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Sexual harassment covers a wide range of behaviors. We are hearing more and more about sexual harassment in workplaces of all types, from business to the media and the arts. Unfortunately, this is also an issue in medicine. While some may think that physicians should “know better” and not engage…
FY 2019 Official Guidelines for Coding & Reporting were released on Thursday and contain notable changes.The National Center for Health Statistics (NCHS) has released and posted the fiscal year (FY) 2019 official guidelines for coding and reporting ICD-10-CM. Oct 1, 2018 will bring some notable changes that will help with…
Preparing for the 2019 IPPS final rule marks a busy time for healthcare professionals. While the Centers for Medicare & Medicaid Services (CMS) posted the 2019 Inpatient Prospective Payment System (IPPS) proposed rule back in April, the move continues to generate controversy and confusion. Of particular note is the agency’s…
Reporting bronchoalveolar lavage is all about location, location, location Reporting bronchoalveolar lavage (BAL) has historically been a documentation nightmare for physicians and a quandary among coders. Physicians often use the right and left lung lobe sections to geographically indicate where the bronchoscope was advanced in the bronchial tree during BAL…
Integrated approach targets both the physical and mental health needs of patients. Up to one in four primary care patients suffer from depression. And some recent studies have shown surprising ties between cardiac health and mental health. Yet for many people, it is difficult to find quality mental health resources…
The author reports on the recently released American Hospital Association’s Coding Clinic. I was just able to free up the time to review the most recently published Coding Clinic (CC), and I will share my thoughts on the updates with you in this article. It took some energy to sort…
Trends in Clinical Documentation, Past, Present, and Future – Part I For nearly a century, since Grace W. Myers of Massachusetts General Hospital became the first medical records librarian in the early 1900s and the American College of Surgeons (ACOS) sought to improve the standards of medical records being created…
CMS proposes to change physician evaluation and management (E&M) coding with a drastic overhaul. EDITOR’S NOTE: The following report first appeared on RACmonitor on July 13, 2018 After soliciting comments from many stakeholders in the last year, the Centers for Medicare & Medicaid Services (CMS) has just proposed sweeping changes…
Document it right on the front end; avoid fighting a denial on the back end I was recently asked about a post from Hospital Performance regarding acute respiratory failure and airway protection (https://soundphysicians.com/blog/2018/06/20/from-the-appeals-desk-acute-respiratory-failure-part-1-2/), and I wanted to expand on what the author, Dr. Hesham Hassaballa, wrote. A key point is…
The “right documentation” is the central pivot point to the revenue cycle   Physician clinical documentation plays a critical role in any overall healthcare delivery model, including the life of the revenue cycle, which drives reimbursement for quality medical care provided to patients. The revenue cycle is defined by the…
The WHO’s definitions of gender-related issues continue to cause controversy. The recent news coming out of Geneva, Switzerland and reported here by ICD10monitor that the World Health Organization (WHO) had released its 11th edition of the International Classification of Diseases (ICD) was greeted by most healthcare professionals as good news.…
Accounting for socioeconomic factors is critical to the sustainability of healthcare. A recent blog headline in the American Council of Science and Health captured the healthcare industry’s attention. The headline read, Medicare Could Cover Food, Air Conditioners...Is Sex Next? The focus was on recent action by the Centers for Medicare…
ICD-10 code I21.A1 identifies Type 2 MI. Over the past two months, I have been making the rounds speaking at regional and national conferences and going on-site for my consulting business. Many of you have approached me and assured me that the message I am trying to convey is indeed…
“Medical necessity” is a much-used but often-misunderstood concept. After our recent four-part series on the “Pitfalls of an Audit” and our last Talk Ten Tuesdays segment on the series, I had taken a position on medical decision-making (MDM) of the evaluation and management (E&M) record being the overarching criteria for…
