Modifiers are sometimes essential to ensure proper payment, but choosing the correct one can be tricky. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS; Katherine Abel, CPC, CPMA, CEMC, CPC-I; and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, discusssome confusing modifiers and how to use them accurately.
Last week, we looked at some strange causes of death in the ancient world and their associated ICD-10-CM codes. Let’s fast-forward to some odd Dark Ages deaths and see if we can code them. Some...
Death smiles at us all. All a man can do is smile back. (Kudos if you know I appropriated that from the movie Gladiator .) History is full of weird circumstances and odd injuries that lead to death...
CMS has been releasing ICD-10 National Coverage Determination (NCD) “omnibus” transmittals since September 2012, which gives providers some information about CMS’ coverage policies moving forward...
Health information exchange between hospitals and other providers has risen by 41% between 2008 and 2012, according to research published in Health Affairs from the Office of the National Coordinator for Health Information Technology (ONC).
The 2014 IPPS Final Rule contains two significant changes that will impact coders: the 2-midnight inpatient presumption and the Part A to Part B rebilling. Marc Tucker, DO, FACOS, FAPWCA, MBA, and Kimberly Anderwood Hoy Baker, JD, CPC, review the key provisions of these changes.
No one is perfect, including coders. Mistakes aren’t necessarily a reflection on one’s abilities or attention to detail. James S. Kennedy, MD, CCS, and Laura Legg, RHIT, CCS, highlight some common problem areas and provide tips for compliance.
Unlike ICD-10-CM, ICD-10-PCS does not include unspecified codes. Thus, clinicians may see an increased number of queries on procedures post-implementation. Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, explains why facilities should review documentation for inpatient procedures now.
Q: A patient undergoes placement of a MediPort ® to receive chemotherapy for lung cancer. What principal diagnosis should we report? Should we report V58.81 (fitting and adjustment of vascular catheter) or 162.9 (malignant neoplasm of bronchus and lung unspecified)?
With the ICD-10 compliance date looming, can we find some fun in it all? We can play Coding “Jeopardy” as a fun learning tool, but if ICD-10 were a game, what game would it be? Some might liken it to...
Labor Day might mark the unofficial end of summer, but sadly, it's not the end of barbecue mishaps at the Fix 'Em Up Clinic. Matt, who last year survived flaming tomato napalm, decided to grill up...
Inpatient coders are used to assigning a present-on-admission (POA) indicator in ICD-9-CM. They will need to continue to assign POA indicators in ICD-10-CM. The POA indicators remain the same, but...
Q: We have a patient with documented age-related osteoporosis. She bent over to pick up a newspaper from a table and fractured a vertebrae. Should we code the fracture as pathologic or traumatic?
When it comes to ICD-10-CM/PCS, coders may be the hardest and most directly hit employees. Laura A. Shaffer, PhD, and Monica Lenahan, CCS, explain how hospitals may be lagging behind in terms of actually managing the change for these individuals.
After a cerebrovascular accident (CVA, also known as stroke), a patient may suffer additional health problems, lasting after the event has passed. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, compares coding for these lasting effects, known as sequela, in ICD-9-CM and ICD-10-CM.
CMS’ Pat Brooks, RHIA, senior technical advisor, Hospital and Ambulatory Policy Group, and AHIMA’s Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, reviewed basic ICD-10 information during a CMS National Provider Call August 22.
When it comes to ICD-10-CM/PCS, coders may be the hardest and most directly hit employees. Yet some experts say that aside from technical training, hospitals may be lagging behind in terms of actually managing the change for these individuals.
E/M coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G-codes.
CMS proposed sweeping changes in the 2014 OPPS proposed rule.In this issue, we examine the proposed changes to E/M codes, packaging, and device-dependent APCs. In addition, our experts answer your coding questions.
Our experts answer questions about billing vasectomy and sperm analysis , coding for ED visit when the patient is admitted for surgery, billing glucose reading before a PET scan, documentation required for the functional limitation codes, and appropriate reporting of observation.
The 2014 OPPS proposed rule is shorter than normal at 718 pages, but the proposed changes are significant and probably the most sweeping changes since the inception of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting.
As meticulous as a coder may be, he or she is bound to make a mistake at some point in his or her career. After all, nobody is perfect. Mistakes aren't necessarily a reflection on one's abilities or attention to detail. Coders know that physician documentation often makes the job much more difficult. Add stringent productivity standards to that, and you've got a potential recipe for disaster.
