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Find Your Routine Series: How Crystal Maintains Productivity
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
What is a Medicare Risk Adjustment Factor (RAF)?
In 2003, the Centers for Medicare and Medicaid Services (CMS) implemented Risk Adjustment Factors (RAF) and Hierarchical Condition Category (HCC) coding to identify individuals with serious and/or chronic illnesses and assign them a risk factor score that is based on a combination of demographic information and reported diagnoses.
Falling Case Mix Have You Confused?
The ICD-10-CM/PCS code changes – effective October 1, 2018 to September 31, 2019 – could be the culprit. Comparatively speaking, there are far less changes this year than in years past. The release includes: 279 new codes, 51 deleted codes,143 revised codes. But don’t let the smaller amount of changes fool you…
Coding Tip: Body Mass Index (BMI) Reporting in Pregnancy
With the publication of the new ICD-10-CM Official Guidelines for Coding and Reporting for FY 2019, we finally have an answer regarding reporting of BMI in pregnancy. The new guideline does state “do not assign BMI codes during pregnancy.”
Query Tip: What is Conflicting Documentation?
Conflicting documentation occurs when health care providers call the same condition different things. When none of the documented conditions are clearly ruled out by the physician, coders may find it necessary to query for the most appropriate diagnosis.
Are You Appealing?
In reviewing hundreds of contracts, the OIG found that insurers overturned 75% of their own denials upon appeal—approximately 216,000 denials each year. However, while the odds of winning an appeal are seemingly good, many providers simply don’t have the time or the internal staff and infrastructure needed to engage in the process.
Coding Tip: Bullying – What is it and how is it coded?
When coding a record with documented bullying, this is coded as child or adult psychological abuse (initial/subsequent encounter or sequela) either as confirmed or suspected. The encounter and whether this is confirmed or suspected is needed in order to assign the appropriate diagnosis code.
Halloween 2018 – 13 Spookiest ICD-10 Codes
It’s Halloween season! It’s time to overindulge on candy, fight over the best costume, become irrationally scared of things like the number 13, and have nightmares of your 6th birthday with that terrifying clown. As for us, we’re getting in the spirit with 13 spooky ICD- 10 codes! Beware – it’s scary out there.
Coding Tip: New Technology ICD-10-PCS Section “X” Drugs for FY2019
Section “X” is a separate place within ICD-10-PCS for certain new technology procedures (such as new technology drugs). Section “X” does not introduce any new coding concepts or unusual guidelines for correct coding and maintains continuity with the other sections in ICD-10-PCS.
Breast Cancer Awareness Month 2018 — Our Stories
October is #BreastCancerAwareness month. HIA wanted to share a few of our employees’ stories who battled or had personal experience with breast cancer.
Coding Tip: New ICD-10-CM General Coding Guideline — Coding for Healthcare Encounters in Hurricane Aftermath
With the Hurricane season in full swing, this new guideline will be helpful in reporting the external cause codes when an injury occurs as a result of the hurricane, and also help in determining sequencing of the reported codes.
Coding & Quality Measures Tip: Coding for the Revised Stroke Mortality Measure (MORT-30-STK)
The refined Stroke 30-day mortality measure (MORT-30-STK) is a statistic defined as death occurring within 30 days of a diagnosed stroke. The Centers for Medicare & Medicaid Services (CMS) publicly reports a 30-day hospital-level stroke mortality measure on Hospital Compare as part of the Inpatient Quality Reporting (IQR) program.
Coding Tip: Coding Lobar Pneumonia
“Lobar” pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia.
Coding Tip: What is Hydronephrosis?
We have seen a lot of recommendations of late where the coders are coding hydronephrosis, UTI and ureteral stone separately or not with the correct code to include all conditions.
Coding Tip: Cerebral Infarction When Patient Has Carotid Stenosis
Coders have struggled for some time with the dilemma of when to assign the combination code of carotid stenosis, with cerebral infarction (i.e.I63.231) and when to assign separate codes for the specific cerebral infarction and carotid stenosis. (i.e. I66.01 and I65.21).
Query Tip: Be Careful Using Yes/No Query Format
Queries in a Yes/No format are limited to use in the four specific circumstances. This format may not be used when only clinical indicators of a condition are present, but the diagnosis has not been documented in the health record.
