News

The goal should be a 100 percent response rate. On a recent onsite, one of the clinical documentation integrity specialists (CDISs) asked me my opinion on how assiduous a clinical documentation integrity (CDI) professional should be to get a query answered. My response may surprise some of you. I must…
“Separate procedure” may not mean what you think. Many procedural codes in the CPT® Book are designated as “separate procedures.” However, the common misinterpretation of this is that coders can report such codes as such in every case. Not true. First, you must consider: Were there other procedures performed during…
Developing a team approach can positively impact coding quality and reduce coding errors. Coding professionals are faced with a myriad of challenges that can significantly impede coding quality. Such challenges include ongoing, increasing pressure to meet management productivity standards and CFO expectations to drop bills in a timely manner to…
Is the healthcare industry tone deaf to physicians’ complaints? The Physicians Foundation 2018 Physician Survey, published on Sept. 18, 2018, features opinions of our nation’s physicians—opinions that are sobering and should sound a loud wake-up call.  When distilled down to the very essence of the report, the “fixes” for our…
Understanding the correct use of chronic condition codes in the coding process. Coders are often confused regarding when they should code co-morbid chronic conditions and when they should not. This leads to inaccurate coding of levels, or sometimes missing out on the opportunity of stressing each patient’s true clinical conditions,…
CMS and ONC get serious about interoperability during HIMSS.During the HIMSS 19 conference in Orlando last week, the heads of the Office of the National Coordinator (ONC) for Health Information Technology and the Centers for Medicare & Medicaid Services (CMS) took extraordinary steps by discussing the content of two proposed…
A National Coverage Determination (NCD) will reimburse providers for diagnostic tests using sequencing.Today’s topic is DNA sequencing and its effect on society as a whole, on healthcare, and on Medicare. Sequencing is a laboratory procedure that maps the pattern of nucleotides in DNA. In 2003, sequencing an individual cost $2.7…
CDI professionals can’t mitigate the magnitude of medical necessity denials by third-party payers. Clinical documentation integrity (CDI) programs, combined with the actions of third-party payers, can erode net patient revenue for inpatient and outpatient services through process design. In reviewing one particular inpatient case with $118,000 in charges denied by…