Medical practices in the U.S. are expanding treatment options for major depressive disorder to include transcranial magnetic stimulation (TMS). Laurie Bouzarelos, MHA, CPC, reviews the basics of TMS, types of providers who can deliver TMS, and ICD-10-CM/CPT coding for TMS delivery and management.
Between 2016 and 2019, Medicare payments to laboratories for genetic tests quadrupled from $351 million to $1.41 billion. This sharp increase in spending on genetic testing is likely linked to excessive and fraudulent billing, according to a recent Office of Inspector General (OIG) report.
CMS recently released the 2022 National Correct Coding Initiative Policy Manual for Medicare Services . Julia Kyles, CPC , breaks down procedure-to-procedure and medically unlikely edits for a selection of new provider-based services.
Q: We recently had a patient with a history of diabetes admitted with gangrene of the left second toe. Can you review any guidance related to ICD-10-CM coding and documentation for a case like this?
The fall 2021 Leapfrog Hospital Safety Grade report has been released, assigning grades to 2,901 hospitals. The grades come from hospitals’ performance on over 30 evidence-based measures of patient safety. For the first time, a new grading factor for post-operative sepsis, blood leakage, and kidney injury were included in those measures.
Many physicians are not entirely aware of the denials landscape and their involvement in it is often something they never anticipated. Educating physicians on their role in coding denials is important as it will help ensure proper reimbursement. Part two of this two-part series discusses involving physicians in administrative law judge appeals and monitoring success rates.
Anneleah Williams-Bridges, MS, MBCA, RHIA, CCS, CCS-P, CCDS, RH-CBS, LIA, says that until recently, many organizations have solely used their coding and CDI resources to strengthen the capture of CCs/MCCs, severity of illness/risk of mortality scores, and MS-DRG validation; however, facilities that are not leveraging these teams for denials management and tracking denials as a key performance indicator should consider doing so.
Jillian Harrington, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, CEMC, MHP, writes that in order to ensure proper coding, documentation, and reimbursement, it’s great practice to have inpatient coding and CDI teams review querying procedures yearly. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
We would fail to see ourselves completely if we didn’t consider external views as well, so for this article, we’ll be looking at CDI-focused works from the medical literature.
Coding and CDI programs can take many approaches to manage denials, whether they focus on physician documentation education, have a team member dedicated to writing appeals, or anything in between.
The 2022 CPT code set includes 249 new codes that went into effect January 1. Review new CPT codes for spinal decompressions, cataract removals, auditory implantations, and more.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
Coding for conditions complicating pregnancy and delivery can be challenging, given the number of factors that influence maternal and fetal health. This article details ICD-10-CM coding for cervical incompetence, in vitro fertilization (IVF), and postpartum care complications.
Q: We recently had a patient admitted after a vertebral body tether procedure for scoliosis. Were there any changes to the fiscal year 2022 ICD-10-PCS codes for procedures related to this?
The Office of Inspector General (OIG) recently released the 2021 version of its annual publication on unimplemented recommendations, which lists overpayments from incorrectly assigned severe malnutrition diagnosis codes as a top concern.
Sarah A. Nehring, RHIT, CCS, CCDS , writes that with new COVID-19 codes coming in April 2022, now is a good time to review these updates as well as an ICD-10-CM code that was previously released in an April update: electronic cigarette, or vaping, product use-associated lung injury (EVALI). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Most risk adjustment models use ICD-10-CM codes to identify patients who are considered “risky” by healthcare insurance companies. The process of risk adjustment is used to predict costs linked to care delivery and quality reporting, which is why thorough knowledge of risk adjustment is important for hospitals to ensure proper quality reporting.
Many physicians are not entirely aware of the denials landscape and their involvement in it is often something that they never anticipated. Educating physicians on their role in coding denials is important as it will help ensure proper reimbursement. Part one of this two-part series discusses how to make time for proactive education.
Patient safety and quality of care are forerunning concerns for organizations today. Not only do we want to ensure our patients are receiving high-quality care, we want to ensure care is safe and effective. We need to examine how and when we evaluate that quality of care, however, in order to remain ethical and compliant.
Q: Effective January 1, CPT codes 94625 and 94626 will replace HCPCS code G0424 for pulmonary rehabilitation. Will these new CPT codes have the same reporting requirements as G0424?
Tackling reporting errors early on is an essential component of denials management. Leyna Belcher, MSN, RN, CCDS, CCDS-O , describes strategies that coding and billing professionals can employ to reduce claim denials and increase the success rate of appeals.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Between January 2019 and August 2020, CMS overpaid physicians an estimated $9.5 million in unallowable Medicare payments associated with facet joint denervation procedures, according to a recent Office of Inspector General (OIG) report.
Shelley C. Safian, PhD, RHIA, CCS-P, COC , breaks down CPT coding for hearing assessments and for auditory osseointegrated implants used to treat certain types of hearing loss.
Inpatient coders and CDI specialists are usually familiar with ICD-10-CM coding for diabetes mellitus and Cushing’s syndrome. However, they may need a refresher on ICD-10-CM coding for less common endocrine disorders. This article breaks down endocrine anatomy and physiology, and ICD-10-CM coding for thyroid, parathyroid, adrenal, and pineal irregularities.