WHO team leader to weigh in on the new coding set. The World Health Organization’s (WHO’s) Robert Jakob, MD is scheduled to appear on Talk Ten Tuesdays this morning, according to Chuck Buck, publisher of ICD10monitor and executive producer and program host of its marquee weekly Internet radio broadcast. Dr.…
U.S. adoption of the new codes is not expected until after 2022. A lot of excitement was generated last week when the World Health Organization (WHO) announced that the International Classification of Diseases, Eleventh Edition (ICD-11) was being released.  But there is a long way to go before the finalization…
National HIV Testing Day is June 27. Wednesday is National HIV Testing Day—a day designated to highlight the importance of testing in detecting, treating, and preventing human immunodeficiency virus (HIV) infection. This special day is designed to encourage people to get tested for HIV, know their status, and get linked to…
A Pittsburgh-based MD weighs in on an emerging area of focus in the healthcare industry. EDITOR’S NOTE: The following are remarks made by the author during a recent broadcast of Talk Ten Tuesdays. Today I would like to focus on outpatient clinical documentation improvement (CDI), often referred to as the…
The deaths of prominent Americans by suicide are driving discussions over a troubling trend. The suicide deaths last week of globetrotting television chef and author Anthony Bourdain and fashion designer Kate Spade have triggered the release of a number of new studies on suicides in America, but an open letter…
Clinical documentation will need to reflect these situations in order to be accurately coded. When beginning research for this article, I opened my 2018 ICD-10-CM book to the External Cause Index section, specifically for the word “harassment,” but it was missing.     The next area I reviewed was the Index, but…
A phenomenon that affects more than a third of American workers is hitting the medical sector particularly hard. Thirty-seven percent of American workers are affected by workplace bullying (WB), amounting to roughly 54 million people. When you include coworker bystanders of those persons bullied, the numbers total nearly 50 percent…
A female physician advisor brings a unique perspective to women’s health in the context of leadership within the industry.   EDITOR’S NOTE: The following are comments made by the author during a recent Talk-Ten-Tuesdays broadcast on women’s health. I would love to take this opportunity to speak about women empowerment.…
A major shift in the reporting of transgender issues is at hand.They’re here, but it won’t be until sometime until after 2022 that the United States is expected to adopt the codes of ICD-11 – the new International Classification of Diseases, Version 11 – released yesterday by the World Health…
Total number of new code changes is 473 with 279 new codes, 143 revised codes and 51 deactivated codes. The Centers for Disease Control and Prevention (CDC) Monday released the fiscal year (FY) 2019 ICD-10-CM (diagnosis) code changes. There are 473 code changes beginning Oct. 1st, including 279 new codes,…
Healthcare can incorporate SDoH data into daily workflows and operations. Earlier in June I wrote about that necessary marriage of costs, coding, and the Social Determinants of Health (SDoH). I was proud to be a guest on ICD10monitor’s Talk-Ten-Tuesdays to continue this dialogue. The interest and response was powerful, and…
New hybrid CDI program blends off and on-site CDI operations. University of Pittsburgh Medical Center (UPMC) is a world-renowned healthcare provider and insurer based in Pittsburgh, Penn. that has 80,000 employees in the state. UPMC operates more than 30 academic, community, and specialty hospitals and more than 600 doctors’ offices…
Is your Electronic Medical Record (EMR) system helping you pass an audit or hurting you?   Editor’s Note: This is the final installment in a four-part series that examines physician documentation issues as seen by an auditor. In the last installment of this four-part series, I want to discuss the…
Nonaccidental trauma (NAT) should code to “child abuse, suspected or confirmed.”The challenges of coding “child abuse, suspected or confirmed” is becoming a source of increased interest for me. When ICD-10 rolled out, as among the changes was a coding guideline that included a code for “child abuse” (and any time…
Risk adjustment has been used to entice payers and providers to accept patients with multiple chronic conditions along with those patients who are relatively healthy. Is coding and billing for risk adjustment really any different than what we have been doing all along? It is different in that the codes…
