ICD-10-CM provides many more combination codes for drug- and alcohol-related diagnoses than ICD-9-CM. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how this could actually result in less work for coders.
Sometimes a surgeon must take drastic action and amputate a patient’s upper or lower extremity. For these cases, we would use ICD-10-PCS root operation Detachment (third character 6). ICD-10-PCS...
Map (third character K) is a very narrowly defined ICD-10-PCS root operation. By definition, Map procedures are used to locate the route of passage of electrical impulses and/or locate functional...
In the Medicare Quarterly Provider Compliance Newsletter , CMS writes about auditor findings for MRI scans that did not meet medical necessity and how to ensure documentation that supports it.
Hierarchical Condition Category (HCC) coding may be a foreign concept for some coders, but making sure documentation for Medicare Advantage patients supports it can be critical. Holly J. Cassano, CPC , discusses what criteria needs to be met for complete documentation.
Changes implemented by the 2014 OPPS Final Rule resulted in the addition and deletion of many codes in the January I/OCE update. Dave Fee, MBA , reviews some of the most important modifications, including changes to evaluation and management services and device reporting.
Even though ICD-10-CM respiratory changes are relatively minor, coders will still have to learn the new guidelines and review anatomy and physiology in order to report them accurately. Tara L. Bell, RN, MSN, CCM, AHIMA-approved ICD-10-CM/PCS trainer, and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, AHIMA-approved ICD-10-CM/PCS trainer, highlight the changes and new guidelines.
Q: When coding excision of a breast mass with needle localization using stereotactic guidance, we report CPT ® code 19125 (excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion) and new code 19283 (placement of breast localization devices, percutaneous; first lesion, including stereotactic guidance). The 3M system says Medicare NCCI edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day. These codes will be rebundled by the Medicare payer and payment will be based on code 19125 only. Does that mean to only report 19125 for this kind of case? If there is an excision of a lesion by one surgeon and needle localization done by a radiologist, can we report 19125, with 19283 and modifier -59 (distinct procedural service)? We can’t find any official reference for this issue for 2014. How do we code excision of a breast mass with needle localization now?
The codes for complications of pregnancy, childbirth, and the puerperium appear in Chapter 11 in ICD-9-CM. They move to Chapter 15 in ICD-10-CM. But you will find some more significant changes than...
Holidays are always interesting times here at the Fix ‘Em Up Clinic. We get to see some of the most interesting cases. First up for St. Patrick’s Day is Sean, who at 8 years old thought it would be...
Is this a dagger I see before me? Why, yes, Caesar, that is a dagger aimed at your heart. And your head and just about everywhere else. Servilius Casca got in the first shot, hitting Caesar in the...
In ICD-9-CM, we have one base code for gestational diabetes: 648.8x (abnormal glucose tolerance). We need a fifth digit to specify the episode of care: 0, unspecified as to episode of care or not...
James S. Kennedy, MD, CCS, discusses the increased clinical specificity required for coders to report strokes and transient ischemic attacks in ICD-10.
Coders may struggle to differentiate the ICD-10-PCS root operations excision and resection. Nena Scott, MSEd, RHIA, CCS, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer, and Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, explain why excision is the root operation of choice for excisional debridement and sebaceous cyst removal.
Coders and clinicians seem to speak different languages. CDI specialists often serve as the translators between clinicians and coders, so it's important that all three groups work together. Cheryl Ericson, RN, MS, CCDS, CDIP , AHIMA-approved ICD-10-CM/PCS trainer, Darice M. Grzybowski, MA, RHIA, FAHIMA , Jonathan Elion, MD, Kathy DeVault, RHIA, CCS, CCS-P , and William E. Haik, MD, FCCP, CDIP , offer tips for determining when to query.
Almost all of the ICD-10-PCS root operations describe very specific intent. Think about the difference between root operations excision and resection. Excision involves removing some of a body part...
