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HCPCS Level 1 Modifiers quick reference
Gloria Miller, CPC, vice president of reimbursement services for Comprehensive Healthcare Solutions, Inc., located in Tacoma, Wash, created this quick reference for HCPCS Level 1 modifiers commonly used in wound care coding.
Self-administered drugs Q&A
Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, and Valerie Rinkle, MPH, vice president of revenue integrity informatics with Health Revenue Assurance Associates, answered these questions about self-administered drugs during the September 12, 2012 audio conference, Self-Administered Drugs: What They Are, When They’re Covered, and How to Bill Them.
Hospital outpatient wound care coding Q&A
Gloria Miller, CPC, CPMA, vice president of reimbursement services at Comprehensive Healthcare Solutions, Inc., based in Tacoma, Wash., answered these questions about hospital outpatient wound care coding.
Sample anatomy and physiology questions
These 10 sample questions can be used to assess coder’s competency in medical terminology and signs and symptoms. These questions are adapted from the pretest questions that are part of HCPro’s Anatomy and Physiology for ICD-10 Coding E-learning Library.
Important updates to the three-day payment window
On January 4, 2013, CMS updated the three-day payment window section of the inpatient chapter of the Claims Processing Manual. Kimberly Anderwood Hoy,JD, CPC, director of Medicare and compliance for HCPro, Inc, in Danvers, Mass, reviews thenew sections which clarify two outstanding questions regarding services in the three-day payment window. She also discusses the update the CPT codes for cardiology procedures considered diagnostic.
Anatomy and physiology sample questions
As organizations prepare for the transition to ICD-10-CM/PCS, they need to assess their coders’ knowledge of anatomy and physiology. These 10 sample questions were taken from HCPro’s ICD-10 Competency Assessment for Coders: Anatomy and Physiology.
Clinical examples for ED coding
Payers often refer to these examples to determine the appropriate level of service for an emergency medicine claim. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer, president of Edelberg Compliance Associates of Baton Rouge, La., created this reference chart of examples for both CPT and American College of Emergency Physician Guidelines. If your claim is consistent with a case example but coded differently, be sure you have the supporting information in the record.
2012 Principal Diagnosis Selection Update
Inpatient coders often struggle with principal diagnosis selection. A clear understanding of the definition of principal diagnosis and the factors that play into principal diagnosis selection is extremely important, although oftentimes confusing. Jennifer Avery, CCS, CPC-H, CPC, CPC-I , regulatory specialist for HCPro, Inc, in Danvers, Mass, explains what factors affect principal diagnosis selection in the white paper, “2012 Principal Diagnosis Selection Update: Understanding factors and new guidance to determine appropriate codes.”
Pain management Q&A
Susan E. Garrison, CHCA, CHC, CCS-P, CPC, CPC-H, PCS, FCS, CPAR, executive vice president of Healthcare Consulting Services at Magnus Confidential in Atlanta, GA and Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, AHIMA-Approved ICD-10-CM/PCS Trainer, president of Safian Communication Services, Inc., near Orlando, answered these five pain management coding questions as part of HCPro’s “Outpatient Pain Management Coding for Diagnoses and Procedures” audio conference.
Sepsis Q&A
Inpatient coders often struggle with when to correctly code for sepsis and systemic inflammatory response syndrome. Robert S. Gold, MD, and Jennifer E. Avery, CCS, CPCH, CPC, CPC-I, answered these questions about sepsis during HCPro's March 29, 2102, audio conference: Sepsis Coding: Learn Documentation Improvement Techniques to Insure Accurate Coding.
ICD-10 Competency Assessment for Coders: ICD-10-CM
These 10 questions are a sample of the 100 questions contained inThe ICD-10 Competency Assessment for Coders: ICD-10-CM & ICD-10-PCS. The questions and answers developed to help you kick off your programs and see where your coding and HIM staff need focused training efforts. You'll identify key areas of your staff members' foundational learning that your programs will need to address.
2012 Medicare ED Facility E/M payments
Use this quick reference chart, provided by Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer, president of Edelberg Compliance Associates in Baton Rouge, La., to find the 2012 Medicare ED Facility E/M payment rates.
