Coronary artery bypass graft procedures are not the only ones coders will report using the root operation Bypass in ICD-10-PCS. Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, and Lisa Crow, MBA, RHIA, explain how to code for other bypass procedures in ICD-10-PCS.
The ICD-10-PCS Manual includes 17 different sections, including Administration. Learn how to assign codes from this section to prepare for ICD-10-PCS implementation.
Q: A patient comes in with a malunion of a fracture. A different physician treated the patient initially for the fracture, but the patient came to see our physician for surgery to repair the malunion. Which seventh character should we use: A for initial encounter or P for subsequent encounter for fracture with malunion?
CMS is adequately preparing to implement ICD-10 October 1, according to a new Government Accountability Office (GAO) report detailing CMS’ transition efforts.
Most coders will spend their time reporting codes from the Medical and Surgical section (first character 0) and the Obstetrics section (1). Each character in those sections has the same meaning:...
“Practice makes perfect” is a well-known adage. How many people can do any new task requiring specific skills successfully without practicing? We can’t consider the transition to ICD-10-CM/PCS...
Don’t look now, but Congress is examining ICD-10 implementation again. The House Energy and Commerce Committee’s subcommittee on healthcare will hold a hearing at 10:15 a.m. Wednesday, February 11 ,...
Curious about how CMS’ end-to-end testing for ICD-10 is going? Want to know how you can sign up? CMS is hosting a National Provider Call on ICD-10 implementation and Medicare testing from 1:30-3 p.m...
Eighty-four percent of providers experienced no major problems with early ICD-10 acknowledgement testing, according to a recent AAPC survey of more than 2,000 providers.
Drug administration coding and billing remains a challenge despite no code changes in six years. Jugna Shah, MPH, and Valerie RInkle, MPA, examine how to apply the new -X{EPSU} modifiers with drug administration codes and review other common questions they receive about injections and infusions.
In the 2015 OPPS final rule, CMS introduced a new modifier for services provided in an off-campus, provider-based clinic. Jugna Shah, MPH, and Valerie Rinkle, MPA, review when the modifier will become required and how it should be reported.
Q: Is it correct to append modifier -52 (reduced services) to a procedure code when the physician performed the procedure, but did not find a mass? This was unexpected, so the surgeon went deeper into the subcutaneous tissue and still did not find anything. This is the outpatient note for a patient with a history of breast cancer and a new lump on her arm with an indeterminate ultrasound: Under local anesthesia and sterile conditions, a vertical incision was made over the area of the palpable abnormality. We dissected down beneath the subcutaneous tissues. I could encounter no definitive mass or lesions in this area. We went down to the fascia of her bicep. Her biceps appear normal, and the skin and subcutaneous tissue appear normal. My presumption is that this represented some sort of venous anomaly, and I either popped it or incised it during our entry into the skin, and it is now resolved. Would CPT ® code 24075-52 (excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm) be correct to report?
The AMA added a new CPT ® code for chronic care management. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about the time and documentation requirements for reporting this service.
And a chilly one it is. It’s also the day after the Super Bowl, which means patients with a variety of injuries arrived at the Fix ‘Em Up Clinic today. First is Phil, who is convinced he is a...
In this month’s issue, we examine how coders and CDI specialists look at chest pain, review the most recent Coding Clinic advice on ICD-10-PCS , and explain how querying can lead to a more accurate representation of a patient’s severity of illness and risk of mortality. Robert S. Gold, MD, discusses whether coders should report every diagnosis mentioned in a patient’s chart.
Coronary artery disease (CAD) develops when the arteries that supply the blood to the heart muscles become hardened and narrowed due to a buildup of cholesterol and other materials, such as plaque, on their inner wall. It's also called atherosclerosis.
In December 2014, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment (HOP Panel) website outlining the hospital outpatient therapeutic services that were recently evaluated for a change in supervision levels. The three-page document contains a chart that includes the HCPCS code, the level of supervision required for coverage, and the effective dates of the changes for various services.
Since portions of the reproductive system use some of the same structures as the urinary system, including the urethra, codes for conditions involving both male and female reproductive systems appear in Chapter 14 of ICD-10-CM, Diseases of the Genitourinary System.
As new and more effective treatment options are created and evaluated, AMA must update the CPT® Manual to add and revise codes that allow providers to accurately report the work they performed. The 2015 updates include more than 500 changes, including more than 250 new codes that impact nearly every section. In the 2015 CPT Manual, only the integumentary and respiratory system sections remain unchanged.
Coding professionals may inappropriately assign codes from parts of the medical record where the doctors, early in the workup of a complex patient, were describing differential diagnoses in their evaluation of the patient. Robert S. Gold, MD, discusses whether coders should report every diagnosis mentioned in a patient’s chart.