Coders will have many more options to report wrist and hand injuries in ICD-10-CM, with codes for individual fingers, wrist bones, and joints, as well as laterality. Review the anatomy of the wrists and hands in order to take advantage of the specificity available in ICD-10-CM.
CMS Administrator Marilyn Tavenner reiterated last week that ICD-10 implementation would not be delayed again, as CMS prepares for end-to-end testing of providers this summer.
Q: I am auditing a note for a fusion. The note lacks detail, therefore is hard to justify. The patient had a prior hardware placement. The note describes dissecting down, debridement of necrotic bone, and tissue work done. This is the entire note, after describing dissection, “Vigorous irrigation with 10 liters of saline and antibiotics was carried out. Hemostasis was maintained. The right S1 screw and rod portion was removed as it was notably loose. Additional decortication and onlay bone grafting was performed at L1-S1. Drains were placed…” They coded: 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar) Add-on code 22614 (each additional vertebral segment) x4 22852 (removal of posterior segmental instrumentation) In the procedures performed area of the note, they state: Hardware removal, lumbar Revision fusion L1-S1 with onlay bone graft Irrigation and debridement of lumbar spine wound Since there is nothing in the note regarding autografting, I assume this is an allograft? Should this be coded? Also is that documentation enough to justify arthrodesis? Modifier -GC (this service has been performed in part by a resident under the direction of a teaching physician) was appended, although the language was not added for this. I can only assume a resident dictated this.
Not surprisingly, coders will have many more options to report how a patient was injured in ICD-10-CM. Betty Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD , and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS , explain how the codes differ from ICD-9-CM E codes, when to report them, and why coders should not be too worried about the transition.
The auditory system has its own code category in ICD-10-CM because of the number of new codes and specificity available. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , reviews ear anatomy and how to report newly introduced diseases and conditions.
Inpatient coders are used to being able to code conditions documented as possible, probable, suspected, or rule out, as if they were in fact confirmed. Outpatient coders can’t do that. They need a...
ICD-10-CM root operations excision and resection are sometimes hard to differentiate. ICD-10-PCS defines excision (B) as cutting out or off, without replacement, a portion of a body part. Resection (T) is almost identical, but involves cutting out or off the entire body part.
CMS has been making it clear over the years that packaging would become a larger and larger part of OPPS, and in calendar year (CY) 2014 CMS made good on this.
You all know that I have been unhappy with some code definitions in ICD-9 and have ucceeded in getting some changes made in ICD-9 and ICD-10-CM code sets.
In this month’s issue, we explain how to differentiate between ICD-10-PCS root operations excision and resection, review when and how to query physicians, and provide a basic introduction to APR-DRGs. You’ll also find a Q&A with Sherine Koshy, MHA, RHIA, CCS, corporate director of HIM coding for University of Pennsylvania Health System in Philadelphia. Robert S. Gold, MD, highlights some additional areas of concern in ICD-10-CM in this month’s Clinically Speaking column.
In this month's issue, we review latest 2014 CPT ® Manual changes, examine how MUEs are determined, take a look at wrist and hand anatomy in preparation for the increased specificity of ICD-10, and answer your coding questions.
Coders and clinicians seem to speak different languages. CDI specialists often serve as the translators between clinicians and coders, so it's important that all three groups work together.
Coders are aware that ICD-10-CM will allow much more specificity than ICD-9-CM, and that is very evident in the section covering injuries to the wrist, hand, and fingers (S60–S69).
When an NCCI edit occurs on a claim, providers can go directly to CMS’ website and download the latest edits to pinpoint why the edit occurred and what codes may be conflicting.
Brush up on your knowledge of cardiovascular system anatomy as you learn how to code cardiovascular diseases in ICD-10-CM during the live, 90-minute webcast Reduce the Fear of ICD-10-CM...
I really want the t-shirt that says, “I only do what the voices in my head tell me” and its companion shirt, “The voices in my head don’t like you.” Sadly too many people I know might believe it...