Query Tip: The Many Meanings of “Unable to Determine”
Queries written in a multiple-choice format include a short list of options for physician response. These options must be relevant and supported by the clinical indicators included in the query.
Coding Tip: Getting Control of Root Operation Control
Since the implementation of ICD-10-PCS in 2015, yearly changes have been made regarding the definition of, and guidelines associated with, the root operation Control. This has caused coding professionals much confusion in determining whether to assign a procedure to root operation Control, to assign another root operation, or to not assign a procedure code at all.
IPPS Final Rule: Here’s What You Need to Know
The policies in the IPPS/LTCH PPS final rule further advance the agency’s priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability, and significant burden reduction so that hospitals can operate with better…
Coding & Quality Measures: The Code Hard Truth
In this current, ever-changing healthcare climate, health systems face many challenges. Facilities large and small must be dedicated to improving documentation and reducing complications, HACs, infection rates, and readmissions as they endeavor towards value-based care. Coding inaccuracies can really undermine…
Achieve Sustained Results with HIA’s Coding Services
It’s imperative, in today’s challenging healthcare environment, that organizations demand complete and accurate coding practices from their vendors if they want: Appropriate and timely reimbursement; Representative quality measures; Improved CMI; Reduction in payor denials and; Mitigation of compliance risks.
Query Tip: Is Sepsis Present on Admission?
In addition to positive clinical indicators documented at the time of admission, any of these that occur within the few days after admission should also be included. This will support the fact that sepsis could have developed after admission. It is important that a POA query give equal attention to what supports POA yes, as well as POA no to avoid the appearance of a leading query.
CMS Releases Proposed Physician Fee Schedule Rule for CY 2019
This major proposed rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.
Coding & Quality Measures Tip PQI 07: Hypertension Admission Rate
Did you know that by coding hypertension with associated CKD correctly along with any surgical dialysis access creation on patients admitted with hypertension, will keep the case out of the AHRQ PQI #07: Hypertension Admission Rate quality measure?
ICD-11: 3 Key Takeaways
On June 18, 2018, the World Health Organization (WHO) released a preview of its new International Classification of Diseases (ICD-11). ICD-11 will be formally presented at the World Health Assembly on May 2019 for adoption by Member States, and will come into effect the 1st of January 2022. The advanced preview will allow countries to plan how to use the new version to prepare translations and train health professionals.
Coding Tip: Reporting Intra-Aortic Balloon Pump (IABP) in ICD-10-PCS
From a coding perspective, the IABP is not classified as a device such as the VAD’s. The IABP is not coded as a device within ICD-10-PCS and is coded with the root operation of “Assistance.” The ICD-10-PCS code for insertion of an IABP for continuous pumping would be 5A02210, Extracorporeal or Systemic Assistance, Physiologic Systems, Assistance, Cardiac, Continuous, Output, Balloon Pump.
Query Tip: Query Question is Key
The key to a quality physician query is the question. The question provides direction for the choice of clinical indicators and options for response. So why do so many coders have trouble writing the question? My theory is that coders overthink the question rather than keeping it simple and to the point. The best way to get a physician to answer a query is with a question that makes sense and eliminates guessing as to what is being asked.
Q1 2018: Top 5 Procedure Code Changes
Locating ventilator times were difficult in the paper medical record, but has not become any easier with the implementation on the electronic health record (EHR.) Coders should be encouraged to review the record for exact ventilator times. As mentioned above, this could come down to minutes when selecting the correct ICD-10-PCS code.
Who Tells Your Story?
Hamilton. If you haven’t seen it, you’ve heard of it. The Broadway mega-hit has been the toughest ticket on Broadway since its debut in 2015. For the uninitiated, Hamilton explores the life and triumphs of the previously obscure “ten-dollar founding father,” Alexander Hamilton, through rap, hip-hop, and musical theatre.
DISCOVER THE DIFFERENCE BETWEEN
THE ROUTINE AND THE UNEXPECTED.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. That’s why we take every step into consideration when telling each patient’s story and help guide you along the way.
We understand the challenges
Critical Access Hospitals face.
Rarely does a CAH have the luxury of a dedicated coding manager, much less an educator and internal auditor. HIA’s service is aimed at providing a reliable resource to address all 3 important functions and more – all for one fixed annual fee.
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