Q: When reporting multiple separate infusions of the same substance or drug provided through the same IV site during one visit, should we add up the total time and then report the appropriate codes?
CMS released four new resources in early April on the Merit-based Incentive Payment System, one of two new payment options under the Quality Payment Program initiative created by the Medicare Access and CHIP Reauthorization Act.
HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations, and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper, and that will hit reimbursement hard.
Coding Clinic for ICD-10-CM/PCS , First Quarter 2017, which became effective March 15, provides interesting perspectives that may be useful in our deliberations with payers or Recovery Auditors. Let’s process some of its guidance.
Ghazal Irfan, RHIA, writes about healthcare’s shift from fee-for-service to pay-for-performance, volume-based care to value-based reimbursement, and case-mix index to outcome measures, and how your facility can achieve compliant coding practices among these changes.
On Friday, April 14, CMS released the fiscal year 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-PCS and ICD-10-CM code proposals.
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, discusses the reporting of alcoholism, its key documentation details, and its effect on MS-DRGs in ICD-10. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Query practices have changed a lot over the years. With so many shifts, coders and clinical documentation specialists may need to take a step back and take stock of the changes they’ve worked through, reassessing current practices against industry recommendations and shoring up policies to prevent well-known pitfalls.
Providers often document “global developmental delay” in pediatric charts. The phrase is used to describe when a child takes longer to reach certain development milestones than other children the same age, such as walking or talking. Children with conditions such as Down syndrome or cerebral palsy may also have a global developmental delay.
A benefit of the switch to ICD-10-CM is the ability to be as specific as possible about a patient’s condition, but the downside of this is that it can make coding fractures time-consuming and confusing. Knowledge of bone anatomy and how fracture codes work is therefore an invaluable asset in fracture coding.
Q: The CPT Assistant advice on how to apply modifier -59 to CPT code 29874 (knee arthroscopy with removal of loose/foreign body) seems to conflict with NCCI edits. Do the NCCI edits override the advice in CPT Assistant ?
Audited hospitals generally applied modifier -59 (distinct procedural service) incorrectly when billing for outpatient right heart catheterizations and heart biopsies provided during the same encounter, leading to overpayments totaling approximately $7.6 million, according to a March report from the Office of Inspector General.
Accurate clinical documentation is the bedrock of the legal medical record, billing, and coding. It is also the most complex and vulnerable part of revenue cycle because independent providers must document according to intricate and sometimes vague rules.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, discusses the use of unspecified codes after the ICD-10-CM grace period and advises providers on how to decrease the use of those codes.
Queries are definitely not what they used to be. When I first started as a CDI specialist, back when dinosaurs roamed the earth, the query process was a muddy exercise in creative writing. CDI specialists wrote all kinds of crazy things in order to get physicians to answer a query. Then in 2001 came the first AHIMA practice brief, “Developing a Physician Query Process,” which gave order and standards to the query process.
Q: Can you please help me determine the query opportunities and code assignment/sequencing argument related to a patient who was admitted with pneumonia, congestive heart failure, acute respiratory failure, and encephalopathy?
Clinical documentation improvement (CDI) specialists bridge the gap between physicians and coders. This article takes a look at the benefits of CDI and coding collaboration, and how CDI specialists can address coding hot topics at their own facilities.
Peggy S. Blue, MPH, CPC, CCS-P, CEMC , writes about hemophilia and how this condition is important for inpatient coders to understand since incorrect reporting can affect MS-DRG assignment.
Erica E. Remer, MD, FACEP, CCDS , comments on a recent Coding Clinic that has garnered a lot of questions on inpatient obstetrics coding and gives advice on how she thinks this new guidance is flawed. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Written comments on upcoming ICD-10-CM/PCS code changes presented during the ICD-10 Coordination and Maintenance Committee meeting in March are due Friday, April 7.
Long before ICD-10 became a focus, working as a clinical documentation improvement manager with physicians to improve their progress and/or operative notes was a challenge—doctors either got it or they didn’t. But as the transition from paper charts to an electronic medical record began, providers started to understand how to better document their visits, since they had to choose from drop-down menus and multiple options to complete their notes.
The 2017 calendar year marks the beginning of a new approach to physician payment through the Quality Payment Program (QPP), an initiative created by the Medicare Access and CHIP Reauthorization Act to revise the physician payment system previously updated through the Sustainable Growth Rate.
