CMS released its latest MLN Medicare Quarterly Provider Compliance Newsletter in April. The newsletter features educational information for providers related to recent audit targets and findings.
Do not view the proposed rule extending the ICD-10 implementation date from October 1, 2013, to October 1, 2014, as a year-long break from ICD-10 preparations. Rather, focus on using the additional time allotted to your advantage. This includes conducting documentation and coding assessments to gauge ICD-10 readiness. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, explains why—and how—facilities should start assessing the readiness of their coding staff and documentation procedures in relation to ICD-10 requirements and create strategies to manage any deficiencies.
In ICD-10-CM, coders must report two codes to fully describe certain conditions. They will find “Use additional code” notes in the Tabular List at codes when they need to report a secondary code to...
So we’ve survived the zombie apocalypse, but we’re not out of the undead woods yet. It seems a group of vampires is trying to one-up the zombies. But, never fear, vampires can actually be regular...
Gregory House, MD, is hanging up his stethoscope before the transition to ICD-10-CM. I loved House MD when Fox first starting airing it in 2005, but the last few seasons, not so much. Let’s ask Dr...
The American Health Information Management Association (AHIMA) continues to advocate for no delay in the implementation date for ICD-10-CM and ICD-10-PCS.
Coders and clinicians often seem to speak different languages. What a clinician considers important information may not be what a coder needs to assign the correct code. Clinicians may not document a piece of information that is vital to the coder. Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, Joseph Nichols, MD, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, explain how clinicians and coders can work together to improve communication.
With the increased specificity required for ICD-10-CM coding, coders need a solid foundation in anatomy and physiology. To help coders prepare for the upcoming transition, we will provide an occasional article about specific anatomical locations and body parts as part of a larger series for ICD-10-CM preparation. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, takes coders on a trip through the digestive system.
QUESTION: We are a small anesthesia group and we are concerned about the specificity for ICD-10-CM. If we submit a claim with an unspecified code and the surgeon submits a claim with more specificity, will we still get paid?
Coders will need very specific information in order to code for fractures in ICD-10-CM, including the type of fracture, specific bone fractured, and whether the patient is seen for an initial or subsequent visit. Robert S. Gold, MD, Sandy Nicholson, MA, RHIA, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, detail the information physicians must document for accurate fracture code assignment.
Coders often report signs and symptoms when physicians document them in the patient’s medical record. However, coders should not always report additional codes for signs and symptoms. How can coders...
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. ICD-10-CM coding conventions for such conditions require coders to report...
When a physician performs a procedure to enlarge the diameter of a tubular body part or orifice, coders will report root operation dilation with 7 as the third character in the medical and surgical...
Although MS-DRGs have stolen the spotlight since CMS implemented them in 2007, hospitals are increasingly using All Patient Refined DRGs (APR-DRG) to compile the most accurate assessment of patient severity of illness (SOI) and risk of mortality (ROM). Cheryl M. Manchenton, RN, BSN, and Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM, describe why APR-DRGs are the most widely-used SOI and ROM-adjusted DRGs and how organizations can use them to their advantage.
QUESTION: A physician documents in an operative report debridement of a necrotic muscle (not due to an open wound). Must the physician also document how the muscle is removed to report ICD-9-CM procedure code 83.45 (other myectomy)? Is this considered excisional or nonexcisional debridement? What documentation is required to code the removal of a necrotic portion of a muscle?
While we know the implementation date of ICD-10 may change to the proposed 2014 deadline, healthcare organizations must keep moving forward with preparations. Annie Boynton, BS, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, CPhT, explains how organizations can use the additional time to better handle the change process associated with ICD-10, especially planning for education and training.
Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) proposed rule, released April 24. The 2.3% is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.
Home repair and improvement can be hazardous to your health. Just ask the residents of Calamity Condos who are visiting the Fix ‘Em Up Clinic. Tom and Wendy decided to repaint the living room of...
Braaaaains! Braaaaains! Don’t look now, but the Centers for Disease Control and Prevention was right about the zombie apocalypse . It’s here! Run for your lives! Okay, we’re not about to be overrun...
CMS did not discuss drug administration services in the 2012 OPPS final rule, but the AMA did make significant additions to the CPT ® coding guidelines in the 2012 CPT Manual . Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, review the guidelines and explain the nuances to keep coders up to date.
When a physician determines the patient has a coronary artery blockage, the physician can choose from several options for treating the patient, depending on exactly what is wrong. John F. Seccombe, MD, and Betty Johnson, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC, discuss invasive and non-invasive treatments, as well as the heart’s anatomy.
The Bishop’s Score is primarily a scoring system to assess the viability and/or success of an induction of labor, odds of a spontaneous pre-term delivery, or whether a cesarean section should be considered instead of a vaginal delivery. Lori-Lynne Webb, CPC, CCS-P, CCP , explains how physicians tally the Bishop’s Score and what coders should look for in the documentation.
CMS instructed fiscal intermediaries (FI) and Medicare Administrative Contractors (MAC) to hold claims containing CPT ® code 33249 (insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber) and HCPCS code C1882 (cardioverter-defibrillator, other than single or dual chamber [implantable]).
