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The federal agency has recommended that healthcare workers self-report symptoms and not work if ill. EDITOR’S NOTE: On March 5, the Centers for Disease Control and Prevention (CDC) held a call to update the provider community on the latest guidance related to COVID-19. During the call, several CDC physicians described…
The nation’s largest healthcare conference has been canceled amid the growing threat. The deadly coronavirus (COVID-19) has resulted in the cancellation of HIMSS20, the 2020 healthcare IT conference initially scheduled to take place next Monday in Florida, according to an announcement on the association’s website. “Following reports from the WHO…
There are growing fears that the spread of the disease could yield racial bias against Americans of Asian descent. EDITOR’S NOTE: The cacophony of news (and misinformation) on the deadly coronavirus is considered likely to yield racial bias and impact the mental health of America’s most vulnerable: those who are…
March 3, 2020
E&M Changes: How Will They Affect Your Practice?
By Kathy Pride, RHIT, CPC, CCS-P, CPMA More changes are likely coming. As many of you have heard, there are major changes coming to evaluation and management (E&M) codes in 2021. The changes were finalized in the 2020 Physician Final Rule. The good news is that the Centers for Medicare & Medicaid Services (CMS) gave us all…
March 3, 2020
Privacy of Health Information: An IFHIMA Global Perspective
By Lorraine Fernandes, RHIA Privacy is the right of an individual to keep oneself and one’s information concealed from unauthorized access and view by others. As the world moves to electronic health records, albeit at varying stages, health data is being used for a wider range of purposes, including improving population health, disease surveillance,…
I'm making a pitch for reciprocal education. EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. To set the stage, I am currently engaged in a really fun, intellectually challenging ongoing project. I compose…
February 25, 2020
New Directions for Medicare Advantage and the Medicare Drug Plan in 2021
By Stanley Nachimson, MS Comments on the proposals set forth in Part I and Part II of the advance notice must be submitted by March 6, 2020. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage (MA, or Part C) and the Medicare prescription drug benefit…
February 25, 2020
New Healthcare Price Transparency Rule – The Best, Worst, and Most Realistic Case Scenarios
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC The American Hospital Association has filed a lawsuit to block the rule. On Nov. 15, 2019, the Trump Administration proposed a new healthcare price transparency rule that would basically require hospitals to explain how much a medical service would cost before a patient receives treatment. This rule is due to…
February 25, 2020
Extravasation vs. Infiltration, and Vesicant Agents: Understanding the Particulars Involved to Avoid Coding Inaccuracies
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer It is important for coders and all healthcare professionals to know the difference, and why it matters. Intravenous therapy (IV) is quite common, administered by healthcare professionals on a very regular basis. As common as it may be, however, it's linked to an unusually high risk of potential harm to…
Cigna does sepsis right. EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesdays. The following is an edited transcript of her reporting. As usual, Dr. Ronald Hirsch clued me into today’s Talk Ten Tuesdays topic. Several weeks ago, he told me to check…
February 18, 2020
Exclusive: Understanding the Impact of Climate Change on Mental Health Part 1
By H. Steven Moffic, MD Nostalgia, solastalgia, and climate change. In our inaugural article in this exclusive series on the impact of climate change on mental healthcare, we listed the numerous climate-related conditions that seem to be emerging. The most intriguing one of all may be solastalgia. Even the name itself may pique your interest.…
February 18, 2020
Avoid Treating Patients Like Check Boxes on a List
By Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC Quality of care cannot be achieved without good data. 2020 has brought us many looming changes in healthcare. Unfortunately, we have already seen increased reporting criteria, more administrative burden, and many payment cuts. As we address all of these, not only this year but also in future years, we need…
February 18, 2020
Exclusive: The Search for Reliable Health Information, Part I
By Joseph C. Nichols, MD The reliability of the current state of health information is extremely limited. EDITOR’S NOTE: Dr. Joseph Nichols is producing a four-part series on healthcare data for ICD10monitor. This is the first installment in his exclusive series. The healthcare industry has spent an extraordinary amount of time, money, and effort to gather…
February 18, 2020
Ignorance of the Social Determinants of Health is not Bliss
