A recent Office of Inspector General audit estimates that Medicare improperly paid inpatient hospitals $267 million over a two-year period for transfer services incorrectly billed as discharges. Judith Kares, JD , analyzes documentation and billing rules for acute and post-acute transfers.
The evolution of the role of clinical documentation integrity (CDI) specialists and their impact on coders has changed the landscape of inpatient coding departments. Learn about how to effectively collaborate with CDI professionals when conducting physician queries.
It’s always been easy to show financial return on investment for inpatient CDI endeavors, but the monetary value of outpatient programs is increasing dramatically year after year, making outpatient CDI reviews more attractive to many healthcare organizations.
Review quality reporting metrics such as length of stay and mortality indexes that you can use to assess patient outcomes and improve revenue cycle processes.
It’s common to see CDI job listings that require applicants to be registered nurses. Often an RN credential is not listed as being “preferred,” but required. There are risks, however, with only seeking candidates from this one background.
Ischemic heart disease has a multifactorial etiology and can be prevented from developing in populations primordially and in individuals at high risk by primary prevention.
Let’s face it: Our organizations are under tremendous scrutiny. As the healthcare dollar shrinks, all payers strive to minimize patient care expenses to maintain profit margins.
In part one of this two-part series, Allen Frady, RN, BSN, CCS, CRC, CCDS, gives tips to CDI and coding teams on how to help improve healthcare quality scores by reviewing CMS star rating calculations, department challenges, physician education, and more.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and present on admission (POA) indicators and the rules governing their assignment in order to ensure proper reimbursement. Part one of a two-part series will review POA indicators in particular.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, says with recent audit activity and the Office of Inspector General’s continued scrutiny of malnutrition diagnoses, it’s important to dig into the coding and documentation requirements for this tricky diagnosis, particularly in the case of COVID-19 patients.
Though the adoption of outpatient CDI has been growing steadily over the years, it’s not always easy to prove the return on investment for such efforts.
Facilities that are not leveraging CDI efforts for denials management and tracking denials as a key performance indicator (KPI) should consider doing so. Denials are the framework for identifying gaps in provider documentation and are a surefire approach to tailoring physician education that is meaningful.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, RHIA, says inpatient coding professionals need to look for signs and symptoms supportive of sepsis in order to report the most accurate codes, which is why staying up to date on the ever-changing clinical criteria for sepsis is so important.
Inpatient coding professionals must have a clinical understanding of COVID-19 and the disease process in order to accurately sequence diagnoses, code etiology and manifestations, and assign present on admission (POA) indicators. In this article, Audrey Howard, RHIA , and Susan Belley, RHIA, CPHQ, focus on coding issues related to POA indicators for the hospitalized, inpatient COVID-19 population.
Howard Rodenberg, MD, MPH, CCDS , writes that ensuring the social determinants of health are appropriately documented within the medical record allows CDI and coding teams to capture the hard data needed to demonstrate the interactions among race, gender, ethnicity, and other key socioeconomic indicators with healthcare costs, utilization, and outcomes.
Both sepsis and malnutrition remain top denied diagnoses, and there is little sign of those denial rates slowing. This article is part two of a two-part series that zeros in on clinical validation and denial prevention for these two diagnoses.
In a year of unprecedented disruption and uncertainty, coding productivity managed to hold steady, according to the results of HCPro’s 2020 Coding Productivity Survey. Review the survey results, which provide data on facility coding productivity, accuracy benchmarks, and more.
Recently, we have seen a rise in the documented diagnosis of malnutrition at our inpatient facilities. Malnutrition is highly reviewed among auditors and just as commonly denied among payers. I want to share the most recent coding updates and best practice guidelines with you.
In the 2021 Medicare Physician Fee Schedule final rule, CMS announced new HCPCS add-on code G2211 for visit complexity inherent to E/M services. Julia Kyles, CPC, describes when and how to report G2211 with E/M codes 99202-99215.
Both sepsis and malnutrition remain top denied diagnoses, and there is little sign of those denial rates slowing. Part one of this two-part series will take a closer look at malnutrition and sepsis criteria challenges, while part two will zero in on clinical validation and denial prevention for these two diagnoses.
Review clinical indicators for various types of encephalopathies including toxic or metabolic encephalopathy, hypertensive encephalopathy, and hepatic encephalopathy. Frequently reviewing clinical indicators for these complicated diagnoses will ensure both proper coding and reimbursement.
Sydni Johnson, RN, BSN, CCDS , and Denice Piwowar, BSN, RN, CCDS , detail some basics of clinical validation and how to request supporting indicators of a documented diagnosis without questioning the provider’s judgment.
One concern CDI professionals and inpatient coders say they struggle with is physician engagement and education. Without an engaged physician staff, CDI and coding efforts will languish with unanswered queries and subpar documentation practices.
I received a note from Diane Matysik, a CDI supervisor for Ascension Health in Duluth, Minnesota, who asked a question near and dear to my emergency department (ED) heart: If a patient suffers an out-of-hospital cardiac arrest and is resuscitated before arrival in the ED, should the scenario be described with an ICD-10-CM Z code?
