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Release by CMS caps months of debate by stakeholders Long awaited and hotly debated, the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) late July, when the Centers for Medicare & Medicaid Services (CMS) released proposed rules for both. Tucked into the MPFS were the controversial revisions to…
October 30, 2018
Telehealth and the Impact of ICD-10-CM
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
CMS announced on Friday a proposed rule to expand telehealth access for patients. Hospitals, doctors, and other providers seeking an edge in today’s highly competitive healthcare environment would do well to consider a smart telehealth strategy. It’s not an option anymore to think that telemedicine doesn’t fit into your practice.…
Diabetes could be a contributing factor without being the direct cause. In the first article in this series, I compared pressure ulcers and diabetic foot ulcers (the latter are considered non-pressure chronic ulcers in ICD-10-CM). My conclusion was that there is significant overlap, but heel ulcers are prime candidates to…
October 30, 2018
ICD-10 Coding for the Flu
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
The five “Ws” about the flu. It is that time of year again – flu season, which occurs in the fall and winter in the United States, stretching from early October until May. For me, it was a new experience this year, as I got my flu shot! I had…
October 30, 2018
Random Thoughts about ICD-11
By Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, AHIMA-approved ICD-10-CM/PCS Trainer
New classification system noted for granularity. Several of my colleagues recently attended an ICD-11 presentation by Kathy Giannangelo[i] at the American Health Information Management Association (AHIMA) Convention & Exhibit. Kathy has been in the trenches with ICD-11’s development for some time. The attendees described the complexity of this new classification…
October 23, 2018
ICD-10 Coding: Diabetic Foot Ulcer or Pressure Ulcer?
By Erica E. Remer, MD, FACEP, CCDS
Even a podiatrist may not know for sure. When is a diabetic’s foot ulcer a pressure ulcer? When is a pressure ulcer a diabetic foot ulcer? These are the questions we are going to explore in this two-part series of articles elicited by my disgruntlement with the advice in the…
October 23, 2018
ICD-10 Coding: Fourth Quarter Coding Clinic Sheds Light on BMI
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
New coding clinic edition offers much to review and follow.Everyone in health information management (HIM), coding, and CDI (clinical documentation improvement) is abuzz about the fourth-quarter AHA (American Hospital Association) Coding Clinic on ICD-10-CM/PCS. We just received the third-quarter issue at the end of September, which everyone is still digesting.…
October 23, 2018
The Latest Disease Scare: Acute Flaccid Myelitis
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
There is no specific code for this condition at the present time. Acute flaccid myelitis (AFM) is a rare and serious condition that affects the areas of the spinal cord called the gray matter and has been in the news recently. According to the Center of Disease Control and Prevention…
The biggest holdout to Sepsis-3 is still CMS. UnitedHealthcare has announced that it will be adopting the Third International Consensus Definition for sepsis and septic shock for all of its lines of business, effective Jan. 1, 2019. This definition is better known as "Sepsis-3." The announcement is significant because it…
October 16, 2018
Clinical Documentation Integrity: Reporting the Over-Reliance on the Query Process
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
The query process is no substitute for education and training.The hallmark of any true clinical documentation integrity (CDI) program consists of medical record chart review by clinical documentation integrity specialists (CDISs) with a goal of identifying gaps in diagnosis specificity as well as addressing other deficiencies requiring clinical clarification. Some…
October 16, 2018
AHA Releases 3rd Quarter Coding Clinic
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
New coding clinic brings valuable guidance Those of us in the health information management (HIM) coding profession were excited to see the third-quarter issue of the American Hospital Association (AHA) Coding Clinic on ICD-10-CM/PCS come out. Contained within the 31 pages for this issue is guidance and advice on several…
October 16, 2018
