JustCoding.com: Special Reports and News

Expanded Q&A tackles coding for tPA, use of modifiers -58 and -78, and more

Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services, tackles some of your coding questions, including whether coders can document in the medical record.

Inpatient or Outpatient Only: Why Observation Has Lost Its Status

In this new white paper, Kimberly Anderwood Hoy, JD, CPC, director for Medicare and compliance at HCPro, Inc., discusses proper patient status classification and helps clear up confusion surrounding observation services. Click here to access other Revenue Cycle Institute white papers.

RAC Preparedness Benchmarking Report

In this new benchmarking report, Kimberly Anderwood Hoy, JD, CPC, director for Medicare and compliance at HCPro, Inc., examines a recent survey of preparation efforts across the country. Click here to access other Revenue Cycle Institute white papers.

Sepsis and Septicemia: Clear Up Coding and Documentation Confusion

In this new white paper, Jennifer Avery, CCS, CPC, CPC-H, CPC-I, senior regulatory specialist for HCPro, Inc., examines sepsis, severe sepsis, and SIRS, to help coders understand how to use these terms accurately to ensure correct coding and billing. Click here to access other Revenue Cycle Institute white papers.

Modifier -59 Q&A

Susan E. Garrison, CHCA, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, and Peggy S. Blue, MPH, CPC, CCS-P, answer questions that were submitted to HCPro after the June 23 audio conference, “Modifier -59: Manage Pre- and Post-Payment Audits to Reduce Denials.” Go to HCPro’s Healthcare Marketplace for more information or to order the audio conference on demand.

Understanding and Applying the 2010 ICD-9-CM Codes

Robert S. Gold, MD, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, review deleted codes as well as the new and revised ICD-9-CM diagnosis codes that take effect October 1, 2009.

Coder Productivity Benchmarks

In this special report, Lisa Eramo, CPC, senior managing editor at HCPro, Inc., in Marblehead, MA, provides a detailed breakdown of coder productivity according to bed size and record type. In addition, the report takes a look at how working remotely affects productivity. This report can be a useful benchmarking tool for you and your organization.

Chapter 7: Continuous Survey Readiness

This excerpt from HCPro’s book, Information Management and Record of Care, Treatment, and Services: The Compliance Guide to the Joint Commission’s Standards, Seventh Edition by Jean S. Clark, RHIA, CSHA, includes guidance outlining best practices to ensure survey readiness. Everyone plays a role in the success of an on-site survey, and waiting until the last minute of the year that the organization is to be surveyed will no longer make the grade. For more information on this book, please visit HCMarketplace.com.

Present on Admission: Accurate Reporting to Ensure Appropriate Reimbursement

In this new white paper, Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director of coding and health information management at HCPro, Inc., discusses tips for handling assignment of present on admission indicators and also addresses hospital acquired conditions. Click here to access other Revenue Cycle Institute white papers.

Survey Says: Use CDI Best Practices to Query Physicians

Most clinical documentation improvement professionals want to know how other facilities fare in getting physicians to respond to queries. More than 350 people responded to this 20-question physician query benchmarking survey that the Association of Clinical Documentation Improvement Specialists (ACDIS) launched earlier this year. Click here to learn more about ACDIS.

Evaluation and Management Auditing: Ensure appropriate coding and reimbursement for your practice

In this new white paper, Joe Rivet, CPC, CCS-P, CEMC, CICA, Revenue Cycle Institute regulatory specialist and Evaluation and Management (E/M) Boot Camp® Instructor at HCPro, Inc, discusses reasons for why it is a best practice to perform E/M audits, shares auditing tips, and explains how to evaluate audit findings. Click here to access other Revenue Cycle Institute white papers.

Incident To in Provider-Based Departments

In this new white paper, Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc, discusses how to meet Medicare’s ordering, supervision, and follow-up requirements in provider-based departments. Click here to access other Revenue Cycle Institute white papers.

