More than 8% of the population in the United States (i.e., 25.8 million children and adults) has some form of diabetes, according to the American Diabetes Association. In 2007, diabetes was listed as the underlying cause on 71,382 death certificates. It was a contributing factor on an additional 160,022 death certificates.
In this month's issue, we look at ICD-10 readiness among various stakeholders, reviewing coding for radiation oncology, explain CMS’ new information about Part A to B rebilling, and answer your coding questions.
Most hospitals have been overwhelmed by Recovery Auditor (RA) requests for documentation. So it's no surprise that the RAs themselves seem to be equally as burdened with the task of processing those records.
Radiation oncology uses high-energy radiation to shrink or kill tumors or cancer cells with minimal harmful effects to healthy surrounding cells. To correctly code for radiation oncology services, coders need to understand the various elements of the treatment.
Consider the following: A beneficiary is admitted to a hospital pursuant to a physician order and receives medically necessary care spanning at least two midnights. CMS will consider this appropriate for payment under Medicare Part A, according to the FY 2014 IPPS proposed rule released April 26. Actuaries estimate that this proposal for what constitutes appropriate inpatient care would increase IPPS expenditures by $220 million due to an expected net increase in inpatient encounters. CMS proposes a 2% reduction to offset projected spending increases.
Auto manufacturers rely on them to make decisions about improving passenger restraints in vehicles. Industrial engineers may reference them when advocating for improved design of staircases to prevent falls. Drug companies use them to bolster support for child-resistant packaging.
Providers were glad to see CMS' ruling (CMS-1455-R) released March 13 (published in the Federal Register on March 18), which allows full Part B payment for inpatient stays that had been denied as not reasonable and necessary. The ruling had very few details on how the process would work, but on March 22, CMS published Transmittal R1203OTN instructing contractors and providers on the details.
ICD-10 implementation challenges will vary from organization to organization, depending on size, setting, and patient mix. Factor in physician buy-in and budget woes, and implementation seems overwhelming.
Our experts answer questions about hydration, excludes notes in ICD-10-CM, L codes for neurostimulator devices, physician supervision for hyperbaric oxygen therapy, E/M service with wound care, and pass-though drugs.
Auto manufacturers rely on them to make decisions about improving passenger restraints in vehicles. Industrial engineers may reference them when advocating for improved design of staircases to prevent falls. Drug companies use them to bolster support for child-resistant packaging.
Sometimes our patients are very sick, very injured, or undergo multiple procedures during their stay. So how do you pick your principal procedure code in ICD-10-PCS? The ICD-10-PCS guidelines offer...
Memorial Day kicked off the summer season and today we are seeing the first summer casualties here at the Fix ‘Em Up Clinic. Apparently not everyone’s holiday celebration went off without a hitch...
One of the advantages to coding in ICD-10-CM is how much information is packed into a single code. You’ll find combination codes throughout the ICD-10-CM Manual. In many cases, you are coding the...
Actress Angelina Jolie made headlines with her New York Times editorial explaining her decision to undergo a prophylactic double mastectomy to reduce her chances of breast cancer. She also plans to...
CMS not only redefines inpatient status in the 2014 IPPS proposed rule, but it also discusses the ‘why’ and ‘how’ physicians should document the defining characteristic of all admissions: medical necessity. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain how the proposals could impact inpatient admissions.
The accuracy and completeness of coded data can potentially affect physicians more as the healthcare industry becomes increasingly transparent to consumers. William E. Haik, MD, FCCP, CDIP, Timothy Brundage, MD, Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, Cathy Testerman, CCS, EMT, and Donna Walker-Thomas, MBA, RHIA, CPC, CMA, review how coded data relates to physician profiling and offer tips for engaging physicians in documentation improvement.
CMS has had a couple of busy months releasing various FY 2014 proposed rules. On May 1, CMS issued its proposed rule for skilled nursing facilities (SNF) . On May 2, the agency issued its proposed rule for inpatient rehabilitation facilities (IRF) . The two rules come in the wake of the IPPS proposed rule issued April 26.
CMS and auditors are increasing scrutiny of CCs and MCCs. William E. Haik, MD, FCCP, CDIP, provides tips that coders can use to look for clinical evidence in the record before querying for these targeted conditions.
The ICD-10-PCS codes for 2014 are now available on the CMS website. CMS also posted the 2014 ICD-10-PCS guidelines and an ICD-10-PCS reference manual. You will find four new codes under new...
The American Medical Association (AMA) may not push for CMS to move directly to ICD-11 without implementing ICD-10 after all, according to a report of the AMA’s Board of Trustees . The report will be...
In a perfect world, inpatient facilities would receive the same payments for diseases and procedures after the switch to ICD-10-PCS. We know that won’t happen, that facilities will see some shift in...
CMS is translating only 27% of its current National Coverage Determinations (NCD) from ICD-9-CM to ICD-10-CM, according to Janet Anderson Brock, CMS’ director of the Division of Operations and Information Management, Coverage and Analysis Group Center for Clinical Standards and Quality.
General equivalence mapping (GEM) is a good tool to use to convert ICD-9-CM codes to ICD-10-CM, but the maps are only a tool. Lori Andersen, MS, and Patrick Romano, MD, MPH, explain to use GEMs as part of your ICD-10 coding transition.
Coder productivity is expected to decline by as much as 50% immediately after the transition to ICD-10. Many organizations are looking to computer-assisted coding (CAC) to help offset those productivity declines. Lisa Knowles-Ward, RHIT, CCS , and Susan White, PhD, CHDA, discuss the results of the Cleveland Clinic’s study of coding accuracy and productivity with CAC.
