CMS recently published Special Edition MLN Matters article 20004 regarding changes to new technology add-on payments (NTAP) under the IPPS that are meant to increase access to innovative antibiotics for hospital inpatients.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes about conflicting documentation and how coders and clinical documentation integrity specialists can resolve inconsistencies in provider documentation to prevent claim denials.
The ICD-10-PCS Official Guidelines for Coding and Reporting were updated for 2020 to include guidelines for coding brachytherapy performed in the inpatient setting. Sarah Nehring, CCS, CCDS , details these changes and how they will impact ICD-10-PCS reporting for permanent and temporary brachytherapy.
New guidelines have been published regarding the diagnosis and treatment of adults with community-acquired pneumonia by the American Thoracic Society and Infectious Diseases Society of America (Metlay et al., 2019).
With the increased focus on clinical validation denials, more and more CDI professionals are finding themselves involved in the appeals-writing process and may initially feel a bit overwhelmed by the magnitude of the job. This article is part two of the two-part series covering best practices and appeal advice for those on the frontlines.
According to the Centers for Disease Control and Prevention, flu season is underway for most of the United States, and the activity level is expected to increase over the next several weeks. In this article, Adriane Martin, DO, FACOS, CCDS, reviews inpatient ICD-10-CM reporting for the flu and its potential complications.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, analyzes pertinent guidelines and coding dilemmas found within Chapter 1 of the ICD-10-CM Manual: Certain Infectious and Parasitic Diseases. Commeree covers instructional note guidance and other chapter specific guidance for diagnoses such as sepsis and HIV. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With the increased focus on clinical validation denials, more and more CDI professionals are finding themselves involved in the appeals-writing process and may initially feel a bit overwhelmed by the magnitude of the job. This article will provide you with best practices and appeal advice for those on the frontlines.
Julian Everett, RN, BSN, CDIP , reviews the background of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) and says that even though the report is only made available through quality or chief financial departments, it is imperative CDI and coding staff have a seat at the table when discussing areas for improvement at a facility.
Sarah Nehring, CCS, CCDS , writes that CDI and coding professionals must understand the guidelines for coding myocardial infarctions (MI) as well as the clinical difference between type 1 MIs and type 2 MIs so they can be clinically validated, queried, and reported effectively to avoid negative reimbursement ramifications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Getting clean, compliant claims out the door is one of the foundations of a sound inpatient hospital. A robust process for handling claim edits and managing denials will go a long way toward supporting that goal.
One strategy for handling the confluence of confusion surrounding frequent criteria changes comes in developing a set of organizationwide clinical criteria for targeted, high-risk/high-volume diagnoses. This article discusses others’ experiences in developing standardized clinical indicators and guidelines at their facilities.
Adriane Martin, DO, FACOS, CCDS, reviews the Centers for Disease Control and Prevention’s recent proposal to update ICD-10-CM reporting for sepsis, which, if adopted, will go into effect October 2020.
Inpatient coders may query to achieve clarity within the medical record and allow for accurate ICD-10-CM/PCS reporting. This article will cover when to query, how to format a query, and review ICD-10-PCS code anatomy to ensure a well-rounded and precise query is submitted. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
As of December 4, nearly 2,300 cases of lung injury related to vaping have been reported, according to the Centers for Disease Control and Prevention. In this article, Adriane Martin, DO, FACOS, CCDS , covers guidance, clinical indicators, and ICD-10-CM reporting for vaping-related lung injury.
According to Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, updating diagnosis codes has been integral to the evolution of our healthcare system. In this article, she reviews the background and basics of ICD-11 in preparation for future implementation of the code set. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to ACDIS’ recent CDI Week Industry Survey , which included an extended section on CDI staffing practices, only 37% of respondents said they had HIM/coding backgrounds represented in their CDI departments.
Very few diagnoses have caused as much gnashing of teeth as sepsis has for inpatient coders and providers alike. Recently, the Centers for Disease Control and Prevention (CDC) has weighed in on the matter and is proposing coding changes , which, if adopted, will go into effect October 2020.
Let’s take a deep dive into the recently released coding guidance and documentation tips for these illnesses. Note that since vaping-related guidance and statistics are ever changing, this information is up to date as of October 2019.
Rachelle Musselman, BSN, RN; Jorde Spitler, BSN, RN; Daniel Lantis, BSN, RN; Joseph E. Ross, MD; and Thomas A. Taghon, DO, MHA, review their experience with implementing pediatric heart failure criteria at Dayton Children’s Hospital.
Brett Hoggard, MD, writes that the healthcare industry continues to transition toward a value-based, pay-for-performance system, but there’s still confusion surrounding different quality and value programs.