By Erica E. Remer, MD, FACEP, CCDS Understanding the ICD-10-CM Z codes is essential. On Feb. 6, RACmonitor posted an article by Ellen Fink-Samnick, a frequent contributor to ICD10monitor and Talk Ten Tuesdays. It was titled “Underutilization of ICD-10-CM Z Codes for Medicare Beneficiaries.” She reminded us that it’s been two years since we were given dispensation…
February 11, 2020
Update: U.S. Hospitals Preparing for Coronavirus
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Coronavirus continues to dominate the news. EDITOR’S NOTE: This is a developing story and ICD10monitor will continue to update you on the latest development on this global health crisis. In the wake of the deadly coronavirus (nCoV), U.S. hospitals are preparing for an emergency response nationally by using the four “Ss”…
February 11, 2020
Physician Engagement Includes Physician Documentation
By Erica E. Remer, MD, FACEP, CCDS EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesdays. The following is an edited transcript of her reporting. When I was a new physician advisor, the chief quality officer at my facility instructed me to not talk about money when discussing clinical documentation…
February 11, 2020
ICD-10-CM and CPT® Coding Mistakes Can Cost You – And not Just Financially
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC Medical coding errors fall into the broad categories of “fraud” and “abuse.” Medical practices are concentrating on critical practice changes in 2020 and 2021, but it is important not to lose focus on the basics of correct coding. Don't be guilty of common CPT and ICD-10-CM coding errors, as it…
February 11, 2020
Unforeseen Advantages of Documentation and Coding Audits: The Importance of EHR Data Integrity
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer CORRECTION: This story has been corrected. There was no Meaningful Use Act. The American Reinvestment & Recovery Act (ARRA) was enacted on Feb. 17, 2009. ARRA included many measures to modernize our nation's infrastructure, one of which was the “Health Information Technology for Economic and Clinical Health (HITECH) Act”. We apologize for the…
Hospitals need to submit Medicare bad debt lists on their cost reports. I was working on a project recently, reviewing bad Medicare debts for a client. I noticed a reduction for a code I do not see a lot on a claim with Medicare primary and Medicaid secondary. It was…
February 4, 2020
The Dilemma of Coding and Reporting Deep-Tissue Pressure Injuries
By Lisa Baris, RHIT, CCS, CCDS Confusion and apprehension surround new guidelines for deep-tissue pressure injury. The release of the 2020 Official Guidelines for Coding and Reporting (OCG) has resulted in confusion and apprehension surrounding the intent of the new guideline related to the new ICD-10-CM codes for pressure-induced deep-tissue damage, or deep-tissue pressure injury (L89.-6).…
February 4, 2020
Deadly Virus is Spreading; its Impact is Escalating
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Coronavirus is now a global public health emergency. EDITOR’S NOTE: This is a developing story and ICD10monitor will continue to update you on the latest development on this global health crisis. The World Health Organization (WHO) declared the novel coronavirus a global public health emergency on Jan. 31. As of Feb.…
February 4, 2020
Physician CDI Input and Clinical Validation for Pelvic Abscess Denial
By Wilbur Lo, MD, CDIP, CCA, AHIMA-Approved ICD-10-CM/PCS Trainer Case study proves the need for physicians to be members of the CDI team. Having a strong denials management team is critical for facilities. If providers do not leverage proper resources to generate strong appeal letters, the third-party payers will uphold their decisions to remove or change diagnosis or procedure…
The symptoms for CTE include depression, anxiety, explosive anger, suicidal thoughts, and actions. Today, millions of people are looking over their shoulders. They are doing so because they are being stalked. They are being stalked by their own brain. Their brain is thinking about chronic traumatic encephalopathy (CTE). Sadly, as…
January 28, 2020
Hierarchical Condition Categories: It’s Not Just for Inpatients
By Erica E. Remer, MD, FACEP, CCDS The number of conditions a patient has is now going to factor into the risk adjustment score (RAS). EDITOR’S NOTE: Dr. Erica Remer reported this story live during the January 21 edition of Talk Ten Tuesdays. The following is an edited transcript of her reporting. In March, I make my…
January 28, 2020
Prior Authorization for Medical Services: A Significant Pain Point for Providers and Practices
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC Prior authorization is mostly a manual process. Prior authorizations are not going anywhere anytime soon, but drastic changes on how they are handled may finally be on the horizon. An April 2018 study from the Government Accountability Office found that Medicare prior authorization programs saved the program between $1.1 billion…
January 28, 2020
Single Source Physician and Facility Emergency Room Coding: What Key Elements to Consider