Hyperbaric oxygen therapy diagnoses
Gloria MillerCPC, CPMA, vice president of reimbursement services at Comprehensive Healthcare Solutions, Inc. in Tacoma, Wash, provides a quick look at some of diagnoses codes for conditions that qualify for hyperbaric oxygen therapy.
Modifier -59 Q&A
Coders continue to struggle with proper use of modifier -59 (distinct procedural service). Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS and Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS,FCS, CPAR, CPC, CPC-H, provide answers to some common questions about modifier -59 use.
ICD-10-CM Competency Assessment for Coders
These 10 questions are a sample of the 100 questions contained inThe ICD-10 Competency Assessment for Coders: ICD-10-CM & ICD-10-PCS. This selection of questions comes from the Genitourinary system, infectious diseases, and integumentary system sections of the assessment. The questions and answers developed to help you kick off your programs and see where your coding and HIM staff need focused training efforts. You'll identify key areas of your staff members' foundational learning that your programs will need to address.
2012 HIM manager and director salary survey benchmarking report
2012 HIM manager and director salary survey benchmarking report
Injections and infuions Q&A
Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC, answered these questions about injections and infusions during the January 18, 2012 HCPro audio conference, 2012 Injections and Infusions: CPT Changes, Nursing Documentation Requirements, and Billing Process Review.
Common hospital outpatient wound care coding scenarios
Wound care coding is not always clear cut. Coders need to look for certain information in the documentation in order to select a code. Gloria Miller, CPC, vice president of reimbursement services at Comprehensive Healthcare Solutions, Inc., in Tacoma, Wash., provided these four outpatient hospital wound care examples, along with the correct coding for each.
Injections and infusions case studies
Coders often struggle with injection and infusion coding, even though the codes themselves have not changed. These four case scenarios provide a look at some simple and complex situations for coding injections and infusions. The answers are based on the 2012 CPT codes. The case examples are adapted from a presentation by Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC.
Mastering the Three-Day Payment Window: New Intricacies for 2012
CMS’ three-day rule defines certain preadmission services as inpatient operating costs, meaning they are bundled and billed as part of the inpatient claim and payment is made as part of the applicable DRG payment for the case. Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc. in Danvers Mass., sorts out the confusion surrounding this rule in her newest white paper, “Mastering the Three-Day Payment Window: New Intricacies for 2012.”
Pain management ICD-9-CM to ICD-10-CM GEMs
Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, AHIMA-approved ICD-10-CM/PCS trainer of Safian Communications Services in Orlando, Fla, created this handout to help coders translate common ICD-9-CM pain management codes to ICD-10-CM.
Get to know new ICD-10-CM coding conventions
Coders must learn and adapt to several new conventions in ICD-10-CM. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Jennifer Avery, CCS, CPC-H, CPC, CPC-I, walk coders through some of the most significant new conventions in this excerpt from HCPro’s The Coder's Guide to ICD-10.
2011 Recovery Auditor Benchmarking Report
This report covers topics addressed in prior years; but it also examines providers’ experiences with the Recovery Auditors and their preparations to handle requests and appeals. Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., in Danvers, MA, examines the survey responses, which reflect a big uptick in Recovery Auditor activity with a large increase in respondents reporting both automated audits and records requests.
The Coder's Guide to ICD-10: Circulatory System
This excerpt about the circulatory system is from HCPro’s The Coder’s Guide to ICD-10, a 100-page training guide with detailed information about the new code sets for outpatient and inpatient coders. The Coder’s Guide to ICD-10 is a resource included in the ICD-10 Training Toolkit, a comprehensive tool that provides the building blocks for your training programs for physicians as well as coding, HIM, documentation, and billing professionals in both inpatient and outpatient settings.
Physician Supervision: Analyzing Current Status and What to Expect in the Future
The Centers for Medicare and Medicaid Services (CMS) began the process of clarifying the level of physician supervision for hospital outpatient services in 2008, continuing with further clarifications and regulatory changes through the CY 2012 outpatient prospective payment system (OPPS) final rule. In this white paper, Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc, in Danvers, MA, will explain the current requirements for supervision of hospital outpatient services, as well as the recent clarification in the CY 2012 final rule.
