In this month's issue, we examine CMS' Part A to Part B rebilling ruling and proposed rule, look at how facilities are being reimbursement for the new molecular pathology codes, review changes to the I/OCE for April, and answer your questions.
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.
When coders begin using ICD-10-PCS the second and fourth character definitions seem simple enough: Second character-Body system Fourth character-Body part However, when coders start assigning codes,...
You know what keeps you up at night thinking about the ICD-10 transition. Have you ever wondered what causes CMS officials to lose sleep? For Denise Buenning, MsM, director of CMS’s administrative...
It was almost inevitable. The possibility of another ICD-10 delay was brought up during the AHIMA ICD-10-CM/PCS and CAC Summit in Baltimore April 24. And just as quickly as it was raised, the...
Distinguishing between clinical and coding significance is often confusing. Joel Moorhead, MD, PhD, CPC, discusses how coders should differentiate between the two.
The three-day rule defines certain preadmission outpatient services as inpatient operating costs that are covered and paid under the IPPS. Kimberly Anderwood Hoy, JD, CPC, and Valerie A. Rinkle, MPA, unravel the complex conditions associated with the rule.
DRGs for procedures unrelated to the principal diagnosis should occur rarely. Robert S. Gold, MD, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain when it is appropriate to report an unrelated DRG.
I wanted to share some interesting numbers from Torrey Barnhouse's presentation at the AHIMA ICD-10 Summit in Baltimore. Torrey is the founder and president of TrustHCS, which conducted an industry...
Trust is a basic human emotion. It allows us to explore out surroundings and grow. You can't expect grouth or change without trust. Cindy Seel, MSA, RHIA, director of education and training at HRS,...
Any healthcare organizations are considering computer-assisted coding (CAC) to help minimize the expected coder productivity decline in ICD-10. Lisa Knowles-Ward, RHIT, coding and reimbursement for...
ICD-10 implementation is only 18 months away. Sounds like a long time, doesn't it? It's really not, Kathleen Frawley, JD, MS, RHIA, FAHIMA, told attendees at the 2013 AHIMA ICD-10 and CAC Summit in...
By now you have probably heard that you need to train more than just your coders on ICD-10. Shelley Weems, RHIA, CCS, implementation lead for the Health Information Management Program Office for the...
At first glance, the new CPT ® codes for reporting molecular pathology services might seem simple. They certainly look easier than the old stacking codes that focused on methodology and processes, resulting in multiple codes and quantities being used to report a single test. Jugna Shah, MPH, and Michelle L. Ruben, detail some of the nuances of correct code assignment for molecular pathology tests.
Q: A physician's office collects a pap specimen and sends the specimen to the hospital lab for processing. The physician's office lists ICD-9-CM code V72.31 (general gynecological examination with or without Papanicolaou cervical smear) as the diagnosis for this service. What is the proper diagnosis code for the hospital to use for billing when only processing the specimen?
More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on. Andrea Clark, RHIA, CCS, CPC-H, CEO, Debbie Mackaman, RHIA, CHCO, and Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , explain how coders and their organizations can benefit from internal audits.
CMS added seven CPT ® codes to the conditionally bilateral list as part of the April update to the Integrated Outpatient Code Editor. When a provider performs a conditionally bilateral service bilaterally, coders must append modifier -50 (bilateral procedure) to the code.
How often do you default to an unlisted code or a non-specific code in ICD-9 because the physician just didn’t document enough information? For example, how many times do you see documentation...
