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Some payers will take back the fee-for-service payment if the wrong diagnosis code is selected. There have been many conversations had since the healthcare industry moved to ICD-10-CM, and many more guidelines developed regarding when to query a physician, which has sparked even more debate. Guideline 19 in ICD-10-CM states:…
Two-thirds of the 27 million annual ED visits by privately insured people in the U.S. are avoidable. Hospital emergency departments (EDs) have long been known as the front lines of healthcare. Especially for communities facing issues associated with the now-infamous social determinants of health (SDoH), EDs provide a site for a…
Don’t preoccupy yourself with DRGs, CCs and MCCs. I don’t think about my previous life as a practicing physician much, but I took a little trip down memory lane this morning. When I was on my pediatrics rotation in Buffalo, I had a supervising resident who had the most profound…
In performing my emergency department documentation audit, I ran across a curious practice regarding critical care time documentation. I had to do some investigating and thought I would share my findings with you. Background: Critical care time (CCT) can only be billed for critical patients. A critical patient according to…
Wrapping your brain around Cerebral Edema You may be noticing an uptick in clinical validation denials for cerebral edema. Here’s my take on this. There are two distinct cerebral edema codes. They both serve as major comorbidity conditions or complications (MCCs). Non-traumatic conditions, which are accompanied by cerebral edema, get…
Applied correctly and consistently, these can solve the problem of missing query opportunities. With each passing year, it seems that clinical documentation improvement (CDI) branches out into new territory. In addition to performing everyday CDI tasks, it is now becoming more important than ever for CDI specialists (CDISs) to understand…
Mid-revenue cycle is becoming increasingly important for driving financial stability. How do you define revenue cycle management (RCM)? Have you clearly delineated what is included in the front, middle, and back of RCM for your facility? You must do so before you can appropriately address the resource requirements for each…
For some coders, confusion exists when coding for critical care services. Code 99291 is used for critical care, evaluation, and management of a critically ill or critically injured patient, specifically for the first 30-74 minutes of treatment. It is to be reported only once per day, per physician or group member of…