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer In the continuous pursuit of improved efficiencies, can single-source coding be a solution? As organizations continue to evaluate the most efficient and cost-effective ways to streamline operations, there is increasing movement toward single-source physician and facility emergency room coding. This has proven to be a successful endeavor for many organizations,…
January 28, 2020
Deadly Virus Continues to Rattle Global Healthcare Officials
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Coronavirus is spreading. EDITOR’S NOTE: This is a developing story and ICD10monitor will continue to update you on the latest development on this global health crisis. As of Jan. 27, eight cases of a novel coronavirus (2019-nCor) have been reported in the United States. The outbreak that started in Wuhan, China…
January 21, 2020
National Coding Contest Indicates Outpatient Coding is Getting Worse, not Better
By Holly Louie, RN, BSN, CHBME More than 4,000 cases were coded in the 2019 contest focused on outpatient coding. ICD-10 is well-established, and we are already discussing and planning for ICD-11. However, where are the long-anticipated and promised increased accuracy and most definitive diagnoses? At least one coding contest found outpatient coding in 2019 had…
January 21, 2020
Be a Success in Your Coding Career
By Lamon Willis, CPCO, CPC-1, COC, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Success can cost you more than you thought it would. You might have heard the phrase, “everyone wants to be successful until they see what it actually takes.” While I’m not sure where the quote originates, I’ve seen it attached to various images, one of which is the feet of…
January 21, 2020
Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging: 2020 Testing Period Officially Underway
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Tackling processes and departmental integration requirements for AUC will be key this year. The testing phase for the Appropriate Use Criteria (AUC) Program officially began on Jan. 1, 2020. Being as there is a purely educational and operational testing period, physicians and practitioners will not be subject to any adverse…
January 14, 2020
Is Recording the Patient Encounter for Posterity a Good Idea?
By Erica E. Remer, MD, FACEP, CCDS EDITOR’S NOTE: Dr. Erica Remer reported this story live during the January 14 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. When I do my Case Western Reserve University documentation course, I sometimes joke about the future, when we won’t need to document because the…
January 14, 2020
MedPAC Suggests Elimination of “Incident To” Billing for NPPs, APRNs, PAs, APPs, Physician Extenders, etc.
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC Incident-to billing for advanced practice providers or APPs (nurse practitioners, physician assistants, clinical nurse practitioners, nurse midwives, etc.) has been available to limited-license practitioners since 1998, and the rules for what is required to bill incident-to are clearly defined by the Centers for Medicare & Medicaid Services (CMS). Yet this…
January 14, 2020
Looking at Possible ICD-10-CM Clinical Coding Challenges in 2020
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer Seven coding challenges reveal a new compliance landscape in 2020. It’s here: 2020! This past year in healthcare, as in many years before, was full of changes, challenges, and some surprises as well. When trying to foresee the key future challenges in clinical coding, the following topics came to mind…
January 14, 2020
New Data Supports Need for CDI Improvement
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FC Improper DRG payments in 2019 demonstrate the urgency for CDI leadership to address issues. The 2019 Medicare Fee-for-Service Supplemental Improper Payment Data Report was recently released, showing marked improvement in the Medicare improper payment rate from 2018. This year’s overall improper payment rate came in at 7.3 percent, equating to…
EDITOR’S NOTE: Anyone who has viewed the wildfires in Australia knows why it has been called the “canary in the coal mine” of climate change. No wonder that Solastalgia was discovered there. As the ever-increasing carbon is being emitted from the world’s coal mines and other fossil fuel sources, life…
December 17, 2019
NEWS ALERT: New Code for EVALI
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Emergency release of the new EVALI code by CDC. On Dec. 9, 2019, the Centers for Disease Control and Prevention (CDC) published additional guidance regarding e-cigarette/vaping associated lung injury (EVALI). The new code is U07.0 (Vaping-related disorder). The CDC consulted with the World Health Organization (WHO) regarding an addition to…
December 17, 2019
Why this Holiday Could be Perilous for Some
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer New Year’s thoughts and reflections. The holidays are times for people to connect with loved ones, including family and friends. I would ask that during this holiday season, please look out for our adolescents. In October 2019, the Public Broadcasting Service (PBS) published an article indicating that suicide is the…