Since the implementation of ICD-10-CM/PCS, thousands of additional codes have been added to clarify aspects of certain conditions or procedures. This, on top of yearly code updates, has had a large impact on coder productivity. In this article, let’s take a look at some recent productivity statistics gathered by First Class Solutions Inc. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julian Everett, RN, BSN, CDIP, writes that early recognition of sepsis in pediatric patients, along with accurate reporting, is vital to the future of healthcare. With the goal of improving patient outcomes through documentation, Everett outlines her experience in providing documentation education to physicians.
CMS recently published an update to the fiscal year (FY) 2020 IPPS final rule. This update corrects certain technical and typographical errors and contains corrections to the final payment factors. In this article, Judith Kares, JD , gives a summary of these key updates and related guidance.
Coders need a solid understanding of complex anatomical terminology and ICD-10-CM coding guidelines to select the most specific codes for trauma and injuries. This article breaks down inpatient diagnosis coding for superficial injuries, fractures, and burns. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The fiscal year (FY) 2020 ICD-10-CM Official Guidelines for Coding and Reporting, released shortly after the FY 2020 ICD-10-CM code release, provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Coders should take time to review these changes that were implemented October 1.
As of October 1, approximately 1,080 cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S., according to the U.S. Centers for Disease Control and Prevention (CDC). Despite continued research into these cases by the CDC and the U.S. Food and Drug Administration (FDA), the specific cause of these illnesses remains unknown.
In part two of this two-part series, Sharme Brodie, RN, CCDS , reviews the recent guidance from Coding Clinic , Second Quarter 2019, including systemic inflammatory response syndrome, partial hip replacements, and more.
While “myocardial ischemia” is a familiar term to CDI professionals and inpatient coders, the term “myocardial injury” does not share the same widespread recognition. In this article, Adriane Martin, DO, FACOS, CCDS , deciphers the clinical criteria and reporting guidelines for capturing myocardial injuries and demand ischemia.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews the basics of reporting with ICD-10-PCS including how to use the ICD-10-PCS manual, decipher root operation guidelines, and identify the principal procedure in physician documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
One thousand eighty cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S. as of October 1, according to the Centers for Disease Control and Prevention. Review provider documentation and ICD-10-CM reporting for vaping-induced illnesses. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With much of the coding workforce working remotely, the inpatient coding manager must implement some control mechanisms to ensure the distractions at home are not interfering with the quality and quantity of work expected from the staff. In this article Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, gives suggestions on the various ways to monitor your remote coding staff, including tips for conducting coding reviews. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews how to report the stage and type of various skin ulcers, the fiscal year (FY) 2020 guideline updates for pressure ulcers, and common terminology traps inpatient coders can get tripped up by.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, HCS-D, reviews the 2020 ICD-10-CM code changes for atrial fibrillation, as well as the clinical background and ICD-10-PCS reporting for related procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, CCS, CCDS, says that the last thing a query writer wants is to provoke a defensive response, but in the current healthcare environment, CDI specialists, clinical, and inpatient coding staff need to think defensively. In this article, Nehring outlines five items to remember when it comes to defendable queries, documentation, and coding.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC, writes that one of the most interesting aspects of the ICD-10-CM code update for fiscal year (FY) 2020 was CMS’ proposal to change the severity assignment for many of these codes. In this article, Blue compares the severity changes that were suggested in the FY 2020 IPPS proposed rule with the designations that were actually finalized.
Valerie A. Rinkle, MPA, CHRI , reviews the fiscal year (FY) 2020 IPPS final rule and highlights key financial implications for hospitals including wage index changes, new technology updates, and more.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that the prevalence and complexity of prostate cancer is why it is so important for even inpatient coders to fully understand the diagnostic, treatment, and procedural aspects of this disease.
ICD-10-CM/PCS coding for heart conditions such as aortic valve stenosis, heart failure, and atrial fibrillation requires an in-depth understanding of anatomical terminology and clinical indications. This article will review these three diagnoses to help ensure accurate reporting and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released the fiscal year (FY) 2020 IPPS final rule on August 2, increasing inpatient operating payment rates by 3.1%, significantly altering rural health payments, expediting opportunities to pay for new technologies, and updating CCs, MCCs, and MS-DRGs. These policy updates affect approximately 3,300 acute care hospitals and apply to discharges occurring on and after October 1.
Cathy Farraher, RN, BSN, MBA, CCM, CCDS, writes that CDI professionals can work to reduce the incidence of physician query fatigue and gives recommendations to help improve provider response rate while reducing query frustration.