The ICD-10 Competency Assessment for Coders: ICD-10-CM & ICD-10-PCS
These 10 questions are a sample of the 100 questions contained in The ICD-10 Competency Assessment for Coders: ICD-10-CM & ICD-10-PCS. The questions and answers developed to help you kick off your programs and see where your coding and HIM staff need focused training efforts. You'll identify key areas of your staff members' foundational learning that your programs will need to address.
Click here for the answer key.
2012 HCPCS code changes
Find the new and revised HCPCS Level II codes and modifiers in this quick reference. This list contains the new and revised codes and modifiers with their long descriptors.
ICD-10-PCS root operations crossword puzzle
The editors of Medical Records Briefing provided this fun way to continue learning the ICD-10 root operations.
Click here for the answer key.
Principal Diagnosis Selection: Understand the Factors to Determine the Appropriate Codes
Inpatient coders often struggle with principal diagnosis selection. In this white paper, Jennifer Avery, CCS, CPC-H, CPC, CPC-I, explains how a clear understanding of the definition of principal diagnosis and the factors that play into principal diagnosis selection is extremely important, although often confusing.
2011 ICD-10 Implementation Benchmark Report
In July, Medical Records Briefing asked HIM managers and directors about their ICD-10 implementation efforts as part of our quarterly benchmarking surveys. In this report, we explore the results and provide you with valuable information regarding ICD-10 implementation efforts nationwide.
Understanding and Applying the 2012 ICD-9-CM Codes
Robert S. Gold, MD, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, provide insight into the new, revised, and deleted diagnosis and procedure codes for 2012, which take effect October 1, 2011.
Observation Q&A
Kimberly Anderwood Hoy, Esq., director of Medicare and Compliance for HCPro Inc., in Danvers, MA, and Denise Williams, RN, CPC-H, director of Revenue Integrity Services for Health Revenue Assurance Associates, Inc., answered these questions following the June 14 HCPro audio conference, “Outpatient Bed Charge Capture: Billing for Common and Complex Cases”
Medicare’s Annual Wellness Visit
Because preventive services are part and parcel to CMS’ initiative to administer the Medicare program in a cost-effective manner, a new benefit called the Annual Wellness Visit (AWV) was rolled out effective January 1. This improvement in Medicare coverage for preventive services, made possible through the Patient Protection and Affordable Care Act, has the potential to yield some significant revenue to primary care practitioners. The creation of this new benefit has raised several questions, though. Peggy S. Blue, MPH, CPC, CCS-P, regulatory specialist at HCPro, Inc., explains what an AWV is, who can perform the exam, and how to bill for it.
List of new 2011 ICD-9-CM diagnosis and procedure codes (including V codes)
On August 1, CMS released its fiscal year 2011 inpatient prospective payment system final rule in which it finalized the ICD-9-CM code changes that take effect October 1. The following list includes new diagnosis codes, new V codes, new procedure codes, and revised diagnosis code and procedure code titles for 2012. Be sure to review the final rule for new procedure codes, deletions, revisions, and subterms.
RAC Preparedness: Five Ideas for Maximizing Your CDI Team Impact
The majority of clinical documentation improvement (CDI) programs are still focused on obtaining documentation of those diagnoses that affect the DRG: a different principal diagnosis, a CC, or an MCC. However, as recovery audit contractors (RAC) post an exponentially growing number of issues approved by CMS for investigation, a growing number of hospitals are now reviewing records with an eye toward RAC protection. Lynne Spryszak, RN, CCDS, CPC-A, CDI education director for HCPro, Inc., in Danvers, MA, discusses this shift and provides five recommendations to ensure that your organization is making the most out of its CDI program.
Master the Intricacies of the Three-Day Payment Window
CMS’ three-day rule defines certain preadmission services as inpatient operating costs, meaning they are bundled and billed as part of the inpatient claim and payment is made as part of the applicable DRG payment for the case. This sounds simple, and there had been very little new guidance for years, so how did it get to the point of causing such major confusion for hospitals that Congress eventually included a clarification in controversial healthcare legislation? Kimberly Anderwood Hoy,JD, CPC, director of Medicare and compliance at HCPro, Inc, unravels the complexities of the three-day rule.
