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).
Globally, millions of people have been infected by the novel coronavirus (COVID-19), according to the Centers for Disease Control and Prevention (CDC) . There have been hundreds of thousands of confirmed COVID-19 cases, and many thousands of deaths, just in the United States
Modifier -22 indicates that the procedural work performed by the provider or surgeon was substantially greater than what is typically required. The application of this modifier allows providers to receive additional reimbursement for a procedural service that was especially challenging, time-consuming, or unusual.
Navigating Medicare’s rules for charging for ancillary services, bedside procedures, and supplies is no easy task. Get an expert perspective on how to apply the rules.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19.
In part two of this two-part series on modifier -22, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews documentation considerations for increased procedural services and tips for the appropriate CPT reporting of this commonly misused modifier.
Q: If laboratory results supporting a positive case of COVID-19 are included in the physician’s note for an emergency department visit, but the physician does not provide an interpretation of the laboratory results, would it be appropriate to report an ICD-10-CM code for a confirmed case of COVID-19?
Providers have two new CPT codes to report for blood tests to check for the presence of COVID-19 antibodies. The codes, which allow for reporting of one- and two-step testing methods, took effect April 10, according to an American Medical Association (AMA) update.
Under the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS has broadened access to telemedicine services during the novel coronavirus (COVID-19) pandemic. Read about how the interim final rule impacts reporting of telehealth visits, virtual check-ins, and e-visits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Office for Civil Rights’ (OCR) enforcement discretion statement seems to open a whole new world of options for providers and patients. However, experts have warned providers that they can still get in a lot of trouble if they are not careful about how they use technology.
The state of New York issued an executive order directly effecting the work of health information management professionals that limits documentation and coding requirements for COVID-19 patients. Around the same time, the U.S. Department of Health and Human Services announced it will reimburse hospitals nationwide at Medicare rates for treating uninsured COVID-19 patients.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah A. Nehring, CCS, CCDS, details ICD-10-PCS reporting for extracorporeal membranous oxygenation (ECMO) procedures and says basic knowledge of what an ECMO procedure is, how it is established in a patient, and why it is used can have a large impact on proper reporting and hospital reimbursement.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , writes that one area of risk unique to CDI and coding staff is the physician query. While the creation of the individual physician query usually garners most of the attention, maintenance of query compliance is equally important and frequently overlooked.
Over 330,000 cases of COVID-19 have been reported in the U.S., according to the Centers for Disease Control and Prevention. In this article, Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , writes about the virus’s etiology and how to effectively document and code for COVID-19 diagnoses.
In its April update to the OPPS, CMS made effective new Proprietary Laboratory Analysis (PLA) codes for biochemical assays and billing codes for novel coronavirus (COVID-19) laboratory tests. Hospital coders should review these updates to ensure that they are selecting the most specific codes for these services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -22 frequently causes compliance headaches for revenue cycle professionals. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , reviews CPT reporting requirements for this commonly misused modifier to ensure that your physicians are being appropriately reimbursed for increased procedural work.
On March 31, the CDC updated the 2020 ICD-10-CM Official Guidelines for Coding and Reporting to include guidance for reporting the novel coronavirus and associated respiratory illnesses, effective April 1 through September 30.
On January 1, 2021, hospitals will enter a new world of price transparency. CMS put hospitals on track to face expanded price transparency requirements with a final rule released November 15, 2019.
Q: Is there is any guidance on ICD-10-CM reporting for screening for COVID-19? For example, a patient was admitted with pneumonia and the physician documented “COVID-19 screening completed–NEGATIVE.” Would it be appropriate to assign ICD-10-CM code Z11.59 (encounter for screening for other viral diseases) for this?
To code for spinal excisions and decompression procedures, coders must break down provider documentation to determine the surgical approach utilized and surgical specialists involved, and in some cases, visualize how the procedure was performed across multiple levels of the spinal column.
CMS and the Centers for Disease Control and Prevention (CDC) announced a new ICD-10-CM code for reporting COVID-19 along with relief for facilities participating in quality reporting during COVID-19. Guidance on MS-DRG assignment and CC/MCC status for the new COVID-19 code has also been released.
Why delve into psychiatric record review? For some programs, the expansion into psychiatric units or facilities may be driven by the needs of the patient population, says Rhonda Mark, RN, BS, CCDS , a CDI specialist at Cleveland Clinic Indian River Hospital in Vero Beach, Florida.
Julian Everett, RN, BSN, CDIP , details the updated pediatric sepsis recommendations presented by the Surviving Sepsis Campaign which provides insight for clinical documentation specialists and inpatient coders on current clinical practices for the treatment of pediatric severe sepsis and septic shock.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a disease caused by the 2019 novel coronavirus, formally named COVID-19 . Recently, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
Providence St. Joseph Health, which cared for the first U.S. novel coronavirus (COVID-19) patient, is sharing how the health system has responded to the crisis.