Coders may need to have a conversation with physicians about how changes in ICD-10-CM could require additional documentation for mental disorders due to a known physiological condition. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I , AHIMA-approved ICD-10-CM/PCS trainer, compares coding for these conditions in ICD-9-CM and ICD-10-CM.
Heather Taillon, RHIA, Cheryl Collins, BS, RN , and Andrea Clark, RHIA, CCS, CPC-H , explain the basic rules regarding principal diagnosis selection in general and for neoplasms in particular in ICD-9-CM.
When it comes to coding malnutrition, coders need to see very specific information in the physician documentation. James S. Kennedy, MD, CCS, William E. Haik, MD, FCCP, CDIP , and Mindy Hamilton, RD, LD, review the clinical factors for malnutrition and how to assign the correct ICD-9-CM codes.
CMS will conduct full end-to-end testing—from submission to remittance advice—with a select sample of providers in July. CMS first announced the decision in MLN Matters® SE1409 and provided additional details during the February 20 webcast, CMS ICD-10 Readiness.
CMS reversed course earlier this week and announced it will conduct end-to-end ICD-10 training with a sample of providers. Previously, CMS had stated it would not conduct any end-to-end testing...
One of the things that drives me crazy about how media, Congress, and the AMA discuss ICD-10 codes is their focus on the External Causes codes. Granted some of those codes are silly or strange or...
Maybe the AMA’s letter did the trick. Or maybe CMS just thought better of its decision not to conduct end-to-end testing prior to ICD-10 implementation. According to MLN Matters® SE1409 , CMS will...
The added specificity of ICD-10 may require coders to learn more about disease processes and terminology in order to code accurately. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, reviews some medical terms coders should know and steps to take to improve communication between providers and coders.
Q: Can we report CPT ® code 32609 (thoracoscopy; with biopsy of pleura) with 32666 (thoracoscopy, surgical; with therapeutic wedge resection, initial unilateral)? We have researched thoroughly and were not able to find a clear answer.
While the 2014 CPT ® Manual features many new combination codes among its hundreds of changes this year, it was also updated to reflect newly recognized technologies and procedures . Denise Williams, RN, CPC-H, looks atsome of the changes made in the Radiology and Laboratory sections.
An overwhelming 87% of respondents to a recent survey by Navicure of physician practices said they are at least "somewhat confident" they will be ready for ICD-10 implementation by October 1.
Debbie Mackaman, RHIA, CPCO, and Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, discuss the purpose of medically unlikely edits (MUEs) and how they are calculated by CMS.
What did you get for Valentine’s Day? Flowers? Chocolate? Mono? It is the kissing disease after all. ICD-9-CM includes only one code for infectious mononucleosis: 075. That code includes glandular...
Poor Paul, he just wanted to take his black Labrador Molly to the vet for her checkup. Instead he ended up needing a doctor. Paul put down a sheet in his truck so Molly wouldn’t have to sit on the...
/*--> */ In its continuing quest to halt ICD-10 implementation, the AMA is touting a new study by Nachimson Advisors that shows much higher costs to physician practices than initially estimated in...
The World Health Organization (WHO) is delaying the launch of ICD-11 until 2017. The WHO did not formally announce a delay, but its website now lists ICD-11 as due by 2017.
ICD-10-PCS defines devices for coding purposes in a very specific way. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, CHTS-CP, explain how to assign the correct device character in ICD-10-PCS.
Inpatient coders will have a new coding system on October 1, but they won’t have to learn new MS-DRGs. They aren’t changing. However, coders will see some shift in MS-DRG assignment in ICD-10. Donna M. Smith, RHIA, and Lori P. Jayne, RHIA, reveal why the MS-DRG shifts will occur.
Is this love that I’m feeling? Or do I have some deadly disease? What are my symptoms? Well, I feel lightheaded and dizzy. It could be the signs of new love or it could be acute mountain sickness...
