Q: Should modifiers for laterality be used for CPT ® code 31624 (bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage)?
A survey conducted in May and June 2015 found providers have completed many steps toward ICD-10 implementation, but lag behind in testing and expect to continue managing the impact after the deadline.
The American Medical Association (AMA) is pushing for a two-year safe harbor for physicians so the doctors won’t be penalized for “errors, mistakes, and malfunctions relating to the transition.” That...
Mary decided to take advantage of a break in the rainy weather to head out and do some bird watching. The birds, however, were in no mood to be watched. Mary first came upon a warbler nest with four...
Sharme Brodie, RN, CCDS , highlights guidance on ICD-10-PCS root operations and seventh characters for ICD-10-CM from the latest issue of Coding Clinic .
Coding Clinic serves as the Supreme Court in interpreting ICD?9?CM or ICD?10?CM/PCS and their guidelines. James S. Kennedy, MD, CCS, CDIP, Kyra Brown, RHIA, CCS, and Nelly Leon-Chisen, RHIA, discuss the best ways to use this additional guidance.
Q: In ICD-9-CM, sprains and strains fall under the same codes. Will that also be the case in ICD-10-CM or are we going to report these injuries separately?
ICD-10-PCS does not include unspecified options so coders will need information for each of the seventh characters in the code. Cheryl Ericson, MS, RN, CCDS, CDIP, and Lynn Salois, RHIT, CCS, CDIP, review some of the areas where a surgical query might be needed.
Coders will find 50 new codes in ICD-10-PCS for 2016, according to the summary of changes posted by CMS . CMS also introduced a new section for ICD-10-PCS, X (new technology). In addition, guidelines B3.11b, B3.4a, B3.2b, and B4.1b were revised in response to public comment.
Sometimes the logic of the American Medical Association (AMA) escapes me. Okay, most of the time, I have no idea what the people at the AMA are thinking. Take the organization’s continuing crusade to...
Rep. Gary Palmer, R-Alabama, doesn't want providers penalized for ICD-10 "errors, mistakes, and malfunctions relating to the transition" for two years after implementation. Unfortunately, it doesn't...
The Alabama state Senate passed a Joint Resolution urging Congress to delay the October 1, 2015 ICD-10 implementation. In and of itself, the resolution means very little. States cannot override the...
A Comprehensive Error Rate Testing (CERT) study found that the improper payment rate for radiation therapy planning claims was significantly higher than many other physician specialty services, according to the Medicare Quarterly Compliance Newsletter .
Q: A patient arrives at the interventional radiology department to have an inferior vena cava (IVC) filter inserted for portal hypertension and an iliac stent for May-Thurner syndrome. The physician is unsuccessful in accessing an appropriate portal vein branch, despite a few attempts to pass a wire into small portal branches, and aborts the placement. The plan is to reschedule and return with a transplenic approach. Do we code the attempted IVC filter placement with modifier -74 (discontinued outpatient procedure after anesthesia administered) and the complete iliac stent procedure? Or do we code the extent of the IVC filter placement (that being venography) with the complete procedure? Or do we only code the completed procedure?
What is the correct ICD-9-CM code for pneumonia due to E. coli? A) 482.81 B) 482.82 C) 482.83 D) 482.84 Know the answer and want to be featured in the next issue of JustCoding News: Outpatient?...
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, writes aboutwhat additional details coders will need to find in documentation to report pneumonia to the highest degree of specificity in ICD-10-CM and how to report it as a manifestation.
The American Medical Association (AMA) is trying to get a seat at the ICD-10 table by resolving to request inclusion as one of the Cooperating Parties. Mind you, today’s resolution at the AMA annual...
The AMA and Republican congressmen have been working together for quite a w hile to try and kill ICD-10, but their latest attempt shows not only desperation, but a fundamental misunderstanding of how...
We’re very excited to add a new voice to the ICD-10 Trainer blog family. I’ve (cough, cough) volunteered Steve Andrews to write for the blog. The joys of being the boss. Steve joined HCPro and...
One of the best parts of attending the Association of Clinical Documentation Improvement Specialists’ (ACDIS) 8 th Annual Conference is talking with others in the field to find out what documentation...
Coding, documentation, and diagnoses aren’t always clear-cut, which can challenge even experienced codes. Review the coding and documentation requirements for encephalopathy, stroke, and anemia.
CMS provided plenty of proposed refinements to quality measures in the 2016 IPPS proposed rule, but did not suggest any changes to the 2-midnight rule. Kimberly A.H. Baker, JD, CPC, James S. Kennedy, MD, CCS, CDIP, and Shannon Newell, RHIA, CCS, highlight the most significant proposed changes.
