Coders can go a bit overboard when reporting CCs and MCCs. Cheryl Ericson, MS, RN, CCDS, CDIP, and Deborah K. Hale, CCS, CCDS, reveal the dangers of over-reporting CCs and MCCs and how to report them appropriately.
CMS has published two ICD-10-related Special Edition Medlearn Matters articles that may be of interest to providers and serve as tools to assist with implementation.
In ICD-9-CM, coders report specific codes to indicate a surgeon used robotic assistance. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains how that will change in ICD-10-PCS.
ICD-10-CM code category J45.- includes new, more specific terms for asthma that may help improve data quality and lead to more effective research and treatments. Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, and Suzan Berman, CPC, CEMC, CEDC, detail the new terminology for asthma coding in ICD-10-CM.
Assess. Educate/train. Practice. Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, and Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, reveal how following those three steps can prepare you for ICD-10 implementation.
Provider documentation of inpatient wound care services may be confusing at best and completely lacking at worst. Coders end up trying to decipher exactly what procedure the provider performed. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, and Robert S. Gold, MD, offer tips to assist coders in choosing the correct code for inpatient wound care.
Inpatient-only procedures are those that CMS has determined providers must perform on an inpatient basis. Kimberly Anderwood Hoy, JD, CPC, and Beverly Cunningham, MS, RN, unravel the complexities of coding for these procedures.
The OIG estimates that Medicare Administrative Contractors paid $8.4 million in overpayments to inpatient rehabilitation facilities (IRFs) because IRF and Medicare payment controls did not adequately identify late submissions of patient assessment instruments.
Q: I have a question about coding transplant complications. My understanding is if the complication affects the transplanted organ, then coders should assign a code for the transplant complication itself. Is this correct? Consider the following physician documentation: Final A/P: Acute renal failure in patient with history of renal transplant. Should coders report 996.81 (complications of transplanted kidney) and 584.9 (acute kidney failure, unspecified)? Also consider this documentation: CHF in heart transplant patient . Should coders report 996.83 (complications of transplanted heart) and 428.0 (CHF, unspecified)?
The HIM profession is constantly changing, but HIM professionals are still responsible for maintaining the integrity of the health records. Lou Ann Wiedemann, MS, RHIA, FAHIMA, CPEHR, explains why HIM professionals can—and should—also play a role in clinical documentation improvement (CDI).
Patients aren’t the only ones paying attention to quality scores these days. Payers are, too. Cheryl Manchenton, RN, BSN, and Audrey G. Howard, RHIA, explain why coders and clinical documentation improvement specialists must understand which conditions affect provider profiles.
Coders play a crucial role in ensuring compliance, and the FY 2013 IPPS final rule , released August 1, gives them many reasons to showcase their skills. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, detail the changes and how coders can take charge of them.
Providers may find themselves with a completely new definition of the term inpatient if CMS follows through with its intent to clarify this ever-confusing patient status, as explained in the 2013 OPPS proposed rule published July 30. The agency solicits input from providers on pp. 45155-45157 of the rule and suggests that it may implement fairly significant changes going forward.
Coders are the backbone of an organization’s fiscal health. Timely coding leads to timely revenue collection. Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, discusses why coders must be willing to look beyond their traditional roles to help ensure the continued financial viability and success of the organization.
Program for Evaluating Payment Patterns Electronic Report compares hospital data regarding a variety of benchmarks. John Zelem, MD, FACS, and Brenda Hogan, RN, BS, explain how hospitals can use PEPPER to identify risk areas and create a plan for self-auditing.
Do you audit records before sending them to your Recovery Auditor? If not, your hospital may be one of many that simply doesn't have the resources to do so. Lori Brocato, Cathie Eikermann, MSN, RN, CNL, CHC, and Laura Legg, RHIT, CCS, reveal why hospitals should consider auditing records before sending them to the Recovery Auditor.
Q: I need further clarification regarding documentation of toxic metabolic encephalopathy. I’m trying to code two different cases in which a physician documents acute mental status change secondary to an infectious process . In each case, the patient’s metabolic panels don’t appear to be abnormal; however, one of the patients is septic. The physician thinks that documenting and coding sepsis separately from encephalopathy would result in unbundling. However, I disagree because coding the sepsis separately demonstrates severity. What is the correct logic to use in each of these cases?