Among the proposed new rules is one intended to clarify the contentious “Stark Law.” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”). The law prohibits…
December 16, 2019
Let’s Talk Turkey: Human Rights, Holiday Lights, and ICD Delights
By H. Steven Moffic, MD Nationally renowned psychiatrist uses humor to discuss social issues. I’d suggest taking my considerations and recommendations below with lots of grains of salt. In all seriousness, to start off, Dec. 10 was not only the annual International Human Rights Day, but as we speak, articles of presidential impeachment are coming…
No longer is burnout unique to physicians; parental burnout is on the rise too. EDITOR’S NOTE: H. Steven Moffic, MD, a nationally prominent psychiatrist and author, has co-authored a new book, the first of its kind on the subject of burnout, titled “Combating Physician Burnout: A Guide for Psychiatrists,” published…
December 10, 2019
Close the Loopholes on Outpatient Claim Denials
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Proactive measures in claim denial management can recoup lost revenue. Unfortunately, the majority of healthcare organizations encounter claim denials on a regular basis, often, habitually. Though claim denials may be an unavoidable reality in the world of healthcare, ineffective claim denials management can result in even more lost revenue. A…
December 10, 2019
Conditions that Impact MS-DRG Assignment for Newborns
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Birth weight is used by APR-DRGs and MS-DRGs, and it impacts the assigned group. The topic of newborns is rarely addressed when we talk about coding or clinical documentation integrity. Birth weight, prematurity, extreme prematurity, and other significant problems are all conditions that impact the MS-DRG assignment. Newborns are assigned…
Sepsis is a clinical diagnosis, and clinicians should be permitted to make the diagnosis appropriately. When I step up onto my sepsis soapbox, people often refer to New York State and tell me how they are not allowed to accept Sepsis-3, pursuant to state regulation. Full disclosure: I hail from…
EDITOR’S NOTE: The following was reported by Dr. H. Steven Moffic during a recent broadcast of Talk Ten Tuesdays. Aren’t you getting frustrated about all the years of talk about the burnout epidemic among physicians and other healthcare workers, yet nothing much happening? All kinds of recommendations, often without much research…
December 3, 2019
The 10-Year Coder Challenge: Growing Your Skills beyond CCs and MCCs
By Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer Today’s coder must embrace APR-DRGs and HCCs in order to stay relevant. At the beginning of the year, Facebook’s “10-year challenge” hit the web, with users posting comparison profile pictures from 2009 alongside their 2019 selfies. I’ve since seen a recent resurgence of the challenge over the last week and…
December 3, 2019
Data Carries Great Importance for the ICD-11 Transition
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer It is important to understand the data needs for your organization from a content perspective as you prepare for ICD-11. As we talk about preparing for the transition from ICD-10 to ICD-11, it is important to realize the importance of data. Healthcare data is important today for population health, determining…
EDITOR’S NOTE: George Vancore appeared during a recent edition of Talk Ten Tuesdays focused his report on lessons learned during the implementation of ICD-10 in preparation for ICD-11. This article is a summary of his remarks. When Chuck Buck recently asked whether I could summarize Florida Blue’s ICD-10 implementation success…
December 3, 2019
Will the H&P be replaced by technology? or “No, Virginia, there is no tricorder”
By Erica E. Remer, MD, FACEP, CCDS EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Dec. 3 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. A Medscape survey popped up in my email a few weeks ago. The title was, “Is Technology Replacing Patient History?” (https://www.medscape.com/viewarticle/921235) and it linked…
Discharge Planning Conditions of Participation is effective Friday, Nov. 29, 2019. In a news release issued late last month, the Centers for Medicare & Medicaid Services (CMS) included the following statement: “The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that empowers patients to make informed…
November 26, 2019
Change is Coming for E&M: Start Preparing Now for 2021
By Kathy Pride, RHIT, CPC, CCS-P, CPMA E&M codes are the most frequently used codes in any physician practice. Change is coming to the world of evaluation and management (E&M) services. With the Physician Fee Schedule Final Rule for 2020 now published, we know there are big changes to be expected in 2021. The good news is…
November 26, 2019
HCC Coding: Preparing for ICD-11
By Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, AHIMA-approved ICD-10-CM/PCS Trainer HCCs thrive on specificity and ICD-11 will provide a higher level of specificity than in ICD-10. For those of you who are coding for hierarchical condition category (HCC) purposes, you know that HCCs are categories of related ICD-10 codes. Only selected significant conditions to drive a payment HCC. That means…
November 26, 2019
Reporting of Wound Debridement Procedures Properly
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC There are lessons to be learned to avoid damaging coding habits. Wound debridement is a medical procedure that removes infected, damaged, or dead tissue to promote healing. Debridement is generally associated with injuries, infections, wounds, and/or ulcers. It is also a procedure that may be part of fracture care as…
Providers and the CDC may be setting up a coding-clinical disconnect. EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Nov. 19 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. Since I don’t practice clinically anymore, it is challenging to keep up…
November 19, 2019
Ten Going on Eleven: Part II
By Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer EDITOR’S NOTE: Ten Going on Eleven is a month-long series on ICD10monitor and Talk Ten Tuesdays that examine important issues related to the transition to ICD-11. Melanie Endicott with the American Health Information Management Association (AHIMA) appeared as a special guest on a recent edition of Talk Ten Tuesdays and…
November 19, 2019
Eight things you should do now to clean up your OP billing
By Allen R. Frady, RN, BSN, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer Tips for improving outpatient coding, CDI and billing. In moving from inpatient clinical documentation improvement (CDI) to outpatient CDI, I have been discovering some unique educational pointers. I know we are all very busy, so let’s just dive right into it. Doctors and coders, you should not have diagnoses that…
November 19, 2019
New Changes to Coding Pressure-Induced Deep Tissue Damage in 2020
By Cari Greenwood, RHIA, CCS, CPC AHIMA approved ICD-10 Trainer Providers should review their protocols to prepare for the changes. The 2020 updates to ICD-10-CM contain some significant changes to Chapter 12, Diseases of the Skin and Subcutaneous Tissue. These changes include the addition of new codes for the reporting of pressure-induced deep-tissue damage, also known as deep-tissue pressure injury…
November 19, 2019
Diabetic Kidney Disease and the Third Quarter Coding Clinic
By Erica E. Remer, MD, FACEP, CCDS A clinician’s perspective on the AHA’s third-quarter coding clinic. I spoke at the inaugural combined Oregon Health Information Management Association (OHIMA) and ACDIS conference in Albany, Ore. last week. One of the comments I hear often when I speak to coders involves how much they appreciate getting a clinician’s perspective.…
EDITOR’S NOTE: Ten Going on Eleven is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines the importance of data mining, as it pertains to the looming transition to ICD-11. World Health Organization (WHO) Classifications and Terminologies Team Leader Dr. Robert Jakob appeared as a special guest on…
November 12, 2019
Medical Coding Data Mining: A Must-Have Skill for Coding Professionals
By Lolita M. Jones, MSHS, RHIA, CCS Data mining skills will be a prerequisite in ICD-11. Medical coding has long been identified as the “signature” skill set or area of expertise of the health information management (HIM) profession, but the new signature skill set is quickly becoming data mining – due in large part to changes…
November 12, 2019
Why Your CDI Job Could be Outsourced Overseas
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FC Queries are simply not enough. We all read about companies moving jobs overseas to cut costs and drive operating performance, with greater profits. As a result, hundreds, if not thousands, of employees are displaced, forced to seek alternate employment or potentially take early retirement, if offered by the employer. This…
November 12, 2019
ICD-11: The New Reality for Providers
By Margaret A. Skurka, MS, RHIA, CCS, FAHIMA Now is the time to begin preparing for the new code set. It is good to be back to talk about ICD-11. Yes, it’s a reality now, and all providers can start to get prepared for this significant new system. ICD-11 has been years in the making, and it is…
EDITOR’S NOTE: Five Looking at Ten is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines lessons learned since the nation’s healthcare system adopted ICD-10 – many of which are expected to come into play with the looming transition to ICD-11. Stanley Nachimson of Nachimson Advisors appeared as…
New series to focus on preparing for the new code set. ICD10monitor and Talk Ten Tuesdays are launching a new series today, which will continue through November, focusing on the need for early preparation for the new ICD-11 code set that most expect will be ready for the U.S. implementation…
November 5, 2019
Government and Private Insurer DRG Audits – Don’t (Necessarily) Believe the Denial!
