According to the Centers for Disease Control and Prevention, flu season is underway for most of the United States, and the activity level is expected to increase over the next several weeks. In this article, Adriane Martin, DO, FACOS, CCDS, reviews inpatient ICD-10-CM reporting for the flu and its potential complications.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, analyzes pertinent guidelines and coding dilemmas found within Chapter 1 of the ICD-10-CM Manual: Certain Infectious and Parasitic Diseases. Commeree covers instructional note guidance and other chapter specific guidance for diagnoses such as sepsis and HIV. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With the increased focus on clinical validation denials, more and more CDI professionals are finding themselves involved in the appeals-writing process and may initially feel a bit overwhelmed by the magnitude of the job. This article will provide you with best practices and appeal advice for those on the frontlines.
Julian Everett, RN, BSN, CDIP , reviews the background of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) and says that even though the report is only made available through quality or chief financial departments, it is imperative CDI and coding staff have a seat at the table when discussing areas for improvement at a facility.
Sarah Nehring, CCS, CCDS , writes that CDI and coding professionals must understand the guidelines for coding myocardial infarctions (MI) as well as the clinical difference between type 1 MIs and type 2 MIs so they can be clinically validated, queried, and reported effectively to avoid negative reimbursement ramifications. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Getting clean, compliant claims out the door is one of the foundations of a sound inpatient hospital. A robust process for handling claim edits and managing denials will go a long way toward supporting that goal.
One strategy for handling the confluence of confusion surrounding frequent criteria changes comes in developing a set of organizationwide clinical criteria for targeted, high-risk/high-volume diagnoses. This article discusses others’ experiences in developing standardized clinical indicators and guidelines at their facilities.
Adriane Martin, DO, FACOS, CCDS, reviews the Centers for Disease Control and Prevention’s recent proposal to update ICD-10-CM reporting for sepsis, which, if adopted, will go into effect October 2020.
Inpatient coders may query to achieve clarity within the medical record and allow for accurate ICD-10-CM/PCS reporting. This article will cover when to query, how to format a query, and review ICD-10-PCS code anatomy to ensure a well-rounded and precise query is submitted. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
As of December 4, nearly 2,300 cases of lung injury related to vaping have been reported, according to the Centers for Disease Control and Prevention. In this article, Adriane Martin, DO, FACOS, CCDS , covers guidance, clinical indicators, and ICD-10-CM reporting for vaping-related lung injury.
According to Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, updating diagnosis codes has been integral to the evolution of our healthcare system. In this article, she reviews the background and basics of ICD-11 in preparation for future implementation of the code set. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
According to ACDIS’ recent CDI Week Industry Survey , which included an extended section on CDI staffing practices, only 37% of respondents said they had HIM/coding backgrounds represented in their CDI departments.
Very few diagnoses have caused as much gnashing of teeth as sepsis has for inpatient coders and providers alike. Recently, the Centers for Disease Control and Prevention (CDC) has weighed in on the matter and is proposing coding changes , which, if adopted, will go into effect October 2020.
Let’s take a deep dive into the recently released coding guidance and documentation tips for these illnesses. Note that since vaping-related guidance and statistics are ever changing, this information is up to date as of October 2019.
Rachelle Musselman, BSN, RN; Jorde Spitler, BSN, RN; Daniel Lantis, BSN, RN; Joseph E. Ross, MD; and Thomas A. Taghon, DO, MHA, review their experience with implementing pediatric heart failure criteria at Dayton Children’s Hospital.
Brett Hoggard, MD, writes that the healthcare industry continues to transition toward a value-based, pay-for-performance system, but there’s still confusion surrounding different quality and value programs.
Since the implementation of ICD-10-CM/PCS, thousands of additional codes have been added to clarify aspects of certain conditions or procedures. This, on top of yearly code updates, has had a large impact on coder productivity. In this article, let’s take a look at some recent productivity statistics gathered by First Class Solutions Inc. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Julian Everett, RN, BSN, CDIP, writes that early recognition of sepsis in pediatric patients, along with accurate reporting, is vital to the future of healthcare. With the goal of improving patient outcomes through documentation, Everett outlines her experience in providing documentation education to physicians.