Auditing Evaluation and Management Services
In this book excerpt, author Joe Rivet, CCS-P, CPC, CEMC, CPMA, CICA, CHRC, CHC, outlines how to conduct a risk assessment for your evaluation and management coding. He explains what to audit, five steps to include in your audit, and factors that can affect your risk.
ICD-10 Puts Revenue At Risk
With mounting mandates and competing priorities, many leaders have yet to focus on the ICD-10 directive. But this HealthLeaders Media Intelligence Report, ICD-10 Puts Revenue at Risk, shows that no matter where they are in the ICD-10 planning stage, many leaders expect a substantial revenue hit.
Modifier -59 Q&A
Modifier -59 is a perennial problem area for outpatient coders. It shouldn't be viewed as a way to guarantee payment but rather as a way to identify unique situations. Misuse of modifier -59 continues and remains a compliance risk. Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, president/CEO and principal consultant for SLG, Inc., of Raleigh, NC, answered these questions about modifier -59 use.
The Clinical Documentation Improvement Specialist's Guide to ICD-10
In this book excerpt, authors Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Sylvia Hoffman, RN, C-CDI, CCDS, examine the clinical indicators of sepsis and compare ICD-9-CM codes to those in ICD-10-CM.
The RAC Toolkit for Hospitals and Health Systems
In this book, authors Elizabeth E. Lamkin, MHA, and Amanda W. Berglund, MS, MBA, describe how to establish and sustain an effective RAC preparedness structure that can be adapted to fit any organization's system. They provide best practices for successful processes and outline each staff member’s role in your RAC audit program. In this excerpt, the authors explain the process of automated reviews and discuss how to address some of the issues the RACs will be reviewing.
Wound care terminology
Gloryanne Bryant, RHIA, RHIT, CCS, CCDS, regional managing director of HIM (Northern California Revenue Cycle) for Kaiser Permanente in Oakland, CA, provided these common terms coders are likely to see for wound care.
ED Coding and Billing Q&A
Emergency department (ED) coding challenges are compounded by changes to critical care guidelines and hard-to-grasp coding requirements. Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, president of Edelberg Compliance Associates of Baton Rouge, LA, and Joanne M. Becker, RHIT, CCS, CCS-P, CPC, CPCI, associate director in the Joint Office for Compliance at the University of Iowa Hospitals and Clinics in Iowa City, IA, answered these questions following the HCPro audio conference, “Emergency Department Coding: A Case Study Approach to Reporting Facility and Professional Services.”
2011 Coder Productivity Survey
Establishing coder productivity standards can be challenging if you don’t know where to begin. There are many factors affecting productivity levels, from record type to the tools coders have available to them. However, establishing fair standards for your coders is important, as is knowing whether your department is running efficiently. This special report allows you, as an HIM director or manager, to examine your own coder productivity levels and standards by comparing them with others in the field.
A Minute for the Medical Staff
Robert S. Gold, MD, and James S. Kennedy, MD, CCS, discuss coding with ICD-10-CM/PCS and the effect the new coding system will have on physician documentation and vice versa. Learn more about this momentous change in their columns from the March and April issues of Medical Records Briefing.
Master the Intricacies of the Three-Day Payment Window
CMS’ three-day rule defines certain preadmission services as inpatient operating costs, meaning they are bundled and billed as part of the inpatient claim and payment is made as part of the applicable DRG payment for the case. This sounds simple, and there had been very little new guidance for years, so how did it get to the point of causing such major confusion for hospitals that Congress eventually included a clarification in controversial healthcare legislation? Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc., aims to clear up the confusion in this special report.
2011 Medical Records Documentation Guide
HIM professionals and hospital accreditation coordinators can use this tool to identify areas in which the documentation in a facility’s medical records may not provide clear evidence of Joint Commission compliance. The guide also provides information regarding required policies and other documentation requirements related to medical records.
Injections and infusions Q&A
Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC, and Valerie Rinkle, MPA, revenue cycle director for Asante Health System in Medford, OR, provide answers to injections and infusions coding questions.