By Lamon Willis, CPCO, CPC-1, COC, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer EDITOR’S NOTE: This is the second portion of a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. In our second example, a 73-year-old female presented to the hospital with syncope following a fall at a physician office: The provider assigned I67.1 (Cerebral…
EDITOR’S NOTE: Five Looking at Ten is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines lessons learned since the nation’s healthcare system adopted ICD-10 – many of which are expected to come into play with the looming transition to ICD-11. Medical Group Management Association Health Information Technology…
October 29, 2019
News Alert: CDC and FDA Issue Framework to Aid Clinicians for Treating Vaping
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Agencies continue their investigation into the underlying cause of electronic cigarette/vaping-associated lung injury. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to investigate the underlying cause of electronic cigarette/vaping-associated lung injury (EVALI). In order to assist public health response in recognizing and…
October 29, 2019
CMS to Penalize Physicians for “Guilt by Association” on Vendor Bad Acts
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC It’s a move sure to stir up controversy. Under a recently passed Centers for Medicare & Medicaid Services (CMS) Final Rule, your Medicare enrollments will be judged not necessarily on your performance but based on your affiliations with other providers and suppliers. Yes, you read that right: “other providers and…
October 29, 2019
Illiteracy as a Social Determinant – and Related Healthcare Costs
By Holly Louie, RN, BSN, CHBME Approximately $230 billion a year in healthcare costs are directly related to illiteracy and the social factors associated with illiteracy. “Illiteracy” is such a broad term. It states a fact, but the underlying causes and far-reaching life and generational impacts are less well-stated. The problems are hiding in statistics from…
October 22, 2019
News Alert: CDC Issues Coding Guidance for Vaping
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer New guidance for coding vaping is retroactive to Oct. 1 discharges. The Center for Disease Control and Prevention (CDC) has posted new coding guidance regarding e-cigarette lung injuries. This guidance, posted Oct. 17, 2019, is retroactive to Oct. 1, 2019 discharges. The guidance states that coding professionals should report…
October 22, 2019
Coding Audits and Selecting a Coding Vendor: What Have we Learned since 2015?
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer Conduct coding audits in all settings and check vendors’ coding credentials are among lessons learned under ICD-10. When we left ICD-9-CM, there were around 14,000 diagnosis codes in use across the healthcare industry – and then, on Oct. 1, 2015, we moved to approximately 69,000 codes. ICD-10-CM/PCS implementation was a…
October 22, 2019
New CC and MCC Designation Technology Explained by CMS
By Erica E. Remer, MD, FACEP, CCDS During a recent conference call, the agency described assessing 64,883 ICD-10-CM diagnoses. I participated in the Centers for Medicare & Medicaid Services (CMS) conference call last Tuesday, explicitly focusing on complication and co-morbidity (CC) or major CC (MCC) designation methodology. This process is similar to how CMS originally determined comorbid…
EDITOR’S NOTE: Five Looking at Ten is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines lessons learned since the nation’s healthcare system adopted ICD-10 – many of which are expected to come into play with the looming transition to ICD-11. George Vancore of Blue Cross Blue Shield…
October 15, 2019
EHRs Continue to Contribute to Medical Malpractice Suits
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC There is a disconnect between what the doctor may have ordered and what the EHR read or translated. In my capacity as a healthcare consultant and auditor, I review patient records from all over the country – actually, the world, with the ever-growing popularity of offshore companies now performing coding…
October 15, 2019
Mortality, Morbidity, and Severity of Illness (SOI): Data to Support Quality Improvement
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer There is a difference between mortality and morbidity and knowing the difference is essential for coders. Often, when used in the healthcare environment, the terms “mortality,” “morbidity,” and “severity of illness (SOI)” are interwoven. However, by definition, they are quite different. Those within the healthcare industry need to understand the…
Expanding clinical conversations to involve all players can only benefit the entire organization. EDITOR’S NOTE: This article is based upon Dr. Erica Remer’s remarks during a recent live Talk Ten Tuesdays Internet broadcast. A while back, I told readers about a fun activity I do with one of my clients.…
October 11, 2019
Government and Private Insurer DRG Audits – Don’t (Necessarily) Believe the Denial!
