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

CMS Clarifies “ICD-10 Families” and Offers Guidance on ICD-10 Flexibilities

The latest from CMS and AMA on July 6, 2015 is a bit confusing – I agree. But a clarification was released yesterday.

In case you missed the July 6, 2015 release, CMS and the AMA announced an effort to work together to help Part B providers under the Physician Fee Schedule prepare for ICD-10. CMS recognized some physician and other professional providers need additional help. To assist in the transition, CMS announced “Medicare review contractors will not deny physician or other practitioner claims billed under Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. Continue reading

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

CHALLENGE QUESTION

A 37-year old male with a long-standing history of the diagnosis of gender identity disorder is currently undergoing counseling and medical therapy in an effort to work toward physically modifying his body to better match his psychological gender identity. The patient is scheduled to undergo an orchiectomy penectomy and surgical construction of a vagina in the near future.

Assign the ICD-10-CM code for the diagnosis of gender identity disorder.

What ICD-10-PCS code will be used for the procedure of a surgical construction of a vagina using autologous tissue procedure for this patient? Continue reading

OPPS Proposed Rule for 2016

I hope the publication of the 2016 OPPS proposed rule on July 1st did not dampen anyone’s July 4th celebration. The new rule continues the migration CMS began in 2014 to a more “prospective payment” type system. That means that there continues to be more packaging and fewer APCs.

A few specifics: Continue reading

Physicians and Coders: No More Unspecified Care

The team I work with has done an enormous amount of work translating medical necessity policies from ICD-9 to ICD-10. And we have had many discussions regarding the codes that represent “unspecified” care in ICD-10. Should they stay in the translations – or go? Is ICD-10 specific enough to cover all care and coding contingencies now?

Unspecified Defined

An internet search (don’t you love being able to search so easily?) revealed:

Un-spec-i-fied: (adjective) meaning “not stated clearly or exactly”. Synonyms: unnamed, unstated, unidentified, undesignated, undefined, unfixed, undecided, undetermined, uncertain… Continue reading

“My Patients Are Sicker”…Prove it!

When thinking of quality outcomes improvement, much focus is on the particular quality concern (such as a readmission, accidental laceration, etc.) and reducing the incidence through better practice, improved documentation or coding. But not enough attention is focused on risk-adjustment for the various quality indicators. And sadly, this is the easiest part to fix! Continue reading

HIMagine That! Coder Agreement

Donna: Sue, what results are you hearing about ICD-10 coder agreement as sites get ready to implement October 1, 2015?

Sue: What do you mean by “ICD-10 coder agreement?”

Donna: Well, as hospitals are in the homestretch of their ICD-10 preparation activities, one of the things they’re doing is having all of their coding staff code the same cases in ICD-10 so they can compare results. Continue reading

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

CHALLENGE QUESTION

A 37-year old male was found unresponsive in a bedroom at his home by a family member. Paramedics arrived and found the patient pulseless and not breathing. The patient’s skin was cool and cyanotic. The family member said the patient had been using Oxycodone for long-standing back pain for the past two to three years. A prescription bottle for the drug was found at the scene. The patient was transported to a nearby Emergency Room where he was pronounced dead. The Emergency Room physician recorded the diagnoses of: Continue reading

Millions Claimed by Lost Physicians and Coders

There was only one time in my life that I literally did not know where I was. I had just moved to Alexandria, Virginia and took a wrong turn off the Beltway. I didn’t know which state I was in until I asked at a gas station. The station attendant thought I was crazy of course, but when I explained my predicament he laughed and told me that I was actually in Maryland. Since this happened pre-GPS, he also gave me directions to get back to Virginia – but, as I said, that only happened once. Continue reading

The Client Experience Summit: It’s No Longer Just for Hospitals!

May 5-7 in Salt Lake City was a fantastic time. It has been three years since 3M acquired CodeRyte and it was great to see many CodeRyte customers attending this year. Additionally, we had a full Ambulatory training track. For customers that missed it, look for your invite next year and consider joining us. Continue reading

Documentation Quality: Time to Line up the Ducks

The Joint Commission’s (TJC) current “Quick Safety” article, intended to advise healthcare organizations about safety and quality issues, is about the potential risks when technology and human workflow practices do not ensure patient documentation is accurate, complete, and understandable. Although the title of the article is, “Transcription translates to patient risk,” the gist of the article is that documentation being captured via dictation and transcription, speech recognition technology, direct entry into templates, straight typing by providers, or any other method, needs to be reviewed with utmost care to protect patients from injury and death. Continue reading