Insufficient documentation is the leading cause of improper payments for claims involving referring providers, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the October 2015 Medicare Quarterly Compliance Newsletter .
Q: I have a question about coding infusion/injections in the ED prior to a decision for surgery. A patient comes into the ED with right lower abdominal pain. The physician starts an IV for hydration, gives pain medication injections, then does blood work and an MRI to rule out appendicitis. The blood work comes back with an elevated white blood count, so the patient is started on an infusion of antibiotics. Then the MRI results come in with a diagnosis of appendicitis. So a surgeon is called in to consult and take the patient to surgery. Can we bill the infusions/injections prior to the decision for surgery? I realize that once the decision is made, then the infusion/injections are off limits and are all included in the surgical procedure. But up until that time, can the ED charge the infusions/injections? They are treating the patient’s symptoms and can’t assume the patient will have surgery until the decision is made by the surgeon.
Kelly Whittle, MS, and Monica Pappas, RHIA, provide methods for determining the impact ICD-10 is having on your department’s productivity and strategies for minimizing losses.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, writes about terms coders will see in physician documentation for ulcers and how to code related conditions in ICD-10-CM.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA-approved ICD-10-CM/PCS trainer, provided documentation and coding examples for reporting breast care procedures and ICD-10-CM diagnoses.
Recovery Auditors have identified numerous potential duplicate claims from Medicare Part B providers, according to the October 2015 Medicare Quarterly Compliance Newsletter . These claims are send to MACs for further action, which could include overpayment recovery.
In addition to updated procedure codes in 2015, ICD-10-CM added new codes for reporting mammography and breast MRIs and ultrasounds. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, writes about how to identify which codes to use to meet Medicare requirements and where third-party payer requirements may diverge.
ICD-10 is undoubtedly affecting coder productivity, but Bonnie S. Cassidy, FAHIMA, RHIA, FHIMSS, CPUR, NAHQ, and Reid Conant, MD, FACEP, provide strategies for increasing proficiency and leveraging technology to reduce the effects of changing to a new code set.
Charlotte L. Kohler, RN, CPA, CVA, CRCE-I, CPC, ACS, CHBC, discusses how modifiers -59 and -91 differ and what coders need to know to use them when reporting laboratory services.
Q: Our business office wants us to start using modifier -PO (services, procedures, and/or surgeries furnished at off-campus, provider-based outpatient departments) for services that are provided in some of our outpatient departments, but not all. We want to hard code this to our charge description master but are not sure why some services will get this modifier and some won't.
Ready or not, ICD-10 is here. Sam Antonios, MD, FACP, FHM, CCDS, writes about how to talk to physicians about the transition in order to make it as seamless as possible.
Most improper payments for diagnostic nasal endoscopies reviewed during a Comprehensive Error Rate Testing (CERT) special study occurred due to insufficient documentation, according to the latest Medicare Quarterly Compliance Newsletter .
Coders can no longer rely on the muscle memory and cheat sheets they developed working with ICD-9-CM for so long. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, reviews ways coders can update their processes for reporting certain OB/GYN services in ICD-10-CM.
Providers have to create their own ED E/M guidelines, which can present a variety of challenges for facilities. For coders, this means an understanding of how to calculate critical care and other factors in order to report the correct visit level.
Combination codes in ICD-10-CM will allow coders to report pressure ulcer location and severity in a single code. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD, review the stages of pressure ulcers and which information coders will have to look for in documentation.
The updated guidelines in ICD-10-CM will impact how coders report certain diagnoses. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, highlights important changes in each section for coders to review before implementation.
A Recovery Auditor review of claims from September 25, 2012, to August 30, 2013, found providers billing hydration therapy with diagnosis codes not considered reasonable and medically necessary, according to the July 2015 Medicare Quarterly Compliance Newsletter .
Q: I have been told by our billers that infusion codes reported in the ED along with an E/M code that has modifier -25 (significant, separately identifiable evaluation and management service on the same day of the procedure or other service) require another modifier. I thought that -25 is the only modifier that should be submitted, unless the provider started a second infusion at a second site on the body. This is the first time I’ve been told the infusion coder need a modifier if the E/M has modifier -25 appended. All of my educational articles tell me that the two can be reported together. Have I missed an update somewhere along the way?
Sue Bowman, MJ, RHIA, CCS, FAHIMA, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, provide strategies for coders and coding department managers to speak with physicians regarding ICD-10 in order to allay physicians’ fears.
Q: I have a question regarding facility coding for evaluation and management (E/M) levels, not for an ED physician, but for facility-level nursing in the ED. If a specialist is called to evaluate or consult on a patient, the nursing intervention is what the facility-level criteria is based on. For example, a patient has difficulty walking, a nurse assists the patient to get an x-ray, takes vitals, does an initial assessment, then provides discharge instructions of moderate complexity. I would code this scenario as a level 3.
ICD-10 implementation is almost here, but coders are still facing resistance from physicians. W. Jeff Terry, MD, highlights ICD-10 challenges from the physician perspective, while Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, responds from a coder’s point of view.
The expanded code set available in ICD-10-CM will give providers the chance to better tell the story of each patient’s care. Glenn Krauss , RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM, explains how coders can assist physicians in telling that story .
The 2016 OPPS proposed rule introduces APC restructuring, new comprehensive APCs, and many other potential changes for next year. Jugna Shah, MPH, and Debbie Mackaman, RHIA, CPCO, CCDS, review the proposals and what they could mean for providers.
