Special Edition MLN Matters article #SE1210 , “Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders,” outlines recovery auditor findings upon completion of medical necessity reviews. In the article, which addresses documentation and billing for inpatients, recovery auditors concluded that providers had been admitting patients even for clinical situations for which outpatient observation services would have been appropriate.
What should inpatient coders remember about the three-day payment window requirements? Although it may seem counterintuitive, Debbie Mackaman, RHIA, CHCO, and Marion G. Kruse, RN, MBA, explain that inpatient coders need to be aware of certain outpatient services that they may need to include on inpatient claims, as well as when they need to alert billers to assign condition code 51.
The ICD-10-PCS defines root operations excision and resection in a very similar way. Excision is cutting out or off, without replacement, a portion of a body part. Coders should report the qualifier...
Coders use ICD-9-CM E codes to describe the accident, circumstance, event, or specific agent that caused a patient’s injury. In ICD-10-CM, these codes will not be prefaced with the letter ‘E,’ and...
Can you begin to imagine how complex a piece of great literature would be if we had to include complete documentation of each medical incident? Or have to stop every time we have to develop physician...
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
Otolaryngology coding covers a wide range of procedures and four parts of the respiratory system—the ears, nose, sinuses, and throat (ENT). Stephanie Ellis, RN, CPC, and Kim Pollock, RN, MBA, CPC, explore some common ENT coding trouble spots.
Just because a physician considers a service or procedure medically necessary doesn't mean insurance carriers will pay for it. When a service or procedure is not covered, facilities must provide patients with an Advanced Beneficiary Notice of Noncoverage (ABN). Judith Kares, JD, CPC, and Jacqueline Woeppel, MBA, RHIA, CCS, explain limits on liability and what modifiers to use with ABNs.
The January update to the Integrated Outpatient Code editor generally includes a large number of changes and the January 2012 update is no exception. Dave Fee, MBA, highlights the most significant changes including the addition of modifier –PD, which he calls one of the real sleepers in this release.
Some of the ICD-10-PCS root operations are very similar—think excision (cutting out or off, without replacement, a portion of a body part) and resection (cutting out or off, without replacement, all...
In honor of Dr. Seuss' birthday, we present: Oh, the ICD-10-CM codes you’ll find Hit by a truck? Bit by a duck? There’s an ICD-10-CM code for that. Liver contused? Wrong substance infused? There’s an...
I love the National Public Radio (NPR) program, "Wait, Wait, Don't Tell me" (WWDTM), a fun look a the news. The program features a panel of amusing well-knowns who answer questions and try to win a...
As technology evolves, providers can perform more procedures at the patient's bedside than they ever could in the past. Previously, they could only perform these procedures in another department of the hospital, and they had to charge separately for them.
Q Addendum B of the APC updates for 2012 indicates the new molecular pathology codes have status indicator E (noncovered service, not paid under OPPS). Our laboratory director said we should report these new codes in addition to the codes that are payable. Can you explain why?
Knowing when and how to query for all conditions is crucial; this couldn't be truer for CCs and MCCs, conditions that affect payment and help capture a patient's true clinical picture and complexity.
As technology evolves, providers can perform more procedures at the patient's bedside than they ever could in the past. Previously, they could only perform these procedures in another department of the hospital, and they had to charge separately for them.
