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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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Case-mix index. Track this monthly and look for changes. What is your highest-volume DRG, primary diagnosis, and secondary diagnosis?
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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.”
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Physician documentation. This is key to accurate code assignment. Have your clinical documentation improvement specialist determine where improvements are needed.
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Coding audits. Perform audits regularly to evaluate accuracy and potential over- or undercoding.
Prepare for miscellaneous costs that may arise during the transition to ICD-10
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?
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
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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→
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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