There before me was a pale horse and its rider was named Reimbursement. Meet the final horseman of the ICD-10 Apocalypse and probably the one that keeps your C-suite up at night: Reimbursement. The...
CMS will present the eHealth Summit: Road to ICD-10 from 9 a.m. to 3:30 p.m., Friday, February 14, in Baltimore and is inviting interested parties who cannot attend in person to register for a live webcast of the sessions .
In part two of a series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how to identify various types of viral skin infections and how reporting for them will change in ICD-10-CM.
Q: I have a question regarding CPT® code 22558 (arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace; lumbar). I perform this exposure as a vascular surgeon, with the orthopedic surgeon preforming the spinal surgery. If I perform an anterior exposure for a spine deformity using code 22808 (arthrodesis, anterior, for spinal deformity, with or without cast; two to three vertebral segments), do I bill 22558 for the exposure?
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, examine the 2014 OPPS Final Rule and explain which services are now packaged, including drugs and biological that function as supplies when used in diagnostic or surgical procedures, clinical diagnostic lab tests, and device removal procedures.
While the digestive and integumentary sections had extensive edits in the latest CPT ® update, many sections were left relatively unchanged. Joanne Schade-Boyce, BSDH, MS, CPC, ACS , and Denise Williams, RN, CPC-H, review which sections only had minor updates and take a closer look at evaluation and management and chemodenervation changes in the 2014 CPT Manual.
It turns out that Punxsutawney Phil seeing his shadow, and thereby forecasting six more weeks of winter, wasn’t the most painful part of Groundhog Day. Phil picked a bad moment to suffer from stage...
In this month’s issue, we examine factors that affect principal diagnosis selection, explain when you should report an unspecified code, discuss how MS-DRGs may shift in ICD-10, and provide sample physician queries for ICD-10. In his Clinically Speaking column, Robert S. Gold, MD, discusses the intent of neonatal codes.
The U.S. healthcare system is and will continue to be dependent on clinical codes and is thus equally dependent on accurate and complete clinical documentation. This relationship then makes documentation and coding truly dependent upon each other; without one you don’t have the other. It sounds plain and simple, but of course it is not.
In addition to increased packaging and collapsing of E/M clinic visit level CPT ® codes in the 2014 OPPS -Final Rule, CMS made additional changes that will have an immediate impact on reimbursement or require operational changes for providers.
One of the most radical changes CMS proposed in this year’s OPPS was to collapse the five levels of E/M CPT ® codes and replace them with three new HCPCS G-codes, including one APC for all clinic visits, one for all Type A ED visits, and one for all Type B ED visits.
In the 2014 OPPS Final Rule, CMS offered the following -example for billing a laboratory test on the same date of service as the primary service, but ordered for a different purpose than the primary service by a practitioner different than the practitioner who ordered the primary service.
Shoveling snow can be great exercise. You can burn a lot of calories (depending on how much snow you’re shoveling and how much effort you’re putting into it). However, shoveling snow can also be...
Whether you work in a dedicated children’s hospital or a general hospital with a pediatric service line, you will likely come into contact with coding charts of kids. Sometimes they are easy (e.g., an inguinal hernia repair without obstruction or gangrene is an inguinal hernia repair without obstruction or gangrene—except it has to be identified as right or left in ICD-10). Sometimes they are not so easy (e.g., complex congenital diseases and their manifestations and complications).
These sample queries were adapted from The CDI Specialist’s Guide to ICD-10, created and donated by Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer, CDI education director at HCPro in Danvers, Mass.
Inpatient coders will see an entirely new coding system October 1 when they begin officially using ICD-10-PCS. However, MS-DRGs are not changing. The only thing that is changing is what codes map to a particular MS-DRG.
The UHDDS defines principal diagnosis as the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. That means the principal diagnosis is not always the condition that brought the patient into the hospital.