Injection and Infusion Coding and Billing

In this new white paper, Joe Rivet, CPC, CCS-P, CEMC, CICA, regulatory specialist at HCPro, Inc, discusses:

Coding and billing for hydration services
Therapeutic, prophylactic, and diagnostic injections and infusions
Chemotherapy and other highly complex drug administration
Coding and charge capture process
Payment validation

Click here to access other Revenue Cycle Institute white papers.

Master physician queries: Clarify coding with compliant questions

This new white paper provides an overview of the American Health Information Management Association practice brief, “Managing an Effective Query Process.” In the white paper, Shannon McCall, RHIA, CCS, CCS-P, CPC-I, director of coding and health information management at HCPro, Inc., in Marblehead, MA, discusses how to query appropriately, how to document queries in a compliant fashion, and how to monitor and audit physician queries. Click here to access other Revenue Cycle Institute white papers.

The New ABN: Specifics to ensure your team is ready to use the new notice

This recently updated white paper provides an overview of the new Advance Beneficiary Notice of Noncoverage. In it, Kimberly Anderwood Hoy, JD, CPC, director of Medicare and Compliance at HCPro, Inc., in Marblehead, MA, discusses how to complete the new form and talks about operational processes to consider. Access other Revenue Cycle Institute white papers.

Breaking News from HCPro

View HCPro’s e-blast covering the breaking news that CMS announced on February 6 that the recovery audit contractor program was again underway as the bid protests filed by Viant, Inc., and PRG Shultz, USA, Inc., had been withdrawn.

Breaking News from HCPro

View HCPro’s e-blast covering the breaking news that CMS revised its recovery audit contractor program expansion schedule, according to the new “RAC phase-in map” posted February 10 to the CMS Web site. The first phase is set to begin March 1, 2009. The second stage will begin August 1, according to the map.

Recovery Audit Contractors Demonstration Program White Paper

This recently updated white paper addresses the Recovery Audit Contractor (RAC) demonstration program, including an overview of RAC focus areas and strategies for success. In it, Kimberly Anderwood Hoy, JD, CPC, director of Medicare Compliance at HCPro, Inc., in Marblehead, MA, also discusses the RAC appeals process. Click here to access other Revenue Cycle Institute white papers.

Breaking news from HCPro

View HCPro’s e-blast covering the breaking news that the Department of Health and Human Services (HHS) announced on January 15 the final regulation to replace the ICD-9-CM code sets now used to report healthcare diagnoses and inpatient procedures with the more advanced ICD-10 code set currently used in other nations. The final regulation will implement the ICD-10 code set two years later than HHS initially proposed: October 1, 2013.

Orthopedic Coding Guide for Ambulatory Surgery Centers, Second Edition: Commonly Reported Modifiers

This excerpt from HCPro’s book, Orthopedic Coding Guide for Ambulatory Surgery Centers, Second Edition by Lolita M. Jones, RHIA, CCS, includes guidance for how and when to append commonly reported modifiers. For more information, please visit HCMarketplace.com

Coding and Medically Unnecessary Settings from The HIM Director's Guide to Recovery Audit Contractors

This excerpt from HCPro’s book, The HIM Director’s Guide to Recovery Audit Contractors by Jean S. Clark, RHIA, examines the DRGs RACs targeted in the demonstration project. The excerpt also discusses critical elements of an internal review of the potential coding and medical necessity problems RACs identified. For more information, please visit HCMarketplace.com

Multiple-procedure discounting policy

This excerpt from HCPro’s book, Orthopedic Coding Guide for Ambulatory Surgery Centers, Second Edition by Lolita M. Jones, RHIA, CCS, discusses the multiple-procedure discounting policy under the new ASC payment system. The excerpt includes a discounting policy example and a list of orthopedic procedures that are exempt from multiple-procedure discounting. For more information, please visit HCMarketplace.com

Understand the coding and clinical documentation improvement link

Coders and CDI specialists have a unique relationship and should recognize the roles that they each play in obtaining accurate documentation and reimbursement. Colleen Garry, RN, BS, explains how these two parties can work together to overcome challenges so that they each function at a high level of productivity and accuracy.

CMS announces physician fee schedule final rule and launches electronic prescribing incentive program

On October 31, CMS announced the Medicare physician fee schedule final rule for calendar year 2009, which included a new initiative for physicians to trade in their prescription pads for a qualified electronic prescribing system.

