News

EDITOR’S NOTE: This is the second portion of a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. In our second example, a 73-year-old female presented to the hospital with syncope following a fall at a physician office: The provider assigned I67.1 (Cerebral…
EDITOR’S NOTE: Five Looking at Ten is a month-long series on ICD10monitor and Talk Ten Tuesdays that examines lessons learned since the nation’s healthcare system adopted ICD-10 – many of which are expected to come into play with the looming transition to ICD-11. Medical Group Management Association Health Information Technology…
Agencies continue their investigation into the underlying cause of electronic cigarette/vaping-associated lung injury. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to investigate the underlying cause of electronic cigarette/vaping-associated lung injury (EVALI).    In order to assist public health response in recognizing and…
It’s a move sure to stir up controversy.  Under a recently passed Centers for Medicare & Medicaid Services (CMS) Final Rule, your Medicare enrollments will be judged not necessarily on your performance but based on your affiliations with other providers and suppliers. Yes, you read that right: “other providers and…
Approximately $230 billion a year in healthcare costs are directly related to illiteracy and the social factors associated with illiteracy. “Illiteracy” is such a broad term. It states a fact, but the underlying causes and far-reaching life and generational impacts are less well-stated.  The problems are hiding in statistics from…
New guidance for coding vaping is retroactive to Oct. 1 discharges.   The Center for Disease Control and Prevention (CDC) has posted new coding guidance regarding e-cigarette lung injuries. This guidance, posted Oct. 17, 2019, is retroactive to Oct. 1, 2019 discharges.   The guidance states that coding professionals should report…
Conduct coding audits in all settings and check vendors’ coding credentials are among lessons learned under ICD-10. When we left ICD-9-CM, there were around 14,000 diagnosis codes in use across the healthcare industry – and then, on Oct. 1, 2015, we moved to approximately 69,000 codes. ICD-10-CM/PCS implementation was a…
During a recent conference call, the agency described assessing 64,883 ICD-10-CM diagnoses. I participated in the Centers for Medicare & Medicaid Services (CMS) conference call last Tuesday, explicitly focusing on complication and co-morbidity (CC) or major CC (MCC) designation methodology. This process is similar to how CMS originally determined comorbid…