CMS proposed extending the delay on enforcement of physician supervision rules for critical access hospitals and small and rural hospitals with 100 or fewer beds for one final year as part of the 2013 OPPS proposed rule. Debbie Mackaman, RHIA, CHCO, and Jugna Shah, MPH, detail some of the more significant proposals for 2013.
Accurate reporting of observation services depends on a lot of factors. Deborah K. Hale, CCS, CCDS, and Cheryl Staley, RHIA, CCS, walk though five case studies to explain the ins and outs of observation coding.
QUESTION: I work for a gastrointestinal (GI) practice and I have a question regarding the correct sequence for adding diagnosis codes to a claim. I have advised our physicians and billers that the primary diagnosis code is always the reason for the visit. I am a little confused about the remaining diagnosis codes the physician will write down in no specific order. Billers will report codes in the order the physicians write down the diagnoses and not always the reason for the visit. For example, a patient is referred for a consult due to weight loss. The patient comes for the consult and the physicians may put down 787.29 (other dysphagia), 401.1 (benign hypertension), 783.21 (abnormal loss of weight), 787.99 (change in bowel habits) in this order and leave it up to the person entering the info to figure it out. I would report 783.21 first since that was the reason for the visit but then I’ve been putting the GI codes next and then anything else last. What is the correct sequence when adding diagnosis codes to a claim?
Hospital medicine is a specialty that provides inpatient services for patients admitted to the hospital. Hospitalists are often called on to consult in regards to and to follow medical problems that occur during hospitalization for surgery, psychiatric hospitalizations, and obstetrical patients. Lois E. Mazza, CPC, explains how to correctly report hospitalist services.
The Hospital Outpatient Payment Panel recommended CMS change the supervision requirements for 15 HCPCS and CPT ® codes during its second meeting this year in August. CMS released details of the meeting September 24.
Legendary Green Bay Packers coach Vince Lombardi once described the ideal linebacker as agile, hostile, and mobile. Sadly, some of our local linebackers are significantly less agile and somewhat...
The rugby players who come into the Fix ‘Em Up Clinic are a pretty tough group. They can shrug off broken ribs, downplay dislocations, and boast about bruises. They are no match for gnats, though...
We all know coder productivity will go down after the transition to ICD-10 and it may never rebound to current levels. The question is, how much will productivity decline? It could drop more than you...
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 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).
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.
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)?
News flash: The sky is NOT falling. You don’t need to press the panic button when you think about the transition to ICD-10. It’s time to prepare, practice, and plan. The transition will be a huge...
How tired are you of hearing the phrase “documentation, documentation, documentation” as you prepare for ICD-10? I have a new phrase that you’ll soon dread as well: “Practice, practice, practice.”...
Got an ICD-10 question? Answers are coming soon. ICD-10 implementation is still almost two years away, but the American Hospital Association’s Coding Clinic will add an ICD-10 section starting in the...
Hospitals and physician practices are used to being in competition with each other and maintaing a veil of secrecy over internal operations. Well, that’s not really limited to just healthcare, it...
Inpatient-only procedures are those that CMS has determined providers must perform on an inpatient basis because they are invasive and require at least 24 hours of postoperative recovery time or monitoring.
In this month's issue, we examine correct coding for critical care, review shoulder anatomy to prepare for ICD-10, unravel coding confusion for chronic kidney disease, and answer your coding questions.
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.
As you may know, ICD-9-CM V codes have been expanded to include higher body mass indexes (BMI). More specifically, code category V85.4x denotes a BMI of 40 or more in an adult. How can you calculate BMI?
Our coding experts answer your questions about coding for hysteroscopy prior to ablation, appending modifier -59 for MRI and MRA, charging for venipunctures, therapy caps under OPPS, reporting limits for Provenge®, modifier -59 and infusion therapy, Reporting TEE pre- and post-operativley, coding for toxic metabolic encephalopathy
Learn about the 2013 IPPS final rule, inpatient-on;y procedures, asthma terminology in ICD-10, computer-assisted coding, and body mass index calculation.
When the AMA revised the instructions for reporting ancillary services with critical care in 2011, facilities knew they wouldn't see an immediate increase in payment. CMS determines payment amounts through use of claims data from two years earlier, meaning the earliest facilities could expect additional reimbursement is 2013.
Now that CMS has finalized a 2014 implementation date for ICD-10-CM/PCS, increasingly more hospitals may turn to computer-assisted coding (CAC) to help ease the transition and mitigate anticipated productivity losses, says Angie Comfort, RHIT, CCS, director of HIM solutions at AHIMA in Chicago.
The transition to ICD-10 code set is expected to be one of the most substantial changes in medical coding history and providers and payers need to start preparing now. Undoubtedly, you still have...
Wouldn’t it be nice if the physician documented a definitive diagnosis for every patient at the time the patient left the office, clinic, or hospital? We know that will never happen. Sometimes, the...
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.
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.
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.
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.
Football season is underway in Anytown and we have some crazy players coming in to Fix ‘Em Up Clinic with some crazy-looking knee injuries. Quarterback Tom is in after suffering an unhappy triad of...