CMS and the Centers for Disease Control and Prevention recently released new ICD-10-CM/PCS codes related to vaccines and treatments for COVID-19. These new ICD-10-CM/PCS codes are effective April 1, 2022.
According to Deanne Wilk, BSN, RN, CCDS, CDIP, CCDS-O, CCS, patient safety and quality of care are forerunning concerns for organizations today, and hospitals need to examine how and when they evaluate that quality of care in order to remain ethical and compliant.
Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , writes that one diagnosis in particular that can take extra effort to understand is acute kidney injury (AKI). Frequently reviewing coding and CDI challenges related to AKI will ensure proper coding and reimbursement.
Sarah Nehring, RHIT, CCS, CCDS, says ICD-10-CM reporting for diabetes can be complex, that’s why it’s important for inpatient coders to regularly review reporting requirements for this diagnosis and associated complications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders and CDI professionals should be active in the rule-making process for the IPPS, as their specific skills and knowledge can make a large impact on what appears in the final rule.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association recently updated the CPT code set to include 249 new and 93 revised codes, which go into effect January 1. Review significant updates the musculoskeletal, cardiovascular, and digestive chapters of CPT.
ICD-10-CM codes for traumatic fractures specify the type of bone injury, affected area of the body, and in some cases, the degree of soft tissue damage. Review orthopedic terminology and documentation requirements for traumatic fractures to resolve the coding challenges.
Effective January 1, CMS is expanding coverage for the use of telehealth technology to include the delivery of mental health services in underserved areas.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks CPT coding for breast biopsies, mastectomies, lymph node excisions, breast reconstructions, and other procedures used to prevent and treat breast cancer.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , writes about key regulatory updates in the 2022 Outpatient Prospective Payment System (OPPS) final rule, including increased price transparency penalties, changes to the inpatient-only list, and payment changes.
Due to the drug ivermectin’s uptick in misuse for treating COVID-19, Susan Belley, MEd, RHIA, CPHQ, reviews ICD-10-CM reporting for poisonings, adverse and toxic effects, and underdosing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down acute respiratory distress syndrome (ARDS) and sepsis criteria and reviews documentation and querying for these diagnoses through a case study.
All inpatient coding and CDI professionals, whether new to the field or industry veterans, should be familiar with the American Hospital Association’s Coding Clinic . This article reviews the steps to take and the importance of submitting coding questions.
Q: Our facility has been seeing more denials lately for acute respiratory distress syndrome (ARDS), especially when both respiratory failure and ARDS are documented in the same record. How should ARDS be reported in ICD-10-CM, and which MS-DRG does this diagnosis group to?
According to a recent audit performed by the Office of Inspector General (OIG), Coventry Health Care of Missouri Inc. received nearly half a million dollars in overpayments from 2014 through 2016 for incorrectly submitting diagnosis codes from high-risk groups.
Four new CPT codes for principal care management services take effect January 1, 2022. Review documentation requirements and billing edits that will affect reporting of these new codes.
Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for mammography, breast ultrasound, and breast magnetic resonance imaging for cancer screening and diagnosis.
CMS recently released the 2022 Medicare Physician Fee Schedule (MPFS) and OPPS final rules, revising E/M coding guidelines for split visit services, retaining Category 3 telehealth codes through 2023, and increasing monetary penalties for hospital price transparency noncompliance.
Read up on documentation requirements and CPT coding for psychiatric diagnostic evaluations and psychotherapy services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, writes that through updated heart failure definitions and clinical criteria, coders and CDI teams now have help to ensure that congestive heart failure is properly documented and denials are avoided.
Sarah Nehring, RHIT, CCS, CCDS , shares insight on the clinical concepts behind new fiscal year 2022 ICD-10-CM code I5A (non-ischemic [non-traumatic] myocardial injury) and Coding Clinic, Third Quarter 2021, advice regarding myocardial infarctions due to in-stent stenosis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down the various definitions and criteria for sepsis and reviews documentation and querying for this diagnosis through a case study.
The Office of Inspector General (OIG) recently announced its intention to publish a toolkit for identifying adverse events through medical record reviews for inpatient hospitals. The OIG plans to have the toolkit published in fiscal year 2022.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, breaks down ICD-10-CM and CPT coding for Meniere’s disease and perilymphatic fistulas—two conditions of the inner ear that affect hearing and balance.
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHPC, CHEP, CHC, CACO, CAC, reviews findings from a recent Office of Inspector General audit of claims for neurostimulator implantation surgeries and their implications for coders.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include a new code for a booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine.
Q: What are the reporting requirements for CPT code 99483 (assessment of and care planning for a patient with cognitive impairment) for cognitive assessment and care planning services?
Applying data governance strategies can help healthcare facilities capture and use social determinants of health (SDOH) data, and a key part of that process is appropriate ICD-10-CM coding, according to a recent AHIMA white paper.
To select the most specific codes for pediatric conditions, inpatient coders must understand the difference between the terms “neonate,” “newborn,” and “infant.”