Many coders and CDI specialists memorized previous Official Guidelines for Coding and Reporting , Coding Clinic for ICD-9-CM and do not have to give them a lot of forethought before applying correctly to their day-to-day reviews. Although many of the Official Guidelines for Coding and Reporting remain the same in ICD-10, none of Coding Clinic's previous advice can be applied to the new code set. Without years of new Coding Clinic advice under their belts, it may take some time before the staff exhibits the same ease when applying ICD-10-CM/PCS codes to the documentation provided.
Our sister website JustCoding.com recently published its 2014 Coder Salary Survey. Since many of our readers responded to the survey, we would like to share some of the results with you.
Coding tells a patient's story, based on the narrative the physician provides in his or her documentation. Accurately painting a picture of the patient's severity of illness (SOI) and risk of mortality (ROM) is essential for good patient care, and it is becoming increasingly important for quality measures and payment.
We’re into dig out mode here in Anytown and apparently, not everyone got the memo about proper snow shoveling techniques. Richard came into the Fix ‘Em Up Clinic complaining of intense pain in his...
A hiatus from Recovery Auditor scrutiny may have allowed HIM professionals to focus on other issues, but Laura Legg, RHIT, CCS, explores why HIM departments need to gear up for Recovery Auditors’ return.
In order to identify patients with a CC or MCC, coders need to know when to report additional diagnoses. William E. Haik, MD, FCCP, CDIP, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, discuss when to report a secondary diagnosis.
Physician documentation for the use of osteogenic stimulators for nonunion of fractures is often insufficient for Medicare coverage, according to Comprehensive Error Rate Testing (CERT) results .
Accurately painting a picture of the patient's severity of illness (SOI) and risk of mortality (ROM) is essential for good patient care, and it is becoming increasingly important for quality measures and reimbursement. Sara Baine, MSN-Ed, CCDS, and Rhonda Peppers, RN, BS, CCDS , explain the importance of accurately reporting conditions that affect SOI and ROM.
Q: When atelectasis is noted on an ancillary test such as a CT scan of the abdomen or chest x-ray, can nursing documentation of turning, coughing, and deep breathing be considered an intervention that qualifies as one of the criteria to meet a secondary diagnosis?
Here in Anytown we are getting blasted by a big winter storm, which means we’re also seeing lots of patients with storm-related injuries at the Fix ‘Em Up Clinic. Doug came into the clinic...
We can choose from 31 root operations in the ICD-10-PCS Medical and Surgical section, but biopsy isn’t one of them. So which root operation do we use when a physician performs a biopsy? The answer is...
Some diseases can cross between species, which can presents a significant problem. Just think back to how quickly avian flu spread starting in 2003. It turns out that diseases have been crossing that...
ICD-10 implementation requires organizational coordination from a variety of departments. Chloe Phillips, MHA, RHIA, and Kayce Dover, MSHI, RHIA, discuss how organizations can overcome challenges regarding staffing, productivity, and data analytics as they prepare for the change.
Blood tests are a common diagnostic tool for providers trying to determine a patient's condition. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the components of blood, detailing key terms and conditions coders should know to prepare for ICD-10-CM.
CMS made incorrect payments to hospitals for established patient clinic visits estimated at approximately $4.6 million in 2012, according to a recent Office of Inspector General (OIG) audit.
Q: When would we use codes from ICD-10-CM category E13 (other specified diabetes mellitus)? If it's secondary diabetes but not due to an underlying condition or drug and is not chemically induced, what kind of diabetes could it be?
The switch to ICD-10-CM won't bring many changes in the codes for reporting genital prolapse, but understanding the nuances of the diagnoses is key for choosing the correct code. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, highlights terms to look for in documentation and provides a sample operative report to test your knowledge.
Every have one of those days when you feel like you’ll never be warm? I’m having one of those. One of the downsides to have a window cube is the cold seeps in with the sunshine. Or with the dreary...
Auditors continue to scrutinize inpatient wound care services. Glenn Krauss,BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, reviews the importance of documenting medical necessity for these services.
The District of Columbia federal district court dismissed a lawsuit December 18, 2014, filed by the American Hospital Association (AHA) against HHS for excessive and inappropriate Recovery Auditor denials, according to AHA News. The AHA announced that it may appeal the court’s decision.
In some cases, coding professionals can—and should—report ancillary services provided to inpatients. Denise Williams, RN, CPC-H, and Valerie A. Rinkle, MPA, explain when and how to bill for ancillary bedside services.
The reason a patient comes in is to a facility not always the same as the reason the physician admitted the patient. Brush up on the guidelines for principal diagnosis selection.
Oh, the joys of being an 8-year-old with a snow day. Joey spent the weekend playing in his newly built snow fort without a hat, scarf, or pair of sunglasses. Now he’s complaining of hot, tender,...
Well, it’s not quite the polar vortex of 2014, but it’s definitely polar bear weather out there. As in, polar bears are the only ones who appreciate this kind of cold. We’re starting to see some...
CMS accepted 76% of all national ICD-10 test claims submitted during its November 2014 ICD-10 acknowledgement testing week. More than 500 providers, suppliers, billing companies, and clearinghouses participated in the tests, which identified no issues with Medicare's system.