CDI: Documenting the Need to Generate Compliant and Meaningful Queries
By Erica E. Remer, MD, FACEP, CCDS
New program for live CDI education is gaining traction. Last week, I shared details about a new activity I have been doing with a client that I think is extremely beneficial, and suggested that perhaps others could implement a similar program in their own practices. I was asked to lay…
October 16, 2018
ICD-10 Coding: HPV Cancers
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
Local radio station personality goes public with his cancer fight. In August 2018, Marty Griffin, KDKA radio personality, announced to his listening audience that he had cancer. His cancer is related to human papilloma virus (HPV), which infects 80 million people, according to the Centers for Disease Control and Prevention…
Two recent studies report on the alarming rate of physician burnout. EDITOR’S NOTE: Physician burnout, a topic of great interest across the healthcare industry during recent years, continues to make headlines.Talk Ten Tuesday host and ICD10monitor Publisher Chuck Buck and renowned psychiatrist H. Steven Moffic, MD discuss the topic. What follows is…
October 9, 2018
Navigate Medical Marijuana with your Eyes Wide Open
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
A lesson in coding and policy.Medical marijuana, or cannabis, as it is commonly referred to in the healthcare field, is allowing chronically ill patients to relieve painful, often debilitating symptoms legally instead of taking pills many claim do little to ease severe pain. The widespread acceptance of marijuana as a useful…
October 9, 2018
Clinical Documentation Improvement: Moving to Improve Patient Outcomes
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
CDI can drive down adversarial determinations of medical necessity and costly denials. In my article published last week, titled Moving in the Right Direction in Getting to the Root Cause of Clinical Documentation Improvement (CDI), I outlined that CDI plays a major role indeed in the context of overall healthcare…
Congress passed an appropriations bill to fund the U.S. Department of Health and Human Services (HHS) through the 2019 fiscal year. We may be rapidly approaching the midterm elections, but there is no shortage of activity here in Washington, D.C. these days already. Before the House of Representatives wrapped up…
October 2, 2018
LGBTQ Patients Are Focus of AHIMA Support
By Julie A. Dooling, MSHI, RHIA, CHDA, FAHIMA
The lesbian, gay, bisexual, transgender, and queer (or questioning) (LGBTQ) population faces barriers to appropriate healthcare access. EDITOR’S NOTE: The American Health Information Management Association (AHIMA) has developed a practice brief on this issue, and ICD10monitor will continue to report on how recognition of this vulnerable population is being demonstrated…
October 2, 2018
Leadership and Ethics during Challenging Times
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
Ongoing ethical issues persist requiring leadership guidance daily We live and work in times that are very challenging, and ever-changing to say the least. We also live and work in times in which our ethics seem to be challenged on a regular basis. One just has to open any newspaper,…
CMS proposes to ease burdens on providers. When it comes to the ever-changing Centers for Medicare & Medicaid Services (CMS) agency rules and regulations, one can’t help but be reminded of the classic tune by The Byrds: “to everything (turn, turn, turn), there is a season (turn, turn, turn).” The…
October 2, 2018
Understanding Presumptive Linkage for Code Titles “With” or “In”
By Erica E. Remer, MD, FACEP, CCDS
Sharing insights on assumptive coding When I was a physician advisor, I used to offer a diabetic Charcot joint as an example of why we must be explicit with linkage. Years ago, if a provider listed diabetes mellitus and a Charcot joint (neuropathic osteoarthropathy) as concomitant diagnoses without documenting clear…
September 25, 2018
Human Trafficking: New ICD-10 Codes Empower Efforts to Identify and Aid Victims
By Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
New ICD-10 codes that address human trafficking become effective Oct. 1. This year has seen the launch of the ICD-10 Z codes, and now we will also have T codes to address human trafficking. Catholic Health Initiatives (CHI) has collaborated with several healthcare organizations , including the American Hospital Association's…
September 25, 2018
Are There ICD-10-CM or CPT® Coding Implications to Clarify Fourth Universal Definition of AMI?
