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SPECIAL GUEST Joseph C. Nichols, MD Health Data ConsultingGUEST CO-HOST Holly Louie, RN, CHBME Healthcare Billing and Management Association ALSO FEATURING Rudy Braccili, Jr., MBA, CRCE; Sarah Laird, RHIA, CCS; Dennis Jones

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It’s so important that we in the healthcare industry continue our discussion regarding the topic of Hierarchical Condition Categories (HCCs), as the risk-adjusted payment models are increasing in prevalence.The assignment of HCCs and risk adjustment has extended beyond Medicare Advantage plans as a result of the Patient Protection and Affordable…
What could be most directly impacting reimbursement among hospitals and health systems? The problem could be, in many cases, the selection of principal diagnoses, since they drive the medical diagnosis-related groups (DRGs).For past 12 months, the health information management (HIM) consulting division at Panacea Healthcare Solutions has been conducting ICD-10 coding reviews among the nation’s…
With more than a full year under ICD-10, it seems it is reasonable to expect local coverage determinations (LCD) to be current and correct. After all, everyone in the industry knew there were errors and omissions in some national and local policies.Many had already been pointed out. And yes, some…
The coding landscape in physician practices is changing rapidly as healthcare moves toward value-based care and quality payment models. Medical practice coding for ICD-10 plays a key role in quality reporting under the new Quality Payment Program (QPP), which was recently solidified by the Medicare Access and CHIP Reauthorization Act…
FEATURING Rudy Braccili Jr. MBA, CPAM, CRCE; Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, RHIT, AHIMA Approved ICD-10-CM/PCS Trainer; Barbara Hinkle-Azzara, RHIA; Laurie Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer; and Erica Remer, MD, FACEP, CCDS

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Often we talk about the patient care team and who makes up that special group of professional caregivers. We similarly look at the role that the coding professional plays in healthcare and with that team in particular. Certainly there can be clarifications made regarding the “direct” patient care team, and…
Two major rules published last month included major changes to the healthcare industry. First, the Centers for Medicare & Medicaid Services (CMS) issued its long-awaited Medicare Access and CHIP Reauthorization Act (MACRA) final rule on paying Medicare Part B providers for quality and performance. This new system, titled the Merit-Based Incentive…
It is very important to stay current with the latest coding guidance from official coding resources. Coding Clinic, published by the American Hospital Association (AHA), has released Fourth Quarter 2016. There are six key takeaways from this issue: Diabetes and Osteomyelitis: Previously, the official coding guidelines for this combination stated that…
While most legacy clinical documentation improvement (CDI) programs have been doing a good job at preserving revenue under the MS-DRG system, a potential blind spot exists. Value-based and alternative payment models (APMs) rely on the concept of risk adjustment to determine final payment in acute care. The Centers for Medicare &…
While most legacy CDI programs have been doing a good job at preserving revenue under the MS-DRG system, a potential blind spot exists as Value-Based and Alternative Payment Models rely on the concept of Risk Adjustment to determine final payment in acute care. The Centers for Medicare & Medicaid Services risk…
SPECIAL GUEST Melissa M. Martin, RHIA, CCS, CHTS-IM Chair of the AHIMA Board of DirectorsALSO FEATURING Rudy Braccili, Jr., MBA, CPAM, CRCE; Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified AHIMA Clinical Documentation Improvement Practitioner; Laurie Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10 CM/PCS Trainer; and Stanley…

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This is the second installment in my series of articles addressing clinical validation denials. Clinical validation denials (CVDs) are the derivatives of diagnosis-related group (DRG) coding validation denials. The latter is a rejection of a claim on the basis of reviewing physician documentation and determining that the correct codes or…
With the specificity of ICD-10, it is important to use tools and technology to assist with coding. Computer-assisted coding (CAC) is one method that can benefit a practitioner, but can also harm them if it is not set up or used appropriately. Technology is only as good as it is programmed,…
All healthcare providers must now be (ICD-10) coding to the highest level of specificity. The ICD-10 flexibilities available during the first year of implementation are gone for physician billing.As of Oct. 1, 2016, all providers are required to code to accurately reflect the clinical documentation in as much specificity as…
“Sully,” the Clint Eastwood-directed movie about US Airways Captain Chesley “Sully” Sullenberger, played by Tom Hanks, recounts the dramatic emergency landing Sullenberger made on the Hudson River after his airliner’s two engines were disabled when struck by a flock of geese.While the newest commercial jets feature onboard flight-control computers, making…
Since August, scary clown activities and sightings started to escalate in the United States, and they have spread internationally. In response, McDonald’s announced that it was giving its clown mascot, Ronald McDonald, a break, and Target took some clown masks and costumes off the market.Some of these sightings have turned…
FEATURING Rudy Braccili, Jr., MBA, CPAM, CRCE; Laurie Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10 CM/PCS Trainer; H. Steven Moffic, MD; Erica E. Remer, MD, FACEP, CCDS;
and Michelle Wieczorek, RHIT, RN, CPHQ

