Susan Belley, RHIA, CPHQ , and Audrey Howard, RHIA , analyze the frequently changing ICD-10-CM guidelines for reporting COVID-19 and related respiratory complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hierarchical Condition Categories (HCC) are used to represent risk scores for patients on Medicare Advantage plans. Learn why it’s important for organizations to understand how HCCs are used across settings.
Effective management of claim edits and denials is a cornerstone of a sound revenue cycle. See how your organization compares to others and what you can do to improve.
Monica Tyiska, MBA-PM, RHIA, CCS, CPC, CPMA, CHA, OHCC, CCP-P, offers advice for how organizations can improve hiring practices to ensure candidates from diverse backgrounds that represents the community are brought in.
Q: I’m having trouble determining how to report an acute myocardial infarction (MI) for subsequent admissions occurring within four weeks of the initial MI in ICD-10-CM. Can you walk me through the process?
Vaginal cuff dehiscence is a severe complication of a total hysterectomy. In this article, Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , writes about ICD-10-CM coding for vaginal cuff dehiscence and ICD-10-PCS coding for dehiscence repairs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Encephalopathy is a general term used to describe any disease of the brain that alters its function or structure. Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , analyzes ICD-10-CM coding for toxic, metabolic, and hepatic encephalopathies.
A Humana health plan in Florida collected nearly $200 million in Medicare overpayments in 2015 by improperly coding for high-severity Hierarchical Condition Category conditions, according to a recent audit from the Office of Inspector General (OIG).
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.
Allen Frady, RN, BSN, CCS, CRC, CCDS, describes steps that coding and clinical documentation integrity managers can take to improve quality metrics and hold staff accountable for reporting errors.
Billing for high-level inpatient stays increased over a six-year period sparking concerns by the government about upcoding, according to a recent report from the Office of Inspector General (OIG).
About 1% of children in the U.S. suffer from chronic malnutrition, according to John Hopkin’s Medicine. In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA, breaks down ICD-10-CM coding and documentation requirements for malnutrition.
Cheryl Manchenton, RN, BSN, Beth Wolf, MD, CCDS, CPC, and Audrey Howard, RHIA, review ICD-10-CM coding for cytokine release syndrome, sepsis, and multisystem inflammatory syndrome. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coding for traumatic fractures is based on details about the broken bone and the event that caused the injury. Review ICD-10-CM codes and guidelines for reporting different types of traumatic fractures.
It’s important for inpatient coders to frequently review hospital-acquired conditions (HAC) and the rules governing their assignment in order to ensure proper reimbursement. Part two of this two-part series will review HACs in particular as part one focused on present on admission indicators.
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.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM codes for immunodeficiencies are CCs for inpatient admissions and can impact severity of illness and risk of mortality calculations, which is why they are important for coders to frequently review. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
Audrey Howard, RHIA, and Susan Belley, RHIA, CPHQ , write that since acute respiratory distress syndrome (ARDS) is included as a common respiratory manifestation of COVID-19 in the ICD-10-CM Official Guidelines for Coding and Reporting , it is essential to understand the syndrome for accurate and complete inpatient reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
Audit defense is a key strategy to ensure coding and billing compliance and defend earned revenue. It’s more important than ever as the COVID-19 pandemic continues to drain hospital resources, but with HIM departments already stretched thin, it’s also more difficult than ever.
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.
Sarah Nehring, RHIT, CCS, CCDS, writes that ICD-10-CM reporting of sequelae generally requires two codes, but the codes assigned and the sequencing depend on whether the sequela is from a cerebrovascular accident, a traumatic injury, or an infection such as COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
ICD-10-CM reporting for genitourinary conditions requires careful attention to detail as many codes in this section of the manual are for conditions that involve multiple body structures and that present with a variety of symptoms.
Hospitals across the country marked the start of the new year by posting new and more detailed price information online. With the Hospital Price Transparency final rule, which became effective January 1, 2021, CMS completed the most ambitious chapter in its ongoing price transparency efforts.
Review clinical indicators and query opportunities for acute respiratory failure, respiratory failure due to surgical procedures, and ventilator MS-DRGs. Frequently reviewing clinical indicators for these complicated diagnoses will ensure both proper coding and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
Malnutrition is notorious for its impact on hospital reimbursement. For example, in 2018 the Office of Inspector General (OIG) conducted an internal audit of the University of Wisconsin Hospitals and Clinics Authority. The audit revealed an overpayment of $9,569,586 for the billing of malnutrition.
In a year of unprecedented disruption and uncertainty, coding productivity managed to hold steady, according to the results of our 2020 Coding Productivity Survey. Learn how facilities adapted and how yours compares.
Sarah Nehring, RHIT, CCS, CCDS, writes that the ICD-10-PCS code set update for fiscal year 2021 included the creation of five new Fragmentation tables. For this article, Nehring will take a look at two vascular Fragmentation procedures: ultrasound-assisted thrombolysis (EKOS) and intravascular shockwave lithotripsy (IVL). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
Although the HIM department plays a key role in the revenue cycle, too often it’s placed in a reactive position, limiting the department’s effectiveness. The HIM department can wind up locked in a cycle of cleaning up claims without being empowered to apply process improvements that would reduce errors and facilitate corrections.
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.
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.
Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, looks at some of the new fiscal year (FY) 2021 ICD-10-CM codes and guidelines pertaining to COVID-19 and Chapter 1 of the ICD-10-CM manual: Certain infectious and parasitic diseases. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Clinical indicators for certain conditions or treatments frequently require greater completeness or specificity in ICD-10-CM, for which concurrent or retrospective query is often required.
Sarah Nehring, RHIT, CCS, CCDS, reviews several new COVID-19-related ICD-10-CM and ICD-10-PCS codes recently released by CMS that will become effective January 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