Many of us are perfectly content with our present jobs. As coders, we may be thrilled to have secured a coding position that’s both challenging and satisfying. Others may feel differently about their work. Lois Mazza, CPC , discusses how to decide when to look for a new job and how to secure it.
Providers are urging CMS to reconsider its current ICD-10 education and outreach strategy to ensure that providers are prepared to implement the new code set. CMS published and addressed specific provider comments in a final rule released August 25 that confirms the delay of ICD-10 to October 1, 2014.
Retain. Train. Assess. Investigate. Analyze. HIM professionals have undoubtedly come across action verbs like these since HHS announced the replacement of the ICD-9-CM code set with the more advanced ICD-10-CM code set currently used in other nations. Mark Jahn, Luisa Dileso, RHIA, MS, CCS, and James S. Kennedy, MD, CCS, CDIP, explain what HIM professionals need to do over the next two years to be ready for the final implementation date of October 1, 2014.
Neoplasm coding in ICD-10-CM is similar to the current ICD-9-CM coding. Most benign and all malignant neoplasm codes are found in chapter 2 of ICD-10-CM, just as in ICD-9-CM, according to Betty Hovey, BA, CPC, CPC-I, CPC-H, CPCD, CCS-P, PCS, CCP, CIC, RMC. She explains some of the ICD-10-CM guidelines for proper coding.
ICD-9-CM and ICD-10-CM stroke and coma codes reveal many similarities and some important differences. Alice Zentner, RHIA, and James S. Kennedy, MD, CCS, CDIP, explain the changes and what coders need to know to prepare for ICD-10-CM stroke and coma coding.
HHS will delay implementation of ICD-10 by one year, from October 1, 2013, to October 1, 2014. HHS announced the delay as part of the Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10thEdition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets final rule released August 24.
Physicians often use the acronyms IBS (which should indicate irritable bowel syndrome) and IBD (which should indicate inflammatory bowel disease) interchangeably even though they represent completely different conditions with different treatment and prognoses. Robert S. Gold, MD, and Drew K. Siegel, MD, CPC, offer tips on how to decipher documentation related to these two conditions.
CMS officially announced the Recovery Auditor prepayment review demonstration in November 2011, but then in January 2012 decided to delay the program by three months. Since then—despite rumors that the program could be coming soon —the official start date has been unknown to the public. This changed however, when CMS announced Friday, August 3, that Recovery Auditor prepayment reviews will begin August 27.
What do cubism and coding have in common? Both can be viewed as art forms. Joel Moorhead, MD, PhD, CPC, details the three steps that the coding artist performs in reassembling medical record elements into abstracted form.
Q: A patient has been diagnosed with peritonsillar cellulitis and oropharyngeal cellulitis. The physician documents that he performed a “needle aspiration of the left peritonsillar abscess.” In the body of the operative report, the physician states, “An 18-gauge needle was inserted and 1 cc of pus was aspirated. This was sent for aerobic, anaerobic, C&S [culture & sensitivity], and gram stain. I then put the 18-gauge needle in again and multiple passes were obtained without any aspirate.” Because ICD-9-CM does not include a code for “aspiration of peritonsillar abscess” some coders wanted to use ICD-9-CM procedure code 28.0 (incision and drainage of tonsil and peritonsillar structures) while others want to report code 28.99 (other operations on tonsils and adenoids). Which code is correct?
QUESTION: I'd like to address our coders' questions on how to code poisoning due to bath salts. Internet research has led me to many different options: codes 977.8 (other specified drug/medicinal), 970.89 (other CNS stimulant), 969.70 (psychostimulant, unspecified), among others. What would you suggest? There don't seem to be any guidelines out there and the coding for this seems to be all over the place.
CMS released its latest MLN Quarterly Provider Compliance Newsletter, volume 2, issue 4 in July. The newsletter addresses common billing and coding errors, with the latest issue addressing frequently cited Recovery Auditors and Comprehensive Error Rate Testing (CERT) findings.