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
The new definition includes clinical concepts that were not an option before when choosing an MI diagnosis. Since 2012, changes and updates have continued to clarify the acute myocardial infarction (AMI) diagnosis. There are now five types of MI diagnoses that have been expanded and updated through the years, and…
September 25, 2018
Moving in the Right Direction in Getting to the Root Cause of Clinical Documentation Improvement
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
The clinical query process is a small yet important part of any CDI initiative.By now I am confident that most in the clinical documentation improvement (CDI) industry are familiar with the lawsuit brought by data analytics firm Integra against Providence Health to recover $188 million for alleged upcoding perpetuated by…
September 24, 2018
The Value of a Certified Coder and CDI in our Practices
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC
With good collaboration and the right team members, continual improvements are attainable.Recently I have been engaged in a project of continual improvement in our clinics, and as chief compliance officer, I am continually looking for ways we can stay compliant, deliver excellent healthcare, and fix revenue leaks.We audit our physicians…
September 18, 2018
Capturing the Spirit of Coding: Part II
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
New code proposals from the ICD-10 Coordination and Maintenance Committee Meeting are discussed. The Coordination and Maintenance Committee met on September 11-12, 2018 to discuss new code proposals, as well as proposals that were previously presented. The presentations began with ICD-10-PCS proposals, with completion by mid-afternoon on the second day.…
September 18, 2018
Healthcare and Hurricane Preparedness
By Sharon Easterling, MHA, RHIA, CCS, CDIP, CRC, FAHIMA
The aftermath of Florence prompts a review of emergency preparedness We know the 2018 hurricane season is upon us, but we are always unsure of where the individual storms will appear, what their track will be, and how they will behave. Hurricane Florence—since downgraded to a tropic depression— has been…
September 18, 2018
2019 CPT® Coding for Skin Biopsies
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner
Skin biopsy codes are changing. EDITOR’S NOTE: This is an updated version of the second installment in a two-part series on the 2019 CPT® codes released recently by the American Medical Association.For many years we have used two codes to report skin biopsies. CPT® 11100 for the first lesion and…
September 17, 2018
2019 IPPS Updates from the Perspective of a Pulmonary/Critical Care Physician
By Emmel “Sonny” Golden, MD, FCCP, CCDS
A review of Major Disease Category 18, Infectious and Parasitic Diseases, Systemic or Unspecified Sites. Systemic inflammatory response syndrome, or SIRS, due to a noninfectious cause can be confusing. SIRS caused by noninfectious conditions occurs in medical and surgical cases alike. Coding guidelines prohibit the use of codes R65.10, noninfectious…
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
September 11, 2018
Misguidance Regarding What Defines Outcomes of CDI
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
The authors discusses the lawsuit against Providence St. Joseph Health Services for alleged upcoding. Performance with a purpose must be the driving force for business operations, personal goals, work and life accomplishments, and personal choices. The concept of performance with purpose must be a fundamental foundation governing all aspects of…
September 11, 2018
Facilities Urged to Strengthen Coding Compliance Program
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
Recent FCA activity focuses on coding compliance issues Recently in healthcare news were articles about two legal actions that cause one to reflect on the need for a strong (or stronger) coding and clinical documentation improvement (CDI) compliance programs. The first legal action cited the False Claims Act (FCA) and…
September 11, 2018
Details Revealed in Fourth Universal Definition of Myocardial Infarction
By Edward Hu, MD, CHCQM-PHYADV
ICD-10-CM supports this new classification system. Four major cardiology associations have once again collaborated to update the universal standard definition of myocardial infarction (MI), and this effort was more ambitious than any prior effort. In a document published simultaneously by the American College of Cardiology (ACC), the American Heart Association…
September 11, 2018
AMA Releases 2019 CPT® Code Set
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner
New code changes number 335. The new current procedural terminology (CPT®) codes have been released with 335 code changes in 2019. There were many code revisions with guideline, description and instructional note changes. Let’s look at the highlights of many new CPT codes for 2019. There six new codes in the…
August 28, 2018
CMS Proposes 50 Percent Reduction in Claims Submitted with Modifier 25
By Shannon DeConda CPC, CPC-I, CEMC, CMSCS, CPMA®
The proposal is on the table as part of proposed E&M changes. EDITOR’S NOTE: The following story was published by RACmonitor on Aug. 16, 2018. By now I am sure that everyone is well aware that the Centers for Medicare & Medicaid Services (CMS) has proposed modifications to the reimbursement…
August 28, 2018
Proposed 2019 Physician Fee Schedule Threatens Single-fee E&M Payment Rates
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
Proposed rule will cut by 50% claims submitted with modifier 25. In what is being reported as the biggest change of its kind in more than two decades, the Centers for Medicare & Medicaid Services (CMS) plans to redefine the documentation requirements for evaluation and management (E&M) coding in 2019,…
August 28, 2018
Capturing the Spirit of Coding
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
