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.
A recent audit conducted by the Office of Inspector General (OIG) found that Cariten Health Plan Inc. in Knoxville, Tennessee, received at least $9.2 million in net overpayments from 2016 to 2017 for incorrectly submitting selected high-risk diagnosis codes.
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.
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.
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.
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.
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)?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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).
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.
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...
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.
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.
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.
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 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.
