CMS announced that it is postponing the eHealth Provider Webinar on ICD-10 compliance that was scheduled for October 1. CMS has not announced a reschedule date.
My head is going to explode. This is seriously epic, end of the world pain. It’s a 20 on the pain scale. It wouldn’t be so bad if I didn’t also feel like I was going to throw up. And the light is...
Q: A patient presents with altered mental status/encephalopathy due to a urinary tract infection (UTI). The patient has a history of dementia. The final diagnosis is encephalopathy due to UTI. Should we code the encephalopathy as a secondary diagnosis because it’s an MCC and not always a symptom of a UTI?
Hospitals are being incorrectly reimbursed for preadmission testing that occurs within the three days prior to admission, according to Recovery Audit findings.
ICD-10-CM and ICD-10-PCS present different challenges, but both will require better documentation. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, Kathy DeVault, RHIA, CCS, CCS-P, Donielle Bailey , and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, discuss some of the areas where coders will need more information to code in ICD-10.
The best way to decrease denials or increase overturn rates begins with a compliant concurrent review of documentation. Marilyn S. Palmer, DO, and Jonathan G. Wiik, MSHA, MBA, review common Recovery Audit targets and provide tips for successfully appealing denials.
Acute kidney injury (AKI) is an abrupt decrease in kidney function that includes—but is not limited to—acute renal failure. Garry L. Huff, MD, CCS, CCDS , and Brandy Kline, RHIA, CCS, CCS-P, CCDS , explain the clinical indicators of AKI and offers tips for composing queries.
Ears are moving up in ICD-10-CM. In ICD-9-CM, they have to share space with the eyes. In ICD-10-CM, they get their own chapter. They also get a lot more codes. Fortunately, many of those additional...
We have just a little over a year remaining until ICD-10 implementation. How well do you know your ICD-10-PCS codes? ICD-10-CM shares a lot of similarities with ICD-9-CM. Sadly, ICD-9-CM procedure...
Some providers are billing only add-on codes without their respective primary codes, resulting in overpayments, according to CMS. Add-on codes billed without their primary codes are considered an overpayment, with one exception.
CMS’ proposed 2014 OPPS rule is set to introduce many changes, such as more packaged services, including lab tests and add-on codes. Jugna Shah, MPH; Dave Fee, MBA; Kimberly Anderwood Hoy, JD, CPC; and Valerie A. Rinkle, MPA, offer their insight on what effect these changes could have for providers.
Q: A patient comes into the ED with chest pain. An EKG (CPT® code 93005) is performed. The patient goes directly to the catheterization lab for catheterization (code 93454). Is a modifier appropriate for the EKG?
Coding may not be brain surgery, but understanding brain anatomy can greatly help coders when reporting head injuries or disorders. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, reviews some major components of brain anatomy and the impact of ICD-10-CM on coding for some common diagnoses.
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...
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.
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.
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).
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)?
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.
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...
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.
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?
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. 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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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...
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.
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.