Sarah Nehring, CCS, CCDS, reviews ICD-10-CM reporting for the novel coronavirus (COVID-19) as well as ICD-10-PCS reporting for procedures such as mechanical ventilations, tracheostomies, and extracorporeal membrane oxygenations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Amy Sanderson, MD , writes that cerebral edema and brain compression are the result of significant brain abnormalities that can be life-threatening, and it’s important for clinicians to recognize and treat these conditions promptly. Properly documenting these diagnoses in the medical record is important to accurately reflect just how sick these patients are.
Under both the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS is increasing access to Medicare’s telehealth services to allow beneficiaries to receive professional healthcare services without having to travel to a healthcare facility.
Given the frequency with which wound procedures are performed, and the expenses associated with their performance, it’s essential that coders have a clear understanding of how to accurately report CPT codes for these services. Review 2020 CPT codes for wound repairs and grafting procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Approximately 12% of Americans suffer from migraine headaches, according to the Migraine Research Foundation. In this article, Shelley C. Safian, PhD, RHIA, CCS-P, CPC-I, reviews coding for migraine headaches and their treatment, including CPT reporting of drug-free alternative treatment options.
Providers will find immediate opportunity to provide virtual visits to patients enrolled in Medicare and Medicare Advantage plans as CMS seeks to facilitate screening and treatment of novel coronavirus (COVID-19) cases.
The AMA announced that its CPT® editorial panel expedited approval of a unique CPT code to report laboratory testing services for COVID-19. The new code supports the urgent public health need for streamlined reporting of testing for the virus.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, details Chapter 5 of the ICD-10-CM manual which contains codes for mental, behavioral, and neurodevelopmental disorders, and says attention must be paid to coding guidelines and instructional notes when reviewing these codes for inpatient assignment.
Yvette DeVay, MHA, CPC, CPMA, CIC, writes that because novel coronavirus (COVID-19) is a new disease, there is still much to learn about how the disease is spread and what severity of illness it causes. For these reasons and more, many inpatient coders are finding this virus hard to report. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We are seeing an influx of possible COVID-19 patients at our facility. How can we prepare to query for COVID-19-related documentation and coding issues that are bound to come our way due to the newness of the diagnosis?
Kay Piper, RHIA, CDIP, CCS, says exciting changes to ICD-10-CM are published in an often-overlooked document called the Addenda. It lists additions, revisions, and deletions to the Alphabetical Index and Tabular List. This might seem mundane until you realize the changes’ potential effect on coding and CDI.
Coders will find a wide range of CPT and HCPCS Level II codes that have been assigned medically unlikely edits (MUE) this year. Review new MUE values that went live January 1 for codes involving drug injections as well as E/M, radiology, and therapy services.
When reporting CPT codes for spinal excisions and decompression procedures, coders must consider the approach used, spinal levels operated on, number of providers involved, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hemorrhoids are the third most common outpatient gastrointestinal diagnosis in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases. Debbie Jones, CPC, CCA , writes about symptoms of hemorrhoids and CPT coding for treatment.
Providers need to clean up coding for electro-acupuncture devices, according to CMS. In Special Edition MLN Matters 20001, the agency noted that some providers are incorrectly coding these devices using HCPCS Level II code L8679 (implantable neurostimulator, pulse generator, any type).
William E. Haik, MD, FCCP, CDIP , details guideline changes regarding the diagnosis and treatment of adults with community-acquired pneumonia and provides criteria to clinically validate a diagnosis of Gram-negative and methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
Sharme Brodie, RN, CCDS, CCDS-O, covers the guidance published in the Fourth Quarter 2019 issue of Coding Clinic , which includes updates for atrial fibrillations, pressure-induced deep tissue damage, and more.
Q: We are seeing more fundoplication surgeries and esophageal sphincter augmentation procedures for patients with gastroesophageal reflux disease at our hospital. Do you have any tips for our coders when reporting these procedures in ICD-10-PCS?
The Surviving Sepsis Campaign recently published new pediatric sepsis guidelines in Pediatric Critical Care Medicine . This update includes information on a two-phase process for septic shock and guidelines for therapy start times.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , reviews instructional notes and reporting guidance for ICD-10-CM codes in Chapter 3 of the manual, which includes codes for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Centers for Disease Control and Prevention (CDC) released an important report in November 2019 on antibiotic-resistant threats in the United States. This comprehensive look at the serious problem of antibiotic resistance has compelling individual stories, great graphics, and actions that healthcare institutions can take to help deal with the issue. The report is free to download. I recommend it for professionals who work in documentation and coding as the information can be applied immediately in your work environments.
ICD-10-CM/PCS coding for severe and potentially fatal heart conditions such as aortic valve stenosis (AVS), heart failure (HF), and atrial fibrillation (AF) requires an in-depth understanding of anatomical terminology and clinical indications. Coders need to be able to select the most specific codes based on reported symptoms and the severity of the disease.
Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.
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. Since FY 2020 is in full swing, now is the time to review these updates if your inpatient coding team hasn’t already.
To enhance efforts to combat the opioid crisis in America, CMS policy allows for a new benefit under Medicare Part B concerning Opioid Treatment Programs.
The Centers for Disease Control and Prevention (CDC) is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. On January 30, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern due to its sustained person-to-person spread within countries and across continental borders.
Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary or excessive services, contributing to rising healthcare costs and the possibility of depleting Medicare funds.
The Centers for Disease Control and Prevention is monitoring the rapid spread of a novel 2019 coronavirus, formally named COVID-19, first identified in Wuhan, Hubei Province, China. Learn about signs, symptoms, and ICD-10-CM coding for the virus. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
More than 34 million people in the U.S. have diabetes and one in five don’t know they have it, according to the Centers for Disease Control and Prevention. In this article, Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC , writes about E/M coding for diabetes management and HCPCS Level II coding for external insulin infusion pumps.
CMS recently announced that it will cover acupuncture therapy sessions for Medicare patients with chronic low back pain. Read about how this change will impact physician coding and billing for acupuncture services.
CMS announced on February 13 that it created a new HCPCS code U0001 to report laboratory testing for the 2019 novel coronavirus (COVID-19). Medicare’s claims processing system will be able to accept this code on April 1 for dates of service on or after February 4.
Julian Everett, RN, BSN, CDIP , says that 2020 should be the year when more CDI programs and inpatient coding teams ponder the idea of expanding into reviewing obstetrics. In this article, Everett details key areas to consider when starting these reviews, including hiring staff that have experience in obstetrics, conducting case sample assessments, and providing education on coding guidelines.
While the premise for quality programs is largely the same across the board, there are many programs and measures that fall under the “quality” banner. From readmissions to present on admission (POA) and patient safety indicators (PSI), CDI programs have a myriad of potential options in terms of record review focus.
Sarah Nehring, CCS, CCDS , writes that because of the complexity and frequency of ischemic stroke admissions, inpatient coders should review clinical criteria and ICD-10-CM reporting regularly for this diagnosis to ensure accurate coding and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In 2017, roughly 48 million incident cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported, according to a study published in The Lancet . According to the study, this represents 19.7% of all global deaths.
As with any new clinical documentation integrity (CDI) initiative, there are many possible starting points for outpatient CDI. Review advice from healthcare professionals at Trinity Health on how to successfully implement an outpatient CDI program.
Nationwide studies show increases in rates of alcohol-related emergency department visits and hospitalizations over the past decade. Review ICD-10-CM documentation and reporting for alcohol abuse and related complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Centers for Disease Control and Prevention estimates that over 30 million people in the U.S. have diabetes mellitus and 25% don’t know they have it. Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about characteristics of the diabetes and ICD-10-CM coding for the disease.
The Centers for Disease Control and Prevention (CDC) recently published an ICD-10-CM index and tabular addenda with reporting criteria for new ICD-10-CM code U07.0 (vaping-related disorders). The agency also updated its MS-DRG grouper software package to accommodate the new code.
Lung cancer is the leading cause of cancer death, making up almost 25% of all cancer deaths in the U.S., according to the American Cancer Society. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O , reviews ICD-10-CM and ICD-10-PCS coding for common types of cancer. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
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 fiscal year 2020 inpatient prospective payment system (IPPS) proposed rule threw gas on the population health fire when it proposed giving social determinants of health (SDOH) codes more weight as complications/comorbid conditions (CC).
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).
Prevention of the flu is important as this illness can lead to hospitalization and even death. The CDC reports the hospitalization rate due to the flu is 2.7 per every 100,000 persons, and there is a 4.8% mortality rate due to influenza and pneumonia.
Coding productivity held steady, but missing documentation and unanswered queries bog down coders, according to the results of our 2019 coding productivity survey
The Medicine section of the CPT Manual includes codes for a variety of services including acupuncture, vaccinations, and behavioral health assessments and is divided into 33 subsections that can make it challenging to navigate.
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve.
The Medicine section of the CPT Manual includes codes for a variety of services and is divided into 33 subsections that can be challenging to navigate. Review guidance for reporting 47 new codes within this section of the manual including those for vaccines, behavioral assessments, ocular examinations, and more. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently rescinded Transmittal 4880, January 2020 Update of the OPPS, and replaced it with Transmittal 4494 to include updated language on the removal of procedures from the inpatient-only list and new information on out-of-pocket costs for screenings with electrocardiography. All other information remains the same.
The American Medical Association introduced new CPT codes for long-term electroencephalogram (EEG) monitoring sessions that went into effect on January 1. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, COC, CPC-I , describes how to accurately apply these codes based on details in provider documentation.
