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The next big milestone for ICD-10 is the Coordination and Maintenance Committee meeting in Baltimore this coming Tuesday and Wednesday. The two-day meeting will cover the latest requests for diagnosis and procedure codes. Monitoring and reporting on the meeting during the next edition of Talk Ten Tuesdays will be Gloryanne…

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EDITOR’S NOTE: At this hour Laurie Johnson is at the Fort Lauderdale Airport awaiting a Southwest Airline flight that is expected to return her tonight to Pittsburgh, Pa.BOCA RATON---Have you ever experienced preparations for a hurricane in a health information management (HIM) department? I just recently added this experience to…
The outpatient clinical documentation program at Essentia Health will be the subject of a special report during the next edition of Talk Ten Tuesdays. Discussing how the department is organized and staffed will be Tracy Boldt, the system’s manager. Essentia is an integrated health system serving patients in Minnesota, Wisconsin,…

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Today my thoughts go out to the people of Texas, especially the first responders and caregivers and all of those being impacted by Hurricane Harvey. Harvey made landfall in Texas on Friday night as the strongest hurricane to hit the U.S. in more than a decade, and because it has…
This is the year of many Centers for Medicare & Medicaid Services (CMS) regulatory requirement changes. This includes the Merit-Based Incentive Program (MIPS), the next steps toward mandatory Authorized Use Criteria (AUC) implementation for advanced imaging, defining more explicitly what is and what is not “quality” care, etc.  It is…
Last week Tracy Boldt contacted me to ask a question about outpatient clinical documentation integrity (CDI), and we are lucky to have her on the Talk-Ten-Tuesdays broadcast today, detailing Essentia Health’s successful outpatient CDI program. She also mentioned that she had been awaiting the third installment of my three-part series…
A recent conversation with a fellow clinical documentation integrity (CDI) specialist about the role of the profession as it pertains to enhancing and affecting positive change in communication of patient care by transitioning to a more holistic approach really struck a chord in me – and it made me question…
For my last article, I wrote about unexplained clinical variation as it pertains to surgical procedures. Today I continue exploring this theme.For men with low-risk prostate cancer, randomized controlled trials have found that active treatment such as radiation or prostatectomy does not improve mortality rates as compared to an initial…
Upon seeing signature attestations of medical scribes on client documents, I became curious as to their duties and training. I was interested in exploring a way in which they may contribute to the goal of clinical documentation improvement (CDI) programs. Since scribes can be employed in any healthcare environment or…
It’s that magical time of year for parents everywhere: back-to-school time. With a return to school comes a flurry of activity and planning and, in addition to obtaining school supplies and new clothes, parents must begin figuring out what their kids are going to eat for lunch. Whether that lunch…
EDITOR’S NOTE: The following is the third and final installment in a three-part series by Dr. Remer on outpatient clinical documentation integrity.In the first two parts of this series, we talked about risk adjustment in general, the shift to population health management, and how quality metrics and reimbursement are linked…
Approximately every five years, the American College of Cardiology, the American Heart Association, the European Society of Cardiology, and the World Heart Federation convene workgroups to try to standardize the definition of myocardial infarction (MI) for both documentation and research purposes.  The last iteration in 2012 produced five different classifications.The…
Join Chuck Buck and Erica Remer, MD, program hosts of Talk Ten Tuesdays, when they welcome Adele Towers, MD to the next edition of the weekly Internet broadcast.  

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August 16, 2017

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I am in the middle of a heads-down project, but I popped my head up long enough to read the new ICD-10-CM guidelines for 2018 (thanks for the notification, Gloryanne Bryant!). I had to take a moment to comment on the Type 2 myocardial infarction (MI) guidelines.The reasons we should…
The August heat is upon us here in the nation’s capital, and lawmakers have left town for their summer recess. The Senate was able to tie up some loose ends before leaving, including the passage of the Food and Drug Administration Reauthorization Act (FDARA), while leaving uncertainty regarding the reauthorization…
There is an unexplained geographic variation in how often patients are admitted to inpatient hospital care for a given diagnosis, with significant variation identified independent of patient age, insurance coverage, or clinical severity of illness. There is an equally important means by which to measure this variation: how often preference-sensitive…
EDITOR’S NOTE: The acronyms MINOCA (myocardial infarction with non-obstructive coronary arteries) and INOCA (ischemia and no obstructive coronary artery disease) recently have come into use in the healthcare industry. ICD10monitor publisher Chuck Buck caught up to and addressed this topic with board-certified cardiologist Stephen Sokolyk, a graduate of University of…
Two developing stories will be reported during the next edition of Talk Ten Tuesdays. 