Do you ever feel like everything is on YouTube? In some cases, it’s more than you want to see, but the video site can be extremely helpful for coders who want to watch procedures. For example, search...
Paracelsus, the father of toxicology (among other things), once wrote: “Everything is poison, there is poison in everything. Only the dose makes a thing not a poison.” Cheery thought, right?...
Does the DRG accurately depict the patient’s story? Does the length of stay and severity of illness correlate with what actually happened? Heather Taillon, RHIA, and Cheryl Collins, BS, RN, offer tips to selecting the correct principal diagnosis.
Q: Our facility has a question about how other hospitals address this scenario: Patient is discharged to home (discharge status code 01). No documentation exists in the medical record to support post-acute care. Several months later, our Medicare Administrative Contractor (MAC) notifies us that the patient indeed went to post-acute care after discharge. The MAC retracts our entire payment. We need to resubmit the claim with the correct discharge status code. We are reluctant to do so because nothing in the medical record supports the post-acute care provided. Are other hospitals amending the record? If so, which department is adding the amended note?
Diagnostic conclusion statements don’t sufficiently capture the clinical context and medical necessity for inpatient admission. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, discusses the importance of clinical context and quality of clinical documentation in the medical record.
Ah, the dogs days of summer. An evil time when, according to the ancient Romans, the sea boils, dogs grow mad, and men contract, among other diseases, burning fevers, hysterics, and frenzies,...
In ICD-9-CM, we know not to code solely from the Alphabetic Index. After all, the code could have additional digits or excludes notes or other coding directions (such as “code first” or “use an...
Evaluation and management (E/M) coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G codes. Dave Fee, MBA, Peggy S. Blue, MPH, CCS-P, CPC, Jugna Shah, MPH, Kimberly Anderwood Hoy, JD, CPC, Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Valerie A. Rinkle discuss the possible impact if CMS finalizes its proposal.
Medical necessity establishes the foundation for evaluation and management (E/M) code selection and supports the need to services provided to the patient. Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , and Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-approved ICD-10-CM/PCS trainer, explain how to define, determine, and defend medical necessity for E/M codes.
CMS added three new HCPCS C codes and one G code to the integrated outpatient code editor (I/OCE) as part of the October quarterly update. The new codes are effective October 1.
One of the bigger challenges with the birth of the new ICD-10-CM coding system is the assignment of the letter O as the leading indicator for OB/GYN codes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS AHIMA-accredited trainer, delivers a comparative look at coding for OB/GYN coding in ICD-9-CM and ICD-10-CM.
Q: The patient comes in for a cardioversion, but the international normalized ratio results were unsatisfactory. The physicians canceled the cardioversion. Would modifier -73 (discontinued outpatient/hospital ambulatory surgery center procedure prior to the administration of anesthesia) be appropriate?
CMS added additional ICD-10 MLN educational resources to its website and will be hosting an ICD-10 National Provider Call August 22. The new MLN educational resources include two fact sheets and a...
It’s baby day at Fix ‘Em Up Clinic and Stitch ‘Em Up Hospital as we prepare to deliver new codes and guidelines for reporting pregnancy and delivery in ICD-10-CM and ICD-10-PCS. Our first patient,...
The 2014 draft ICD-10-PCS guidelines include a code for the usage of a robotic-assist device in surgery, something coders can currently report in ICD-9-CM. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , compares documentation requirements for coding robotic-assisted surgery in both ICD-9-CM and ICD-10-PCS.
At first glance, codes for insertion, removal, and revision of pacemakers look quite different in ICD-10-PCS. Kimberly J. Carr, RHIT, CCS, CDIP, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, compare and contrast pacemaker procedure coding in ICD-9-CM and ICD-10-PCS.
Complete capture of procedure codes in ICD-9-CM helps to ensure accurate translation to ICD-10-PCS. Donna M. Smith and Patricia L. Belluomini, RHIA, reveal coding errors—including omission of procedure codes—that make the translation process more challenging.
Q: Which ICD-10-CM external cause code should we report if a patient falls while on an escalator? This is the first time that the patient has been seen for such a fall.
First we saw the new ICD-10-PCS codes and guidelines in May, followed by the new ICD-10-CM codes in June and the ICD-10-CM guidelines in July. Now we have updated general equivalence mappings (GEMs)...
Q: A clinician goes to a patient's home and does not perform an evaluation and management, but performs a catheter replacement. How should we code this encounter?
Medical necessity is as simple as it sounds and it isn’t important just for inpatients. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews the importance of establishing medical necessity for outpatient services.