Codes for epilepsy and migraine headaches are getting a makeover for ICD-10-CM. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, reviews the additional specificity in the new ICD-10-CM codes.
Q: Does the physician have to document the stage of a decubitus ulcer or can it be a wound care nurse? Does that person have to document stage 1 or can he or she describe the wound?
Physicians can biopsy numerous body sites and structures, including muscles, organs, and fluids. Mark N. Dominesey, MBA, RN, CCDS, CDIP, and Nena Scott, MSEd, RHIA, CCS, CCS-P, dig into biopsy coding in both ICD-9-CM and ICD-10-CM.
Decreased productivity isn’t the only looming concern with the transition to ICD-10. Scot Nemchik, CCS , and Rachel Chebeleu, MBA, RHIA , reveal why accuracy will be just as important as productivity.
Baby, it’s cold outside. Really, really cold. And unlike polar bears and snow leopards, I am not a cold weather animal. So to offset the cold this morning (and motivate myself to crawl out from under...
You can stop holding your breath. Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA , AHIMA-approved ICD-10-CM/PCS trainer, and Tara L. Bell, RN, MSN, CCM, AHIMA-approved ICD-10-CM/PCS...
Our beloved (and much used) ICD-9-CM code 250.00 (unspecified diabetes) is going away soon. In fact, the whole idea of controlled or uncontrolled diabetes won’t matter either for coding purposes in...
Q: I am looking for information about to how to bill for a transnasal-endoscope approach in removing a skull-base tumor. I have never been comfortable with the doctors wanting to use CPT ® 61600 (resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural) to bill a non-invasive procedure. I am perplexed about which CPT code(s) to report for this type of procedure.
The added specificity available in ICD-10-CM allows for more details to be included when reporting bacterial skin infections, such as the location of the infection. Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how to identify various types of infection and which codes to use to report them.
With the ICD-10-CM implementation date approaching, training and retaining staff that knows the new system is paramount for coding departments. Sabita Ramnarace, MS, RHIA, CCS, CHP , and Rudy Braccili, Jr., MBA, CPAM, review strategies that can help providers develop retention plans in their organization.
The transition to ICD-10-CM may require coders to brush up on their anatomy and physiology in order to report the most accurate codes. We take a look at the anatomy of the knee and how coding for knee injuries will change in ICD-10-CM.
A recent survey of healthcare payers and providers by accounting firm KPMG shows that many organizations are lagging when it comes to ICD-10 testing. Nearly three-quarters of respondents said they had yet to begin end-to-end ICD-10 testing or were not planning on conducting it.
What can we revise today at Stitch ‘Em Up Hospital? First, we need to know what falls under root operation revision in ICD-10-PCS. Is it a procedure where the physician alters a body part, such as a...
Odds are, most coders will never use ICD-10-PCS table 0W4. Why? Because root operation 4 is creation (making a new genital structure that does not physically take the place of a body part). Unless...
259 days. That’s the time remaining until we start using ICD-10. How far along are you? You’ve completed your coding assessments, right? Hopefully, you’ve already started your coder training. At the...
Recovery Auditors have identified substantial overpayments for inpatient psychiatric services directly following an acute care stay within the same facility, according to CMS’ MLN Matters® SE1401 .
Without the right details in the documentation, coders can’t assign the correct code and that becomes more apparent in ICD-10. Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, Paul Weygandt, MD, JD, MPH, MBA, CCS , Kathy DeVault, RHIA, CCS, CCS-P, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, highlight some areas coders and clinical documentation improvement specialists should focus on to prepare for ICD-10.
Coders are often in the difficult position of trying to determine whether to report a CC. William E. Haik, MD, FCCP, CDIP, and Kathy DeVault, RHIA, CCS, CCS-P, discuss problems areas in documentation of CCs and what clinical indicators coders should use to help with CC reporting.
Q: Can you explain when a neoplasm should be listed as the principal diagnosis? We have some coders who believe the neoplasm should always be the principal diagnosis.