Coordination and Maintenance committee takes place Sept. 11 and 12 at CMS. The Coordination and Maintenance Committee meeting takes place twice per year, in March and September. These meetings develop the spirit of coding. In other words, the meetings center on the philosophy or the intent of the codes. One…
Proposed E&M code changes would impact specialty physicians. Some physicians are probably not very happy with recently proposed changes to the Medicare Physician Fee Schedule. The Centers for Medicare & Medicaid Services (CMS) designed the changes to reduce paperwork and enable physicians to spend more time with patients. Those seem…
HATA survey reveals membership dissatisfaction with prior authorization transactions. In a recent report to the U.S. Senate Committee on Finance, the Government Accountability Office (GAO) was asked to examine the Centers for Medicare & Medicaid Services’ (CMS’s) prior authorization programs, including its benefits and challenges. The GAO spoke with many…
The OIG continues to review cases of malnutrition. The diagnosis of severe protein calorie malnutrition is under high scrutiny from the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). Today, I’d like to explore the reasons…
August 21, 2018
Parkinson’s and ALS Claims Filed by Former NFL Players
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
In addition to CTE, head trauma could also lead to Parkinson’s and ALS. The National Football League (NFL) signed an agreement in January 2017 covering 17,200 registered league retirees to compensate them for treatment of diagnosed neurological disorders, up to $5 million per person. The proposed fund totaled $675 million…
August 21, 2018
Are HIM Coding Professionals Qualified to Query for Clinical Validity? Part III
By Anny Pang Yuen, RHIA, CCS, CCDS, CDIP
It’s not the credentials, but knowledge of the clinical validator that counts. Clinical documentation integrity (CDI) professionals come from a variety of backgrounds and skill sets. Frequently, we see health information management (HIM) coding professionals and nurses stepping into the role of CDI. Their respective education and experiences help provide…
August 14, 2018
Are HIM Coding Professionals Qualified to Query for Clinical Validity? Part II
By Debra Beisel Denton, RHIA, CCS, CCDS, CDIP
Trends in Clinical Documentation, Past, Present, and Future – Part II EDITOR’S NOTE: This topic has solicited many comments, creating as contentious debate, since Part I was published in the ICD-10monitor e-News on July 17 and discussed the same day on Talk-Ten-Tuesdays. I want to highlight some of the comments,…
Overview of CMS final rules is provided by the author So this is the season for 2019 Medicare facility payment rules. These rules are required each year to update payment rates and processes, as well as additional policies for the next fiscal year, which begins on Oct. 1. These are…
August 14, 2018
Is it Patients over Paperwork, or Providers over Patients?
By Erica E. Remer, MD, FACEP, CCDS
The author comments on proposed E&M changes. Has my entire career been based on a lie? For 33 years, I have been espousing the party line that good documentation positively impacts patient care. I have taught documentation to providers who have gotten in trouble with their medical boards for six…
August 14, 2018
Physicians to Expect Greater Competition for Bonuses in 2019
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
Proposed rule on 2019 Physician Fee Schedule offers greater incentives Revisions in the Quality Payment Program (QPP) proposed rule, tucked into the 2019 Physician Fee Schedule, will make for heightened competition and expectations among physicians participating in the Merit-based Incentive Payment System (MIPS) as the Centers for Medicare & Medicaid…
August 7, 2018
CMS Proposes new Guidelines for Evaluation and Management Services for Office and Clinic Visits
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner
CMS proposes significant changes to E&M services. There has been much confusion over the years regarding documenting for evaluation and management (E&M) services since the 1997 Official Guidelines were released. The Centers for Medicare & Medicaid Services (CMS) kept promising revised guidelines for years without delivering results. During that time,…
August 7, 2018
2019 Official Guidelines for Coding & Reporting: Contain Significant Changes
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
Changes coming with 2019 Official Guidelines for Coding and Reporting of ICD-10-CM The 2019 Official Guidelines for Coding and Reporting of ICD-10-CM have been released, and they certainly encompass some notable changes, as always. Changes occur in the “Conventions,” the “General Guidelines,” and several chapter-specific guidelines as well. Narrative changes…
August 7, 2018
Preview of New ICD-11 Codes Revealed
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC
New codes to be presented at the September Coordination and Maintenance Committee meeting There is a lot of buzz in the industry about the possibility of ICD-11. We are so many years from that becoming a possibility, though, with our clinical modifications and political culture. And we still have a…
August 7, 2018
CMS Proposed E&M Changes Would Eliminate 1995 and 1997 Guidelines
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
Major E&M changes on the horizon. Probably the biggest change in healthcare in two decades is the Centers for Medicare & Medicaid Services (CMS) proposal to redefine the documentation requirements for evaluation and management (E&M) coding in 2019. The agency is proposing to forego the 1995 and 1997 guidelines for…
August 7, 2018
Coding and Documenting BAL: Use a Medical DRG, Not a Surgical DRG
By Erica E. Remer, MD, FACEP, CCDS
The author responds to a Talk Ten Tuesday listener's comments regarding the coding of bronchoalveolar lavage. During the Talk Ten Tuesday broadcast on July 24, 2018, Stacey Elliott, an inpatient compliance specialist and a guest panelist on program, and I had a discussion regarding bronchoalveolar lavage (BAL). Stacey had a…