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Just released on Thursday, Aug. 10 are the Official ICD-10-CM/PCS Coding and Reporting Guidelines for the 2018 fiscal year, totaling 117 pages. The National Center for Health Statistics, via the CDC (Centers for Disease Control and Prevention), has posted the guidelines on its website here: https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf.Readers should note that the…
Are the current evaluation and management (E&M) documentation guidelines outdated and burdensome? Evidently, the Centers for Medicare & Medicaid Services (CMS) thinks so.

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Last month, the American Health Information Management Association (AHIMA) released a practice brief titled “Impact of Physician Engagement on Clinical Documentation Improvement Programs.” The brief contains some extremely valid and interesting points. Genuine, consistent physician engagement is essential for any clinical documentation improvement program meant to achieve scale and long-term…
There is a 2003 Academy Award-winning movie called Lost in Translation, and that title reminds me of the topic of healthcare claims denial management. Let’s discuss medication and administrative denials. When medication is denied, it can be a costly reimbursement problem for whoever is submitting the appeal. These should be…
Medicare celebrated its birthday on July 30. It was 52 years ago, on the morning of July 30, 1965, that President Lyndon Johnson signed the four-inch-thick Medicare bill into law after it had undergone more than 500 amendments during its passage through the House and Senate. The bill was signed…
It's apparent that the traditional fee-for-service model for reimbursement cannot be sustained. New concepts have been introduced in the industry and some have "died on the vine,” others such as bundled payments are evolving, and new models have erupted, such as those outlined in the Medicare Access and Chip Reauthorization…
The third-quarter 2017 issue of AHA’s (the American Hospital Association’s) Coding Clinic for ICD-10-CM/PCS has been released, and during the next edition of Talk Ten Tuesdays, Gloryanne Bryant will report on its significance and why it’s good news to have this publication earlier than usual.

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EDITOR’S NOTE: The following is an outline of a presentation by author Bonnie S. Cassidy scheduled to take place at the American Health Information Management Association (AHIMA) “Advancing the Documentation Journey” Summit, which began Monday, July 31 and continues today, Tuesday, August 1 in Washington, D.C.During my presentation yesterday at…
There is a widespread belief in many circles that if you have enough data, you should be able to derive some meaningful knowledge from it. The healthcare industry has struggled for years trying to get meaningful cross-enterprise information that provides consistent, shareable, and actionable knowledge to guide improvement. This has…
EDITOR’S NOTE: Janice Tarlecki, MBA, RHIA, CCS, is the director of advanced education at Ciox Health. Janice has over 14 years of health information management experience (HIM) experience, with concentrations in acute-care coding, clinical documentation integrity (CDI), recovery audit appeals, coder development, and coder performance improvement. ICD10monitor publisher Chuck Buck…
For those of you ready to pack up and head for the highways or airports and take off for your summer vacations, I have some advice…Stay at home.  I mean it: stay at home. It’s not just travel-related peril I’m talking about here. There is a world of nasty stuff…
Here we are in July, and the third-quarter 2017 issue of AHA’s (the American Hospital Association’s) Coding Clinic for ICD-10-CM/PCS has been released, earlier than we’ve seen in the past. It’s good news that this publication has been released so early, though, because we now can get to reading through…
In just about two months, we will be dealing with our second ICD-10 code deluge from the Centers for Medicare & Medicaid Services (CMS). Our first deluge came last year, when over 5,500 new codes were added to the ICD-10 code set. Somewhat surprisingly, with about 4,000 new codes being…
EDITOR’S NOTE: This is the second installment in a three-part series by Sarah Laird on the issues and solutions associated with coder burnout. Remote work settings can constitute an adjustment for anyone, whether a team member or leader. The remote work setting typically provides flexibility in work hours, eliminates stressful commutes,…
As human beings, we are programmed with a desire to help others in need, but this is one of the reasons that hackers are so successful in infiltrating our networks.This week the Black Hat Conference takes place, followed by DefCon (in its 25th year); both cover the security landscape and feature plenty…
The second installment in a series of broadcasts highlighting the new 2018 ICD-10-CM/PCS code updates is coming up during the next edition of Talk Ten Tuesdays. There are changes in both the CM and PCS categories, plus new codes that impact other codes; reporting on these changes will be Patty…

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AUGUST 16: ICD-10-CM ChangesAUGUST 23: ICD-10-PCS ChangesAUGUST 30: Impactful Codes and Other IPPS Changes

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Thousands of new ICD-10 codes are coming your way, just in time for the Oct. 1, 2018 fiscal year. The changes are massive, and this coming Tuesday’s broadcast of Talk Ten Tuesdays marks the first in a series of reports to review them.