By Lamon Willis, CPCO, CPC-1, COC, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer EDITOR’S NOTE: This is the first in a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. I shouldn’t be surprised. I have been reviewing denials by insurance companies since the late 1980s. I’ve seen the same things over and over again, such…
October 8, 2019
Former CMS official reflects on challenges, genesis of ICD-10 implementation
By Mark Spivey It all started with a move from one office to another. Considering the monumental quantities of time and energy expended by the healthcare industry on the shift from the ICD-9 coding classification system to ICD-10 about five years ago, it might have come as a bit of a surprise to…
October 8, 2019
Looking for Codes on Facebook
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC The risks of using the Internet to self-diagnose and code. A majority of us turn to the Internet for health-related information. According to the Pew Research Center, in 2014, a total of 87 percent of American adults had access to the Internet, and in 2012, a total of 72 percent…
October 8, 2019
The CDC is Proposing Changes to Sepsis Coding; Make Your Voice Heard
By Erica E. Remer, MD, FACEP, CCDS The criteria and definitions for sepsis are presented to help medical staff better understand sepsis. I popped on LinkedIn to repost the details of the Centers for Medicare & Medicaid Services (CMS) listening session regarding complication and comorbidity (CC) and major CC (MCC) comprehensive analysis after a recent edition of…
October 7, 2019
ICD-10-CM/PCS Lessons Learned Regarding the Official Guidelines and Coding Clinic
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer The actual go-live of ICD-10-CM/PCS was generally smooth, with no major problems. For health information management (HIM) coding and clinical documentation improvement/integrity (CDI) professionals, the use of and adherence to the ICD-10-CM/PCS Official Guidelines for Coding and Reporting is a must. In addition, the American Hospital Association (AHA) ICD-10-CM/PCS Coding…
The five-week series will highlight progress made during the implementation of the coding set that became effective Oct. 1, 2015. ICD10monitor and Talk Ten Tuesdays are poised to embark on a five-week series, “Five Looking at Ten,” that will focus on the lessons learned during the adoption of ICD-10 that…
October 1, 2019
Does using SIRS to diagnose sepsis improve mortality?
By Erica E. Remer, MD, FACEP, CCDS Electronic alerts for systemic inflammatory response syndrome (SIRS). EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Sept. 24 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. Dr. Ronald Hirsch recently brought an article to my attention, and I felt compelled to share…
October 1, 2019
The Vaping Epidemic Worsens
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Confusion persists for the coding of vaping. The issue of vaping continues to generate national and international headlines. On Sept. 18, a teen from London, Ontario in Canada suffered a severe case of pulmonary illness after using e-cigarettes daily. This marked the first reported case in Canada. In the U.S.,…
Do your physicians and ancillary staff know the ICD-10-CM coding rules? Based on many years of personal experience, most physicians and ancillary staff who do not code really don’t know or understand the coding rules. This is not particularly surprising, because even the best coders are sometimes confused by the…
Three revenue cycle tips are provided to reduce denied claims. Claim denials represent millions of dollars in lost and delayed net reimbursement annually. According to the American Medical Association (AMA), cost estimates of inefficient healthcare claims processing, payment, and reconciliation top out at $210 billion per year. Denials are so…
September 24, 2019
Supporting a Value-Based Care Structure: Social Determinants of Health (SDoH)
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer The SDoH are an essential element to providing patient care while addressing social needs. What determines health? While medical care is one determinant of one’s health, it plays a minor role in comparison to the economic and social conditions of an individual, otherwise known as social determinants of health (SDoH):…
September 24, 2019
Warning: Auditors Will Target SNF Patient Conditions, Not Services and Time Rendered
By Knicole Emanuel Esq. Oct. 1, 2019, marks the beginning of a new era of billing for skilled nursing facilities (SNFs). EDITOR’S NOTE: This article was published on Aug. 1, 2019, in the RACmonitor news and is reproduced today given the approaching deadline for coding compliance. Say goodbye to RUG-IV, and hello to the…
September 24, 2019
With late signatures, can you still bill for your medical services?
