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Archive for Coding

Nov
17

Region D RAC approved to audit modifiers -TC and -26

Posted by: Andrea Kraynak, CPC-A | Comments (0)
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HealthDataInsights has been approved by CMS to audit for inappropriate billing related to the use of modifiers -TC and -26 on Part B claims in all RAC Region D states.

The new issue is as follows:

  • Global vs TC/PC. An overpayment exists when providers are reimbursed for global procedures and then receive additional reimbursement for technical (modifier TC) and/or professional (modifier 26) components for the same service.

To see an updated list of issues approved in your area, visit the Tools section of the Revenue Cycle Institute Web site, and download our chart of approved RAC issues.

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Nov
17

Refresh your knowledge of core concepts for coding accuracy

Posted by: HIM Connection | Comments (0)
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Clinical knowledge is an essential element for capturing severity and MS-DRG assignment, according to Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM at Kaiser Permanente in Oakland, CA. “When we’re talking about DRG changes and coding changes, it’s important to enhance clinical knowledge,” she said.
 
Additionally, refresh your knowledge of the following core concepts for coding accuracy:
  • Case-mix index. Track this monthly and look for changes. What is your highest-volume DRG, primary diagnosis, and secondary diagnosis?
  • Accurate and complete coding. Know the Uniform Hospital Discharge Data Set definition of principal diagnosis: “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”
  • Physician documentation. This is key to accurate code assignment. Have your clinical documentation improvement specialist determine where improvements are needed.
  • Coding audits. Perform audits regularly to evaluate accuracy and potential over- or undercoding.
“These are great actions to take to ensure accuracy in documentation, case-mix index, and certainly your MS-DRGs,” Bryant said.
 
Editor’s note: This tip is adapted from the November 2009 issue of Briefings on Coding Compliance Strategies.
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Nov
12

Revenue Cycle Institute posts free coding tool

Posted by: The RAC Report | Comments (0)
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Each month the Revenue Cycle Institute publishes a free sample tool or form for readers. We hope you find this month’s tool—a chart of the new ICD-9 codes, including E and V codes—helpful in ensuring you’re on top of the code changes for 2010.
 
Editor’s note: Access the free tool via by clicking on “Tools.”  The chart originally appeared in the October issue of Medical Records Briefing.
 
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Nov
10

Prepare for miscellaneous costs that may arise during the transition to ICD-10

Posted by: HIM Connection | Comments (0)
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Despite an HIM director’s best efforts to prepare for a smooth transition to ICD-10, there may be unforeseen challenges along the way, says Tori Sullivan, RHIA, MHA, PMP, manager of Capgemini Government Solutions in Reston, VA. Having money in reserve is always a good idea. “Set aside money in case you don’t get reimbursed or can’t process claims for a period after go-live,” she advises. Use your hospital’s highest average daily reimbursement and multiply that amount by five. Set aside this amount for reserve in the event of claims submission errors or denials, she says.
 
One potential challenge for critical access hospitals is the likelihood that ICD-10 will require an encoder, an extra expenditure for hospitals that don’t have one, says Debbie
Mackaman, RHIA, CHCO, regulatory specialist at HCPro, Inc., in Marblehead, MA. “[An encoder] will make things so much easier for coders who are trying to work out of books because it will do an automatic crosswalk for them,” she says.
 
Editor’s note: This tip is adapted from the December 2009 issue of Medical Records Briefing.
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Sep
30

Q&A: Charging for behavioral therapy in the home setting

Posted by: JustCoding News | Comments (0)
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Q: I have a question regarding behavioral health treatment sessions. Can a physician or licensed therapist (e.g., LPC or LCSW) provide therapy to a client at the client’s home and then charge this service to the insurance company?

Read More→

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Sep
30

2009 JustCoding.com Coder Salary Survey

Posted by: JustCoding News | Comments (0)
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JustCoding.com is conducting its annual coder salary survey, and we would appreciate your input. Please take a few moments to complete this survey. Only participate in the survey if you are a coding professional. If you are not a coding professional, please forward the survey to one of your coding colleagues. Note that the survey should take less than 5 minutes to complete. We appreciate your time! If the click-through does not work, please cut and paste this URL into the address bar of your browser: www.zoomerang.com/Survey/?p=WEB229JMJLMWKC 

Thank you for your time and assistance.

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Sep
29

Accurately assign POA indicators with the right info

Posted by: HIM Connection | Comments (0)
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The present-on-admission (POA) indicator refers to conditions that are present at the time an order for inpatient admission occurs. Coders should report a POA indicator for a principal diagnosis, as well as any secondary diagnoses or E codes.

To assign POA, coders must rely on a treating physician’s documentation. Assuming physician documentation is accurate and complete, a coder can consider these tips when assigning a POA indicator: Read More→

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Sep
29

Q&A: Coding conditions as “acute” versus “chronic”

Posted by: HIM Connection | Comments (0)
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Q: A patient came into the ER with complaints of a headache and facial pain. The ER physician gave a final diagnosis of sinusitis. This patient had no history of sinusitis. After a coding review, the reviewer said we were wrong to use “acute” and told us to use “chronic.” She told us never to use “acute” unless the physician documents the condition as “acute.” We were previously under the impression that when coding ER accounts, coders should always report conditions as “acute.” Do you know of any ER coding guidelines or publications that would clear this up?

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