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The addendum for new codes coming out was recently released with many notable additions and deletions. The next several articles in this series will address some of these conditions in order to help us get ready for the October 1 implementation date.One of the things I love most about getting…
A recent conversation with a vice president of the revenue cycle for a large multi-hospital health system evolved into an active conversation on the merits of a fully staffed clinical documentation improvement (CDI) program versus a fully staffed and fully operational high-performing program. The two are distinctly different in their…
Important news recently came from the Centers for Medicare & Medicaid Services (CMS) with the earlier-than-expected July 13 release of the Outpatient Prospective System (OPPS) proposed rule. The rule can be found in its entirety online at https://federalregister.gov/d/2017-14883.Per CMS, “the proposed rule would revise the Medicare hospital (OPPS) and the…
The Healthcare Business Management Association (HBMA) Government Relations Committee was fortunate to have the opportunity to meet with Centers for Medicare & Medicaid Services’ (CMS) directors and Senate Ways and Means Committee staff the day the proposed rule was published.  As I think we all have recognized, the most significant changes…
Before there was the Gutenberg press, there were scribes: those charged with the arduous task of hand-copying documents. In ancient Judaism, scribes were recognized as record keepers.

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July’s designation as UV Safety Month comes as no surprise. July is the month of summer vacations, beach trips, and plenty of other outdoor activities. Because I have a family history of skin cancer, UV Safety Month holds a unique and important personal importance. When I was asked to author…
Are you current with all of the healthcare industry acronyms being freely tossed around in 2017? It is critical for you to understand what they mean and the role of health information management (HIM) in the new age.Although many HIM professionals have been exclusively acute care-focused in their careers, that…
As coders, we often face dilemmas without benefit of clear guidance, creating the feeling of being pulled in different directions. In today’s audit environment, coders need practical solutions to succeed in a setting of conflicting expectations. This article focuses on coding and clinical criteria dilemmas, and the value of having…
The key to any successful relationship is communication, and that applies to the relationship between physicians providing services in a practice and the hospital, coders, and billers.   Maintaining communication between physicians and coders often is a challenge because both parties are so busy. However, again, communication will make a…
MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, is back in the news. This past Tuesday, the Centers for Medicare & Medicaid Services (CMS) released its anticipated MACRA proposed rule for 2018 – one that would exclude approximately 134,000 small providers from participating in the program.

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Just as we’re getting our minds wrapped around the 2,398-page Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, published by the Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016 and becoming effective Jan. 1, 2017, a new proposed rule for 2018 was published on June 20,…
Clinical documentation integrity (CDI) as a profession is quite similar in nature to running a business. Successful businesses exhibit certain operational qualities and traits that serve to ensure continued growth and prosperity, and their leaders possess a long-term vision and ability to consistently meet, exceed, and solidly predict current and…
Physicians are quite honestly all over the place on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the legislation that permanently repealed the sustainable growth rate (SGR) formula that for years threatened to cut physician payments by about 20 percent, requiring annual congressional patches.Congress needed to pay for…
EDITOR’S NOTE: The Congressional Budget (CBO) on Monday scored the proposed Senate bill reporting 22 million more uninsured by 2026.On June 22, U.S. Senate GOP leadership unveiled the Better Care Reconciliation Act of 2017 (BCRA) to repeal the Patient Protection and Affordable Care Act (PPACA), known colloquially as “Obamacare” –…
Innovation has had a tendency to move at a glacial pace, and world history is littered with scientific discoveries that took a long time to reach us and have an impact on our lives.So many fields such as advanced math and complex numbers discovered in the 16th century were originally described…
June 22, 2017

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What lessons can be applied at your facility when monitoring coder productivity? Is coder productivity at your facility keeping pace with top performers, according to survey results from the largest ICD-10 productivity research study conducted to date?