CMS recently published an update to the fiscal year (FY) 2020 IPPS final rule. This update corrects certain technical and typographical errors and contains corrections to the final payment factors. In this article, Judith Kares, JD , gives a summary of these key updates and related guidance.
Coders need a solid understanding of complex anatomical terminology and ICD-10-CM coding guidelines to select the most specific codes for trauma and injuries. This article breaks down inpatient diagnosis coding for superficial injuries, fractures, and burns. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The fiscal year (FY) 2020 ICD-10-CM Official Guidelines for Coding and Reporting, released shortly after the FY 2020 ICD-10-CM code release, provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Coders should take time to review these changes that were implemented October 1.
As of October 1, approximately 1,080 cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S., according to the U.S. Centers for Disease Control and Prevention (CDC). Despite continued research into these cases by the CDC and the U.S. Food and Drug Administration (FDA), the specific cause of these illnesses remains unknown.
In part two of this two-part series, Sharme Brodie, RN, CCDS , reviews the recent guidance from Coding Clinic , Second Quarter 2019, including systemic inflammatory response syndrome, partial hip replacements, and more.
While “myocardial ischemia” is a familiar term to CDI professionals and inpatient coders, the term “myocardial injury” does not share the same widespread recognition. In this article, Adriane Martin, DO, FACOS, CCDS , deciphers the clinical criteria and reporting guidelines for capturing myocardial injuries and demand ischemia.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews the basics of reporting with ICD-10-PCS including how to use the ICD-10-PCS manual, decipher root operation guidelines, and identify the principal procedure in physician documentation. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
One thousand eighty cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S. as of October 1, according to the Centers for Disease Control and Prevention. Review provider documentation and ICD-10-CM reporting for vaping-induced illnesses. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With much of the coding workforce working remotely, the inpatient coding manager must implement some control mechanisms to ensure the distractions at home are not interfering with the quality and quantity of work expected from the staff. In this article Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, gives suggestions on the various ways to monitor your remote coding staff, including tips for conducting coding reviews. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, reviews how to report the stage and type of various skin ulcers, the fiscal year (FY) 2020 guideline updates for pressure ulcers, and common terminology traps inpatient coders can get tripped up by.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, HCS-D, reviews the 2020 ICD-10-CM code changes for atrial fibrillation, as well as the clinical background and ICD-10-PCS reporting for related procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Sarah Nehring, CCS, CCDS, says that the last thing a query writer wants is to provoke a defensive response, but in the current healthcare environment, CDI specialists, clinical, and inpatient coding staff need to think defensively. In this article, Nehring outlines five items to remember when it comes to defendable queries, documentation, and coding.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC, writes that one of the most interesting aspects of the ICD-10-CM code update for fiscal year (FY) 2020 was CMS’ proposal to change the severity assignment for many of these codes. In this article, Blue compares the severity changes that were suggested in the FY 2020 IPPS proposed rule with the designations that were actually finalized.
Valerie A. Rinkle, MPA, CHRI , reviews the fiscal year (FY) 2020 IPPS final rule and highlights key financial implications for hospitals including wage index changes, new technology updates, and more.
Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that the prevalence and complexity of prostate cancer is why it is so important for even inpatient coders to fully understand the diagnostic, treatment, and procedural aspects of this disease.
ICD-10-CM/PCS coding for heart conditions such as aortic valve stenosis, heart failure, and atrial fibrillation requires an in-depth understanding of anatomical terminology and clinical indications. This article will review these three diagnoses to help ensure accurate reporting and reimbursement. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS released the fiscal year (FY) 2020 IPPS final rule on August 2, increasing inpatient operating payment rates by 3.1%, significantly altering rural health payments, expediting opportunities to pay for new technologies, and updating CCs, MCCs, and MS-DRGs. These policy updates affect approximately 3,300 acute care hospitals and apply to discharges occurring on and after October 1.
