Q: Why isn't a secondary diagnosis of morbid obesity considered a complication or comorbidity (CC) by CMS? What obesity diagnoses are classified as CCs by CMS?
Malnutrition includes undernutrition, inadequate vitamins or minerals, overnutrition, obesity, and diet-related noncommunicable diseases. Inpatient coders must be familiar with clinical criteria and ICD-10-CM coding for this condition as it is frequently the focus of clinical validation audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Interventional radiology describes a set of procedures that involve the insertion of medical devices and instruments to diagnose or treat disorders of blood vessels. This article covers common revascularization procedures, CPT codes associated with each vascular territory, and potential coding errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The American Medical Association (AMA) released the Category I vaccine product codes for monkeypox tests and vaccines. The organization made them effective immediately upon their approval by the CPT Editorial Panel on July 26. The new codes are scheduled to appear in the in the 2024 CPT Manual.
Coding professionals can get an early start to 2023 by reviewing CPT codes that will be added, revised, and deleted next year. Analysis of the proposed 2023 Medicare Physician Fee Schedule reveals changes to 10 chapters in the CPT Manual , in addition to the revisions to the E/M chapter.
In part two of this series, expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, addresses the “nuts and bolts” of ICD-10-CM coding for anesthesia services, including how and when to append modifiers.
Bronchoscopy is often performed in conjunction with other therapeutic procedures for the treatment of lung problems. Sarah Nehring, BS, RHIT, CCS, CCDS , breaks down ICD-10-PCS coding for bronchoscopy with bronchoalveolar lavage and suction of a mucus plug.
Q: When would you report an ICD-10-CM code from category I22 (subsequent ST elevation and non-ST elevation myocardial infarction [MI]) with a code from I21 (acute MI)?
A spinal fusion is used to permanently connect two or more vertebrae, eliminating motion between them. Read up on ICD-10-PCS guidance for reporting spinal fusions based on key details in the operative note. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released the fiscal year (FY) 2023 IPPS final rule on August 1, increasing hospital payment rates by 4.3% and establishing three health equity-focused measures in hospital quality programs.
Inpatient coders have malnutrition on their mental list of diagnoses at risk of audits. Learn how to effectively work with dieticians and CDI staff to ensure accurate documentation and ICD-10-CM coding for malnutrition.
Because of the prevalence of eating disorders, coders should become familiar with their types, symptoms, codes, and relevant guidelines. They appear in ICD-10-CM under category F50 (eating disorders), but codes for individual symptoms appear throughout the manual.
Capturing obesity as a CC Q: Why isn't a secondary diagnosis of morbid obesity considered a complication or comorbidity (CC) by CMS? What obesity diagnoses are classified as CCs by CMS? A: The...
A broken nose is a break in the bone or cartilage over the bridge of the nose or over the septum—the structure that separates the nostrils. Debbie Jones, CPC, CCA , explains how to select the most specific CPT codes for nasal fracture and dislocation treatments.
The 3-day payment rule is known to coders by various names such as the 72-hour rule, the 3-day payment window, or MS-DRG window policy. Kimberly Lee M.Ed., RHIA, CCS-P , describes how to navigate the rule’s nuances for billing purposes.
A spinal fusion is used to permanently connect two or more vertebrae, eliminating motion between them. Read up on ICD-10-PCS guidance for reporting spinal fusions based on key details in the operative note.
Reconciling CDI reviews and queries against final coding is an important but sometimes overlooked step. Use these expert tips to refresh or develop your organization's CDI and coding reconciliation process.
CMS proposes to adapt the 2023 AMA CPT guideline changes to the nursing facility (NF) codes into its Medicare policy structure next year, according to the 2023 Medicare Physician Fee Schedule proposed rule.
