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A new study shows Medicare’s policy against paying for hospital acquired conditions (HAC) will only save the $400 billion program $1.1 million to $2.7 million.
California researchers conducted the study, according to a Wall Street Journal article. The researchers studied discharge data from California Medicare beneficiaries in 2006, looking for six conditions the authors deemed definable, according to the article. Out of the total 767,995 cases, there were 828 cases of those conditions, and 26 would have been subject to lower payments.
The following ICD-9-CM codes denote acute respiratory failure (ARF):
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518.81, ARF
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518.82, other pulmonary insufficiency, not elsewhere classified (includes acute respiratory distress, acute respiratory insufficiency, and adult respiratory distress syndrome NEC)
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518.84, acute and chronic respiratory failure
Check out Coding Clinic, fourth quarter 1998 and first quarter 2005, for more information about when ARF should be the principal diagnosis, as well as documentation requirements.
The sequencing of respiratory failure depends on the reason for admission. When respiratory failure from an underlying condition causes the inpatient admission, the failure becomes the principal diagnosis; when the patient develops respiratory failure after admission, it is the secondary diagnosis and should be coded as such.
Q: What does an incidental pregnancy (code V22.2) mean? Is it related at all to an ectopic pregnancy (code 633.11)? Should I report the two together?
A: Coding Clinic, fourth quarter 1996, p. 50–51, states that code V22.2 is a secondary code only for use when the pregnancy is in no way complicating the reason for the visit. Otherwise, coders should report a code from the obstetric chapter.
For routine outpatient prenatal visits when no complications are present, report codes V22.0 (supervision of normal first pregnancy) and V22.1 (supervision of other normal pregnancy) as the first-listed diagnoses. Do not report these codes in conjunction with Chapter 11 codes. For more information, see Chapter 11 (Pregnancy/Childbirth) of the ICD-9-CM Official Guidelines for Coding and Reporting that took effect October 1, 2008.
Editor’s note: Alison Stangeby, RHIA, CCS, CPC, senior consultant at BKD, LLP in Little Rock, AR, answered this question that originally appeared in the August 2009 issue of Briefings on Coding Compliance Strategies.
CMS recently posted a fact sheet regarding ICD-10 that summarizes structural differences between the new system and its predecessor, ICD-9. It also explains how organizations and facilities should plan for the change and provides a list of helpful Web sites.
CMS is accepting comments through August 25 on two cardiac outcomes measures that it may implement for use in the hospital inpatient quality pay-for-reporting program. Providers may also comment on four hospital outpatient quality reporting measures pertaining to a specific population of patients with cardiovascular conditions or chronic obstructive pulmonary disease, as well as those who have undergone cataract surgery.
For more information and to provide comments, click here.
By now, most coders are aware that ICD-10 will usher in expanded codes that will require additional specificity and more detailed documentation. A single diagnosis or procedure code in ICD-9-CM may be expanded to multiple codes in ICD-10-CM or PCS.
More hospitals will likely develop clinical documentation improvement (CDI) programs as ICD-10 takes center stage. Those programs that are already in place will likely need to grow, expand, and mature, says Heather Taillon, RHIA, manager of coding compliance at St. Francis Hospital in Beech Grove, IN, and a board member of HCPro, Inc.’s Association for Clinical Documentation Improvement Specialists (ACDIS). CDI programs will become commonplace, Taillon says, adding that this is something she’s already seeing on a national level.
Editor’s note: For more information about CDI programs and to purchase a copy of this article for $10, visit the HCPro Web site. Subscribers to Briefings on Coding Compliance Strategies have access to this article in the August issue.
Industry experts have repeatedly said that ICD-10 implementation must begin immediately for hospitals, health plans, and vendors to meet the October 1, 2013 compliance deadline. But now there is detailed evidence to prove it. North Carolina Healthcare Information and Communications Alliance, Inc., (NCHICA) and The Workgroup for Electronic Data Interchange (WEDI) released a timeline that quantifies each ICD-10 preparation task in terms of the number of days it will take to complete.
On July 20, the NCHICA and WEDI estimate it will take providers nearly 1,286 work days to implement ICD-10. For vendors, it will take nearly 1,521 work days to complete. And the clock is ticking.
"The NCHICA-WEDI timeline shows graphically that the full time from now to October 2013 will be required to successfully meet the compliance deadline. We cannot continue to delay this effort," said Holt Anderson, executive director of NCHICA in a press release.
Q: Where can I learn more about national coverage determinations (NCD) for surgical never events?
A: On June 29, CMS posted on its Web site three NCDs for surgical never events:
- View the NCD for wrong site surgery.
- View the NCD for wrong surgery on a patient.
- View the NCD for surgery on the wrong patient.
CMS also posted Medlearn Matters article MM6405 that explains the coverage determinations that took effect January 15.
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