Strive to achieve coding compliance that really works. I’m often asked about how one would or should strive for coding compliance and make it happen. The first thing I do is to identify and acknowledge the risks or potential risks that occur. We all know that there are risks across…
The industry knows that focusing more on SDoH reduces costs. Healthcare costs and coding have been married over 35 years, since the Social Security Act was amended to include a national Diagnostic Related Groups (DRG)-based hospital prospective payment system for all Medicare patients.  The culture of the healthcare industry changed…
Some providers hesitate to use the word “abuse” preferring, instead, to use non-accidental trauma (NAT). Despite what revenue cycle may believe, clinical documentation is not solely for billing. One of the biggest problems with imprecise, nonspecific diagnoses which lead to unspecified codes or, even worse, index to no codes at…
There will be 392 new PCS codes; eight revision titles; and 216 deleted codes.The Centers for Medicare and Medicaid Services (CMS) has released and posted the fiscal year (FY) 2019 ICD-10-PCS (procedural coding system) changes. The files contain information on the ICD-10-PCS updates for FY 2019 that all hospital inpatient…
Eight steps to create a physician advisor system. The physician advisor (PA) role has become more commonplace over the last decade, with an increasing number of hospitals and health systems turning to PAs to assist with a variety of issues, such as supporting clinical documentation integrity (CDI), ensuring compliance with…
Is your Electronic Medical Record (EMR) system helping you pass an audit or hurting you? Editor’s Note: This is the third piece in a four-part series that examines physician documentation issues as seen by an auditor. As we dive even further into the auditing pitfalls of a physician E&M audit,…
New CMS document features gems that fill risk adjustment voids for coding rules. Coders love rules. In risk adjustment coding, we live by the Official Guidelines for Coding and Reporting, the ICD-10-CM conventions for code lookup, and the AHA Coding Clinic for ICD-10-CM and ICD-10-PCS. Too often, though, we run…
CDI, when properly performed, supports the ancient physician oath, “First, do no harm.”  Clinical Documentation Improvement Specialists(CDISs) play a vital role in the overall scheme of healthcare delivery through affecting measurable meaningful improvement in the quality, completeness, and accuracy in the telling of the patient story. The major beneficiaries of…
ICD10monitor recognizes National Women’s Health Week. Women’s issues have a starring role in the national reckoning that has followed the presidential election of 2016. Nowhere is this more true—and more important—than in the field of healthcare, where the way women are hired, paid, and treated in the workplace affects not…
An inspiring story about rebranding a facility’s CDI department To raise a torch to the strength of women working in healthcare I must share an introductory story on the transformation of a revitalized CDI Department that has pursued success through the strength of 23 women, and the celebrations are taking…
ICD-10 codes for the top five women’s health issues are provided in this report. Heart disease, breast cancer, osteoporosis, depression, and autoimmune diseases are the top five women’s health issues, according WebMD. This article will provide information such as risk factors, treatment, and the ICD-10-CM associated codes (of course!).  …
Health of teenage girls is in the nation’s spotlight on women’s health issues. We would be remiss to focus on National Women’s Health Week and not include topics specific to teenaged girls. Having said that, my first of two items admittedly pertains to girls and boys. But, given the higher…
AHIMA hopes data gathering and sharing will help address the issue. Every day, more than 115 people in the United States die as a result of opioid overdose, according to the National Institute on Drug Abuse (NDA). Tracing the origin of the crisis to the widespread distribution of opioid pain…
Physician documentation issues during an audit go beyond CDI. The issues are the chief complaint and HPI. Editor’s Note: This is the second piece in a four-part series that examines physician documentation issues as seen by an auditor. As I discussed in the first portion of our series on physician…
CMS encourages providers to talk, test, and treat STDs. When it comes to sexually transmitted disease (STD) awareness, the Centers for Medicare & Medicaid Services (CMS) is encouraging providers to take three simple steps in protecting their patients through talk, testing, and treating: Talk openly about STDs with your partners…
