Not all new technologies are created equal.  Facility-specific coding guidelines are key to code hospital visits and encounters consistently. Another role that facility-specific guidelines play is to capture all possible reimbursement that is due to an organization.    Every Oct. 1, the MS-DRGs and ICD-10-CM/PCS are updated. In addition to the…
New PCS codes were released late last week and are effective Aug. 1, 2020. The codes are considered V37.2. There are 12 new procedure codes, and they are related to COVID-19.The good news is that these procedure codes are not designated as DRG OR procedures, so they do not affect…
The FY21 ICD-10-CM codes will be finalized this month. The Centers for Medicare and Medicaid Services (CMS) released the final FY21 ICD-10-PCS codes on May 28, 2020 which was earlier than expected.  The table below will show the changes between Final FY20, Proposed FY21, and Final FY21: Section FY20 Proposed…
Success can cost you more than you thought it would. You might have heard the phrase, “everyone wants to be successful until they see what it actually takes.”  While I’m not sure where the quote originates, I’ve seen it attached to various images, one of which is the feet of…
EDITOR’S NOTE: This is the first in a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. I shouldn’t be surprised.  I have been reviewing denials by insurance companies since the late 1980s. I’ve seen the same things over and over again, such…
The actual go-live of ICD-10-CM/PCS was generally smooth, with no major problems.  For health information management (HIM) coding and clinical documentation improvement/integrity (CDI) professionals, the use of and adherence to the ICD-10-CM/PCS Official Guidelines for Coding and Reporting is a must. In addition, the American Hospital Association (AHA) ICD-10-CM/PCS Coding…
Fall ICD-10-CM/PCS Coordination and Maintenance Committee Meeting kicks off today. Today and tomorrow mark the dates for the next ICD-10 Coordination and Maintenance Committee meeting. Health information management (HIM) and coding and clinical documentation integrity/improvement (CDI) professionals often wonder about what the Coordination and Maintenance Committee is and does, so…
Guidance and advice effective with discharges occurring on and after June 21, 2019. The American Hospital Association (AHA) Coding Clinic for ICD-10-CM/PCS for the second quarter of 2019 was released last month, and there are some interesting topics and guidance within this volume (Volume 6, Number 2). Due to copyright restrictions,…
Final ICD-10-PCS codes for FY 2020 are here. The Centers for Medicare & Medicaid Services (CMS) released the final FY 2020 ICD-10-PCS codes on May 31. This included a total of 77,559 procedure codes for the MS-DRG V37.    The changes include 734 new codes, 2,056 deleted codes, and two…
2020 IPPS proposed rule has a total of 149,405 ICD-10 codes. The Inpatient Prospective Payment System (IPPS) Proposed Rule for fiscal year (FY) 2020 comes with a great many changes to the ICD-10-CM/PCS classification systems as well as the MS-DRGs.  While the IPPS applies to inpatient services for acute care…