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The new normal: High volumes of acutely ill and dying patients. As a licensed clinical social worker, professional case manager, and doctor in behavioral health student, concern for my colleagues on the front lines of care is absolute. That concern has me hitting pause this week for my usual report…
To think that queries and increased case mix index (CMI) is the end-all and be-all of CDI is a fallacy. In a recent conversation with a chief financial officer of a medium-sized hospital where a clinical documentation integrity (CDI) program was well-established, I raised the question of whether a CDI…
There are very few places in the U.S. that are experiencing low levels of disease and hospitalization. As I and many experts predicted, the COVID-19 pandemic in the United States has ramped up, and the winter is going to be bleak. On Dec. 10 (the day prior to when I…
Moderna’s vaccine is expected to be shipped to providers nationwide, on the heels of Pfizer’s. A reeling nation couldn’t have asked for a better Christmas present. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for individuals 16 and older last week…
CMS has finalized a new requirement that the nation's 6,200 hospitals report information about their inventory of therapeutics to treat COVID-19. There has been a recent flurry of activity at the Centers for Medicare & Medicaid Services (CMS), with the federal agency publishing final rules for 2021 payments, giving providers…
As we near the end of what some consider the most unprecedented year in coding, there are more updates to review and decipher in preparation for 2021.   As the science around the COVID-19 pandemic continues to evolve, there remain many unknowns of post-COVID-related conditions. There is an ongoing and…
New procedure codes do not impact the MS-DRG assignment. The Centers for Medicare and Medicaid Services (CMS) released 21 new ICD-10-PCS codes that apply to the vaccination or treatment of COVID-19. These codes are effective January 1, 2021.  The procedure codes introduce six specific medications that can be used for…
Dysrhythmias like complete heart block, AF, and SSS all fall into HCC 96, with a risk adjustment factor of 0.268. Our listeners and readers ask the most interesting questions! One named Dena recently wrote me and said, “I am an HCC coder, and there is a hot debate about coding…