AHIMA issues final practice brief on managing an effective physician query process

On September 29, The American Health Information Management Association (AHIMA) released its long-awaited guidance on physician queries titled, “Managing an Effective Query Process.” The brief, which continues to focus on compliant querying, updates AHIMA’s 2001 version of a similar document titled, “Developing a Physician Query Process.”

2008 coder salary survey: A special report

As coders, you understand the important role your work plays in the revenue cycle and in ensuring that a facility or practice receives the reimbursement it deserves. But does administration recognize this? And are you paid accordingly? In the wake of added responsibilities and higher productivity standards, this question has been at the forefront of many coders’ minds. Check out this special report that is based on a 2008 JustCoding.com coder salary survey. It provides a detailed breakdown of coder salaries, age, education level, gender, experience, and work hours according to geographic region.

Key risk factors may reveal gram-negative pneumonia

Understanding and applying the 2009 ICD-9-CM Codes

This year ushers in many more specific ICD-9-CM codes and very few changes to the Medicare Severity DRG (MS-DRG) groups. Robert S. Gold, MD,along with Gloryanne Bryant, BS, RHIT, RHIA, CCS, and Shannon E. McCall, RHIA, CCS, CPC-I, explain some of the major code categories undergoing change for 2009.

Orthopedic terminology

Querying common conditions

The query process is an effective way to improve clinical detail and coding accuracy. More specific and detailed documentation improves future continuity of care and can potentially lead to improved quality of care. Colleen Garry, RN, BS, describes several common conditions for which CDI specialists can expect to query.

List of the ICD-9 code changes

This list includes new diagnosis codes, new V codes, new procedure codes, and revised diagnosis code and procedure code titles for 2009.

Don't 'grab and run' with diagnoses: Become a clinically savvy documentation improvement specialist

If they don’t perform a thorough record review, clinical documentation improvement (CDI) specialists may fail to catch many DRG-changing complications and comorbidities (CCs) and major CCs (MCCs). Glenn Krauss, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, and Deborah Mange, RN, BSN, talk about what it takes to be a savy and successful CDI specialist.

The Present on Admission Training Handbook

The pressure is on for hospitals to accurately report present on admission (POA) data to avoid Medicare denials. Take a proactive approach to POA indicators by educating coders and physicians about POA reporting and documentation requirements.

The MS-DRG Training Handbook

The MS-DRG Training Handbook is a one-stop training tool that meets the different needs of physicians and coders and forges a partnership for documentation excellence, coding compliance, and reimbursement success under MS-DRGs.

Recovery Audit Contractors Whitepaper

This white paper addresses the Recovery Audit Contractor (RAC) program, including an overview of how to prepare for RACs and what your hospital can expect. In it, William L. Malm, ND, RN, practice director of revenue cycle management consulting and revenue cycle excellence at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA,discusses the RAC appeals process and provides resources for additional information.

Shelley Safian answers five questions

Shelley Safian answers five of your questions. Learn about durable medical equipment, protein energy malnutrition, and other topics.

Five Q&A's about outpatient care

Read the questions and answers to five questions about outpatient care in this week’s Just Coding Platinum!

Executive summary of ACDIS survey results

HCPro distributed its clinical documentation improvement (CDI) survey in January 2008. This overwhelming response rate demonstrates the importance of this subject to health information management (HIM) managers and CDI specialists and managers, according to Colleen Garry, RN author of HCPro’s soon-to-be released book, The Clinical Documentation Improvement Specialists Handbook.

Treatment of new and deleted laboratory codes

CMS changes payment allowance for two influenza vaccines

Physician Presence Policy now applies to renal dialysis monthly capitation payment

CMS releases new instructions for observation vs. inpatient admission and discharge codes

Reporting subsequent hospital visits and hospital dicharge day management services

CMS has modified the 2005 National Coverage Determination for a treatment of obstructive sleep apnea (OSA) to cover continuous positive airway pressure (CPAP). Coverage is limited to a 12-week evaluation period. If patients experience improvement during this 12-week period, they may have use of the machine covered for a longer period of time.