Because of the prevalence of eating disorders, coders should become familiar with their types, symptoms, codes, and relevant guidelines. They appear in ICD-10-CM under category F50 (eating disorders), but codes for individual symptoms appear throughout the manual. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Most coders never have the opportunity to code for anesthesia. Expert Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA, COBGC, explains that ICD-10-CM coding for anesthesia services is interesting and straightforward, but can be confusing if an individual is unfamiliar with coding guidelines and terminology for anesthesia administration.
The current year (CY) 2023 OPPS proposed rule, released July 15, details hospital payment updates, remote behavioral services, and enrollment requirements for rural emergency hospitals, among other proposals.
Hospital coders must be able to determine the reason for an admission and to differentiate conditions present on admission (POA) from those that develop during an inpatient stay. Learn how to effectively decipher documentation to identify the principal diagnosis and conditions that were POA.
Twenty-five percent of hospitalized Medicare patients experience patient harm, and 43% of those harm events could have been prevented, according to a recent Office of Inspector General (OIG) report.
Determining the most specific ICD-10-PCS code for a procedural service can be tricky given that there are 34 character values and over 78,000 ICD-10-PCS codes for 2022. This article breaks down potentially confusing ICD-10-PCS guidelines for obstetric and cardiovascular procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sepsis and systemic inflammatory response syndrome are historically difficult to document and report in ICD-10-CM. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , breaks down sepsis definitions and outlines a process for query creation.
Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-19-related billing flexibilities, and value-based care, according to the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule released July 7.
This article analyzes ICD-10-CM codes for diseases that can manifest from prolonged hypertension. These codes appear throughout the ICD-10-CM manual, but most are found in Chapter 9 (Diseases of the circulatory system). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A broken nose is a break in the bone or cartilage over the bridge of the nose or over the septum—the structure that separates the nostrils. Debbie Jones, CPC, CCA , explains how to select the most specific CPT codes for nasal fracture and dislocation treatments.
Q: We are getting some National Correct Coding Initiative (NCCI) edits for repeat laboratory services. What modifier do we use if a component of a panel test is repeated later?
The American Medical Association’s (AMA) CPT Editorial Panel recently published changes to its E/M Services Guidelines. The update includes code revisions, additions, and deletions, which are scheduled to take effect January 1, 2023.
A handful of new ICD-10-CM/PCS codes took effect April 1. Read up on the updates and CMS’ process for implementing code changes biannually. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders in acute care facilities must be comfortable assigning ICD-10-CM/PCS codes for abortions. Sarah Nehring, BS, RHIT, CCS, CCDS , breaks down ICD-10-CM/PCS codes for spontaneous and induced abortions and related complications.
In an industry that changes both quickly and frequently, keeping staff educated is important not only for your healthcare system, but for your employees’ professional growth. Catherine Sheika, BSN, RN, CCDS, writes about coding and team-building games that make even the driest topics more engaging.
Peoples Health Network received an estimated $3.3 million in overpayments between 2015 and 2016 for incorrectly billing ICD-10-CM codes from high-risk groups, according to a recent audit by the Office of Inspector General (OIG).
Every organization’s priorities will differ, but any outpatient CDI program must determine how to measure the improvement associated with its efforts. Outpatient CDI will directly contribute to the facility’s overall quality performance and risk adjustment models.
Sepsis and systemic inflammatory response syndrome are historically difficult to document and report in ICD-10-CM. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , breaks down sepsis definitions and outlines a process for query creation.
The 2023 CPT update will shift provider consults, facility, and home-based E/M visits to a coding model based on medical decision-making (MDM) or time, according to the AMA.
The Centers for Disease Control and Prevention recently released the 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting. Review key ICD-10-CM updates including new codes for dementia, head injuries, and long-term drug therapy.
by Kim Conner, BSN, RN, CCDS, CCDS-O In our ever-changing landscape of healthcare, quality and prevention continue to drive the way we deliver care to our patients. As a result, social determinants...