The recent escalation of mass murders prompts this article previously posted on ICD10monitor. EDITOR’S NOTE: At least 31 people were killed over the weekend in mass shootings in Texas and Ohio, begging the question of what have we learned? On Feb. 26, 2018, ICD10monitor published my interview with renowned psychiatrist H.…
Patients in New York may be certified to use medical marijuana as a substitute for opioids. EDITOR’S NOTE: The following is a transcript of a recent Talk Ten Tuesday broadcast featuring the author. An interesting development in the use of medical marijuana was reported recently by a number of major…
CMS proposed major changes to E&M coding but still solicits feedback from stakeholders. The Centers for Medicare & Medicaid Services (CMS) wants to simplify outpatient E&M coding by letting providers choose an office visit code level based on the most important component, medical decision making (MDM), or face time spent…
More than physician payment rules in the CMS IPPS proposal The physician fee schedule rule is one of many payment system rules that the Centers for Medicare & Medicaid Services (CMS) issues each year. There are also rules for the Inpatient Prospective Payment System (IPPS), Outpatient PPS, Skilled Nursing Facilities…
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…
July 27, 2018
News Alert: 2019 ICD-10-CM Coding Guidelines Have Been Released
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
July 24, 2018
Physician Nightmare, Coder Quandary: Bronchoalveolar Lavage
By Stacey Elliott, CCS, CPC
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…
Join us for special news coverage of the 2020 IPPS update during our summer celebration of IPPSpalooza!AND don’t forget to check out all of our 2020 IPPS coding webcasts in August → 2020 IPPS CODING WEBCASTS SERIESICD-10-PCS • ICD-10-CM • MS-DRG ShiftsNew Rules for Compliance & Reimbursement LEARN MORE
July 17, 2018
HIM Coding Professionals Told They’re Not Qualified to Query for Clinical Validity
By Debra Beisel Denton, RHIA, CCS, CCDS, CDIP
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…
July 17, 2018
Is All Airway Protection Acute Respiratory Failure?
By Erica E. Remer, MD, FACEP, CCDS
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…
July 17, 2018
Physician Clinical Documentation: The Lifeblood of the Revenue Cycle
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
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.…
July 10, 2018
Incorporating Socioeconomic Status for Medicare Advantage: Addressing the Social Determinants of Health
By Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
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…
July 10, 2018
The Controversy Continues: Medical Necessity versus MDM
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
“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.…
June 26, 2018
ICD-11: Hurry Up and Wait
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
June 26, 2018
Advice for Coding and Documenting HIV
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
June 19, 2018
ICD-10-CM is Lacking Detail for Sexual Harassment
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
June 19, 2018
The Side Effects of Workplace Bullying in Healthcare
By Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
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…
June 19, 2018
Women Urged to “Take Time for Health,” Embrace Empowerment
By Vinita Manoraj, MD, CHCQM
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…
June 12, 2018
News Alert: FY2019 ICD-10-CM Code Changes Have Been Released
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
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,…
June 12, 2018
Assessing the Social Determinants of Health: The Secret Ingredient to the Cost, Coding, and Care
By Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
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…
June 12, 2018
Auditing Issues Uncovered in Physician Documentation: Part IV
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
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…
June 5, 2018
Coders Urged to Avoid Clinical Coding Risks
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
June 5, 2018
Healthcare Costs, Coding, and The Social Determinants of Health: A Necessary Marriage
By Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
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…
June 5, 2018
Coding-Clinical Disconnect Reducing Apparent Child Abuse Incidence? Not on My Watch
By Erica E. Remer, MD, FACEP, CCDS
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…
May 24, 2018
News Alert: CMS Releases ICD-10-PCS Changes for FY2019
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer
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…
May 22, 2018
Supporting CDI with Physician Advisors
By Sarguni Singh, MD, Hemali Patel, MD, and Debra Anoff, MD
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…
May 22, 2018
Auditing Issues Uncovered in Physician Documentation: Part III
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC
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,…
May 22, 2018
CMS Issues RADV Blueprint for Handling Flawed Documentation
By Sheri Poe Bernard, CCS-P, CPC, CRC, CDEO
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…
May 22, 2018
CDI Can Help Reduce Medical Errors
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
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…
May 15, 2018
Exclusive: Women’s Issues on Both Sides of the Examination Table, in the Age of #MeToo and #TimesUp
By Stephanie Thompson, ICD10monitor National Correspondent
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…
May 15, 2018
Are You at Risk for a Women’s Health Issue?
By Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer
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!). …
