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…

Diseases and procedures are hitting the news.  Last week, the Food and Drug Administration (FDA) announced that 35 people had reported seizures (R56.9) after using electronic cigarettes (F17.290). The seizures were considered adverse events and involved children and young adults. Seizures are possible side effects of nicotine poisoning (T65.221-). The…

Bypassing the bypass guidelines for the coronary and peripheral arteries Forget the coding guidelines (at least temporarily) – let’s focus on the procedures first. The classic first step in coding is to read the guidelines, but in the case of many ICD-10-PCS guidelines, starting there may prove to be confusing…

The U.S. is in the middle of flu season this month and the opioid crisis appears unabated. There are several public health issues that are impacting the United States at the moment, and this article will focus on two of them: flu immunization and the opioid epidemic, in particular.   Have…

New coding clinic edition offers much to review and follow.Everyone in health information management (HIM), coding, and CDI (clinical documentation improvement) is abuzz about the fourth-quarter AHA (American Hospital Association) Coding Clinic on ICD-10-CM/PCS. We just received the third-quarter issue at the end of September, which everyone is still digesting.…