What do you know, bubonic plague is still hanging around. It seems like we should have eradicated it by now. Turns out, if you go to the desert southwest and play with dead animals you too can...
Dr. Cap I. Larry is back at work on some blood vessels at Stitch ‘Em Up Hospital. Let’s see what she’s up to today. For all of Dr. Larry’s procedures, we’re going to be coding from the Medical and...
The publication of the final rule officially announcing a change in the ICD-10 compliance date from October 1, 2013 to October 1, 2014, ends the uncertainty surrounding ICD-10 implementation that has plagued the healthcare industry. Sue Bowman, MJ, RHIA, CCS, FAHIMA, details what healthcare organizations should be doing now to prepare.
ICD-10-CM coronary artery disease and myocardial infarction codes will undoubtedly differ from their ICD-9-CM counterparts in some ways, but certain aspects will remain the same. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, explain what coders need to know about reporting these conditions.
Coders are already familiar with the Table of Drugs in ICD-9-CM, but they will find some important differences in ICD-10-CM. Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Ann Zeisset, RHIT, CCS, CCS-P, walk through the key similarities and differences in the Table of Drugs.
Athenian philosopher Socrates famously drank poisonoud hemlock after being found guilty of corrupting the minds of the youth of Athens and of impiety for not believing in the gods of the state...
Ever have one of those nights when you just can’t sleep? Maybe you’re awake fretting about the transition to ICD-10. Or maybe you had one too many cups of coffee. Never fear, we have plenty of ICD-10...
Today we are taking a peek into OR 3 at the Stitch ‘Em Up Hospital to watch Dr. Cap I. Larry work on some blood vessels. Then we’re going to code her procedure. Dr. Larry is harvesting part of the...
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?
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.
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.
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.
By now, you probably know that ICD-10-PCS codes contain seven alpha-numeric characters. Each character represents a specific piece of information and those meanings can vary by section. In the...
If you have looked at the ICD-10-PCS Manual, you know that the codes are arranged in tables based on the first three characters of the code. The table contains all of the possible choices for...
Physicians and facilities use the same codes to report evaluation and management (E/M) levels for emergency department (ED) services, but follow different rules. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, and Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, explain how to correctly choose the most appropriate E/M code for ED services.
QUESTION: I work in an urgent care setting and need to know if we can bill an administration code for injection of Toradol. For example, a patient comes in, and the provider performs an E/M and administers 60mg Toradol intramuscular. I have not been charging for it, thinking it’s bundled into the E/M.
Providers will now soon need only one unique health plan identifier when billing insurance companies. CMS finalized the Administrative Simplification: Adoption of Standard for Unique Health Plan Identifier rule released August 24.
CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6. One has to do with how CMS proposes to calculate APC relative weights; the other addresses the reimbursement level for separately payable drugs and biologicals without pass-through status. Jugna Shah, MPH, and Debbie Mackaman, RHIA, CHCO, discuss the proposed changes for OPPS payment.
Labor Day might mark the unofficial end of summer, but we have plenty of summer-related injuries today at the Fix ‘Em Up Clinic. Our first guest of the day, James, went rock climbing for the first (...
Information received by TMF Quality Institute during the past year indicates that 61% of hospitals use PEPPER data to guide their auditing process and help them focus on areas of potential vulnerability.
Coding managers and their team members sometimes must approach physicians in person regarding documentation. Clarification may be necessary, or perhaps you will need to coax the physician to complete certain records without further delay.
Learn about ICD-10-CM stroke and coma codes, how coding and clinical terminology differences make coding complications difficult, why code evolution is sometimes for better and sometimes for worse, how self-audits benefit the Recovery Audit process, how PEPPER benefits an audit program, and how to help physicians understand what coders need.
CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6. One has to do with how CMS proposes to calculate APC relative weights; the other addresses the reimbursement level for separately payable drugs and biologicals without pass-through status.
Many coders can quickly quote the code for diabetes mellitus in ICD-9-CM (code 250.00) when the physician only documents diabetes mellitus. But what will coders need in the documentation for diabetes mellitus in ICD-10-CM? Dissect the differences in coding for diabetes mellitus in ICD-9-CM and ICD-10-CM.
In this month's issue, we review the proposed changes in the 2013 OPPS proposed rule, compare coding for diabetes in ICD-9-CM, ICD-10-CM, and answer reader questions.
Our coding experts answer questions about reporting dialysis for ESRD patient in ED, coding for sequential infusions, procedures on the inpatient-only list, replacement code for C9732, and new drug HCPCS codes.
Do you audit records before sending them to your Recovery Auditor? If not, your hospital may be one of many that simply don't have the resources to do so.
Welcome to Stitch ‘Em Hospital, where we’re preparing for ICD-10-PCS by actually coding some of our procedures using the new system. We want to make sure we’re ready to go on October 1, 2014, and...
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.
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.
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.
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.
