All Entries in the "Coding" Category
Note from the CCDS Coordinator: Over the Y92.838 and through the Y92.821 to Grandmother’s Y92.01 we go
CCDS Coordinator Penny Richards
By Penny Richards
Ah. Thanksgiving. While the ACDIS team will be out of the office for the Thanksgiving holiday and Black Friday, we know that the opportunities for mishaps requiring medical attention are far too plentiful to mention. We wouldn’t want to leave you without ACDIS’ guidance in this trying time, so here is a short list of codes that might prove helpful to the on-duty clinical documentation specialist. [more]
Book excerpt: Unexpected CDI effects
Trey La Charité, MD, FACP, SFHM, CCDS
By Trey La Charité, MD, FACP, SFHM, CCDS
No new hospital initiative operates in a vacuum. And there is no way to anticipate every consequence of your CDI program. Even with the best intentions, there will be downstream consequences to navigate.
Let’s start with the first place your program’s effects will be noticed: the medical records department. If you didn’t know, your medical records department maintained a Discharged Not Final Billed (DNFB) or Discharged Not Final Coded (DNFC) list before the advent of your CDI program. [more]
Note from the Instructor: Is your CDI program stagnating? Get out of the rut and fast!
Allen Frady, RN, BSN, CCDS, CCS, CRC
By Allen Frady, RN, BSN, CCDS, CCS, CRC
The basic tenant of learning CDI is learning how MS-DRGs work, and the tiered structure of CC and MCC levels. That is the first step, to be sure, but it is not the final destination. In the new era of quality based reimbursement, there are a number of growth opportunities. And yet, I believe many (if not most) CDI programs are either missing completely or performing poorly in meeting them. In the age of bundled DRGs, 30-day readmissions, hospital acquired conditions, Medicare Advantage Plans, patient safety indicators, quality reporting, and mortality rankings, if you find yourself having a harder and harder time justifying the value of proper documentation to your chief financial officer, take another look at the current state of affairs. [more]
Guest post: Time to learn about HCCs
James S. Kennedy, MD, CCS, CDIP
by James S. Kennedy, MD, CCS, CDIP
Now that you’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the new risk-adjustment method, Hierarchical Condition Categories (HCC).
HCCs are to physicians what DRGs are to hospitals and, as such, are subject to government and Recovery Auditor scrutiny. In fact, a whistleblower accused United Healthcare of “upcoding” ICD-10-CM diagnosis codes affecting HCC-derived risk-adjustment factor scores, mentioning that CMS overpaid insurers by $14.1 billion in 2013 alone, according to an article in the New York Times in May. [more]
Q&A: Acceptable documentation for HCCs
Have CDI questions?
Q: What clinical documentation is acceptable to pull Hierarchical Condition Category (HCC) information from for reporting purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?
A: Follow the coding guidelines when reporting diagnosis codes for HCC purposes. The coding guidelines don’t change with HCCs. As long as the documentation meets the MEAT (monitored, evaluated, assessed, treated) criteria, it can be reported from anywhere in the note. [more]
Guest post: Keep up with coding compliance for physicians facing MACRA changes
James S. Kennedy, MD, CCS, CDIP
by James S. Kennedy, MD, CCS, CDIP
What’s a physician’s favorite radio station? When it comes to coding compliance and revenue cycle management of their practices, WII-FM, What’s In It For Me, is what physicians listen to.
Physician salaries have traditionally been based on CPT-driven relative value units in a fee-for-service environment, meaning the more that the physician did, the more he or she got paid. As a result, many physicians diminished their understanding or application of ICD-10-CM diagnosis coding because, most of the time, these don’t affect physician reimbursement unless it is to determine medical necessity for a procedure they want to perform. [more]
Q&A: Coding mixed cardiogenic and septic shock
Have CDI questions?
Q: If the attending documented, “likely mixed cardiogenic and septic shock,” can I assign codes R57.0 and R65.21?
A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember, Excludes 1 notes instruct us that we cannot use codes from this grouping with those listed within the Excludes 1 note. Cardiogenic shock (R57.2) falls within this grouping. Also listed is R65.2 septic shock. Purely relying on the coding conventions, I would conclude that we cannot code septic shock with cardiogenic shock. See the image below. [more]
Guest Post: New ICD-10-CM/PCS codes up the ante in coding compliance, part 3: Right heart failure
James S. Kennedy, MD, CCS, CDIP
by James S. Kennedy, MD, CCS, CDIP
Editor’s note: With the fiscal year 2018 ICD-10-CM/PCS codes released, Kennedy unpacked some of the compliance pitfalls and opportunities awaiting CDI and coding professionals when these new codes are implemented on October 1. Some of these issues may be addressed in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting or the American Hospital Association’s Coding Clinic, Fourth Quarter, 2017, so be sure to compare Kennedy’s opinions with these documents. This article is part three in a three-part series. Click here to read parts one and two!
Right Heart Failure
Notice that we now have new codes for acute, chronic, and acute-on-chronic right heart failure. Remember also that Coding Clinic, Third Quarter, 2013, p. 33, states that the documented term of “decompensated” indicates that there has been a flare-up (acute phase) of a chronic condition. [more]
Guest Post: New ICD-10-CM/PCS codes up the ante in coding compliance, part 2: Pediatric Glasgow coma scales
James S. Kennedy, MD, CCS, CDIP
by James S. Kennedy, MD, CCS, CDIP
Editor’s note: With the fiscal year 2018 ICD-10-CM/PCS codes released, Kennedy unpacked some of the compliance pitfalls and opportunities awaiting CDI and coding professionals when these new codes are implemented on October 1. Some of these issues may be addressed in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting or the American Hospital Association’s Coding Clinic, Fourth Quarter, 2017, so be sure to compare Kennedy’s opinions with these documents. This article is part two in a three-part series. Click here to read part one. Return to the blog next week to read part three!
Pediatric Glasgow coma scales
In what should have been a welcome change, the National Center for Health Statistics amended the ICD-10-CM Alphabetic Index to allow for reporting of the clinical descriptors of the pediatric Glasgow coma scale. Notice that in the best motor response section, “flexion to pain” gets three points in the clinical scale whereas “withdrawal from pain” gets four points. Now notice how ICD-10-CM manages these conditions in 2018: [more]
Note from the Instructor: Your 2018 IPPS Final Rule questions, answered
Allen Frady, RN-BSN, CCDS, CCS, CRC
By Allen Frady, RN-BSN, CCDS, CCS, CRC
Yesterday, 845+ codes took effect thanks to the fiscal year 2018 IPPS Final Rule, which was released at the beginning of August. As you review the updates, additions, and deletions in this year’s rule, I wanted to answer some of your burning questions to help guide you through this transition.
1.) Is it true that chronic obstructive pulmonary disease (COPD) does not have to be sequenced before pneumonia?
The Index for 2017 had the language “use additional code to identify infection.” This was misinterpreted as applying to conditions such as pneumonia by both coders using the index and the AHA’s Coding Clinic. “Use additional code” means that a subsequent diagnosis must be sequenced as a secondary code. However, “use additional code to identify infection,” usually means to assign an additional organism code from the organism code category of B95 to B97. [more]