Expansion of new ICD-10 codes has slowed. The 2019 Inpatient Prospective Payment System proposed rule covers many Medicare Severity Diagnosis-Related Groups (MS-DRGs) changes, in addition to changes to the Value-Based Purchasing (VBP), Hospital-Acquired Conditions (HACs), and Hospital Readmission Reduction program, as well as the post-acute care transfer policy. The length…
The importance of an effective outpatient CDI program cannot be overstated When working with a member of the sales force for a previous employer, I was asked, “What is the biggest problem coders encounter?” My answer, very simply put, was “physician documentation!” I should have added “or lack thereof!” We…
Physician documentation issues during an audit go beyond CDI. EDITOR’S NOTE: This is the first in a four-part series that examines physician documentation issues as seen by an auditor. One of the services I offer, aside from coding and billing education, is practice audits for evaluation and management (E&M) procedural…
Ten strategies for avoiding burnout are provided by the author. On any given day, if you walked into my home office, you might think you were in a spa. The walls are painted a soothing aqua color (at least, I think it’s soothing), a scent diffuser releases a pleasant tea…
Removal of the requirement, if adopted, becomes effective FY 2020. Our early review of the document and accompanying fact sheets has identified a number of provisions of interest to inpatient rehabilitation facility (IRF) providers. One of the key provisions, the removal of the Functional Independence Measure (FIMTM) Instrument and associated…
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Early documentation instruction sorely lacking Last week, during ICD10monitor’s Talk Ten Tuesdays broadcast, Larry Field, DO, treasurer of the American College of Physician Advisors (ACPE), shared the tale of a relatively new hospitalist who was disenchanted with medicine and considering a transition into physician advising after only three years of…
Achieving accurate and comprehensive coding of such issues is an imperative. Mental and behavioral disorders have recently had a media spotlight shone on them, and coding of these disorders can sometimes be tricky. Learning the nuances can help achieve accurate coding, which will enhance data necessary to make improvements in…
Anticipated schedule of the posting of new ICD-10 codes, including dates for public comment. Typically, after the annual Coordination and Maintenance Committee meeting, the next question is this: when will the new codes be published? The short answer is potentially near late April or early May. Final decisions regarding the…
Each patient’s story should be told in the official record. The clinical documentation integrity (CDI) profession has only scratched the surface of instilling positive change in patterns of physician documentation and communication of patient care. There exists a myriad of opportunities for CDI specialists to capitalize upon and truly improve…
She had chosen palliative care as the medical therapy. EDITOR’S NOTE: Former First Lady Barbara Bush died Tuesday at age 92 at her home in Houston, having decided to decline further medical treatment for health problems and instead to focus on “comfort care.” The ‘Great Man Theory’ of history was…
Women earn less than men in nearly every single occupation. Recently, I left my home base in southeastern Wisconsin and landed in the warm and humid landscape that is Orlando to attend Hospital Medicine 2018, hosted by the Society of Hospital Medicine. It’s a bit of a homecoming as this…
CCD is when the typical and customary documentation of a condition does not line up with the available codes or the indexing. Last week, I discussed the Type 2 MI issue. This week, I will address the higher-level problem of the “coding-clinical disconnect,” which I am going to refer to…
HIM coding can play a part in stopping the abuse and neglect of children Marking April as National Child Abuse Prevention Month, we note that the Center for Disease Control (CDC) reports that child abuse and neglect are significant public health issues in the United States. The CDC reports that…
It is highly recommended to self-audit first, internally, with qualified staff. EDITOR’S NOTE: This is the first in a four-part series on the importance of passing or failing an audit and avoiding being a red-flag to payers. One of the services I offer, aside from coding and billing education, is…
A recent study on gender wage discrepancy sheds new light on an old issue.   EDITOR’S NOTE: Opinions expressed by ICD10monitor contributors are their own. Following the sea of knitted pink hats worn by some of the hundreds of thousands of women who took to the streets in cities across…