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC Late physician signatures pose serious issues. In the last few months, I have had questions about late signatures on documentation come in from several clients. I've been hearing about providers signing their notes a very long time after the encounter – sometimes weeks later, sometimes months, and sometimes even turning…
September 24, 2019
Which clinical criteria does your institution use to diagnose sepsis?
By Emily Anderson ExtStore.AdvPoll.initResult(); Which clinical criteria does your institution use to diagnose sepsis? jQuery(document).ready(function() { var $wrapper = jQuery('.advpoll-wrapper-53'); $wrapper.find('.advpoll-answer-graph').each(function() { var $this = jQuery(this); $this.find('.advpoll-answer-line').width(0).animate({ 'width': $this.data('percent') }, 900); $this.find('.advpoll-answer-line-percent').width(0).animate({ 'width': $this.data('percent') }, 900); }); }); Sepsis-2 (Infection plus SIRS) 18.18% Sepsis-3 (Infection plus organ dysfunction) 9.09% CMS definition (Infection plus…
The author ruminates on the Fall C&M meeting. EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Sept. 17 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. I listened to the ICD-10 Coordination and Maintenance Committee Meeting last week. Here are my thoughts.…
September 17, 2019
C&M Meeting: Plan for Classification Changes
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Public comments due by Nov. 8 to CMS and CDC. EDITOR’S NOTE: Senior healthcare consultant Laurie Johnson reported this story live during the Sept. 17 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. The Coordination and Maintenance Committee met on Sept. 10-11, 2019 at the…
September 17, 2019
The Controversy Continues: When Sepsis is Not Sepsis
By Erica E. Remer, MD, FACEP, CCDS If there is no organ dysfunction, it is not sepsis. EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Sept. 10 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. Apparently, I am not done pondering and pontificating about sepsis, which is apropos, considering…
September 17, 2019
The Coding Conundrum: Vaping-Related Lung Injury
By Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer Confusion persists for the coding of vaping. The Centers for Disease Control and Prevention (CDC) is currently investigating vaping-related illnesses that have recently been reported. There are 450 confirmed or suspected cases in 33 states. The first death was reported on Aug. 23, 2019, in Illinois. The concern has escalated…
September 17, 2019
When CDI Fails: The Unrelenting Pursuit of Reimbursement
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FC The CDI is more than diagnosis capture through the query process. The Association for Clinical Documentation Improvement Specialists (ACDIS) recently released a paper titled Proactive CDI: Tackling the Problem of Physician Engagement, which featured six CDI leaders outlining their thoughts and ideas on facilitating physician engagement in CDI initiatives within…
Under PDPM, reimbursement will be driven by coding and documentation. South Florida has historically been a hotbed of healthcare fraud, and there is a long list of those responsible other than Philip Esformes, who was sentenced to 20 years in prison on Thursday for fraud committed in connection with billings…
September 10, 2019
How AI-driven CDI Programs Give Us More of What We Need Most
By Mel Tully MSN, CCDS, CDIP Artificial intelligence (AI) solutions are designed to support CDI teams in their quests for efficiency. The concept of “doing more with less” is far from uncommon. You hear it every day in nearly every aspect of life: at home, we strive to live simply; in the community, we build resiliency;…
September 10, 2019
Potentially New Codes Coming Your Way
By Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer Fall ICD-10-CM/PCS Coordination and Maintenance Committee Meeting kicks off today. Today and tomorrow mark the dates for the next ICD-10 Coordination and Maintenance Committee meeting. Health information management (HIM) and coding and clinical documentation integrity/improvement (CDI) professionals often wonder about what the Coordination and Maintenance Committee is and does, so…
September 10, 2019
Smoking Cessation Counseling: Is it Payable?
By Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC EDITOR’S NOTE: This article has been updated to include commercial contract coverage information and CPT® direction to challenge payer contract provisions when necessary. Is your medical practice providing smoking cessation counseling and treatment? Did you know you can bill and get reimbursed for your services? There are rules, linked diagnosis…
September 10, 2019
Outpatient CDI: Follow the Money
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FC Moving from the inpatient to the outpatient setting is gaining momentum. Outpatient clinical documentation improvement (CDI) programs are becoming more prevalent in the healthcare sector, as the value and benefit to the revenue cycle have become readily apparent. Consulting companies are developing service lines and software to grow their position…