Medicare recently published revisions to its appeals process, focusing on the Administrative Law Judge (ALJ) level of appeal. These revisions were published in the Federal Register in the form of final regulations on January 17, 2017, and became effective March 20.
Our experts answer questions about hitting MUEs on injections and infusions, setting multiple prices for the same CPT codes, payment rates for cancer centers, and more.
Q: We have trouble billing multiple units of injections and infusions – mostly CPT add-on codes 96375 and 96376–that are done during observation stays and exceed the medically unlikely edits number. What is the correct way to bill these and get paid?
CMS released a new educational initiative , Connected Care , on March 15 to help raise awareness of the benefits of chronic care management services, as Medicare has recently added and started paying for these services.
Glands located throughout the body are responsible producing hormones and releasing chemicals into the bloodstream as part of the endocrine system. These glands help maintain many important purposes of the body, including metabolism, growth, and reproductive functions. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
In the second part of this two-part series on the Merit-based Incentive Payment System (MIPS), dive deeper into the four performance categories, their requirements, and their scoring parameters for the first year of MIPS reporting. This article also gives readers tips on what clinicians need to do to prepare for and participate in MIPS in 2017.
In the first part of a two-part series on the Merit-based Incentive Payment System (MIPS), discover the basics of the MIPS program, understand who is eligible for 2017 participation, and navigate the scoring system for the first year of reporting.
Since the physician doesn't need to document a specific root operation, coders cannot rely solely on the terms the physician uses; thus it is important for each coder to fully understand each definition. This article takes a look at the root operations Drainage, Extirpation, and Fragmentation. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, discusses the importance of monitoring your facility’s case-mix index, and how evaluating each component of a case-mix index allows you to narrow your focus and to hone in on all of the factors that might be affecting them.
James S. Kennedy, MD, CCS, CDIP , reviews recent coding audits at that Northside Medical Center of Youngstown, Ohio, and Vidant Medical Center of Greenville, North Carolina, and gives readers tips on how to better prepare their facilities through these examples.
Q: One of my coworkers thought we needed the phrase “unable to clinically determine” as an option on every multiple-choice query we send. My take on it is that if we have “other” with an option for free text, that would cover us for compliance. Further, I thought it was inappropriate to include this option in some cases, as it may offer an option that is preventing me from obtaining the detail and specificity I need.
On March 8, CMS released eight frequently asked questions (FAQ) related to the Medicare Outpatient Observation Notice (MOON). The FAQs reinforce that psychiatric hospitals must comply with the Notice of Observation Treatment and Implication for Care Eligibility Act and MOON.
Q: I am the coding manager for our inpatient coding department. I am wondering if I should create an audit plan to monitor new coders or difficult diagnosis. If so, is there anything specific I should consider when trying to implement a plan?
Laura Legg, RHIT, CCS, CDIP , explains how external coding audits are an important part of shining a light into all coding operations and turning risk into security and peace of mind. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
A study conducted by Journal of American Medical Association (JAMA) based on data obtained from the 2013 Nationwide Readmissions Database, revealed that sepsis accounts for a higher rate of unplanned readmissions than the other studied medical conditions.
The incidence of stroke and transient ischemic attack is increasing as the baby-boomer population ages. James S. Kennedy, MD, CCS, CDIP , writes that understanding and embracing clinical and coding fundamentals for these conditions is essential in the joint effort to promote providers’ complete documentation and the coder’s assignment of clinically valid codes.
Accurate clinical documentation is the bedrock of the legal medical record, billing, and coding. It is also the most complex and vulnerable part of revenue cycle because independent providers must document according to intricate and sometimes vague rules.
Coders prepared for 2017 with numerous changes to the Official Coding Guidelines for the ICD-10-CM and the addition of many new codes. Quietly waiting in the wings was the updated CPT® Manual for 2017 with its changes waiting to be discovered.
As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims.
In today’s ever-changing healthcare landscape, emphasis is shifting away from fee-for-service to pay-for-performance, from volume-based care to value-based reimbursement, and from case-mix index to outcome measures.
The selection of the principal diagnosis is one of the most important steps when coding an inpatient record. The diagnosis reflects the reason the patient sought medical care, and the principal diagnosis can drive reimbursement.