Type 2 MI is not a coding construct.  I received some correspondence regarding my Type 2 myocardial infarction article last week which prompted me to ponder the coding-clinical disconnect. Let us address the Type 2 MI concerns this week, and next week, I will tackle the broader picture. Historically, the…
This disease of the brain is the most common neurological disorder Parkinson’s awareness is being addressed tomorrow, April 11, as “World Parkinson’s Day,” also making April national Parkinson’s awareness month here in the U.S. As a neurodegenerative disease of the brain, which impacts an individual’s motor function, Parkinson’s Disease (PD)…
Review your payer policies when performing these services. Pain management coding can be tricky.  Trigger point injection therapy is a common procedure performed by pain management specialists, orthopedic surgeons, physical medicine and rehab and other specialties. Trigger point injection therapy is used for the treatment of myofascial pain syndrome (MPS).…
Frustrations arise over inconsistent guidance from MACs and CMS. Every single day, I get numerous email notices from the Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractor (MAC) for our jurisdiction on a wide variety of “priorities:” correct coding, quality measures, new reporting initiatives, and a…
The main burden for this change is on healthcare providers such as physicians, clinics, hospitals. The Centers for Medicare & Medicaid Services (CMS) will start issuing the new Medicare cards with the MBI (Medicare Beneficiary Identifier) number beginning April 1.  The Social Security Number (SSN) based HICN (Health Insurance Claim…
The ICD-10 code set is growing, and feedback from the medical community on the changes is needed. This is the second piece in a series of articles encompassing a review of the Coordination and Maintenance (C&M) Committee meeting held March 6 and 7, 2018. What follows is a review of…
Complicated coding of type 2 myocardial infarctions. Advancing technology often leads to evolution of medicine. As our laboratory studies become more sensitive, we need to evaluate what the clinical significance of a positive test is. Such is the case with troponin. In October 2012, the Third Universal Definition of Myocardial…
Coders are encouraged to learn more about the clinical conditions associated with the patient encounters they are coding. As coders, we often struggle with assigning the correct codes. There are many gray areas in the guidelines and instructional notes, and sometimes even conflicting information can be found. This leads to…
The ICD-10 code set is growing, and feedback from the medical community on the changes is needed. This is the first in a series of articles encompassing a review of the Coordination and Maintenance Committee meeting, which was held March 6 and 7, 2018. First, we will review the procedure…
Three key takeaways from this effort by healthcare giant UnitedHealthcare UnitedHealthcare (UHC) is continuing its quest to revamp many facets of our healthcare industry. Last year, they adapted mandatory policies for the use of the SA modifier to indicate that a professional service was performed as incident-to, and now the…
AHIMA is recognizing the contributions being made by healthcare information professionals throughout the country this week. The American Health Information Association (AHIMA) is celebrating health information professionals during the 29th annual Health Information Professionals (HIP) this week (March 18–24, 2018). Each year, HIP Week provides a platform to celebrate the…
Amid confusion over New Technology codes, much attention was focused on partial knee joint replacements during the recent ICD-10 Coordination and Maintenance Committee meeting, March 8 and 9 at CMS headquarters. The Coordination and Maintenance (C&M) Committee meeting was held March 6 and 7 to discuss potential new codes. The…
Moving beyond CDI to optimize reimbursement requires returning to an optimal and sustainable level of achievable excellence.  A well-guided, thought-out, directed mission is paramount to driving and ensuring success in any professional role – and this particularly holds true for the profession of clinical documentation improvement (CDI). In my travels…
Newly covered treatment offers promising relief for sufferers of condition tied to poor blood circulation in the legs.  The main symptom of peripheral arterial disease (PAD) is intermittent claudication. This is an aching, cramping, tired, and sometimes burning sensation in the legs that comes and goes – it typically occurs when walking…