We’ve all heard of deranged killers, but have you ever heard of a deranged knee? Better yet, can you code for it? Coding for a derangement isn’t new. We have derangement codes in ICD-9-CM. For...
HHS will delay implementation of ICD-10 by one year, from October 1, 2013 to October 1, 2014. HHS announced the delay August 24 as part of the Administrative Simplification: Adoption of a Standard...
Penny came into the Fix ‘Em Up emergency department Friday, complaining of tingling and numbness in her face and arm. She was also somewhat unsteady on her feet. Her husband Dave also reported Penny...
Some wounds and conditions don’t respond to conventional therapies and treatment modalities. In those cases, providers may consider hyperbaric oxygen therapy (HBO). Gloria Miller CPC, CPMA, and Todd Sommer, DO, DPM, CWS, review the conditions eligible for HBO therapy and correct code assignment for these services.
When is in appropriate to use modifier -59 to override coding edits? When is another modifier more appropriate? Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H, and Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS , explain the appropriate use of modifier -59.
Q. When is it appropriate to append modifier -74 (procedures discontinued after anesthesia administration or after the procedure has begun) or -73 (procedures discontinued prior to anesthesia) instead of to modifier -52 (reduced service)? Is there more than anesthesia that determines their use? The report below was coded with CPT ® 62311 (injection[s] of diagnostic or therapeutic substance[s]…; lumbar or sacral [caudal]). I asked the coder if modifier -74 should be appended, and the coder said that -52 should be appended. Is this correct? Procedure: Attempted lumbar midline interlaminar epidural steroid injection L5-S1 with fluoroscopy After identifying the L5-S1 interlaminar space fluoroscopically, the skin was sterilely prepped and draped. The skin and subcutaneous tissue were anesthetized with 1% lidocaine. Utilizing a loss of resistance technique and intermittent fluoroscopic guidance, an 18 gauge Tuohy needle was utilized to approach the epidural space. I was not able to successfully identify the epidural space secondary to encountered resistance. The needle depth was checked on lateral views and noted to be superficial to the epidural space when resistance was encountered. We were going to utilize a caudal approach, however skin breakdown was noted. At this point, I elected to have her return for care in 2 weeks and get the skin breakdown in the caudal area treated.
Coders face many challenges when coding for services provided by teaching physicians, interns, residents, and students. Medicare has specific rules and regulations surrounding what services it will pay for when an intern, a resident, or a student provides services. Lori-Lynne A. Webb, CPC, COBGC, CCS-P, CCP, CHDA, details what coders need to see in the documentation before reporting these services.
We’ve hit the middle of August and Anytown’s summer adult baseball league is winding down its season. Just like the pros, though, our players haven’t escaped injury free. Randy, the league’s top...
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.
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?
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.
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.
Diseases of the ear and mastoid process are moving up in the ICD-10-CM world. They’re getting their own chapter. In ICD-9-CM, eyes and ears shared a section. You’ll find diseases of the ear in...
We’re one step closer to knowing whether the Department of Health and Human Services (HHS) will actually delay ICD-10 implementation and if so, by how long. The Office of Management and Budget (OMB)...
The dogs days of summer have arrived so the residents of Anytown descended on the dog park with their furry friends today. Sadly, not all of the puppies (and people) play well together and some of...
As part of the July update to the Intergrated Outpatient Code Editor, CMS reinstated HCPCS C1882 to the list of acceptable devices for CPT code 33249. Dave Fee, MBA, explains the implications of the change and reviews code changes included in the update.
Observation services can generate so much confusion that CMS actually asked for comments on observation and inpatient status as part of the 2013 OPPS proposed rule. Kimberly Anderwood Hoy, JD, CPC, and Deborah K. Hale, CCS, CCDS, help coders unravel the complexities of observation services.
QUESTION: A patient complained of intractable pain from compression fracture (sustained the day prior to admission). The guidelines state if pain is not documented as acute or chronic, don't assign codes from the 338 category. Should we query the physician if the pain was acute or chronic rather than just using the fracture code if it appears that pain control was the main reason for the visit?
Physicians can perform three different types of wound debridement and coders will find different codes for each type. Gloria Miller, CPC, CPMA, and John David Rosdeutscher, MD, discuss the different types of debridement, as well as coding and documentation requirements.
Inpatient facilities received mixed news on proposed changes to the list of complications and comorbidities (CC) and major CCs (MCC) in the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) final rule , released August 1.
When a physician places a device that takes the place of all or some of a body part, assign a code from ICD-10-PCS root operation replacement (third character R). Think of a total knee replacement or...
Patience may be a virtue, but knowledge is power. Okay, enough clichés. The bottom line is we’re still waiting for a new ICD-10 implementation date. HHS published the proposed rule, moving...
Coders can run into two types of edits that may require them to append modifier -59 (distinct procedural service) to override: NCCI edits and medically unlikely edits (MUE).
In this month's issue, we unravel confusion surrounding use of modifier -59, explain the difference between NCCI and MUE coding edits, discuss building E/M ED visit level, review the updates to the I/OCE, and answer reader questions.
