A new white paper from the industry bellwether looks back, forward in framing big picture of coding. Benchmarking, the term that encompasses performance measurement in the healthcare industry, will be key for providers seeking to refine their efforts to master ICD-10 as ICD-11 implementation looms in the distance, according to…
There are ICD-10 codes for cold weather injuries.The weather has been rough for the people living in the Midwest and Northeast. The reported temperatures have been as low as -60 with the wind chill factor applied. Such severity of temperatures does calls to mind some injuries and illnesses such as…
Noncompliant queries can be overt or subtle.The underlying hallmark of clinical documentation integrity (CDI) programs is the query process utilized to clarify documentation from a diagnosis perspective. Much emphasis is placed upon ensuring the issuing of a compliant query by the clinical documentation integrity specialists, reinforced by the American Health…
Rapidly shifting societal demographics impact SDoH. 2018 saw the Social Determinants of Health (SDoH) rise to be among the most popular hot topics for the healthcare industry. In 2018 alone: $1.7 trillion in care was attributed to 5 percent of the population. ICD-10 coding reimbursement for the SDoH took place…
Coders must ensure documentation supports the service, either moderate sedation or MAC. Coding moderate sedation (or conscious sedation) and monitored anesthesia care (MAC) is not difficult; however, distinguishing what the services provided are and deciphering conflicted information about which physicians can report what codes can be confusing for some coders…
Address documentation and coding issues up front, rather than correct them later. Coders have had many challenges throughout the years.  When I started in the industry, we did not submit claims electronically; they were submitted on paper and we used an IBM Selectric Typewriter to complete what was then the…
To link, or not to link: that is the question for physician documentation Since the adoption of the ICD-10 code set, clinical documentation integrity specialists (CDISs) have experienced an ongoing dilemma of capturing complication codes with regard to adverse drug events versus ‘known’ or ‘inherent’ side effects. At our organization,…
Are there “Zs” in your spinal fusion coding? The fiscal year (FY) 2019 ICD-10-PCS updated an area that has not received much attention: Spinal fusion codes. During the Centers for Medicare & Medicaid Services (CMS) Coordination and Maintenance Committee meeting in September 2017, the topic of invalid spinal fusion codes…
The 2019 CMS risk adjustment model is version 23. The Centers for Medicare & Medicaid Services (CMS) released, in April, the latest update to the CMS-hierarchical condition category (HCC) Risk Adjustment Model (V23).  It applies to payment year 2019.  As Medicare Advantage is a prospective payment system, that means care…
New classification system noted for granularity. Several of my colleagues recently attended an ICD-11 presentation by Kathy Giannangelo[i] at the American Health Information Management Association (AHIMA) Convention & Exhibit. Kathy has been in the trenches with ICD-11’s development for some time. The attendees described the complexity of this new classification…