Remember as a child using the argument, “Everyone else’s parents are letting them” and your mother asking, “If everyone else jumped off a bridge, would you jump too?” When it comes to capture of diagnoses, the same type of argument can occur between HIM and Quality. Coding professionals will refer to the alphabetical/tabular indexes, official Coding Guidelines and AHA Coding Clinics for ICD-9-CM to support the capture of a diagnosis or for specific code assignment. Quality staff will refer to the clinical picture, the probable intended meaning of the author and in applicable cases, the CDC diagnostic criteria as support for not assigning a code. I can remember a very passionate “discussion” between myself and a coding professional about a complication and whether or not it had to be assigned as a complication. I stated, “Just because you can code it that way does not mean you have to code it that way!” Continue reading
In previous blogs, I’ve written in detail about the different sets of exam guidelines, scoring of HPI, ROS, MDM and other details. These are the components that make up the supporting documentation for most E&M services. There are a few exceptions, however, like critical care, facility coding, and preventive medicine.
There are many types of E&M visits, primarily separated into sick versus well visits. They can occur at the same time, but usually don’t. Patients coming in for their annual physical usually schedule another visit to discuss any acute issues. Continue reading
It’s our 500th blog post! Our first blogs focused on ICD-10, so it’s fitting that today’s post is written by ICD-10 blogger Rhonda Butler. Read Rhonda’s very first blog post here.
The GEMs are nothing more than ICD-10 training wheels. You can use them to get the hang of ICD-10, but then you should just use ICD-10 directly—stop leaning on the extra wheels and just ride the bike.
Remember that first moment? Pedaling faster to get off the training wheels is intolerably scary for about two seconds, and then suddenly it’s like flying and you don’t even remember being afraid. As an industry we have had the training wheels on long enough. We should be weaning ourselves from the GEMs. Continue reading
Posted in ICD-10
Tagged CMS, GEMs, ICD-10
Donna: Sue, did you listen to the U.S. House Energy & Commerce Subcommittee hearing on health industry readiness for ICD-10 last week?
Sue: I wasn’t able to tune in as I was at a customer site that day, but I read all of the presenter remarks and watched video of the questions asked by the subcommittee and the responses from the panel of witnesses. It’s all posted on the Coalition for ICD-10 website. How about you?
Donna: I had the hearing on in the background while I was working, but I didn’t get to listen to the entire proceedings because I was on conference calls . . . you know how it goes. So what did you think? Continue reading
It’s already two months into 2015 and I can’t help but think of the changes coming to the outpatient prospective payment system (OPPS) and APCs. CMS introduced APCs and OPPS in 2000. Since then, they have been working to slowly increase packaging within the system.
In 2014, significant increases in packaging were introduced. This year, they have continued to make major changes that will have an impact on every hospital that is subject to the Medicare OPPS and APCs. I am specifically thinking about: Continue reading
The title says a lot: “Patient-Centered Medical Homes In Louisiana Had Minimal Impact On Medicaid Population’s Use Of Acute Care And Costs.”¹
Health plans and other payers want to improve total cost of care and quality by aligning payment and measurement models with better health care delivery. They ask “How will we know better care delivery when we see it?” The National Committee for Quality Assurance’s PCMH (patient-centered medical home) recognition program is one way. Continue reading
A subway train car filled with thick black smoke due to an electrical malfunction. One woman on board had difficulty breathing and collapsed to the floor of the train, unconscious. Fellow passengers began performing CPR in an effort to help the woman. Emergency workers arrived and transported the woman to the Emergency Room of a nearby hospital. Resuscitative efforts were continued to no avail and the woman expired. The Emergency Department physician recorded the following diagnoses: acute respiratory failure due to smoke inhalation.
Assign diagnosis codes for this outpatient encounter. Continue reading
Aaron Mckethan, PhD, and Ashish K. Jha, MD, MPH, recently wrote an article for The Journal of the American Medical Association (JAMA) with an irresistible title: “Designing Smarter Pay-for-Performance Programs¹.” The key sentences of the perspective article are:
To the extent that higher-risk patients can be reliably identified prospectively, this information can inform the design of smarter, more targeted pay-for-performance programs. Specifically, a targeted pay-for-performance program would have, at its core, a prediction model that would identify patients who are at elevated risk of failing to meet a meaningful clinical goal or of having a bad outcome. Continue reading
Healthcare reform has been a hot topic over the past few days and health information technology (HIT) is at the hub. Last week, the Office of the National Coordinator (ONC) released a Shared Nationwide Interoperability Roadmap¹, setting the goal to exchange and use “a common set of electronic clinical information at the nationwide level by the end of 2017.” Also, President Obama highlighted the Precision Medicine initiative² which included funding for ONC to support the development of interoperability standards, and CMS announced that Medicare payments are moving towards a model based on value and care coordination rather than volume and care duplication (and it is well known that lack of interoperability underlies the latter)³. Continue reading
I’m not an expert on population health, though I’d like to be. So I read a lot—books, blogs, magazines, newsletters, white papers, you name it. Time and time again, there are a handful of organizations I go back to for reliable information and credible opinions.
If you want to keep pace with payment policies, economic shifts, market disruptions, and technology, I recommend the following: Continue reading