Cathy Farraher, RN, BSN, MBA, CCM, CCDS, writes that CDI professionals can work to reduce the incidence of physician query fatigue and gives recommendations to help improve provider response rate while reducing query frustration.
Regularly reviewing hospital-acquired conditions (HAC) and preparing for unanticipated reporting situations will ensure your facility can submit these with the utmost accuracy. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, helps coders better understand HACs by outlining the basics and giving tips for improving inpatient documentation and coding for these conditions.
While it is essential to receive continuing education on ICD-10-CM/PCS code selection, it is also important to stay current with industry news. Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , reviews inpatient reporting and guideline updates for fiscal year 2020. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Tamara Hicks, RN, BSN, MHA, CCS, CCS, ACM-RN, CCDS-O , explains how her organization implemented a CDI career ladder and why it’s an important step for hospitals looking to expand their coding and CDI departments.
Allen Frady, RN, BSN, CCDS, CCS, CRC , reviews the answers to commonly asked questions pertaining to sepsis documentation to help coders and CDI specialists ensure accurate reporting of this condition.
Sepsis is a potentially fatal condition that affects nearly 1.7 million adults in America each year, according to the Centers for Disease Control and Prevention (CDC). Nearly 270,000 Americans die each year from sepsis-related complications.
We have come a long way in our understanding of post-traumatic stress disorder (PTSD) but still have a lot to learn about the condition’s prevalence and impact.
The American Hospital Association (AHA) released Coding Clinic, Second Quarter 2019, just in time for summer vacation. If Coding Clinic didn’t make your summer must-read list, then be sure to review this article, which summarizes coding updates discussed in the quarterly newsletter and their impact on severity and DRG assignment
Sepsis and systemic inflammatory response syndrome (SIRS) have historically been difficult to report due to changing terminology and continuous updates to ICD-10-CM coding guidelines. Review clinical terminology and complex guidelines to select the most specific codes for both conditions.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS , explains why physicians may feel that coding and CDI professionals are asking too much and offers potential solutions to ease workplace tensions.
Adriane Martin, DO, FACOS, CCDS , describes key takeaways from Coding Clinic , Second Quarter 2019, including helpful advice on well-known coding challenges and their impact on severity and DRG assignment.
PTSD is marked by persistent mental and emotional stress that occurs as a result of severe psychological shock. Peggy S. Blue, MPH, CCS, CCS-P, CPC, CEMC , reviews symptoms of and ICD-10-CM coding for PTSD, as well as barriers to psychosocial treatment for the condition.
Keeping up with commercial payer requirements can stump any revenue integrity department, and commercial payer audits can be an especially tough puzzle to solve. Review advice from experts on improving internal processes for dealing with commercial audits.
Adriane Martin, DO, FACOS, CCDS , writes about how to accurately capture and report social determinants of health to improve patient outcomes and decrease costs. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Keeping up with coding changes in the circulatory system chapter in the ICD-10-CM manual is an ongoing process. Almost every fiscal year coders are met with new codes for myocardial infarctions (MI), changes to congestive heart failure codes, and updates to the guidelines for reporting cerebrovascular diseases.
This summary, organized by major diagnostic category (MDC), highlights some of the changes to the IPPS proposed rule affecting MS-DRG and ICD-10-CM/PCS code assignment.
Acute kidney injury (AKI) and acute tubular necrosis (ATN) remain targets for both coding and clinical validation. Over the years, we’ve gleaned valuable insights from appealing hundreds of coding and clinical validation denials for AKI and ATN.
Correct documentation and coding are key to accurate reimbursement, but according to the Office of Inspector General, organizations aren’t hitting the mark on either when billing for inpatient rehabilitation facility (IRF) services.
Treatment options for spinal conditions are varied and may include pain management with medications, injections, or surgical interventions. Adrienne Commeree , CPC, CPMA, CCS, CEMC, CPIP , breaks down spinal anatomy and ICD-10-PCS coding for spinal fusions and laminectomy procedures.
