Tag Archives: coding

Taking flight: How the right metrics can improve computer-assisted coding

Recently, I boarded a Delta Boeing 757 plane. The plane held 180 passengers with a cruising speed of 517 mph. My flight to Portland, Oregon lasted just under two hours, of which I slept for more than an hour. By contrast, Wilbur Wright covered 852 feet in 59 seconds on that day in 1903 when the Wright brothers completed the first four sustained flights with a powered, controlled airplane.

It’s hard for the modern day traveler to imagine that the airplane and way of life we understand today wasn’t always the case. What enabled the evolution of the aviation industry from the first recognized flight of the Wright brothers to the kind of aviation travel we have today? Continue reading

They just don’t get it: Who is to blame for increased complication rates?

Let me start by saying Happy Holidays to everyone. However, I am feeling a bit like Mr. Scrooge. I have heard from many clients lately regarding their struggles with obtaining accurate complications rates. In almost every instance, there is finger-pointing (with coding and CDI taking the hit) and even software gets blamed for the increased capture of complications rates.

So let me explain a few things: Continue reading

ICD-10: No news is good news

It seems that wishes are not just for fairy tales, they can come true after all. So far, it looks like the wish for an uneventful ICD-10 transition is a reality. Even the month-end report from CMS was fabulously dull.

The bottom line is, coding issues are historically a tiny percentage of the total claim denials, and that is just as true for ICD-10 as for ICD-9. Historically, total claim denials run around 10% of total, and of those, 2% are due to incomplete or invalid information of any kind, including things like provider ID. Both the 10% and the 2% statistic remained stable across the transition to ICD-10. Continue reading

ICD-10: One month in

October 1, 2015 has come and gone. I didn’t really expect everything to come to a screeching halt, as warned during the anticipation of Y2K. I did, however, expect that by the middle of this month, we would have some horror stories about claims issues with regard to the transition from ICD-9 to ICD-10. I’m still waiting. I’m sure there have been individual issues, but scanning list serves, web sites, CMS, etc., I haven’t seen any systemic issues with regard to claims payment in the professional, Part B world. Insert sigh of relief here. Continue reading

E&M coding: Element-based or time-based?

I went to see one of my physicians today. She at her computer, me in a chair, discussing the multiple medications I’m taking, and the resulting side effects. If you’re a regular reader of my blog, you’re aware of my recent health challenges. I try not to think about what it was like before having a drawer full of medicine bottles but, I’m just whining. I know I’m lucky and I know I’m basically healthy. I’m probably a bit spoiled, too. But, back to the office visit today. My doctor and I talked for a long time. We reviewed my extensive (for me) list of medications and I complained about those side effects. She proposed a different medication regimen, then we discussed the risks associated with this change. I had a lot of questions, she consulted some studies online and we talked some more. At the end of this visit, I was examined and the impression and plan were discussed. Continue reading

ICD-10: After the Thaw

If you have the slightest inclination to freak out about ICD-10 because change makes you nervous, please ignore this blog.

Okay, now for the rest of you: the code sets have been frozen for more years than is good for them, and once we get to “thaw” the code sets, they need to be updated. How can that be, you say? ICD-10-CM/PCS is brand spanking new. No, not exactly—not new, unused. New and unused are not the same thing. Putting meat in the freezer does not make it fresh—it lets you put off cooking it for a while. 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

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

Cut through to the “Gut” of Accidental Lacerations

One of the most controversial complications is an accidental laceration. It is a potentially preventable complication (PPC), a complication in all surgical cohorts for Healthgrades and is a patient safety indicator (PSI 15). Additionally, PSI 15 is included in the PSI 90 composite score and is the highest weighted component (29.83%). Hence, the importance of “getting it right” cannot be underestimated.

So when should an accidental laceration be documented, coded or clarified? Continue reading

Why So Many Coding Software Releases?

Take a glance at your phone, or your laptop screen, or your desktop monitor. Do you see an alert about downloading a new software release or system update? We ignore them, we avoid them, and we put off installing them for days. When we finally get around to it, inevitably a new alert pops up with yet another set of updates!

Many of you may have wondered… why does 3M provide so many releases for the 3M Coding and Reimbursement System? Well, in this blog I hope to address the question of updates in a way that will help you understand how these releases impact you and which ones are critical for you to perform to keep your coding system updated. Continue reading