Hypertension, also known as high blood pressure, is a condition in which the force of blood exerted against the artery walls is higher than normal for a prolonged period. This article explains hypertension pathophysiology and ICD-10-CM coding for the condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 3-day payment rule is known to coders by various names such as the 72-hour rule, the 3-day payment window, or MS-DRG window policy. Kimberly Lee M.Ed., RHIA, CCS-P , describes how to navigate the rule’s nuances for billing purposes.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting. Review key ICD-10-CM updates including new codes for dementia, head injuries, and long-term drug therapy.
CMS recently published its first quarter HCPCS Application Summaries and Coding Recommendations, which, included 22 requests to establish new HCPCS Level II codes for drugs and biologicals and CMS' final HCPCS coding decisions.
Q: Based on National Correct Coding Initiative Manual guidelines, CMS allows facilities to bill 1 unit of CPT code 94640 per episode of care regardless of the number of treatments provided. Should you bill 1 unit of CPT code 94640 even if the service was performed three times?
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting , introducing new codes and guidance for reporting dementia, head injuries, and long-term drug therapy.
Hospitals have made avoiding and managing denials a top priority, but for many, their best efforts have yet to turn the tide. Take steps to address compliance concerns and reduce denial rates.
Coding a chart with a sepsis diagnosis requires careful attention to detail. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews sepsis documentation, ICD-10-CM coding requirements, and quality measures for public reporting.
Cranial diagnoses present with varied symptoms and require an individualized approach to treatment. Brush up on documentation and ICD-10-CM/PCS coding for neuroendoscopy, posterior fossa decompression, and embolectomy/thrombectomy procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
Many factors influence the identification of a primary diagnosis, including varying provider documentation styles and health record nuances. Holly Cassano CPC, CRC, navigates challenges that come with selecting an appropriate primary diagnosis code.
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services is used to control improper coding leading to inappropriate payment for Part B services. This article provides an in-depth overview of 2022 updates to the NCCI Manual including new and revised reporting guidance. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently announced that it released a new HCPCS Level II code for AstraZeneca's EVUSHELD COVID-19 antibody treatment, effective for dates of service on or after February 24. The initial dose authorized for use during the public health emergency has been changed to 600 mg for pre-exposure prevention of COVID-19.
Various ICD-10-CM/PCS and CPT codes may be used to report hospital services for the diagnosis and treatment of COVID-19. Review Q&As on appropriate coding for COVID-19 laboratory testing, comorbidities, and treatments.
Inpatient coding for brain surgery can be challenging as many approaches, techniques, and devices may be used to treat cranial abnormalities. Read up on reporting requirements and ICD-10-CM/PCS coding for craniotomies and deep brain stimulation (DBS). Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Correct present on admission (POA) identification and use of POA indicators is important, as these indicators directly affect how insurance providers and patients are billed. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC , breaks down POA reporting requirements and payment implications.
CMS recently released the fiscal year (FY) 2023 ICD-10-PCS code set and ICD-10-PCS Official Guidelines for Coding and Reporting . The ICD-10-PCS update includes several new codes for Destruction and Occlusion, and a new guideline for Detachment procedures of the extremities.
Q: What clinical criteria should coders use to support ICD-10-CM code assignment for upcoming 2023 dementia codes in category F02 (dementia in other diseases classified elsewhere)?
Various ICD-10-CM/PCS and CPT codes may be used to report hospital services for the diagnosis and treatment of COVID-19. Review Q&As on appropriate coding for COVID-19 laboratory testing, comorbidities, and treatments.
Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. Refresh your knowledge of this modifier with coding tips and example scenarios.
Ongoing labor shortages and a competitive hiring market are putting a strain on HIM departments. As competition for qualified staff increases, learn how HIM leaders can turn to a variety of short- and long-term fixes and even find opportunities for improvement.
Coding managers should not assume that they can review every coding guideline, Coding Clinic , or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes.
Coding a chart with a sepsis diagnosis requires careful attention to detail. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , reviews sepsis documentation, ICD-10-CM coding requirements, and quality measures for public reporting.