QUESTION: Can you explain the difference between modifier -80 (assistant at surgery by another physician) and –AS (physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery)? Medicare requires us to use both modifiers for our physician assistants. We have been instructed to use -AS first and -80 second for all Medicare claims submissions. Is this correct?
...and the documentation coach will turn into a pumpkin if you're not on time. As a CDI specialist, what has been your approach to ICD-10? Are you hoping it will go away? Are you waiting for 2014?...
Spinal conditions can be congenital, pathologic, or traumatic, and they can affect the vertebrae, spinal cord, muscles, nerves, discs, or a combination of the parts of the spine.
In this month's issue, we unravel some of the confusion around coding for injections and infusions, compare ICD-9-CM and ICD-10-CM coding for spinal conditions, examine the changes to fracture coding in ICD-10-CM, and provide expert answers to reader questions.
Our coding experts answer your questions about unsuccessful foreign body removal, assigning modifier -52 for cancelled procedures, new HCPCS codes for April, reporting vaccine administration codes, new composite codes for 2012.
Learn how the ICD-10 delay will affect coders, why you shouldn't fear ICD-10 implementation, why you should review pregnancy coding guidelines, and how to motivate your coding staff.
Depending on the demographics of the region a hospital serves, its coders could determine code assignment for hundreds of deliveries and pregnancy-related services annually — reviewing coding guidelines is helpful.
Coders will need more information in order to code for fractures in ICD-10-CM. For instance, the physician must document which specific bone is fractured, including which side of the body. They will also need to document whether the patient is seen for an initial or subsequent visit.
Happy Monday! I hope you had a great weekend because it’s time to dive into coding for today’s visitors to the Fix ‘Em Up Clinic. Our first patient, nine-year-old Chris, arrived with a really nasty...
A surgeon performs an open reduction of right tibia fracture for an inpatient. Which ICD-10-PCS root operation should be reported? In this case, it’s fairly easy: reposition. In a reposition...
ICD-10-CM and ICD-10-PCS contain a significant number of new codes, which shouldn’t be news to anyone at this point. Most of the codes are longer than the current ICD-9-CM codes, which could increase...
Unfortunately, ICD-10-PCS is not very comparable to the current ICD-9-CM volume 3 codes inpatient coders currently use. But coders shouldn’t despair, according to Sandy Nicholson, MA, RHIA, Jennifer Avery, CCS, CPC-H, CPC, CPC-I and Robert S. Gold, MD —ICD-10-PC coding may even be fun once coders get the hang of it.
The additions and revisions to the ICD-10-CM Official Guidelines for Coding and Reporting in 2012 include some new information that coders should be aware of in preparation for ICD-10-CM/PCS implementation. Sandy Nicholson, MA, RHIA, and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, explore some of the biggest guideline changes.
HHS’ proposed rule announcing a one-year delay of the implementation of ICD-10-CM/PCS was printed in the April 17 edition of the Federal Register . If HHS finalizes the delay, ICD-10-CM/PCS would become effective October 1, 2014.
Each year the number of quality measures being used for public reporting across provider settings increases. Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, and Linda Hyde, RHIA, explain why organizations that have not started to evaluate the impact ICD-10 will have on their quality measure data should start now.
QUESTION: How will we be able to code for procedures such as Billroth procedures, Roux-en-Y anastomoses, and Whipple’s procedure when eponyms won’t be used in ICD-10-PCS?
[caption id="attachment_2698" align="alignright" width="150" caption="Hey, look, it's a friend of Wile E.!"] [/caption] Wile E. Coyote is back in the Acme ED, this time with a broken arm, leg, pelvis...
Not all of the ICD-10-PCS root operations are complicated or confusing. Take reattachment for example. The root operation is pretty much what you would expect. The official definition of reattachment...
QUESTION: I would like to know the correct codes to use when a patient comes into the ER after smoking synthetic marijuana and has symptoms of palpitations, seizure, or anxiety. Some physicians document ingestion, while others document abuse. What is the proper way to code considering we do not have a specific code for this new drug on the market?
A physician or clinical provider of care may have a completely different understanding, interpretation, and definition of medical necessity than the patient or a third-party insurance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA, explains the differences in the definition and application of the term medical necessity.
To correctly assign codes for any surgical procedure, coders need to have an operative (OP) report. But simply having an OP report isn’t enough. Coders also must be able to read the OP report and pick out the important information. Lynn Pegram, CPC, CEMC,CPC-I, CGSC, breaks down the OP report to help coders find the information they need.
As charges become more specific to provide additional concrete and transparent cost data, providers must consider what procedures they routinely provide to patients and what procedures are specifically related to the patient's condition. Denise Williams, RN, CPC-H, and Kimberly Anderwood Hoy, JD, CPC, reveal tips for determining when to separately bill for ancillary bedside services provided to inpatients.
A one-year delay in ICD-10-CM/PCS isn’t a slam dunk. “We’re recommending it, but it’s not [guaranteed],” said Denise Buenning, group director CMS Office of E-Health Standards and Services. Buenning...
After HHS proposed year-long delay of ICD-10, questions emerged regarding the current ICD-9-CM code freeze. CMS confirmed that the code freeze will hold until ICD-10-CM/PCS is implemented regardless...