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When we look back on what we learned in our first year of ICD-10, it’s clear that some providers were and some were not fazed by the Oct. 1, 2015, implementation date. As I reflect on conversations with our customers (at MediRegs, we service customers across the spectrum, including but…
ICD10monitor’s resident psychiatrist, H. Steven Moffic, MD, who is also a popular guest on Talk Ten Tuesdays, recently received the received the Administrative Psychiatry Award from the American Psychiatric Association (APA) and the American Association of Psychiatrist Administrators (AAPA). The award was presented to Moffic on Oct. 6, during the fall…
Are you familiar with IBM’s supercomputer Watson? IBM’s stated aspiration is to make it “the world’s best diagnostician,” because it can store way more medical information than a human doctor and makes decisions based on evidence, free of cognitive biases. It is consistent, and, according to the company, “given the…
Providers nationwide have been scratching their heads for some time now over how to combat the increasingly problematic issue of clinical downgrading of diagnosis-related groups (DRGs) by auditors.Mount Sinai Health System in New York City might not have the solution – but it sure does have a game plan.The System’s…
Providers nationwide have been scratching their heads for some time now over how to combat the increasingly problematic issue of clinical downgrading of diagnosis-related groups (DRGs) by auditors.Mount Sinai Health System in New York City might not have the solution – but it sure does have a game plan.The System’s…
October 19, 2016

HRS

By
SPECIAL GUEST Erica E. Remer, MD, FACEP, CCDS; Founder and President, Erica Remer, MD, Inc.ALSO FEATURING Maria Bounos, RN, MPM, CPC-H, PMC, CSPO; Rudy Braccili, Jr., MBA, CRCE; Sandra L Brewton, RHIT, AHIMA-Approved ICD-10-CM/PCS Trainer; and Laurie Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10 CM/PCS Trainer

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I chose the titular subject for this article because many of us have been focusing on ICD-10-CM and PCS – and while CM is used by both inpatient and outpatient coders, we may have lost sight of CPT and HCPCS.CPT and HCPCS education is as important as ICD-10, especially considering…
Live reporting from the 2016 national convention of the American Health Information Management Association (AHIMA) continues today on Talk Ten Tuesdays, the weekly Internet radio program produced by ICD10monitor.In addition to the long-running regularly scheduled Talk Ten Tuesdays broadcast heard at 10 a.m. EST, two other broadcasts will air today, with…
The use of computer-assisted coding (also known as CAC) software is becoming more widespread in the coding industry, particularly in the coding of inpatient claims.It’s not a surprising trend, really, given the many known benefits of implementing a CAC system. Computer-assisted coding software helps streamline the coding workflow, reducing backlogs…
The use of computer-assisted coding (also known as CAC) software is becoming more widespread in the coding industry, particularly in the coding of inpatient claims.It’s not a surprising trend, really, given the many known benefits of implementing a CAC system. Computer-assisted coding software helps streamline the coding workflow, reducing backlogs…
In my previous article, Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant, I suggested that one of the actions to prevent unjustified clinical validation denials (CVDs) is to perform concurrent clinical documentation integrity (CDI) reviews and pre-bill audits. Permit me to expound on the role of CDI reviews in…
Live reporting from the 2016 national convention of the American Health Information Management Association (AHIMA) continues today on Talk Ten Tuesdays, the weekly Internet radio program produced by ICD10monitor.In addition to the long-running regularly scheduled Talk Ten Tuesdays broadcast heard at 10 a.m. EST, two other broadcasts will air today, with…
I chose the titular subject for this article because many of us have been focusing on ICD-10-CM and PCS – and while CM is used by both inpatient and outpatient coders, we may have lost sight of CPT and HCPCS.CPT® and HCPCS education is as important as ICD-10, especially considering the…
SPECIAL GUEST: Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS Chief Operating Officer, First Class Solutions, Inc.ALSO FEATURING: Larry Field, Larry Field DO, MBA, CHCQM, CPC, CHC, LHRM; Andres Jimenez, MD; Laurie M. Johnson, MS, RHIA, FAHIMA; and Stanley Nachimson