The fiscal year 2020 IPPS proposed rule includes nearly 1,500 CC/MCC designation changes, which impact MS-DRG groupings used to calculate pricing for inpatient hospital claims. Rhonda Butler, CCS, CCS-P , reviews noteworthy proposed changes to MS-DRG assignment for the coming fiscal year. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Patients who use oxygen at home for a primary respiratory condition typically present with some degree of respiratory failure. Howard Rodenberg, MD, MPH, CCDS , describes common documentation issues related to oxygen requirements for the diagnosis of acute respiratory failure.
Diagnosis coding for neoplasms can be particularly challenging, as neoplasms are classified by site, behavior, and morphology. Review ICD-10-CM coding and guidelines for reporting solid organ tumors and cancers affecting the bone marrow and lymphatic system. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Having taken on more diverse responsibilities, many providers regard medical coding as a necessary evil; their primary focus is caring for their patients. Although many physicians select codes for the work they perform, they rely on specialized coding and auditing professionals to review their documentation and reporting for accuracy.
Valerie Rinkle, MPA, CHRI, covers important proposals found in the fiscal year (FY) 2020 IPPS proposed rule, including coding updates, new technology payment changes, and increases to low wage index hospitals.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, writes that accurate ICD-10-CM/PCS coding for the heart improves data quality, which in turn is used for statistics and tracking trends, so it is imperative to ensure the disease process is captured correctly.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, presents a review of MS-DRG basics to ensure that inpatient coders have a thorough understanding of MS-DRGs’ intricacies, thus perfecting assignment and reimbursement accuracy.
At the beginnings of inpatient coding and CDI, we had books like DRG Expert and Excel-based programs for MS-DRG selections. More than 10 years later, vendors are offering web-based technologies that use artificial intelligence and machine learning to make us even more productive in both coding and CDI. The real question, however, is how we can best leverage those technologies.
Adriane Martin, DO, FACOS, CCDS, reviews recent Coding Clinic, First Quarter 2019, advice, which includes guidance on reporting abdominal aortic aneurysm (AAA) repairs, spinal fusions, Whipple procedures, midline and central venous catheters, and more.
Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC , writes that due to the frequency of diagnoses and treatments for breast cancer, it’s more important than ever for inpatient coders to make sure they are reporting these diagnoses and procedures with the utmost accuracy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Health records are data-rich, and more stakeholders are looking to dip into them for increasingly diverse purposes such as population health and value-based care programs.
Although computer-assisted coding and natural language processing software has improved many aspects of daily CDI work, the technology requires ongoing oversight to ensure efficacy and accuracy. Therefore, CDI professionals, and even inpatient coders, need to be aware of the software’s potential pitfalls within the CDI department and develop tactics to overcome them.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS , reviews the background of MS-DRGs, as frequently revising MS-DRG basics will ensure that inpatient coders have a thorough understanding of the MS-DRG intricacies, thus perfecting overall assignment and reimbursement accuracy.
Adriane Martin, DO, FACOS, CCDS, writes that treatment of peripheral arterial disease (PAD) is variable and includes both medical and surgical therapy. Given the frequency of this condition, it is imperative that inpatient coding professionals have a clear understanding of the surgical treatment of PAD to avoid costly ICD-10-PCS errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The beginning of the year is a time to go back to basics—or even, in some cases, to start over. Revisiting information on how to conduct a medical record review may, at first glance, feel like a basic or beginner topic. But medical record review is an important subject for all CDI professionals, and even coders, to consider.
Kay Piper, RHIA, CDIP, CCS, details the process of submitting ICD-10-CM codes to the ICD-10 Coordination and Maintenance Committee meeting by sharing the experience a medical coding educator and a CDI physician adviser had when submitting a proposal for the March 2018 meeting.
