Adriane Martin, DO, FACOS, CCDS, explains the confusion behind the various sepsis definitions and provides guidance to coders when reporting sepsis in ICD-10-CM.
It’s true that most CDI specialists are not coders, and coding a record isn’t our specific focus. To complete our given mission, however, we must understand the process and the guidance related to code assignment. The focus of provider education is to assist in translating “coder speak” to “medical speak” and vice versa.
Outpatient procedures involving anesthesia should be reported using five-digit CPT codes as well as applicable hospital modifiers. Review types of anesthesia administration and documentation elements required for accurate code assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Findings from an Office of Inspector General (OIG) audit show that Novitas Solutions Inc. overpaid hospitals for intensity-modulated radiation therapy (IMRT) services provided to nearly all sampled Medicare beneficiaries over a 30-month period, resulting in overpayments of at least $7.2 million.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
Beginning in 2018, total knee arthroplasty (TKA) was removed from the Inpatient Only List and assigned a comprehensive APC payment. Outpatient coders need to ensure they are assigning the correct CPT codes for TKA to reduce their hospital’s risk of audits.
When pneumonia documentation is questioned, CDI specialists or coders should always query the provider. But reviewing the following clinical elements involving aspiration and pneumonias with your physician staff may help improve the documentation of complex pneumonias and avoid adverse determinations by external reviewers.
A new risk model provides a simple way to determine whether acute myocardial infarction (AMI) patients are at a high risk for hospital readmissions, says a study published in the Journal of the American Heart Association.
Q: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
Sharme Brodie, RN, CCDS, reviews recent guidance published in Coding Clinic , Third Quarter 2018, including advice on diabetes, acute myocardial infarctions (AMI), pressure ulcers, and more.
Crystal R. Stalter, CPC, CCS-P, CDIP, says that there is still confusion around documenting patient stays to show quality, especially in the inpatient realm. Is it really as simple as documenting conditions to their fullest specificity or does it involve a more complex approach?
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that understanding spinal anatomy, the reporting of detailed spinal diagnoses, and the selection of applicable procedure codes can ensure that these complicated claims are reimbursed correctly and in compliance with coding guidelines. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Like it or not, provider documentation is the foundation for everything done in medicine. Without it, nothing is accomplished. As healthcare reform progresses (and hospital reimbursement shrinks), the need for excellent provider documentation only increases.
Coders must have a solid understanding of complex terminology and CPT and ICD-10-CM coding guidelines to select the most specific codes for traumatic fractures and their treatments. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
This month we are pleased to introduce Deborah Clinard, CPC, who has 12 years of experience as a coder and who currently works as a practice manager at Women’s and Children’s Specialists, LLC in Nashville, Tennessee.
Q: A lung cancer patient presents to the infusion clinic to receive chemotherapy treatments. The patient receives a Carboplatin infusion, a Gezmar infusion, and an Anzemet intravenous push. Which CPT codes would be used to report these services?
CMS recently released both the calendar year (CY) 2019 Medicare Physician Fee Schedule and OPPS final rules last week, revising the payment structure for E/M office visits and expanding payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted, off-campus, provider-based departments.
The CMS risk adjustment model uses Hierarchical Condition Categories (HCC) to calculate risk scores based on ICD-10 diagnoses. Review HCC coding do’s and don’ts to help your facility manage risk effectively, enhance shared savings, and provide patient-centered care.
The death of one twin in utero complicates oversight of a multifetal pregnancy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews symptoms of vanishing twin syndrome and ICD-10-CM coding for continuing pregnancy after intrauterine death .
Remittance processing and appeals are integral parts of the revenue cycle. When facilities submit a claim to Medicare, the hope is that the claim will be paid in full and in a timely manner, but that does not always happen.
In the 2019 OPPS final rule, released November 2, CMS implemented several site-neutral payment policies, though the agency did delay or shelve other proposals due to stakeholder feedback.
Q: What’s the difference between an incomplete miscarriage, a septic miscarriage, and a missed miscarriage and how would surgical treatments for these conditions be reported using CPT codes?