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Hospitals paid under the Outpatient Prospective Payment System (OPPS) could receive a rate increase of 1.6 percent starting on Jan. 1, 2017, according to the proposed rules issued by the Centers for Medicare & Medicaid Services (CMS) on July 6, 2016.All integral, ancillary, supportive, dependent, or adjunctive services will continue…
Are you an organ donor? Before October 2005, I did not think much about this question. You may ask what happened in October 2005. My cousin had a heart transplant that month. He had been on the heart transplant list since October 1996. My cousin was 45 years old and…
EDITOR’S NOTE: National Hispanic Heritage Month runs from Sept. 15 through Oct. 15. In recognizing the healthcare contributions of Hispanics, ICD10monitor reached out to Andres Jimenez, MD. His story follows, as told to Chuck Buck.He naturally considered being a physician. His father was a surgeon in the Republic of Colombia…
EDITOR’S NOTE: During a recent Talk Ten Tuesday broadcast, listeners were asked “what percent of your claims are downgraded by third-party payers?” Downgrading by third-party payers occurs when the hospital-billed DRG is changed upon review by health insurance auditors to a lower-paying DRG. The majority of those who responded, over 51 percent,…
SPECIAL GUEST James Jones, MD Vice President of Administration and Senior Medical Director of CDQI Mount Sinai Health System New York, NY GUEST CO-HOST Maria T. Bounos RN, MPM, CPC-H, PMC, CSPO Wolters KluwerALSO FEATURING Rudy Braccili, Jr., MBA, CRCE; Laurie M. Johnson, MS, RHIA, FAHIMA; Laurie A. McBrierty, MLT,…

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The Centers for Medicare & Medicaid Services (CMS) has announced that the proposed rule for bundled payments (also known as episode payments) for high-quality, coordinated cardiac and hip fracture care modules will be targeted for initial implementation in 98 randomly selected metropolitan demonstration areas starting in July 2017. The full phase-in…
Prescription Opioid and Heroin Epidemic Awareness Week was observed from Sept. 19 -25, 2016. Prescription painkillers have taken the lives of more than 165,000 Americans since 1999. And even more lives have been lost globally.President Obama is asking for $1.1 billion in federal funding to address this healthcare and community…
For coders and clinical documentation improvement (CDI) specialists, the nuances and changes regarding coding superbug infections remain as dynamic as the pathogens themselves. Medication resistance, and especially antibiotic resistance, can be a challenging issue in the coding world.The bacteria in question include enterococcus, staphylococcus, klebsiella, acinetobacter, pseudomonas, and enterobacter. In…
There were no reports of major collisions on the I-10 Thursday, Oct. 1. Computer systems failed to crash and everything was pretty much business as usual for America’s healthcare system on a day some once thought might lead to a year of calamity. It didn’t happen. Remarkable for its absence of…
Modernmagic will work with you to create the best medical website solution for your specific needs. modernmagic.com
SPECIAL GUEST Sonya Manuel LPN, CCS, CCS-P, CHC, AHIMA-Approved ICD-10-CM/PCS Trainer Jzanus Consulting, New YorkALSO FEATURING Rudy Braccili, Jr., MBA, CRCE; Sandra L Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer; and Laurie M. Johnson, MS, RHIA, FAHIMA, FAHIMA Erica Remer, MD, FACEP, CCDS

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The goal was to avert fraud, waste, and abuse.We all support that – we collectively pay for Medicare, and who likes throwing their money away?Let’s review the ideal: the patient receives excellent medical care, the provider does a good job documenting that care, the coder translates the documentation into codes…
Throughout the country, physicians have been taught to make sure that they capture all of the elements of history of present illness (HPI), review of systems (ROS), past family and social history (PFSH), and physical exam (PE). However, either they have not been taught or have failed to show that…
Of all the challenges associated with the transition to ICD-10-PCS, coding spinal fusion procedures is by far the most difficult to tackle, in this author’s opinion. Even after training, many coders still struggle with the complexities of coding these procedures. This article focuses on the importance of thoroughly reviewing operative…
Over the many weeks since the release of the updates to the ICD-10-CM Official Coding Guidelines for the 2017 fiscal year, I have had the opportunity to engage in multiple conversations about the most controversial guideline, which addresses the use of clinical indicators for code assignment.   Some of those conversations…
SPECIAL GUEST Larry Field DO, MBA, CHCQM, CPC, CHC, LHRM, ICD10 CM/PCS Trained; Baldrige Quality Trained Treasurer- American College of Physician AdvisorsALSO FEATURING Sue Bowman, MJ, RHIA, CCS, FAHIMA; Rudy Braccili, Jr., MBA, CPAM, CRCE; Sandra L Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer; and Laurie M. Johnson, MS,…

