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.
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...
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.
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.
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.
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.
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.
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.
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?
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.
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.
Q: Should “diabetes with gastroparesis” be coded as 536.3, diabetes with a complication code? I understood that the term ‘"with’" can link two diagnoses, but that it does not represent a cause-and-effect relationship. Can you please clarify this, and why a cause-and-effect relationship can be assumed in the term “diabetes with gastroparesis”?
Patient Safety Indicator 15 tracks events during surgical procedures that can hurt patients, but not whether the patient actually suffers harm from the event. Robert S. Gold, MD, identifies some of the challenges involved with this quality measure.
Coders tell a patient’s story with a principal diagnosis and additional diagnoses, some of which are CCs or MCCs. William E. Haik, MD, FCCP, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, James Fee, MD, CCS, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain the value of educating physicians and coders about CCs and MCCs.
Great tip from 3M's Donna Smith, the Association of Clinical Documentation Improvement Specialists conference general session speaker. "We're collecting data for the future. It is a little...
Super CDI specialist Cheryl loves Mexican food. Really, she loves it a little too much. She decided to celebrate the end of her teaching duties at the Association of Clinical Documentation...
Our friends at the Association of Clinical Documentation Improvement Specialists (ACDIS) and 1,400 or so of their closest friends have descended on San Antonio for their annual conference. Things did...
“The definition of insanity is doing the same thing over and over again and expecting different results.” - Albert Einstein The closer we get to ICD-10 implementation, the more we see the same...
Congress is getting involved in the ICD-10 transition again with a new bill introduced into the House of Representatives May 12. The good news is H.R. 2247 , Increasing Clarity for Doctors by...
Coding and guideline changes in ICD-10-CM for neurological conditions may require coders to learn new terms and look for additional information in documentation. Caren J. Swartz, CPC, CPMA, CPC-I, CIC, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, explain the changes for hemiplegia, hydrocephalus, and meningitis and how to find the proper code.
Coding Clinic won't be updating its ICD-9-CM guidance for ICD-10-CM, but that doesn't mean none of the previous answers will be applicable in the new code set. Nelly Leon-Chisen, RHIA, Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, and Anita Rapier, RHIT, CCS, review various tricky coding situations that can be resolved now, ahead of implementation.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, defines abnormal pregnancies and explains how to determine the appropriateCPT ® , ICD-9-CM, and ICD-10-CM codes.
Providers have one last chance to volunteer for ICD-10 end-to-end testing, with CMS extending the deadline to sign up for the July testing period through May 22.
Our friends at the Association of Clinical Documentation Improvement Specialists are putting the final touches on their conference preparations. They have sent off the final shipment to San Antonio (...
We love surveys, especially about ICD-10. Seriously, how many ICD-10 surveys have you been asked to fill out in the past year alone? It’s very easy to look at survey results and think things look...
PSI 7 evaluates the hospital’s risk-adjusted rate of central venous catheter-related bloodstream infections. Shannon Newell, RHIA, CCS, Steve Weichhand , and Sean Johnson explain inclusions, exclusions, and risk adjustment factors for this measure.
Coders and clinical documentation improvement specialists need to pay attention to what conditions are considered CCs and MCCs, as well as sequencing rules which could affect MS-DRGs. Laurie L. Prescott, MSN, RN, CCDS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, and William E. Haik, MD, FCCP, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, discuss some common CCs and MCCs.
As coders have prepared for ICD-10-CM, they have raised questions about how to select the correct seventh character. Nelly Leon-Chisen, RHIA, and Jennifer E. Avery, CCS, CPC-H, CPC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, offer tips for determining the correct seventh character.
An automated Recovery Auditor review of discharge status codes identified improper payments, according to the Medicare Quarterly Compliance Newsletter . However, CMS did not report the prevalence of the errors.
If nothing else, Rep. Ted Poe, R-Texas, is consistent. He again introduced legislation to kill ICD-10. (The bill is H.R.2126 if you are interested.) Poe has tried this trick before. He introduced an...
