I am back to my ICD-10 blog following a long illness. It is great to be back! Why is it that a date ending in 2013 seems so much closer to October 2014? Others must feel this way because there seems...
Anytown got hit with some significant snowfall, which lead to some interesting injuries at the Fix ‘Em Up Clinic. Dave came in complaining of back pain after spending two hours shoveling his driveway...
Cold and flu season is in full swing, so I thought it might be a good time to look at coding for influencza in ICD-10-CM. If you look up influenza in the ICD-9-CM index, you might think we currently...
National Government Services, under contract with CMS, will host a series of listening sessions about lessons learned from the Version 5010 upgrade to prepare providers, vendors, and payers for the transition to ICD-10-CM/PCS.
Q: I’ve heard that queries differ between critical access and short-term acute care hospital settings. Is this true, and if so, where can I find more information?
Leading queries are frequently a topic of discussion among coding and clinical documentation improvement professionals. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, explains how to determine what constitutes a leading query and how to craft compliant queries.
Physicians, especially ED physicians, need to start paying attention to how their documentation affects the facility. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Bernadette Larson, CPMA, discuss how documentation in the ED affects medical necessity and inpatient coding.
MLN Matters ® article SE1236, which discusses documenting medical necessity for major joint replacements, may be aimed at physicians, but Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, and Lynn Marlow, BS, RHIT, CCS, explain how it also applies to hospitals and coders.
A sequela is the residual effect (condition produced) after the acute phase of an illness or injury ends. ICD-10-CM includes codes specifically designed to report sequela, such as I69.953 (hemiplegia...
Being a Jedi knight is hard work. And it’s dangerous, especially when your father is out to kill you and your friend gets encased in carbonite. Intrepid coders that we are, we will brave the frozen...
Coders will find plenty of changes throughout the musculoskeletal, respiratory, and cardiac sections of the CPT® Manual for 2013, as well as guidelines changes, deletions, and editorial revisions. Andrea Clark, RHIA, CCS, CPC-H, Georgeann Edford, RN, MBA, CCS-P, and Marie Mindeman walk through some of the major changes for 2013.
Q: How should we bill for the physician in the following situation? A patient who has end-stage renal disease (ESRD) comes into a hospital’s emergency department (ED) with an emergent condition (dialysis access clotted or chest pain that is ruled out), but misses his or her dialysis treatment. Part of the treatment is dialysis performed in the ED or as an outpatient. The hospital bills G0257 (unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility) as per CY 2003 OPPS Final Rule guidelines and Pub 100-04, Chapter 4, section 200.2
The American Medical Association completely overhauled the CPT ® Manual’s psychiatry subsection for 2013. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains the new codes and guidelines associated with psychiatric services.
CMS announced changes to reporting therapy services—the biggest operational change for 2013—in the Medicare Physician Fee Schedule final rule instead of the OPPS final rule. Jugna Shah, MPH, and Valerie Rinkle, MPA, explain the changes to therapy reporting and molecular pathology coding.
Coding for stent placement procedures will look very different in 2013. The American Medical Association deleted the two CPT ® codes used to report nondrug-eluting intracoronary stent placement procedures.
So far, we’ve covered three different ICD-10-PCS guidelines for multiple procedures. We’ve looked at how to report multiple procedures involving: Same root operation, different body parts as defined...
Happy 2013! We survived the Mayan apocalypse and received a one-year extension on ICD-10 implementation (which according to some people is more of an apocalyptic event than 12-21-12). Where do your...
In this month's issue, we review the major changes to OPPS for 2013, discuss the potential impact of CMS' packaging clarification, examine therapy, molecular pathology changes, offer suggestions on how to begin teaching providers to speak ICD-10, and answer your coding questions.
Providers and coders seem to speak two different languages-clinical and coding. Providers already have issues parsing ICD-9-CM "coder speak," so how can you get them to understand ICD-10?
Upon quick glance, the FY 2013 ICD-10-CM Official Guidelines for Coding and Reporting probably look very familiar to coders. They're comparable in length to the ICD-9-CM guidelines. They also follow the same format.
Hospitals earned a big win with drug payments this year in the 2013 OPPS final rule, released November 1. CMS decided to finalize its proposal to follow the statute and reimburse facilities at the average sales price (ASP) plus 6%.
After a six-month delay, the Recovery Auditor prepayment review demonstration program began in August 2012. The program continues through August 2015, at which point CMS will determine the potential for a national rollout.
The biggest operational change for outpatient facilities for 2013 does not appear in the 2013 OPPS final rule. Instead, CMS announced changes to reporting therapy services in the 2013 Medicare Physician Fee Schedule (MPFS) final rule.