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The 2017 Inpatient Prospective Payment System (IPPS) guidelines contain several fundamental changes, and certainly some challenges insofar as clinical documentation improvement (CDI) and coding practices are concerned.As an advocate for integration of coding guidelines into our CDI practice, the 2017 IPPS certainly offers an opportunity for tighter collaboration between the…
September 19, 2016

ICD-10: Coding the Killers

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As it does every year, the Centers for Disease Control and Prevention (CDC) recently released its list of the leading causes of death in the United States. With the transition to ICD-10 and new codes facing provider organizations looming on Oct. 1, 2016, what should coders be aware of regarding this list? A…
If you would allow me to vent a little today, then please indulge me. If you are not in the particular mood for what some might call a rant, well, you should read anyway, because this promises to be an entertaining and thought-provoking example.    The topic is a common criticism…
I often hear auditors and coding leaders say that their physicians are pretty good at listing rationale for their diagnoses of sepsis, acute respiratory failure, and encephalopathy. However, commercial insurance continues to deny their claims.They are very frustrated – and wondering if the new ICD-10-CM guideline will help. What they…
FEATURING Rudy Braccili, Jr., MBA, CRCE; Sandra L Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer; David Glaser, Esq.; Laurie M. Johnson, MS, RHIA, FAHIMA, FAHIMA; and Stanley Nachimson

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EDITOR’S NOTE: Laurie Johnson will be reporting live from the ICD-10 Coordination and Maintenance Committee meeting getting underway today. Her report will be carried during this week’s edition of Talk Ten Tuesdays, the Internet radio broadcast produced by ICD10monitor.When are Type II myocardial infarctions (MIs) not really MIs?Intensely debated during the…
The new guideline instructing coders not to use clinical indicators for code assignment has generated considerable interest. I have received many emails from colleagues, and even some from physicians, voicing concerns or sharing enthusiasm for coding and documentation integrity.No matter what your stance is on this guideline, it is clear…
Physician practices have had nearly a year to acclimate themselves to the ICD-10 coding that took effect in October 2015. Thanks to a grace period known as ICD-10 “relaxed rules,” which were established jointly by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA), the…
FEATURING Betty B. Bibbins, MD, BSN, CHC, CI-CDI, CPEHR, CPHIT; Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, CENTC, COBGC, CPEDC, CGSC; Laurie M. Johnson, MS, RHIA, FAHIMA, FAHIMA; and Michelle Wieczorek, RN RHIT CPHQ

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EDITOR’S NOTE: This is the second piece in a series of articles on the issue of burnout among healthcare professionals – a problem leading medical experts say is not only increasing in prevalence, but also intensity. During the coming month, several of these experts will be making appearances on Talk-Ten-Tuesdays, the…
ICD10monitor and RACmonitor have been covering the controversy that the release of the 2017 ICD-10 Official Coding and Reporting Guidelines has drummed up yet again.Two excellent articles this past week were “Coding Conundrum: Clinical Indicators for Code Assignment” by Sandra Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer; and “Developing:…
In the final rule for the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) PPS for the 2017 fiscal year, the Centers for Medicare & Medicaid Services (CMS) continues to move the Medicare program toward paying providers based on the quality, rather than the quantity, of care…
The new year for diagnosis codes begins Oct. 1, 2016. That date also marks the end to the moratorium on new codes that has been in place since Oct. 1, 2011. For the upcoming year, there are 1,974 code additions, 311 deletions, and 425 revisions. In addition to many new, more…
SPECIAL GUEST James S, Kennedy, MD, CCS, CDIPALSO FEATURING Rudy Braccili, Jr., MBA, CRCE; Sandy Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer; Laurie M. Johnson, MS, RHIA, FAHIMA, FAHIMA; and H. Steven Moffic, MD

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With the 2017 ICD-10-CM and PCS coding update on the horizon, we in the healthcare industry have a lot to talk about.One of the most important and possibly controversial updates affects Section I of the ICD-10-CM Official Guidelines for Coding and Reporting. This new guideline, titled Code assignment and Clinical…
Renewed interest in ICD-10 education has been prompted by the announcement last Thursday from the Centers for Medicare & Medicaid Services (CMS) indicating that the Medicare ICD-10 flexibilities agreement will end and will not be extended beyond Oct. 1, 2016.CMS also stated that Medicare would not “phase in” the requirement…
The 2017 Inpatient Prospective Payment System (IPPS) final rule brings with it a number of changes that are likely to have an even bigger impact on documentation, coding, and revenue than ICD-10 itself. An unprecedented number of dramatic changes will go into effect on Oct. 1.I knew that things were…
EDITOR’S NOTE: This is the second in a series of articles on the issue of burnout among physicians – a problem leading medical experts say is not only increasing in prevalence, but also intensity. During the coming month, several of these experts will be making appearances on Talk-Ten-Tuesdays, the weekly Internet…
Renewed interest in ICD-10 education has been prompted by the announcement last Thursday from the Centers for Medicare & Medicaid Services (CMS) indicating that the Medicare ICD-10 flexibilities agreement will end and will not be extended beyond Oct. 1, 2016.CMS also stated that Medicare would not “phase in” the requirement…
SPECIAL GUEST Sue Bowman, MJ, RHIA, CCS, FAHIMA ALSO FEATURING Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer; Allen Frady, RN, BSN, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer; Laurie M. Johnson, MS, RHIA, FAHIMA, FAHIMA; and Rhonda Taller, MHA