CMS released Transmittal 836 on October 19, clarified language in Chapter 6 of the Medicare Program Integrity Manual regarding medical review of diagnostic laboratory tests.
Coding and documentation teams can replicate an organization’s overall denial avoidance and management program by scaling it to the scope of denials for which they are responsible. Lynette Kramer, MA, RHIA , outlines a four-step process that coding teams can use to monitor claim data and establish accountability for denials.
According to the National Center for Chronic Diseases Prevention and Health Promotion, an estimated 5.7 million adults throughout the U.S. have heart failure. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, writes about ICD-10-CM coding for heart failure diagnoses and CPT coding for procedures used to treat the disease.
The FY 2019 ICD-10-CM update includes 54 code additions, three deletions, and 87 revisions to Chapter 19 of the ICD-10-CM Manual , “Injuries, Poisonings, and Certain Other Consequences of External Causes.” Review updated codes and guidelines for reporting burns, infections and sepsis following a procedure, drug abuse, and human trafficking. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We have a patient admitted with a history of chronic heart failure (CHF) and end-stage renal disease (ESRD) who was admitted with volume overload due to acute kidney injury and dialysis noncompliance. How should we report this in ICD-10-CM?
The rate of most hospital-acquired conditions (HAC) continued to decline from 2014 to 2016, according to the latest national scorecard released by the Agency for Healthcare Research and Quality.
Cheryl Manchenton, RN, BSN, CCDS , details the recent updates to patient safety indicator (PSI) 90 and says that these changes are the reason why it’s more important than ever to ensure that PSI metrics are complete and accurate.
Chris Simons, MS, RHIA , outlines tasks that generally fall within the CDI department’s realm and writes that to ensure that inpatient CDI specialists can thoroughly complete these tasks, they must have strong clinical skills and a working knowledge of ICD-10-CM and MS-DRG assignment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Adriane Martin, DO, FACOS, CCDS , reviews some of the ICD-10-CM/PCS code and CC/MCC updates that made the final cut in the fiscal year 2019 IPPS final rule.
Patients determined to have a tubo-ovarian abscess (TOA) require immediate and aggressive surgical therapy. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , reviews clinical documentation and ICD-10-CM coding for TOAs as well as CPT coding for surgical interventions used to treat them.
Before radiation therapy can be administered, several steps must be taken prepare the patient for treatment. Review CPT coding and documentation for the first two steps in the process: the initial consultation and preparation for radiation treatment. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A retrospective study recently published in the Journal of Pediatric Surgery found that 59% of reviewed cases across four institutions contained discrepancies between operative dictation and CPT coding for pediatric abdominal surgeries.
Modifier -25 is frequently a target of payer and Office of Inspector General audits. Susan E. Garrison, CHCA, CPC, CPC-H, reviews CMS and NCCI guidance for reporting modifier -25.
Creating a query and knowing when to query can be complicated, and there are a number of continued training tactics that prove successful for the coder when trying to improve upon physician query practices. This article looks at a few of the official sources that offer query guidance for coders. 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 for syncope workup. The workups were negative except for incidental findings of acute kidney injury (AKI). The physician documented “AKI likely 2/2 hypovolemia. Treatment focus is to trend creatinine levels and hydration.” Would the AKI or hypovolemia be sequenced as the principal diagnosis?
Cesar M. Limjoco, MD, writes that although different literature has become available on principal diagnosis selection through the years, questions and disputes keep popping up. In this article, he revisits the issue and provides additional insight to code selection for conditions such as acute respiratory failure and congestive heart failure.
Acute heart failure patients in an emergency department's clinical pathway program had a 13.1% lower readmission rate, according to a report published in the American Journal of Emergency Medicine.
Adriane Martin, DO, FACOS, CCDS, reviews Coding Clinic guidance published in the first and second quarters of this year as it pertains to coding guidelines, severity of illness, and MS-DRG assignment for the inpatient setting.
As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption.
Developing an outpatient CDI program isn't just about metrics--departments needs to consider how to engage providers and interact with other teams to be truly effective.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