For FY 2022, CMS continues to expand inpatient access to cutting edge health care technologies by increasing the additional payments designed to cover their development costs and streamlining applicable FDA approval processes.
Transcatheter arterial septostomy and transcatheter intracardiac shunt procedures are used to treat congenital cardiac diseases that restrict blood flow and atrial communication. Review documentation requirements and CPT coding for these minimally invasive surgeries.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia.
The Surviving Sepsis Campaign recently released a 2021 update to guidelines for the care of patients with sepsis. The updated guidelines emphasize the difficulties with treating patients who are experiencing long-term effects of sepsis.
Hospitals often put significant thought, time, and energy into hiring new team members, and while coding and CDI managers can have the best possible staff, if they don’t feel appreciated, the odds of them staying with the company long term are low.
In part two of this two-part series, Audrey Howard, RHIA, covers fiscal year (FY) 2022 updates to ICD-10-PCS reporting for spinal procedures, specificity updates to the ICD-10-CM official coding guidelines, and modified MS-DRG logic for type 2 myocardial infarctions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In this article, Alba Kuqi, MD, CICA, CCS, CDIP, CCDS, CRCR, CSMC, MSHIM, RHIA , breaks down a clinical scenario and corresponding query so inpatient coders and CDI specialists can better work to ensure proper reporting and reimbursement for diagnoses related to acute tubular necrosis (ATN).
Between 2016 and 2017, CMS overpaid hospitals and other providers an estimated $636 million in unallowable Medicare payments associated with neurostimulator implantation surgeries, according to a recent Office of Inspector General (OIG) report.
Kimberly A. Hoy, JD, CPC , summarizes proposed changes to physician coding and billing for therapy assistant services in the 2022 Medicare Physician Fee Schedule proposed rule.
The fiscal year 2022 ICD-10-CM code set introduced 165 new codes, effective for encounters on or after October 1. Read about notable changes including new codes for anemia and thrombolysis, COVID-19-realted conditions, depression, and gastric metaplasia. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews ICD-10-CM and CPT coding for cervical incompetence, in vitro fertilization (IVF), and postpartum care complications.
In this article, we will take a closer look at clinical indicators for acute myocardial infarction, congestive heart failure, and arrythmias. Frequently reviewing clinical indicators for complicated diagnoses such as these will ensure both proper ICD-10-CM reporting and reimbursement.
In part one of this two-part series, Audrey Howard, RHIA, covers fiscal year (FY) 2022 updates to ICD-10-CM reporting for non-ischemic myocardial injury and traumatic brain compression and herniation. 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 it only takes one or two inappropriate queries to a provider for the process to seem burdensome to them. To avoid this scenario, Rodenberg proposes three questions to consider once you’ve decided a query is in order.
The October 2021 quarterly update to the OPPS announces new HCPCS codes for endoscopic submucosal dissection and central venous catheterization. It also introduces new HCPCS drug codes and revisions to the list of those qualifying for pass-through payment status.
Q: A wound care patient with a 25-sq-cm chronic foot ulcer presents with a new cellulitic rash, which is treated using topical medication. During the visit, the physician also surgically removes dead tissue from the ulcer. How would these services be reported in CPT?
The latest quarterly National Correct Coding Initiative (NCCI) update includes a reversal of procedure-to-procedure (PTP) edits that involve E/M codes along with new medically unlikely edits (MUE) for a series of COVID-19 vaccination codes. Review the changes, which went into effect on October 1.
ICD-10-CM coding for neuropathies can be challenging given the complexity of these diagnoses and associated complications. Demystify documentation requirements and ICD-10-CM coding for ischemic and hemorrhagic strokes, migraine headaches, and paralysis. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , unpacks ICD-10-CM coding for uncommon obstetric (OB) complications and symptoms and CPT coding for surgical management of miscarriages.
Several CPT modifiers have similar definitions, which can make distinguishing between them challenging. Review guidance for the appropriate application of modifier -51 versus -59 and discontinued service modifiers -52, -53, -73, and -74.
You may wonder why an article about the coding of Hierarchical Condition Categories (HCCs) in the outpatient wound care setting is appearing in an inpatient periodical. When I first approached this topic, I focused on the outpatient wound care setting. But the more I thought about it, I realized this topic is pertinent for inpatient coders.
Since the start of the pandemic, HIM, CDI, and coding professionals have focused on understanding acute respiratory distress syndrome (ARDS) as a manifestation of COVID-19.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down CPT coding for diagnostic services performed during the second and third trimesters, and provides an overview of an obstetric (OB) hospitalist's role in caring for high-risk maternity patients.
Documentation is an integral part of a patient’s healthcare encounter. Improper or imprecise documentation may create an inaccurate picture of what truly occurred during a patient’s hospital stay or outpatient visit. How do CDI and inpatient professionals capture the most accurate picture possible? The answer may lie in solving a more complex question: How do we encourage and expand critical thinking?
ICD-10-CM coding for neuropathies can be challenging given the complexity of these diagnoses and associated complications. Demystify documentation requirements and ICD-10-CM coding for ischemic and hemorrhagic strokes, migraine headaches, and paralysis.