A cesarean section is typically performed when complications from pregnancy make a traditional vaginal birth difficult. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , breaks down ICD-10-CM coding for common labor and delivery complications, and ICD-10-PCS coding for cesarean deliveries.
Items eligible for CMS’ New Technology Add-on Payment (NTAP) often yield high reimbursement but are prone to charging, coding, and billing errors. Learn about the NTAP designation and its impact on coding and billing processes.
Approximately 37.3 million Americans have diabetes, and nearly 20% of them don’t know they have it, according to the Centers for Disease Control and Prevention. Review the signs and symptoms of diabetes and guidelines for reporting the condition in ICD-10-CM. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The establishment of mandatory sepsis protocols at all hospitals in New York state is estimated to have saved more than 16,000 lives between 2015 and 2019, according to End Sepsis.
Medication Therapy Management (MTM) is a group of services provided by pharmacists that involve active management of drug therapy. Review CPT coding, the role of pharmacists, and documentation tips associated with MTM.
The American Medical Association (AMA) recently announced an editorial update to the CPT code set for COVID-19 vaccines that includes new codes for Pfizer-BioNTech’s booster vaccine and Sanofi-GlaxoSmithKline’s (Sanofi-GSK) vaccine candidate.
Hospital coding for wound procedures is notoriously difficult, as the process can seem as messy as the injuries themselves. Clarify wound documentation and guidance for reporting wound diagnoses and procedures using ICD-10-CM, CPT, and HCPCS Level II codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Although many provisions of the 2022 OPPS final rule are a light lift for hospitals, several have far-reaching implications. Apply these expert tips to ensure you're up to speed and aware of compliance pitfalls.
Q: What is the best way to determine if an E/M service is above and beyond the physician work normally associated with a procedure to justify the use of modifier -25?
CMS is proposing to hit pause on major changes to MS-DRG designations while considering numerous changes to quality reporting and value programs, according to the fiscal year 2023 IPPS proposed rule. Read up on CMS’ proposed updates, which will impact inpatient hospitals beginning October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Aspiration pneumonia is a lung infection caused by inhaled oral or gastric contents. Alba Kuqi, MD, CCS, CDIP, CCDS, CRCR, CICA, CSCM , breaks down documentation and ICD-10-CM coding requirements for aspiration pneumonia.
Revenue leakage can be caused by a number of factors including late filings, inconsistent documentation, and inaccurate coding. Fran Jurcak, MSN, RN, CCDS, CCDS-O , describes proactive strategies that coding professionals can use to address mid-revenue cycle leakage.
Hospitalists coded a significantly higher proportion of Medicare beneficiaries as high severity compared to non-hospitalists, according to a study published in the Journal of the American Medical Association Health Forum .
Determination of what is medically necessary for any given diagnosis is set forth by the healthcare industry’s Standard of Care. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation .
CMS’ recently released fiscal year (FY) 2023 IPPS proposed rule includes 1,179 proposed ICD-10-CM code additions, mainly affecting reporting for dementia, concussions, and injuries due to motor vehicle collisions. The code changes, if finalized, would take effect October 1, 2022.
Sometimes even the most seasoned revenue integrity professionals get stumped trying to navigate the maze of billing, charging, and coding rules that govern chargemaster structure. Review expert answers to perplexing chargemaster questions.
Podiatry is the study, diagnosis, and treatment of disorders or deformities of the foot and ankle. Read up on foot and ankle anatomy and CPT coding for hallux valgus and rigidus corrections, cock-up fifth toe repairs, toe amputations, and more. 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 , describes the difference between an implant and a foreign body removal and outlines CPT coding for these procedures.
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation .
Approximately 37.3 million Americans have diabetes, and nearly 20% of them don’t know they have it, according to the Centers for Disease Control and Prevention. Review the signs and symptoms of diabetes and guidelines for reporting the condition in ICD-10-CM.
As a result of the pandemic, delivering consistent, quality CDI education has become more challenging. My hospital has been no exception, and although adapting has not been easy, it is doable.