Q: When I started as a coder, I learned that the complication code, such as from ICD-9-CM series 998 or 999, takes precedence as the reason of admission when present with another contributing condition. Is this correct, and is there any written guidance from AHA Coding Clinic for ICD-9-CM/ICD-10-CM/PCS that discusses this?
Shannon Newell, RHIA, CCS, Steve Weichhand, and Sean Johnson conclude their four-part series on PSI 90 with an in-depth look at PSI 12, which evaluates a hospital’s risk adjusted rate of perioperative deep vein thrombosis and/or pulmonary embolism in surgical discharges for patients 18 years and older.
CMS declared its second week of ICD-10 end-to-end testing , held from April 27 through May 1, a success. Approximately 875 participants submitted 23,138 test claims during the week and CMS accepted...
Are you currently dual coding to prepare for ICD-10 implementation? Or are you double coding? Do you know the difference? When you dual code, you assign both ICD-9-CM and ICD-10 codes to the same...
The April quarterly I/OCE update from CMS did not defy convention?featuring the typically small number of updates following extensive changes in the previous quarter?but CMS did continue to clarify the logic for comprehensive APC (C-APC) payments.
Taxonomy codes play a very important role in medical billing and credentialing for providers or group specialties.HIPAA-standard code sets specify a "standard" for transactions. In many cases, a taxonomy code is required to reimburse a claim; however, the reporting requirements for a taxonomy code may vary between insurance carriers and your third-party payers.
In the third part of our series on Patient Safety Indicator 90, we focus on inclusions, exclusions, and coding and documentation vulnerabilities for PSI 7.
ICD-10-CM will still allow coders to report unspecified codes. However, coders will not have that option in ICD-10-PCS. Every character has to have a value, which will lead to an increase in surgical queries.
In this month’s issue, we explore queries for ICD-10-PCS, review CMS’ proposed changes to the IPPS, and focus on inclusions, exclusions, and coding and documentation vulnerabilities for PSI 7. Robert S. Gold, MD, highlights areas of confusion involving PSI 15 guidance.
The 2016 OPPS proposed rule is likely to continue CMS' trend of expanded packaging and feature refinements and expansion of comprehensive APCs based on comments CMS has made in prior rules.
The April quarterly I/OCE update from CMS did not defy convention?featuring the typically small number of updates following extensive changes in the previous quarter?but CMS did continue to clarify the logic for comprehensive APC (C-APC) payments.
Ah, summer—sand, surf, and…ICD-10 education? That’s right. Summer, especially this summer, is no time to stop your ICD-10 education. We have 125 days left until ICD-10 implementation, so we need to...
Our friends at the Association of Clinical Documentation Improvement Specialists (ACDIS) held their 8 th annual conference last week. Aside from a few mishaps involving their crack team of CDI...
This sample case study is an excerpt from HCPro’s ICD-10 Competency Assessment for Coders , which is a resource included in the ICD-10 Training Toolkit . The toolkit provides the building blocks for your training programs for physicians as well as coding, HIM, documentation, and billing professionals in both inpatient and outpatient settings.
ICD-10-CM codes for reporting dementia diagnoses include new specificity. Caren J. Swartz, CPC, CPMA, CPC-I, CIC, and Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, examine what terms and details providers might need to add to their documentation.
Q: We have a patient with chronic severe low back pain, etiology unknown, on MS Contin®, an opioid. Due to the patient’s history of drug-seeking behavior and cannabis abuse, the physician orders a drug screen prior to refilling the prescription. With the changes to drug testing codes in 2015, what would be the appropriate laboratory CPT ® codes to report?
A Comprehensive Error Rate Testing (CERT) contractor special study found improper payments on Medicare Part B claims including HCPCS code 84999 (unlisted chemistry procedure) submitted from October to December 2013, according to the latest Medicare Quarterly Compliance Newsletter .
Since CMS introduced the four replacements for modifier -59 (distinct procedural service), providers have struggled with how and when to apply them. Gloria Miller, CPC, CPMA, CPPM, and Christi Roberts, RHIA, CCA, AHIMA-approved ICD-10-CM/PCS trainer, provide examples of when these new modifiers can be used.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, reviews the different methods of fetal monitoring and what coders will need to look for in documentation to report them.
Clinical documentation improvement (CDI) specialists are a passionate group and they love ACDIS director Brian Murphy. They love him so much, in fact, that his appearance in the exhibit hall at the...
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Cheryl Ericson, MS, RN, CCDS, CDIP, compare and contrast coding for poisonings and adverse effects in ICD-9-CM and ICD-10-CM and explain the new concept of underdosing.
