year. What else is it time to do? It’s time to look at the 2018 Third and Fourth Quarter Coding Clinic advice to make sure it’s not overlooked as the new year comes into full swing. This article, although not a complete summary, will review Coding Clinic advice as it pertains to coding guidelines, impact on severity, and/or MS-DRG assignment.
Alzheimer’s disease is the most common form of dementia, with symptoms that include problems with memory, thinking, and behavior. Understanding Alzheimer’s disease and its symptoms is important to coders, as some of the entries in the ICD-10-CM Alphabetic Index can be confusing.
Pay close attention to new CPT documentation and coding guidance for reporting radiological imaging. For example, a new paragraph titled “Imaging Guidance” in both the surgery and medicine guidelines advises that even when imaging guidance or supervision are included in a surgical procedure code, you must still follow the radiology documentation requirements in the CPT manual.
In 2018, most organizations held the line on coder productivity, according to the results of sister publication HIM Briefings’ 2018 coding productivity survey.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. This does not reduce the payment for the drugs, so this is an informational modifier, but it is a mandatory modifier.