RAC preparedness benchmarking report
Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., discusses results from a recent HCPro survey that addressed provider trends in preparation for Recovery Audit Contractors (RAC) as well as provider experiences with the RAC program. Among the survey results, providers’ preparations have focused on inpatient medical necessity and one-day stay issues, with 41% of respondents indicating they identified and plan to address issues in this area. Providers are preparing financially as well. Forty-two percent of respondents report having a reserve fund in anticipation of possible recoupments, ranging from tens of thousands to several million dollars.
New and revisied HCPCS codes
Find the new and revised HCPCS Level II codes and modifiers in this quick reference. This list contains the new and revised codes and modifiers with their long descriptors.
Q&A: Observation services and condition code 44
Condition code 44 is used when a patient’s initial inpatient status is successfully changed to outpatient for purposes of billing and payment. This generally occurs when case management and other utilization review personnel were not available (weekends and holidays) at the time that the admission decision was made, and it is later determined that the patient does not meet Medicare’s inpatient guidelines. Debra Hale, President of Administrative Consult Service LLC, answered these questions during HCPro’s September 24, 2010 audio conference, “Observation Services Versus Inpatient Admission: Assign Proper Level of Care and Prevent Denials”.
Cardiac and pulmonary rehab Q&A
Cardiac and pulmonary rehabilitation services are now covered Medicare benefits, but questions still surround the correct coding for these services. Chris Garvey, FNP, MSN, MPA, FAACVPR, manager at Seton Pulmonary and Cardiac Rehabilitation, and nurse practitioner at University of California San Francisco Sleep Disorders, and Karen Lui, RN, MS, legislative and regulatory analyst with GRQ Consulting, LLC, in Washington, answered these questions as part of HCPro’s October 21 audio conference, Cardiac and Pulmonary Rehab: Identify and Resolve Medicare Benefit Challenges.
What Every CDI Program Needs to Succeed: Structure, Staff, Process
Today, the most successful CDI programs contain the following elements: physician education and participation, concurrent and retrospective record analysis, and administrative support. Lynne Spryszak, RN, CCDS, CPC-A, CDI Education Director for HCPro, Inc., discusses each of these critical elements.
Expanded radiology Q&A
Coders continue to struggle with correct code assignment for a variety of radiology procedures, even when the codes do not change. Stacy Gregory, CPC, CCC, RCC, lead interventional radiology coder and consultant for Health Record Services in Baltimore, MD, answered these questions following HCPro’s July 7 audio conference, “Interventional and Diagnostic Radiology: Decipher Documentation for Accurate Coding.”
Understanding and Applying the 2011 ICD-9-CM Codes
Robert S. Gold, MD, and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, provide insight into the new, revised, and deleted diagnosis and procedure codes for 2011, which take effect October 1, 2010.
ICD-10-CM and ICD-10-PCS: Are YOU Getting Ready?
As the clock ticks closer and closer to the implementation of ICD-10-CM and ICD-10-PCS in 2013, do you wonder what everyone else is doing to prepare? Does the thought of such a major change make you want to consider retiring to the islands or changing professions altogether? Or are you ready for this challenge? Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CEMC, CPC-I, CCDS, director of HIM and coding at HCPro, Inc., in Marblehead, MA, shares tips on how to prepare for the upcoming transition to ICD-10.
List of new 2011 ICD-9-CM diagnosis codes (including E and V codes)
On July 30, CMS released its fiscal year 2011 inpatient prospective payment system final rule in which it finalized the ICD-9-CM code changes that take effect October 1. The following is a list of new diagnosis codes, E codes, and V codes. Be sure to review the final rule for new procedure codes, deletions, revisions, and subterms.
Appendix C: ICD-10 Frequently Asked Questions
HIM directors must take a lead role in their organization’s ICD-10 implementation, including advocating for and securing an appropriate budget, developing a robust staff retraining program, and ensuring timely IT system changes. Gloryanne Bryant, BS, RHIA, RHIT, CCS, CCDS, Jean S. Clark, RHIA, CSHA, and Caroline Piselli, RN, MBA, FACHE, provide answers to frequently asked questions about ICD-10.