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, writes that the better the CDI policies and procedures, the better CDI and inpatient coding departments can work efficiently together to achieve proper documentation, coding, and reimbursement.
Up to now, public health data collection has been mainly focused on adult COVID-19 patients, but we are beginning to see data indicating that COVID-19 is impacting children’s health as well. With more of the spotlight on pediatric COVID-19 diagnoses, it’s important to ensure proper documentation to help improve data collection.
A few years ago, there was a change of attitude within seizure medicine that manifested itself as new terminology. The older term “pseudoseizure” was replaced by the phrase “psychogenic non-epileptogenic seizure.”
According to Johns Hopkins Medicine, approximately 30% of patients with the novel coronavirus (COVID-19) have acute kidney injury (AKI). Because of this, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, details COVID-19-related AKI to ensure accurate documentation and appropriate queries.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM, explains the definition of acute ischemic syndrome and the clinical indicators that make a difference when reviewing a medical record. In part two of this two-part series, Kuqi takes a look at myocardial infarctions (MI), treatments for MIs, and clinical documentation concepts.
Julian Everett, RN, BSN, CDIP, reviews ICD-10-CM reporting and clinical criteria for pneumonia and its causative agents and associated comorbidities. Everett also details documentation recommendations for providers to ensure inpatient coders can report this disease with the utmost accuracy.
Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM, explains the definition of acute ischemic syndrome and the clinical indicators that make a difference when reviewing a medical record. In part one of this two-part series, Kuqi takes a look at the myocardial anatomy, stable/unstable angina, and Prinzmetal's angina.
Departmental silos are prevalent in the healthcare world and can lead to unvoiced frustrations and counterproductive work. Different organizations have different approaches to breaking down these walls, often through regular interdepartmental meetings or newsletters.
Physicians can be a bit prickly at times. While this statement intentionally downplays the behavior of (hopefully) only a few doctors, I believe that most physicians are amenable to CDI concepts. While attempting to effect change in physician documentation patterns, I’ve learned many lessons from my medical staff and from other creative CDI colleagues.
Coronaviruses are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). The SARS-CoV-2 coronavirus, which had not previously been identified in humans, is the strain that was discovered in 2019. It causes novel coronavirus disease (COVID-19) and is responsible for the current global pandemic.
Joel Moorhead, MD, PhD, CPC , writes that certain clinical indicators provide strong support for a diagnosis of acute-on-chronic congestive heart failure (CHF) in adults. Because of this, it’s important for inpatient coders to familiarize themselves with baselines and clinical indicators in order to ensure accurate reporting.
To deal with the rising rate of infection and increased hospital admissions for extraordinarily sick patients due to the novel coronavirus (COVID-19), CDI teams have had to act quickly by adapting to remote work, modifying CDI practices, and more.
Cheryl Manchenton, RN, BSN, CCDS, CPHM, writes that when it comes it reporting novel coronavirus (COVID-19), our understanding of it and its sequelae/manifestations is continually evolving. There is one “manifestation” of COVID-19 that is of interest for experimental treatment: cytokines.
It’s been nearly three years since HCPro’s last survey dedicated to query practices . Since querying is a constant and continuous aspect of CDI work, a 16-question survey focused on physician queries was recently conducted. Because of the survey’s limited length, it concentrated primarily on productivity and compliance concerns.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC , gives guidance to CDI teams working on clinical validation, denials prevention, and appeals processes to help ensure proper reimbursement for their hospitals.
Sarah A. Nehring, CCS, CCDS, writes that an inpatient coder’s first concern regarding the reporting of novel coronavirus (COVID-19) is to code all confirmed cases and only confirmed cases. In this article, Nehring details guidelines on how to accomplish this.
Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , reviews Coding Clinic , First Quarter 2020, guidance, which includes topics such as reporting vaping-related disorders, malnutrition, and bariatric procedures.
Clinical validation reviews and queries ensure that the documented diagnoses and clinical indicators hold up to inspection. This article gives an overview on processes and templates, top queried diagnoses, and physician engagement to help CDI teams perfect their clinical validation efforts.
All queries, regardless of their origin, are bound to follow the “ Guidelines for Achieving a Compliant Query Practice .” In order to ensure queries stand up to outside scrutiny and are effective, many CDI and inpatient coding leaders have put query audit practices in place for their departments as they bring on new team members.
Sarah Nehring, CCS, CCDS, says that strokes are complicated, which is why it is important for inpatient coders to be familiar with the brain’s anatomy and the clinical concepts of a stroke in order to report the most accurate ICD-10-CM codes.
Pulmonary hypertension is a complex, progressive disease that affects both children and adults, and leads to significant morbidity and mortality. In this article, Amy Sanderson, MD , reviews this disease to help ensure proper inpatient reporting and more precise queries.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O , takes a closer look at the main topics addressed in a recently published Coding Clinic Advisor FAQ, including ICD-10-CM coding for antibody testing, virus signs and symptoms, and comorbidities related to the novel coronavirus (COVID-19).
