“I was an ED patient recently,” wrote Robert, a listener of the last edition of Talk Ten Tuesdays. “After receiving and reviewing my electronic medical record, it (was) revealed (that) the entire physical exam was counterfeit – no exam was performed. I was fully alert and my wife was present, yet (no) complete…

AHIMA conference programs include subjects designed to improve one’s proficiency in the areas of coding, documentation and compliance.The American Health Information Management Association (AHIMA), holding its annual convention and exhibit in Los Angeles this week, has as a theme, “Inspire, Innovate and Lead.” It  is a joy to attend as…

With two recent major disasters confronting caregivers, the question remains: are caregivers prone to experience PTSD than others? Exhibiting a wealth of knowledge and instinct, honed and sharpened by experience, medical first responders and emergency room professionals triage and treat thousands of emergency department (ED) patients each year in America’s hospitals.…

The mass shooting in Las Vegas has prompted renewed attention on emergency medicine and trauma care and especially on the clinical documentation of care in this setting. I practiced emergency medicine (EM) for twenty-five years before I transitioned to being a physician advisor. My expertise had been in the professional…

Major financial penalties loom for providers not following reporting requirements.We are more than halfway through the first year of the Medicare Access and CHIP Reauthorization Act (MACRA), and a majority of clinicians still do not understand the program.In fact, the Centers for Medicare & Medicaid Services (CMS) reported that an…

Painful to recall, yet now burned into the nation’s consciousness, are the gruesome scenes and sounds from last Sunday night’s shooting massacre during an outdoor music festival in Las Vegas, an event that left 59 dead and more than 500 injured.

Puerto Rico hospitals continue to struggle in the aftermath of Hurricane Maria.Reporting that only nine of 61 hospitals in Puerto Rico have electric power, a hospital billing company representative told Talk-Ten-Tuesdays listeners this past Tuesday that the lack of electricity is one of the biggest problems residents of the U.S.…

ICD10monitor is producing a two-day series of broadcasts featuring industry thought leaders presenting at the AHIMA 2017 Conference in Los Angeles next week.ICD10monitor will be broadcasting live from the American Health Information Management (AHIMA) 2017 Conference in Los Angeles next week, with a long lineup of subject matter experts scheduled…

Artificial intelligence is poised to be the next big revolution in healthcare. Are you ready?There isn’t a day that goes by without a story in the news on artificial intelligence, or AI, as we’ve come to know it. From Amazon’s Alexa and Samsung’s Bixby, to Apple’s Siri and IBM’s Watson,…

Now that the compliance deadline for implementing ICD-10 codes has passed, ICD-11 is already on the horizon. For the very latest news on this development, be sure to listen to the upcoming edition of Talk Ten Tuesdays, when Robert Jakob with the World Health Organization (WHO) will provide you with…

A comprehensive look at how clinical documentation improvement and the actual practice of medicine overlap.There are a multitude of business and ancillary healthcare processes that serve to support the practice of medicine. That practice centers on direct patient care, facilitated and dependent upon specific synergistic processes that contribute to cost-effective,…

MACRA continues to be a subject that perplexes providers even as the program evolves.It has been recently confirmed that the Comprehensive Care for Joint Replacement (CJR) bundled payment has been cut from 67 to 34 percent in the program, and the carding rehabilitation incentive with bundled payments has been cancelled.…

Toting boxes filled with plaques, awards, and photos earned from decades of professional advocacy, speaking, writing, and volunteer work in the field of health information management (HIM), Gloryanne Bryant soon will gather her personal effects, take the elevator from her Oakland-based Kaiser Permanente (KP) office down to the lobby, and…

A new set of codes for blindness and low vision was recently released, and with that brings many changes for documentation and coding. The codes are effective Oct. 1, 2017and come as a result of a campaign by the World Health Organization (WHO), which in 2013 advocated for greater clarity…

Senate Republicans will not vote to repeal and replace Obamacare. Congress must still deal with many other healthcare initiatives before Sept. 30. Who doesn’t love a good to-do list? But when it comes to what Congress is looking to accomplish in September, let alone before the end of the year,…

Hospital CDI managers always look for process improvement. Essentia Health’s outpatient CDI operation provides a practical case study. EDITOR’S NOTE: This the final installment in a two-part series on the clinical documentation integrity department at Essentia Health, a health system that serves Minnesota, Wisconsin, North Dakota, and Idaho.Becker’s Hospital Review…

ICD-10 codes for blindness and low vision are effective Oct. 1, 2017 and reflect parameters from the World Health Organization (WHO). A new set of codes was released for use beginning on Oct. 1, 2017. The category, H54, includes codes for blindness and low vision and with that brings many…

New developments in interoperability and mobile health technology were presented at the Translational Medicine Conference in Northern Ireland where the new Patient Buddy app was revealed. I attended the innovative eighth annual Translational Medicine Conference (http://www.c-tric.com/wp-content/uploads/2017/09/c-tric_conferenceprogramme_tmed8_v19w.pdf) this past week in Derry/Londonderry, Northern Ireland, an event hosted by the Clinical Translational…

EDITOR’S NOTE: As the floodwaters caused by Hurricanes Irma and Harvey recede, anxiety is expected to rise as residents in impacted cities and states recover. Some even could experience post-traumatic stress syndrome (PTSD). During the past two weeks, H. Steven Moffic, a former resident of Houston, has been closely monitoring…

Tens of thousands of Americans are now living in shelters.

Much was covered during the ICD-10 Coordination and Maintenance Committee (C&M) meeting last week at the Centers for Medicare & Medicaid Services (CMS) headquarters in Baltimore.The first striking item was that there were no procedure proposals made during this meeting. There was discussion about three root operations – creation, control,…

EDITOR’S NOTE: This is the second installment in a two-part series on the coding and documenting of social determinants of health (SDoH). It comes on the heels of the aftermath of Hurricanes Harvey and Irma and their impact on victims and survivors in the flood-ravaged states of Texas and Florida.The…

EDITOR’S NOTE: During a recent Talk Ten Tuesdays, Candice, a listener, asked Erica Remer, MD a question about pyloromyotomy root operation. Dr. Remer’s response appears below.Paraphrased, the question posed centered on the notion that references previously recommended using dilation as a root operation because the intent of pyloromyotomy is to…

In the coding and clinical documentation community, we are still trying to sort out sepsis. In my previous article on this topic (https://www.icd10monitor.com/sepsis-then-and-now-how-the-oldest-disease-continues-to-plague-providers-part-ii), I made some recommendations on how to approach sepsis. We need to revisit this.We have now had some time to live with the Sepsis-3 criteria, established by…

EDITOR’S NOTE: This the first in a two-part series on the clinical documentation integrity department at Essentia Health, a health system that serves Minnesota, Wisconsin, North Dakota, and Idaho.Previously, Essentia Health’s clinical documentation improvement (CDI) department consisted of three segregated, separated, regional teams. Employees had minimal interaction with each other.…

EDITOR’S NOTE: This is the first in a two-part series on the coding and documenting of social determinants of health (SdoH). It comes on the heels of the aftermath of Hurricanes Harvey and Irma and their impact on victims and survivors in the flood-ravaged cities of Texas and Florida. Hurricanes…

Now it’s just a little less than three weeks until the beginning of October and when the fiscal year (FY) 2018 changes for ICD-10-CM take effect.  Here is a summary of the new changes for ICD-10-CM: 360 new code additions 142 deletions 250+ revisions The Centers for Medicare and Medicaid…

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…

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,…

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.  

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. 

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.

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.

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…

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

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.

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.

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.

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…

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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?

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