Category Archives: Coding Best Practices

Improving coding accuracy; complete and accurate coding; computer-assisted coding; CAC; remote coding; web-based coding; APR-DRGs; DRGs; diagnosis related groups

Where Would We Be Without Clinical Coders?

I’m sitting on a plane today, traveling through the air as a result of some very bright people that enabled this mode of transportation. I’m doing so safely, thanks to strict airport security practices. Many years ago, when more stringent airport security screening was established, I would listen to fellow travelers complain about the invasion of privacy, the maybe not-so-random searches and the added expense tacked on to everything. And the lines in security, oh the lines! However, as a frequent traveler I’m forever thankful for the process we flyers have to go through to ensure the safest passage possible. Continue reading

Taking a Closer Look at the March ICD-10 Coding Challenge

CHALLENGE QUESTION:

A 62-year old male who was diagnosed with pancreatic cancer two weeks ago, was admitted to the hospital with malaise, fever, and an elevated WBC of 15.21 k/uL. The patient was diagnosed with sepsis. Blood cultures were positive for carbapenem-resistant Enterobacteriaceae (CRE). Infectious Diseases was consulted. A review of the patient’s history revealed that the patient had undergone an ERCP with biopsy of the pancreas approximately two weeks ago at which time a diagnosis of cancer of the head of the pancreas was made. It was eventually determined that the patient had been contaminated with the CRE organism from the duodenoscope used during the ERCP. The patient was discharged to an extended care facility with a PICC line for ongoing IV antibiotic therapy. Assign diagnosis codes for this inpatient encounter and sequence appropriately. Continue reading

Better Living—and Documentation—Through Computer Assistance

Have you ever driven a car without power-steering? It’s quite a workout. We used to all drive without power-steering and for “entertainment” you had to spend ten minutes twisting a small dial back-and-forth trying to get a radio station to come in clearly, only to drive under a bridge and completely lose it. Now we’re on the verge of self-driving cars and I can stream an entire album saved in the cloud into my car just about anywhere and anytime I want. No more fine-tuning that pesky radio dial. Continue reading

SGR and ICD-10: Time for Spring Cleaning

It’s that time of year again. For people not working in the healthcare industry, it’s time for flowers to start blooming, windows to be opened to fresh air, swimsuit shopping and, even though we had a short-lived blizzard in Colorado yesterday, I’m ready for spring! Let the spring cleaning begin. However, there is the painful memory of last year, when ICD-10 was delayed “at least until October 1, 2015” via the SGR repeal bill, also known as the doc fix bill. I remember exactly where I was when I heard the news. Continue reading

Do You have Questions About Edits 71 and 77?

I live in the Salt Lake City area, but last week I ventured east for the public Hospital Outpatient Payment (HOP) Panel meeting at CMS. As I listened to the testimony, I thought about some of the emails I have received about OCE edits 71 (Claim Lacks required device code) and 77 (Claim Lacks allowed procedure code). I have been asked a number of questions about these edits along with requests to talk to CMS to see if they would reinstate them, or as a last resort, have 3M create similar edits. Continue reading

Data Value: Important Mammogram Coding Change

A policy and data specialist colleague of mine was working with the 2015 NCCI data and noted that CMS had, for the first time, added screening and diagnostic mammogram codes to the edit.

Specifically, CPT 77055 and 77056 and HCPCS G0204 and G0206 (diagnostic mammography) and CPT 77057 (screening mammography) and 77063 (screening digital breast tomosynthesis, bilateral) cannot be billed on the same claim on the same date of service (DOS). Continue reading

Compliance Confusion: Observation Coding

I wonder how many millions of dollars are lost due to coding errors that have nothing to do with ICD-10 but everything to do with complex and confusing requirements and new rules. I’ve said this before: I don’t believe folks make mistakes intentionally, especially when it impacts reimbursement, but I think there is a lot of coding compliance confusion. And, in my humble opinion, it’s not the coders “fault” when errors are encountered. Continue reading

Taking a Closer Look at the February ICD-10 Coding Challenge

CHALLENGE QUESTION:

An 11-year old boy with severe autism presents to the Emergency Department with a fall from a 4-5 foot round hay bale. He landed backwards on his left arm and chest two hours ago at his family’s farm. His father was present at the time of the fall and states that he did not lose consciousness, but might have “gotten the wind knocked out of him.” He got up afterwards and was ambulatory. His parents brought him in because he was not moving his left arm and was supporting it with his right arm. On examination, the left arm is minimally swollen and there is moderate pain. Pain is relieved with positioning and immobilization of the arm. The exam was difficult due to pain and the patient’s autism. Intranasal fentanyl was administered so proper assessment could be completed. Continue reading

Partial Dictation: A Smart Compromise for Quality Documentation

Last month, AHDI created a new Facebook group called “SR Errors – Funny or Fatal?” as a forum for healthcare documentation specialists (HDS) to share speech recognition “bloopers” that they caught during the editing process.

The submissions vary from hilarious:
“The patient slipped on the ice and fell on her Botox.”

To scary:
Dictated: “Lipitor 20, two pills a day”
Speech recognition result: “Lipitor 22 pills a day” Continue reading

It’s Complicated! Just Because You “Can” Doesn’t Mean That You “Should”

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