Some interesting tidbits of information can be gleaned from the most recent release of the AHA Coding Clinic for ICD-10-CM/PCS to help coders as they work in the new code set.
Perhaps recognizing the massive undertaking for coding and HIM departments in 2015 with the implementation of ICD-10, the latest CPT® update includes a relatively small 367 changes for 2016.
Q: I was reviewing a case with one of our clinical documentation improvement (CDI) specialists this morning. The following clinical indicators documented in the chart are elevated cardiac enzymes, shock, and demand ischemia. Cardiology documented “elevated cardiac enzymes in setting of shock representing a Type 2 injury.” Also documented in another note is “demand ischemia.” Should the CDI specialist query for more information?
Laurie L. Prescott, RN, MSN, CCDS, CDIP, looks at the definitions for primary, principal, and secondary diagnoses and how to determine them from provider documentation.
Even before ICD-10, unclear definitions for certain diagnoses and procedures led to confusion for coders trying to interpret physician documentation. Robert S. Gold, MD, writes about conditions in the new code set that could lead to potential risks for providers.
A decrease in staff productivity has been the top challenge for providers after ICD-10 was implemented, but relatively few organizations have seen a significant decrease, according to a recent survey from Navicure.
Denials are on the rise for certain diagnoses, procedures, and regulations. Sarah C. Mendiola, Esq., LPN, CPC, outlines steps providers can take to reduce denials by focusing on certain documentation details.
CMS audits for meaningful use could mean collecting information across the coding and HIM departments. David Holtzman, JD, CIPP, and Darice Grzybowski, MA, RHIA, FAHIMA, review what auditors could request and how to prepare your facility.
Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed?
Hospital coders can choose multiple modifiers to apply to a procedure code if the service was discontinued. Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, provides an overview of these codes and in which instances to use them.
The government recently approved changes for physician payment systems. Is your clinical documentation improvement (CDI) team ready to tackle these challenges? More importantly, are your physicians ready?
The improper payment rate for oxygen equipment and supplies to the Medicare program was 62.1% with projected improper payments of approximately $952 million during the 2014 reporting period, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the January 2016 issue of the Medicare Quarterly Compliance Newsletter.
Gwen S. Regenwether, BSN, RN, and Cheree A. Lueck, BSN, RN, discuss how the clinical documentation improvement department at their facility operates and their process for conducting a baseline audit and determining query rates across specialties.
Joel Moorhead, MD, PhD, CPC, writes about details for spinal conditions for coders to consider when choosing the most accurate ICD-10 codes for diagnoses and procedures.
Gwen S. Regenwether, BSN, RN, and Cheree A. Lueck, BSN, RN, look at how to use audit and query rate information to improve documentation at a facility and how to encourage continuing education and collaboration going forward.
If two ICD-10-CM diagnoses are not related to each other, but exist at the same time, they may be reported together despite an Excludes1 note, according to a recent release from the Centers for Disease Control and Prevention. The coding advice has been approved by the four Cooperating Parties—the American Health Information Management Association, the American Hospital Association, CMS, and the National Center for Health Statistics.
Q: CMS released guidance last summer about not auditing or counting errors for the specificity of an ICD-10-CM code. CMS is not going to count the code as an error as long as the first three digits are correct. Does this apply to medical necessity diagnoses and edits?
Q: What can we report for the physician if circumcision is done during delivery? Do we bill that on a separate claim for the infant? Is this a covered procedure?
Perhaps recognizing the massive undertaking for coding and HIM departments in 2015 with the implementation of ICD-10, the latest CPT® update includes a relatively small 367 changes for 2016. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Peggy Blue, MPH, CPC, CEMC, CCS-P, review updates to the digestive system and E/M codes.
While providers are still awaiting further guidance on the four modifiers CMS introduced as subsets of modifier -59 (distinct procedural service), the latest NCCI Manual does include clarification for certain scenarios involving the modifier.