A lack of funding shouldn't prevent you from getting creative in your morale-boosting celebrations, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, and Nicolet Araujo, RHIA. So when your staff members are around, this time of year can be a great time to boost their morale with summer outings and special staff recognition for jobs well done.
There is nothing new about stress; humans have felt stress since the beginning of time, and coders are certainly no exception. Lois Mazza, CPC, discusses how coders can mitigate the many effects of stress while they handle the pressures of their jobs and lives.
In late May, CMS released nationwide a new short-term (ST) acute care Program for Evaluating Payment Patterns Electronic Report (PEPPER). The ST PEPPER provides short-term acute care hospital (STACH) statistical data for the most recent 12 federal fiscal quarters, ending with the first quarter of fiscal year 2012.
New clinical guidelines for malnutrition could help alleviate compliance challenges associated with coding the condition, which has never had universally accepted clinical criteria. Jane White, James S. Kennedy, MD, CCS, CDIP, and Alice Zentner, RHIA, describe the new guidelines and what coders need to know about malnutrition coding.
The thought of learning ICD-10 is intimidating for many coders, but does it need to be? Robert S. Gold, MD, and Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explain why coders may not need to fear the transition quite as much as they think.
QUESTION: A patient is admitted with pneumonia and atrial fibrillation and both are present on admission. The patient receives antibiotics for the pneumonia and a pacemaker during the stay, but undergoes no other procedures. Does the procedure automatically make ICD-9-CM code 427.31 for the atrial fibrillation the principal diagnosis?
The digestion process is complex and there’s a lot that can go wrong. Thankfully, Robert S. Gold, MD, unravels the topic of mechanical and paralytic ileuses in this week’s article.
Choosing a principal diagnosis can be tricky for coders. Luckily, Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, and Robert S. Gold, MD, help unravel the complexities of principal diagnosis selection.
Medical necessity denials traditionally focus on high-dollar MS-DRGs, such as those for hip and knee replacements; other MS-DRGs may also soon become targets, such as inpatient wound care, according to Nelly Leon-Chisen, RHIA, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, CCDS. Krauss and Leon-Chisen discuss coverage determinations, excisional vs. nonexcisional debridement, debridement of multiple layers, and more.
Medicare Fee-For-Service (FFS) will accept only ASC X12 Version 5010 or NCPDP Telecom D.0 electronic transactions beginning on July 1, according to a CMS June 11 Medicare Fee-For-Service Provider Partnership Program e-newsletter.
QUESTION: A patient was exposed to shingles, for which a coder reported ICD-9-CM code V01.79 (exposure to other viral diseases, including HIV). This poses a problem for billing as code V01.79 is a confidential diagnosis, requiring special release of information from the patient and would remain on the insurance record. As an RN and certified coder, I believed code V01.71 (exposure to varicella) is the correct code because the varicella virus causes both chicken pox and shingles. However, I am being overridden by the chief business office. Which code is correct?
Why do coders need to know about Value Based Purchasing, the Readmissions Reduction Program, and Hierarchical Condition Categories codes? Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, explains why it all comes back to coding accuracy and complete documentation.
QUESTION: Do you predict coder productivity will decline as a result of ICD-10? If so, what do you think the declines will be six months after implementation?
By now, you may have heard that the ICD-10-CM codes are more specific than those used in the ICD-9-CM system, and fracture coding is one of the areas undergoing the most changes. Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CPC-I, CCDS, discusses fracture coding in ICD-10 and some of the expected documentation challenges associated them.
A lot of learning is ahead for coders and others who will need to learn how to code in ICD-10. There are changes all around, and OB coding is no exception. Lori-Lynne A, Webb, COBGC, CPC, CCS-P, CCP, CHDA, explains coding for OB ultrasounds, amniocentesis, MRIs, and other procedures in CPT ® , ICD-9, and ICD-10
Many HIM directors and coding managers are aware of the decrease in productivity that is anticipated with the implementation of ICD-10. The concern is a valid one, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, who explains what’s ahead and how HIM professionals should prepare.
CMS has issued both a National Coverage Determination (NCD) Transmittal 143 and Medicare Claims Processing Transmittal 2473 on the coverage of extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) in certain circumstances under clinical research studies.