Productivity benchmarks for the POA indicator: An executive summary

Has the present-on-admission (POA) indicator affected coder productivity at your facility? Find out what your fellow coders have to say about their coding experiences since the implementation of POA reporting. Also learn about the benefits that coder/physician education and system preparation had on the transition to Medicare Severity DRGs.

ASCRI's quarterly benchmarking report

In this new Ambulatory Surgery Coding & Reimbursement Insider (ASCRI) quarterly benchmarking report, we take a look at ASC coder compensation. This report is based on the results of a survey in which we asked coders to provide information about their salaries and discuss the importance of coder compensation in ASCs. To view the report click

Pass on the humble pie and admit your own value: Coders should recognize their worth

Although coders are among those most responsible for a hospital's financial health and data quality, fewer than one-third feel very respected in their organization, according to a JustCoding.com survey of 226 readers. The survey also found that fewer than half of respondents feel only somewhat respected, while one in five feel that they are not respected at all.

Understanding and applying the 2008 ICD-9-CM codes

This special report provides coders with a detailed explanation of the new 2008 ICD-9 codes that took effect October 1, as well as the clinical rationale for each new code to ensure proper code assignment, appropriate reimbursement, and accurate data reporting.

Revenue codes: Compliance risks and reimbursement pitfalls

2007 CMS-DRG CC and 2008 MS-DRG CC/MCC Table

Complete list of 2008 ICD-9-CM diagnosis and V codes

What do you do when physicians use the wrong terms?

There are several scenarios that can make DRG assignment difficult. For example, when a physician uses a word in his or her documentation that has two meanings, a coder may assume the wrong one. Faulty reporting also occurs as a result of clinical misunderstanding. In this case, a coder might take a code that is inherent to one body system and inadvertently apply it to surgery in another body system. Robert S. Gold, MD, provides coders with advice on how to avoid incorrect documentation pitfalls.

CMS proposes policy, payment changes for physician services in 2008

CMS proposes policy, payment changes for physician services in 2008: MPFS revisions add new quality measures, boost value of anesthesia work by 32%

Take note of Medicare foot care coverage guidelines

Survey shows mixed approach to documentation improvement

CMS corrects DRG relative weights for FY 2008

CMS recently corrected an error made in the calculation of the DRG relative weights in the Fiscal Year (FY) 2008 Inpatient Prospective Payment System (IPPS) proposed rule. CMS revised the relative weights and recalculated the IPPS amounts. The result of the correction is that CMS will increase the DRG relative weight amounts by $0.18.

CMS reminds providers to submit all paper claims on the UB-04 as of May 23

As of May 23, providers who submit paper claims must do so using the UB-04, CMS said in a reminder.

CMS releases new instructions for payment of astigmatism-correcting intraocular lenses

On April 27, CMS issued a new ruling concerning the insertion of astigmatism-correcting intraocular lenses (IOL) following cataract surgeries. This type of IOL imparts improved near, intermediate, and distance vision.

New transmittal outlines bariatric surgery billing requirements

On April 28, 2006, CMS issued change request CR 5013 to provide coverage for certain bariatric surgeries. The change request was necessary because the national coverage determination (NCD) was not uniformly implemented. Many claims that did not involve bariatric surgery were denied while other covered bariatric procedure claims were held. The new CR was meant to clarify claims processing instructions. Now, CMS issued CR 5477 to further explain these instructions.

CMS clarifies coding requirements for inpatient psychiatric facilities that furnish hemophilia clotting factors

On April 27, CMS released Transmittal 1234 to clarify coding requirements applicable to inpatient psychiatric facilities that furnish hemophilia clotting factor. The implementation date is October 2, 2007. Transmittal 1234 replaces Transmittal 1222.

CMS offers instruction on billing for brachytherapy sources in Q&A

According to a question and answer published on the CMS Web site, hospitals may report and charge Medicare and the Medicare beneficiary for all brachytherapy sources that are ordered by the physician for a particular patient and used in the care of that patient.