Keeping up with changing coding guidance adds to the complexity of reporting digestive procedures. In this article, Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , reviews ICD-10-PCS reporting for common digestive procedures including the Whipple procedure and lysis of adhesions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laura Legg, RHIT, RHIA, CCS, CDIP, takes a look at some common questions asked about MS-DRG optimization and reviews how inpatient coding and documentation plays a large role in the process.
Karen, a 67-year-old patient with a history of hypertension, diabetes, and tobacco use, presents to her primary care physician with complaints of pain in her right buttock and thigh when she walks from her house to her mailbox. She is then admitted as an inpatient for surgery.
Assigning the appropriate ICD-10-PCS code for spinal procedures can be a challenge for inpatient coders, as they need to correctly assign the entirety of a seven-character ICD-10-PCS code.
Cheryl Manchenton, RN, explains CMS’ Hospital-Acquired Condition Reduction Program (HACRP) and says inpatient coding professionals can play a significant role in HACRP success by understanding the basis for hospital-acquired condition scores and ensuring that documentation and coding accurately and fully captures patient conditions and complications.
A transcatheter aortic valve replacement (TAVR) is an interventional cardiology procedure that has proven to be an important life-saving cardiac intervention frequently seen by inpatient coders. In this article, Stephen Houlahan, RN, MSN, MBA, CCDS, reviews TAVR history, clinical background, and documentation and reimbursement methodologies to ensure proper education and compliance for facilities.
Coders often wonder how to define realistic productivity benchmarks. Different facilities establish the responsibilities and expectations of their coding teams, so productivity standards are not uniform.Coders often wonder how to define realistic productivity benchmarks. Different facilities establish the responsibilities and expectations of their coding teams, so productivity standards are not uniform.
With March declared National Endometriosis Awareness Month, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, details endometriosis-related procedure reporting for inpatient coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, reviews the clinical validation of acute congestive heart failure (CHF) exacerbation and shares his hospital’s coding and documentation strategy to help in appeal battles.
Adriane Martin, DO, FACOS, CCDS, details the updates found in the 2019 ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice” and writes that thorough knowledge of query guidelines is essential for inpatient coders and staying abreast of these guideline updates is crucial.
Laurie L. Prescott, MSN, RN, CCDS, CDIP , details the basics of ICD-10-CM/PCS for newer inpatient coders including a review of the ICD-10-CM seventh-character extension, placeholder use, and ICD-10-PCS root operations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The benefits outweigh the difficulties when it comes to retrospective reviews. How do you get started with this new venture? Like many aspects of CDI, there are many ways to approach the problem. This article details these approaches, including how to enhance coder and CDI collaboration for these reviews.
Not many clinical conditions cause more consternation for inpatient coders and CDI specialists than acute and chronic respiratory failure. In this article, William E. Haik, MD, FCCP, CDIP, details acute and chronic respiratory failure and the critical elements in the health record that validate their reporting.
If we look at each element of a coding audit, we can see the benefits these coding reviews provide. Every healthcare organization and hospital should invest in routine, internal coding audits. The alternative is waiting until the payer conducts an audit, denies a claim, and incurs costs for the organization.
As an inherited blood disorder, sickle cell disease is passed from parent to child. Children with sickle cell disease often have two defective hemoglobin S genes , one from each parent. However, various forms of sickle cell disorder also occur when a person inherits one hemoglobin S gene (sickle cell gene) from one parent and a different type (other than the S type) of defective hemoglobin gene from the other parent. All of these forms have distinct ICD-10-CM diagnosis codes, making reporting complex.
In 2013 the “ Guidelines for Achieving a Compliant Query Practice ,” a collaboration between AHIMA and ACDIS, was published. It has served as the industry guideline for the establishment of best practices surrounding queries. Since that time this brief has been updated twice: once in 2016 and most recently in 2019 .
Consider the story of a patient—say, a pneumonia patient—whose treatment cost a lot of money. The hospital’s reimbursement for that care, however, was less than the cost of providing it. Now say someone looked at that case and how complex it was, and then saw that the reimbursement only paid for half the cost of caring for that patient. That’s how CDI was born.