After a six-month delay, the Recovery Auditor prepayment review demonstration program began in August 2012. The program continues through August 2015, at which point CMS will determine the potential for a national rollout.
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) that could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates, says Jugna Shah, MPH, president of Nimitt Consulting based in Washington, D.C.
The holiday presents have all been unwrapped, and while the children were (mostly) thrilled by their gifts, their parents aren’t as pleased with what happened once the kids started playing with them...
Q: Is nursing documentation of completion of physician-ordered procedures, such as splinting/strapping, Foley catheter insertion, etc., sufficient to assign a CPT ® code for billing the procedure on the facility side in the ED?
Coders will find significant changes in the medicine section of the 2013 CPT® Manual . Denise Williams, RN, CPC-H, and Georgeann Edford, RN, MBA, CCS-P, review the changes to nerve conduction studies, vaccine administration, ophthalmology, and allergy testing.
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) concerning packaged services. Jugna Shah, MPH, and Valerie Rinkle, MPA, explain how this clarification could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates.
CMS recently posted an updated version of the National Correct Coding Initiative (NCCI) manual to the CMS NCCI website . The manual includes changes identified in red text and will be effective with dates of service January 1, 2013.
The AMA added new CPT ® codes to report transcatheter aortic valve replacement for 2013. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details these and other code changes for cardiology.
‘Tis the day before Christmas and all are not well at North Pole Industries. Ernie the head elf has lost his grip, literally. Ernie, it seems, can’t hold on to the toys he’s building. When he goes to...
It’s the end of the world as we know it and the people in the Fix ‘Em Up Clinic waiting room don’t feel fine. Apparently some people really believed that today would be the end of the world and their...
Moderation is not a term usually associated with the holiday season, as you can see from the waiting room at Fix ‘Em Up Clinic. Clark spent two days stringing holiday lights over everything: his tree...
ICD-10-PCS introduces plenty of new concepts. One that could cause coder confusion involves how to report a procedure when the physician changes the approach. The ICD-10-PCS guidelines state: If...
In a recent CMS email to providers, the agency reminded hospitals that any department, form, template, or other information that uses ICD-9-CM codes today will need to accommodate ICD-10-CM/PCS codes as of October 1, 2014.
Q: A patient has unintentionally failed to take a prescribed dosage of insulin due to his Alzheimer’s dementia (age-related debility), and is admitted for initial care with inadequately controlled Type 1 diabetes mellitus. Which ICD-10-CM code(s) should we assign?
Nervous or worried about the upcoming transition to ICD-10-PCS? Don’t be. Charlotte Lane, RHIA, CCS, and Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, offer up tips to reduce your anxiety about the new coding system.
In order to assign the correct ICD-10-PCS code, coders will need to determine the correct root operation. Christina Benjamin, MA, RHIA, CCS, CCS-P, discusses the various root operations found in the medical and surgical section of ICD-10-PCS.
ICD-10-CM Chapter 19 codes for injury, poisoning, and certain other consequences of external causes (S00-T88) demonstrate the specificity inherent in the new coding system. Betsy Nicoletti, MS, CPC, and Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, dig into the details of codes for injuries and underdosing.
When you search the 2013 ICD-10-CM Official Guidelines for Coding and Reporting you will find chapter-specific guidelines for each chapter except for Chapters 3, 8, and 12. Chapter 1: Certain...
We’ve already discussed one of the multiple procedure guidelines in ICD-10-PCS, but we still have three more to go. And that’s not counting the guidelines that are not included in the multiple...
Misusing modifier -25 (significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service) can be an expensive proposition. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, and Debbie Mackaman, RHIA, CHCO, explain how to determine when an E/M service is significant and separately identifiable.
As tempting as it might be to append modifier -59 (distinct procedural service) to a claim in order to get paid, doing so poses a huge compliance risk. Karna W. Morrow, CPC, RCC, CCS-P, Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS , Peggy Blue, MPH, CPC, CCS-P, and Kimberly Anderwood Hoy, JD, CPC, walk through five case studies to help coders chose the correct modifier.
Five new CPT ® codes will be used to report services in two new evaluation and management categories: complex chronic care coordination services and transitional care management services. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, details the codes and guidelines for these services.
Q: CPT ® code 85660 (sickling of RBC, reduction) has a medically unlikely edit of one unit. We test blood for transfusion for sickle cell before we provide it to a sickle cell patient. If we test three units of blood prior to administering the blood to the patient, which modifier is more appropriate: -59 (distinct procedural service) or -91 (repeat laboratory test)?
It’s the second week of deer camp and all the hunters are at Fix ‘Em Up Clinic. Moe came into the clinic with some serious frostbite. Apparently, he fell asleep in the latrine at the camp and spent...