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The Centers for Medicare & Medicaid Services (CMS) released the 2018 ICD-10-CM files last week, exciting many in the healthcare industry. The 2018 files contain information on the ICD-10-CM coding updates for the 2018 fiscal year. These 2018 ICD-10-CM codes are to be used for discharges occurring from Oct. 1,…
With the help of hindsight and data, we can now more accurately predict coding productivity and staffing needs. The run-up to ICD-10 had most of us very concerned, expecting to experience a decline in productivity of as much as 40 percent or more.  Early productivity reports, based on perceptions and/or…
Before I get into detail on this topic, let me establish a baseline understanding. Whether it be the Medicare Access and CHIP Reauthorization Act (MACRA) and value-based programs; the Healthcare Effectiveness Data and Information Set (HEDIS) measures, used to measure performance on important dimensions of care and service; or even…
As an ICD-10 trainer, five years ago I was knee-deep in instructor-led training. The landscape was exciting and new, and it was exhilarating to be part of training the coding workforce on an entirely new coding system.  Fast forward and here we are, almost two years into ICD-10 – and…
Wednesday, July 12, 2017  1:30-2:30 PM ET  12:30-1:30 PM CT  10:30-11:30 AM PT

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“With the daily interactions that need to be had with physicians related to their documentation, it is clear that all coding departments should have physician champions or physician advisors to help develop and strengthen the … critical link between coders and physicians,” Lisa Baker, MD recently wrote.

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So here is a different take on how important it is for coders and physicians to have a link with one another, and to respect the professionalism inherent in each field. The 2017 fiscal year ICD-10-CM Official Guidelines for Coding and Reporting recently produced a new guideline (I.A.19) that had…
In short, you can avoid sepsis denials when documentation in the patient encounter shows a clear delineation of a non-systemic infection. This is the only ironclad defense that will withstand any and all scrutiny. Sepsis clinical parameters are good for capturing and preempting even early sepsis cases, but unless the…
EDITOR’S NOTE: The following is the second installment in a three-part series on outpatient clinical documentation integrity.In Part 1 of this series, we detailed the concept of risk adjustment and how historically, the healthcare industry rewarded volume under the fee-for-service (FFS) model. The Centers for Medicare & Medicaid Services (CMS)…
I want to begin this article with a scenario: say sepsis due to MRSA (methicillin-resistant Staphylococcus aureus) is documented by the clinician and ICD-10-CM code A41.02 is captured by the coder. Assume that there are no secondary diagnoses or procedures. This leads to the assignment of MS-DRG (Medicare Severity Diagnosis-Related…
The American Hospital Association’s (AHA’s) second-quarter Coding Clinic for ICD-10-CM/PCS offers key coding advice and code assignments. Reporting on highlights in the official publication that was released May 17 during the next edition of Talk Ten Tuesdays will be Nelly Leon-Chisen, director of coding and classification for the AHA.

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These days, when healthcare IT expert Stanley Nachimson sees a Volkswagen, he’s likely to think of the $155 million whistleblower settlement involving electronic health record (EHR) vendor eClinicalWorks (ECW) announced last week by the U.S. Department of Justice.In its announcement, the Justice Department reported that ECW, headquartered in Westborough, Mass.…
EDITOR’S NOTE: The following a part of a series on outpatient clinical documentation integrity (CDI). Part IV was published on May 16, 2017 in the ICD10monitor e-News.The medical record serves primarily as a physician’s communication tool for patients and all associated healthcare stakeholders. The effectiveness and completeness of the documentation…
EDITOR’S NOTE: The following is part one in a three-part series on outpatient clinical documentation integrity.There is a great push within the healthcare industry to move clinical documentation integrity (CDI) into the outpatient arena. People refer to this as “outpatient CDI,” but I think this is a misnomer. If you…
Las Vegas is best known for its casinos, crowds, and Celine Dion. But now the city can also be recognized for coding and clinical documentation improvement (CDI). Why?The American Association of Professional Coders (AAPC) and HCPro’s Association of Clinical Documentation Improvement Specialists (ACDIS) both convened in Las Vegas during the…
A study just out by researchers at the University of California’s San Francisco Medical Center reviewed more than 23,000 progress notes over an eight-month period and found that less than 15 percent constituted new and unique content. Residents were the worst offenders, with 88.2 percent of their text being copied…
The prevalence of malnutrition in the elderly hospitalized patient; the physical, social, and psychological factors contributing to it; the documentation, treatment, and coding of it; and its impact on outcomes will be our lead story in the next edition of Talk Ten Tuesdays. Charles Winans, MD will be reporting on…