CMS is proposing a new status indicator to be assigned to laboratory tests so when the tests are the only service on a claim, CMS will pay for them separately under the Clinical Laboratory Fee Schedule without providers having to do anything additional from a reporting perspective.
CMS has repeatedly tweaked its logic regarding comprehensive APCs since inception. Dave Fee, MBA, reviews the latest changes regarding complexity adjustments, as well as new and deleted codes.
Q: We had a patient come into our ED with a severe head injury. To protect his airway, we intubated the patient. Can we report an emergency endotracheal intubation (CPT ® code 31500) and CPR (92950) together if only bagging happens and no chest compressions?
Organizations have their hands full with ICD-10-CM implementation finally on the horizon. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, and AHIMA-approved ICD-10-CM/PCS trainer, examines how coding departments can clean up their processes now so they are ready for the new code set.
Coders may need to review the anatomy of the gastrointestinal system and disease processes for gallstones, hemorrhoids, and ulcerative colitis to choose the most specific ICD-10-CM code. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, explain aspects of anatomy and what coders will need to look for in the documentation.
CMS has released a document to clarify questions providers raised about its recent guidance on ICD-10-CM, including answers on how the agency is defining a family of codes.
A Comprehensive Error Rate Testing (CERT) study found insufficient documentation to be the cause of 97% of improper payments for certain kyphoplasty and vertebroplasty procedures, according to the Medicare Quarterly Compliance Newsletter.
The 2015 CPT ® Manual included big changes to drug test reporting. Denise Williams, RN, CPC-H, AHIMA-approved ICD-10-CM/PCS trainer and AHIMA ICD-10 ambassador, and Steven Espinosa, CCS, AHIMA-approved ICD-10-CM/PCS trainer, explain the changes and how they will impact documentation and coding.
Q: I am a coder in a hospital outpatient setting. Our physicians document drug use in social history. For example, marijuana use is documented as just "marijuana use" without any further information regarding a pattern of use or abuse. Based on that information, can I report ICD-9-CM code 305.20 (cannabis abuse, unspecified)? How would this be reported in ICD-10-CM?
The gastrointestinal system is subject to many diseases and conditions that ICD-10-CM allows coders to report in more detail. Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, and Annie Boynton, BS, RHIT, CPCO, CCS, CPC, CCS-P, COC, CPC-P, CPC-I, describe the changes for reporting hernias and Crohn’s disease in ICD-10-CM.
Physician office coders are likely familiar with coding for x-ray procedures, but may not have much experience coding ultrasound. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, and ICD-10-CM/PCS trainer, reviews how ultrasound procedure codes are categorized and offers tips on reporting them in office settings.
Q: When the surgeon documents excision of a complex pilonidal cyst with rhomboid flap closure, is the flap closure coded separately or is it included in CPT ® code 11772 (excision of pilonidal cyst or sinus; complicated)?
Betty Hovey, CPC, COC, CPB, CPMA, CPC-I, CPCD, and Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, review anatomy details of the heart and how to report ICD-10-CM codes for atherosclerosis and conduction disorders.
CMS continues to move toward increased packaging with its policies in the 2016 OPPS proposed rule released July 2, with additional comprehensive APCs (C-APC) and extensive APC reconfigurations.
Despite no recent changes from CMS, many providers still struggle with when to report modifier -25 (significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service) . Jugna Shah, MPH, explains how providers can review claims to determine if they are using the modifier correctly.
Since CMS introduced comprehensive APCs in January, the agency has continued to tweak the logic and codes included in the process. Dave Fee, MBA, and Judith L. Kares, JD, describe those changes in CMS’ April quarterly updates and review code and edit updates.
Cardiac conditions are some of the most common diagnoses seen in hospitals. Betty Hovey, CPC, COC, CPB, CPMA, CPC-I, CPCD, and Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, review coding conventions and documentation details for reporting heart failure and angina in ICD-10-CM.
Q: Should modifiers for laterality be used for CPT ® code 31624 (bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage)?
Many organizations still lag in ICD-10 implementation, but it's not too late to prepare. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CCDS; Jean S. Clark, RHIA, CSHA; and Caroline Piselli, MBA, RN, FACHE, detail the steps organizations should take in order to be ready by October 1.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, explains how to identify anemia in documentation for OB/GYN patients and which ICD-9-CM and ICD-10-CM should be reported.
A survey conducted in May and June 2015 found providers have completed many steps toward ICD-10 implementation, but lag behind in testing and expect to continue managing the impact after the deadline.
A Comprehensive Error Rate Testing (CERT) study found that the improper payment rate for radiation therapy planning claims was significantly higher than many other physician specialty services, according to the Medicare Quarterly Compliance Newsletter .
What is the correct ICD-9-CM code for pneumonia due to E. coli? A) 482.81 B) 482.82 C) 482.83 D) 482.84 Know the answer and want to be featured in the next issue of JustCoding News: Outpatient?...
Q: A patient arrives at the interventional radiology department to have an inferior vena cava (IVC) filter inserted for portal hypertension and an iliac stent for May-Thurner syndrome. The physician is unsuccessful in accessing an appropriate portal vein branch, despite a few attempts to pass a wire into small portal branches, and aborts the placement. The plan is to reschedule and return with a transplenic approach. Do we code the attempted IVC filter placement with modifier -74 (discontinued outpatient procedure after anesthesia administered) and the complete iliac stent procedure? Or do we code the extent of the IVC filter placement (that being venography) with the complete procedure? Or do we only code the completed procedure?