Coding Q&A from the August issue of Briefings on Coding Compliance Strategies
The mission of Coding Q&A is to help you find answers to your urgent coding/compliance questions. To submit your questions, contact Briefings on Coding Compliance Strategies Contributing Editor Lisa Eramo at leramo@hotmail.com.
2010 CDI Program Benchmarking Survey
In response to a 30-question survey, 482 CDI professionals provided data about the number of staff they employ, the number of queries they generate, and the number of chart reviews their staff perform. In this special report, Melissa Varnavas, CPC, associate director of the Association for Clinical Documentation Improvement Specialists, shares results that illustrate where seasoned programs are expanding their documentation efforts and also provide guidance for new CDI programs just getting off the ground.
ICD-10: What Every Healthcare Professional Should Know
Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director for HIM and coding for HCPro, Inc., explains the structure and improvements of ICD-10-CM and ICD-10-PCS and discusses timelines and costs related to implementing the new coding system.
Critical Access Hospitals: Setting the Top 10 Myths Straight
Critical access hospitals (CAH) face many challenges searching for clear guidance on how to appropriately bill for its services. Most of the references and instructions are written for prospective payment system (PPS) hospitals, leaving CAHs wondering what applies to them and feeling lost in the world of CMS transmittals, manuals, regulations, and laws. In this report, Debbie Mackaman, RHIA, CHCO, MedicareBoot Camp® Instructor for HCPro, Inc., sets straight the top 10 myths on the topic.
2010 Medical Records Documentation Guide
HIM professionals and hospital accreditation coordinators can use this tool to identify areas in which the documentation in a facility’s medical records may not provide clear evidence of Joint Commission compliance. Although this activity is fairly labor-intensive, hundreds of hospitals that have used past versions of the documentation guide have found it to be one of the best ways to identify documentation problems that need further attention.
Injection and Infusion Q&A
In this Q&A excerpt from Briefings on APCs, Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC, and Angela Simmons, CPA, director of clinical revenue and reimbursement at The University of Texas MD Anderson Cancer Center in Houston, answered these questions as part of HCPro’s April 8 webcast “Injection and Infusion Coding Made Easy: A Case Study Approach to Accurate Charge Capture.”
The CCDS Exam Study Guide, Chapter 4: Identification of Clinical Indicators
This excerpt from HCPro’s book, The CCDS Exam Study Guide by Fran Jurcak, RN, MSN, CCDS, prepares candidates for the Certified Clinical Documentation Specialist (CCDS) exam. Each chapter reviews clinical documentation improvement program principles and contains sample questions for self-testing. For more information on this book, please visit HCPro’s Healthcare Marketplace.
2009 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? Check out this special report that is based on a 2009 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.
2010 Medicare Consultation Changes
In this white paper, Shannon McCall, RHIA, CCS, CCS-P, CPC, CCDS, director of HIM and Coding for HCPro, Inc., discusses CMS’ decision to no longer accept consultation codes as of January 1, 2010, as well as the financial impact, mapping challenges, and the future of consultation services.
Expanded Q&A tackles coding for rehab services, chronic bronchitis, locum tenens billing, and more
Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services, tackles some of your coding questions, including how to code for rehab services at a critical access hospital.
Physician Supervision: CMS Clarifications and Changes for 2010
In this white paper, Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., focuses on the clarifications and changes to the definition of “direct supervision” in the CY 2009 OPPS final rule (CY 2009 rule) and new provisions related to direct supervision in the CY 2010 rule.
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
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
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
Treatment of new and deleted laboratory codes
CMS changes payment allowance for two influenza vaccines
CMS changes payment allowance for two influenza vaccines
Physician Presence Policy now applies to renal dialysis monthly capitation payment
Physician Presence Policy now applies to renal dialysis monthly capitation payment
CMS releases new instructions for observation vs. inpatient admission and discharge codes
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
Revenue codes: Compliance risks and reimbursement pitfalls
2007 CMS-DRG CC and 2008 MS-DRG CC/MCC Table
2007 CMS-DRG CC and 2008 MS-DRG CC/MCC Table
Complete list of 2008 ICD-9-CM diagnosis and V codes
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
Take note of Medicare foot care coverage guidelines
Survey shows mixed approach to documentation improvement
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.