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As a health information management (HIM) coding professional, I always anxiously await the quarterly publication of the American Hospital Association (AHA) Coding Clinic for ICD-10-CM/PCS.  This is something that should be on all coding professionals’ calendars each quarter, and we should all allocate time to read through the content, noting…
Be adaptable and ready for change if you are responsible for payer reimbursements in your healthcare organization. The Centers for Medicare & Medicaid Services (CMS) has announced a large number of changes to diagnosis-related groups DRGs for 2018, along with changes in ICD-10-CM and PCS. Here is a quick summary…
An estimated 20 percent of all healthcare claims in the U.S. are denied each year. The financial impact for some hospitals is estimated to be in the range of $250 million annually.When denials are appealed, success rates can vary from 55 to 98 percent.Some hospitals are moving from denial management…
We continue our series of discussions exploring malnutrition – specifically, undernutrition – in hospitalized patients in more depth. Our topic is malnutrition in the elderly hospitalized patient, including the documentation and coding of it, its impact on outcomes, its treatment, and its prevalence and the physical, social and psychological factors…
Together on Talk Ten Tuesdays for the first time during the next edition of the weekly Internet broadcast will be healthcare IT expert and former Centers for Medicare & Medicaid Services (CMS) official Stanley Nachimson and George Vancore, director of IT integration for Blue Cross Blue Shield Florida. 

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I want to begin with a coding scenario: sepsis and pneumonia are documented, and the coder captures these conditions and assigns MS-DRG 871 and APR-DRG 720 with severity of illness (SOI) 2.  Sepsis presents challenges for coders as well as clinicians. I want to provide insight into the complex molecular…
Much attention and dedicated work have been devoted toward clinical documentation improvement and accurate, specific coding. Clearly, those are of great importance. However, I want to address the physician Part B insurance denials that have nothing to do with how good the clinical documentation is and how accurate the coding…
Recently, Dr. Joseph Cristiano did a Talk Ten Tuesdays DocTalk segment on his experience educating residents on clinical documentation at Wake Forest University. We received a follow-up question from Suzanne, so I am focusing this article on more details about resident training. During my stint as physician advisor (PA) at…
EDITOR’S NOTE: The following is part of a series on outpatient clinical documentation integrity (CDI). Part III was published on May 9, 2017 in the ICD10monitor eNews.Outpatient CDI specialists must first and foremost exhibit the mindset and display characteristics of a businessperson. This individual should be capable of identifying, developing,…
Well-respected coding authority Laudine Markovchick, manager of coding and learning and development for H.I.M. On CALL, Inc., will report our lead story on the rising number of denied claims under ICD-10 during the next edition of Talk Ten Tuesdays. The issue of claim denials is impacting cash flow and revenue…

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Providers, nurses, clinical care specialists, health information management (HIM) and utilization review professionals, clinical coders, and clinical documentation integrity specialists (CDISs) are all key to ensuring the integrity of coding, which is an essential requirement in denials mitigation. Collaboration is the theme of my presentation at the American Academy of…
Now that ICD-10 has been with us a while, the most frustrating tasks that hospitals are dealing with are claims denials. Whether for line items or entire stays, they present significant challenges as it pertains to revenue and resources. Does your facility have the proper process in place to handle…
The Centers for Medicare & Medicaid Services (CMS) and third-party auditors are going after sepsis admissions for which patients are discharged within 72 hours. It may seem preposterous, from the hospital’s perspective, that they are being allegedly unfairly targeted for payment denials for sepsis admissions. But is this actually the…
EDITOR’S NOTE: The following a part of a series on outpatient clinical documentation integrity (CDI). Part II was published on April 25, 2017 in the ICD10monitor eNews.Critical to the successful rollout of an outpatient clinical documentation improvement (CDI) program is the selection and hiring of employees to staff the program.…
The complex and complicated diagnosis of sepsis is still cofounding many in healthcare. But there’s new hope for a better understanding of sepsis. During what is expected to be a remarkable broadcast, Talk Ten Tuesdays special guest Dr. Wilbur Lo will discuss the disease at a molecular and cellular level…

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There is good news and bad tucked away in the details of the 2018 proposed Inpatient Prospective Payment System (IPPS) Final Rule released last week by the Centers for Medicare & Medicaid Services (CMS).Some acute-care hospitals could see a decrease in their case mix index (CMI), as a number of…
EDITOR’S NOTE: The following is a physician’s perspective on the Sandy Brewton article, “LHC vs Coronary Angiography: Take Heart When Coding.”I was one of those physicians who once thought a left heart catheterization was done with the coronary artery angiography procedure. That’s because, in the strictest, semantic sense of the…
Is your provider performing a left heart catheterization every time a coronary angiography is performed? Are you coding a left heart catheterization procedure code every time you code coronary angiography procedures? Can coronary angiography be performed without a left heart catheterization? If you are unable to answer these questions with…
As we reflect on the transformation into spring, with large parts of the country still confronted by temperatures in the mid-30s at night and days when temperatures creep up into the high 70s, we are reminded of the profound disparity that was created between physicians and coders when the Society…