Everyone in healthcare—providers and payers alike—faces the same problems when preparing for ICD-10 implementation . Stephen Spain, MD, CPC, Michael Miscoe, Esq., CPC, CPCO, CASCC, CCPC, CUC, and Annie Boynton, BS, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, offer the physician, compliance, and payer perspectives on the ICD-10 transition.
Q: A patient suffered a nontraumatic intracerebral hemorrhage six months ago and is now being seen for long-standing aphasia as a result of the stroke. How would we code this in ICD-10-CM?
Do you want to work harder or work smarter? We all know electronic medical records (EMR) are great in some ways, not so great in others. Drop down menus make life easier for physicians, but can also...
Planning a big bonfire for October 1, 2014, using your ICD-9-CM Manuals? You might want to think again. Not everyone is required to transition to ICD-10. Only HIPAA covered entities must begin using...
Under a new ruling, CMS allows full Part B payment for inpatient stays that a contractor denies because it deems them to be not reasonable and necessary. David Danek and Ann Marshall, both from CMS, explain how the rebilling works under the ruling and what will be different under a simultaneously released proposed rule.
Although coders and billers don’t play a role in determining whether condition code 44 is appropriate, they certainly ensure correct billing of the code. Deborah K. Hale, CCS, CCDS, and John Zelem, MD, FACS, review the requirements for condition code 44 and when coders should report it.
The increasing complexity of the healthcare reimbursement system, quality initiatives, and the transition to ICD-10-CM/PCS put clinical documentation improvement programs in the spotlight . Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, discusses the importance of documentation improvement specialists.
Q: A surgeon’s dictated report for a right hip hemiarthroplasty states the following: Of note, while drilling one of our transosseous suture holes with a 2.0 mm drill bit, the end of the drill bit broke off inside of the trochanter. It seemed to be quite deep into the bone and was not retrievable. As such, it was left in place. Should we report 998.4 (foreign body accidentally left during a procedure) for this case?
I love the ICD-10-CM external causes codes. I’m weird, I know, but I’m also a writer and I love telling good stories. When I first started coding, my boot camp instructor Peggy Blue, MPH, CPC, CCS-P...
Penny comes in to see Dr. Morang for pain in her wrist. After performing a comprehensive exam and history, Dr. Morang documents the following ICD-9-CM codes: 354.0, carpal tunnel 715.04,...
The April 2013 issue of CMS’ Medicare Quarterly Provider Compliance Newsletter highlights two Comprehensive Error Rate Testing (CERT) issues that affect outpatient providers.
In February, AHIMA published an update to its 2010 query practice brief. The updated brief, Guidelines for Achieving a Compliant Query Practice, is the result of a joint effort between AHIMA and the Association for Clinical Documentation Improvement Specialists (ACDIS). ?
According to the Centers for Disease Control and Prevention, 31% of all American adults have high blood pressure, so odds are coders see the condition documented often. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-Approved ICD-10-CM/PCS Trainer , compares coding for hypertension in ICD-9-CM and ICD-10-CM.
Nearly 75% of participating hospitals nationwide with RA activity reported receiving at least one underpayment determination, according to the AHA RACTrac survey, fourth quarter 2012, released in March. Sixty-nine percent of hospitals with underpayment determinations cited incorrect MS-DRG as a reason for the underpayment.
William E. Haik, MD, FCCP, CDIP, a practicing pulmonologist and director of DRG Review, Inc., in Fort Walton Beach, Fla., says he first became interested in coded data in 1986 after a local newspaper published his hospital’s costs, length of stay, and mortality rates for simple pneumonia. At the time, he was the only pulmonologist in the local area. The patients he treated were often those with multiple comorbidities as well as gram-negative bacterial pneumonia who had been transferred from two smaller facilities in the county.
Successful appeals can actually lead to CMS policy changes. Facilities have been successfully appealing to receive Part B payments after a Medicare review contractor denied a Part A stay as not medically necessary. As a result, CMS is changing its policy on rebilling for Part B services.
Gloria Miller, CPC, vice president of reimbursement services for Comprehensive Healthcare Solutions, Inc., located in Tacoma, Wash, created this quick reference for HCPCS Level 1 modifiers commonly used in wound care coding.
The AMA revised the molecular pathology codes in the CPT ® Manual in 2012, but at that time CMS did not adopt the codes as it was still debating whether and how to change the reimbursement system for these services going forward. For CY 2013, CMS elected to recognize the codes, which meant it had to finalize how to pay for them. While CMS did not change pamyent for these services under the Clinical Laboratory Fee Schedule (CLFS) despite industry pressure, its change to the new codes means a change in the payments providers can expect this year and in the future.
Q: If a patient has a spinal deformity on L5-S1 and we use the appropriate codes from 2280X and then the physician performs an arthrodesis/fusion on the same level, can we bill the appropriate fusion codes (225XX-226XX) as well? My impression is no, but I would love to get some insight into this question.
Coders should question the validity of coding advice and work collaboratively with physicians to develop sound coding guidelines. Last month, I addressed coding advice related to percutaneous endoscopic gastrojejunostomy and cardiorenal syndrome. This month, I’ll address coding advice related to several other conditions.
Anesthesia coding in some ways is similar to evaluation and management coding—only easier. Chandra Stephenson, CPC, CPC-H, CPMA, CPC-I, CANPC, CEMC, CFPC, CGSC, CIMC, COSC, explained the 10 steps to coding anesthesia during the AAPC National Conference in Orlando, Fla., April 14-17.
CMS corrected edit 84, added five APCs to the I/OCE, deleted two APCs, and changed the description of another as part of the April updates to the I/OCE. In addition, CMS deleted all of the genetic testing modifiers, retroactive to January 1.
Don't let underpayments fly under the radar Nearly 75% of participating hospitals nationwide with RA activity reported receiving at least one underpayment determination, according to the AHA...