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EDITOR’S NOTE: This is the first in a series of articles on the issue of burnout among physicians – a problem leading medical experts say is not only increasing in prevalence, but also intensity. During the coming month, several of these experts will be making appearances on Talk Ten Tuesdays, the…
One item that has not yet received much attention is a guideline addressing the ability of a facility to report or not to report a diagnosis provided by a physician.What is a facility to do when a physician documents a diagnosis that may be unsupported by the clinical circumstances reflected…
We all know how important clinical documentation is to patient care, and from a compliance standpoint, it is also crucial to auditing – but for those dealing with the financial side of healthcare, the importance may translate into reimbursement losses. Let us look at a clinical scenario.Say an 80-year-old male…
The Centers for Medicare & Medicaid Services (CMS) released the Inpatient Prospective Payment System (IPPS) final rule for the 2017 fiscal year on Aug. 2, one day after its federally mandated deadline. This final rule will be effective for inpatient discharges taking place on and after Oct. 1, 2016.There were…
SPECIAL GUEST H. Steven Moffic, MDALSO FEATURING Chris Bundy, MD, MPH; Larry Field, DO, MBA, CHCQM, CPC, CHC, LHRM ICD-10CM/PCS-Trained, Baldrige Quality Trained; Laurie M. Johnson, MS, RHIA, FAHIMA, FAHIMA; and Melissa Walton-Shirley, MD

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Well, the long-anticipated ICD-10-CM Official Coding and Reporting Guidelines for the 2017 fiscal year have been released, and there are definitely some key areas on which to focus. The Guidelines still are to be organized into sections. Section I includes the structure and conventions of the classification and general guidelines…
When I think back on all of the road trips I went on with my family when I was a child, I don’t remember how many miles we drove. We once traveled from Arizona to West Virginia – quite a long trek across the country. But what I do remember…
Last spring I wrote about the new third definition of sepsis with a fair amount of enthusiasm and excitement. From my perspective, this new definition was the answer to the ever-present criticism of sepsis criteria – namely, the notion that people who meet the criteria often are not septic. The…
Physicians can benefit from the talents of their medical assistants, and possibly in areas other than ICD-10.Medical assistants (MAs) are typically members of physician office teams. If certified, these individuals have completed a structured education program with courses in anatomy, medical terminology, coding, and disease processes. They are among the…
SPECIAL GUEST Barbara Hinkle-Azzara, RHIA, HRSALSO FEATURING Rose T. Dunn, MBA, RHIA, CPA, FACHE; Ronald Hirsch, MD, FACP, CHCQM Laurie Johnson, MS, RHIA, FAHIMA; and Stanley Nachimson

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Given the massive number of new ICD-10 codes and the Oct. 1, 2016 compliance date, HRS and ICD10monitor are producing a special-edition Internet broadcast that will focus on the imperative of pre-bill auditing.The free broadcast will air live at 1:00 p.m. on Thursday, Aug. 4. The 60-minute live event is being sponsored…
In order to determine what makes a query leading versus non-leading, I would like to use a coding question I received recently. It goes like this… “Our doctors here frequently document ‘acute respiratory distress.’ They are using J80 for this, which codes to ‘acute respiratory distress syndrome’ (ARDS).”I responded by noting that…
Though ICD-10-PCS (procedure) codes are only required for billing purposes on inpatient claims, ICD10monitor wanted to know how many of you are using them for your outpatient claims.For billing purposes, facilities are only required to code and submit CPT® codes for outpatient services; however, pre-ICD-10 implementation, many facilities captured both…
One of the most vexing issues coding professionals face when coding for infusions and drug administration is the absence of start and stop times.According to the Centers for Medicare & Medicaid Services (CMS) Transmittal 902, hospitals are to report codes that indicate the actual time in which an infusion is…