2007 Coder Salary Survey: A Special Report

As coders, you understand the important role your work plays in the revenue cycle and in ensuring that a facility or practice receives the reimbursement it deserves. But does administration recognize this? And are you paid accordingly? In the wake of added responsibilities and higher productivity standards, this question has been at the forefront of many coders' minds. Check out this special report that is based on a 2007 JustCoding.com coder salary survey. It provides a detailed breakdown of coder salaries, age, education level, gender, experience, and work hours according to geographic region. It will also take a glance into the future and address how technological and other changes may affect salary.

Drug administration: Master the 2007 coding, billing changes

Learn the injection and infusion changes for 2007 to ensure compliant coding.

Billing and Coding Audits Made Easy

Learn the top 10 reasons why performing billing and coding audits will increase your organization's effectiveness. Get an 11-step plan to audit one-day stays to verify that your organization admits patients under the appropriate status. Read this a nine-step plan for ensuring that your hospital is billing appropriately for patients who are discharged and readmitted on the same day. And more!

Pay attention to details when documenting diabetes

Robert S. Gold, MD, of DCBA, Inc., and Larry C. Deeb, MD, president of the American Diabetes Association, co-authored this special supplement to HCPro's Medical Records Briefings.

Medicare beneficiaries have new copayment for colorectal cancer screenings in non-OPPS hospitals

When providers perform one of the three colorectal cancer screenings in a non-OPPS hospital setting, they can expect to collect a higher copayment (25%) from Medicare beneficiaries, according to Medlearn Matters article number MM5387.

Medicare introduces new secondary payer modifier

Physicians who participate in the Competitive Acquisition Program (CAP) should note that when they procure a CAP drug from a source other than a CAP vendor, they should append new modifier -M2, according to Medlearn Matters article number SE0703.

50 Tips Every HIM Director Should Know

This goldmine of tips will help both the beginning HIM director or the experienced one. Read more of our special report to improve your department.

To the End of the Paper Trail

Those who are on their way to the end of the paper trail and those who have already reached it agree: The first step to a successful EHR project is planning. Read our special report for more information.

CMS establishes IRF-PPS edit to enforce proper transfer coding and payment

Inpatient rehabilitation facilities (IRF) are now subject to edits that the Centers for Medicare & Medicaid Services (CMS) will implement effective April 1, 2007. These edits will match beneficiary dates with admission dates to other providers to identify potentially miscoded claims, according to Medlearn Matters (MM) article number 5354 dated November 2.

CMS issues clarification of billing protocol for modifier -FB

CMS has provided additional information on how providers should bill no-cost and reduced cost devices under the outpatient prospective payment system (OPPS) in Medlearn Matters (MM) article number 5263, effective January 1, 2007. This Medlearn Matters article supplements Transmittal 1103, dated November 3, which outlines application of modifier -FB that providers should use for such devices.

OPPS final rule brings few surprises for ASCs: Industry focused on proposed changes for 2008

The Centers for Medicare & Medicaid Services (CMS) issued its final rule for the 2007 outpatient prospective payment system (OPPS) on November 1, and providers should expect reimbursement cuts and revisions to the ambulatory surgery center (ASC) list of Medicare-approved procedures effective January 1, 2007.

CMS declares post-operative drug administration a packaged service during a Sept. 21 Open Door Forum call

In terms of hotly debated OPPS coding/billing topics, there are few subjects that approach the level of post-operative drug administration-i.e., pain medication injections. The questions come up again and again-which injections/infusions can you bill separately from an associated procedure? Which are considered integral to the procedure and therefore not separately billable? Until recently providers have found guidance supporting both sides of the argument, leading to nationwide confusion. However, in the CMS Open Door Forum call of Sept. 21, Medicare appeared to deliver the definitive word when a representative stated that an injection for pain relief following an outpatient surgery is packaged into the surgery, and it is not proper to append modifier -59 to get the injection paid.

Compliance Benchmarking Report

To gain a better understanding of which topics healthcare organizations plan to audit this year, HCPro conducted a survey of 309 compliance and audit personnel. In this special report, we share the results of our survey and provide analysis by industry experts.