For implanted cardioverter defibrillators, (ICDs) there is no national coverage determination (NCD), nor is there an implementation date.   As we have reported in past editions of RACmonitor eNews, the national coverage determination (NCD) for placement of implanted cardioverter defibrillators (ICDs) was recently updated. As I reported last week, the…
“Ebony and ivory live together in perfect harmony  Side by side on my piano keyboard, oh Lord, why don't we?”— Sir Paul McCartney and Stevie Wonder, 1982   Left alone in a small examining room, I scrolled the Associated Press news app on my cell phone, waiting for my physician to…
Communication, collaboration, and coding exemplify the tone of last week’s C & M meeting. “Communication, collaboration, and coding” are three words that describe the March 6 and 7 ICD-10 Coordination and Maintenance meetings in Baltimore last Tuesday and Wednesday. The meetings were conducted at the headquarters of the Centers for…
Recently I reviewed a case that triggered an exposition. As a clinician, I am always trying to wrap my head around a coding-clinical disconnect in the ICD-10-CM Official Coding and Reporting Guidelines regarding poisoning versus adverse effects. All medications have side effects; a clinician considers the cost-benefit ratio of each…
EDITOR’S NOTE: This article originally was published March 1, 2018 in the RACmonitor e-News A look back on the difficult end to a cherished friend’s life. “Larry only has a couple of weeks to live,” read the Facebook message from the wife of one of my oldest living friends. “He…
The American Hospital Association (AHA) recently announced that notes from social workers and registered nurses will be considered social determinants of health (SDoH).In 1945, World War II was ending, soldiers were returning home, and my mother graduated from nursing school. Her nursing board exam review book is short; the answer…
Ronald Hirsch, MD reported on this breaking news story during the Feb. 20 edition of Talk Ten Tuesdays. Here are highlights of that reporting.   The Centers for Medicare & Medicaid Services (CMS) released a final decision memo on implantable cardioverter defibrillators, also known as ICDs, to update the national…
In this article, the author examines the implications for the capture of Hierarchical Condition Codes (HCCs) in the inpatient setting.By now, most clinical documentation improvement (CDI) programs have an appreciation for the use of cases reflecting how Hierarchical Condition Codes (HCCs) impact upon quality and reimbursement. For those who do…
March 1, 2018

ACPA

By
EDITOR’S NOTE: Nationally renowned psychiatrist H. Steven Moffic, MD, recently discussed lessons learned from his reporting on the Sandy Hook Elementary School massacre and the Feb. 14 mass shooting that took place at Marjory Stoneman Douglas High School in Parkland, Fla. Dr. Moffic was interviewed during the Feb. 20 edition…
The author believes that it is more compliant to assign total knee replacements as outpatient services and then reassess the patient’s progress the next day to determine if there is a need for inpatient status. First of all, in five years I believe what follows will all be a non…
Coding leadership routinely benefits from learning team members' strengths and weaknesses and adjusting plans to match. I began working with Novant Health in 2011, when I used the phrase “best of the best” for my team. This was our department’s vision for our future, and it is a standard we…
Indiscriminate copying and pasting is the enemy of accurate, complete, concise, and relevant documentation. Does copy and paste make you as crazy as it does me?! I have been doing a lot of chart reviews lately, and the only saving grace is that this healthcare system has a mechanism to…
Click here to view this webcast on the webstore Why is This Webcast Relevant? Altered mental status is a common manifestation of illness which often signifies severe physiological derangement. To accurately reflect its importance, clinicians need to use appropriate terminology to capture risk adjustment. Attendees will resolve their confusion about…
Smith preaches collaboration, outreach, advancement on TTT broadcast. EDITOR’S NOTE: The following are remarks made by American Health Information Management Association (AHIMA) President and Board Chair Diann Smith during the live Talk-Ten-Tuesdays broadcast on Feb. 13. The American Health Information Management Association (AHIMA) celebrates its 90-year anniversary this year, and…
The new classification is designed as a database and has up to 13 dimensions. The World Health Organization (WHO) will be releasing the 11th Revision to the International Classification of Diseases, or ICD-11, this May. The WHO and many of its 194-member countries have been working on this since 2007.…