HIAlearn – Coding Staff Development & Training
Unmatched industry expertise
Ensuring the educational development of your coding staff is of utmost importance. Whether you need additional focused education based on review findings or the tools to foster ongoing coder development, HIA has you covered with the latest coding updates and regulatory changes. Much of our material is approved by AHIMA and/or AAPC for CEUs. View our extensive HIAlearn library here.
HIAlearn Offerings
Education may take many avenues, including on-site visits, audio recordings and online education modules. Training can consist of one-on-one, group sessions or self-paced. Programs can be tailored to fit any time frame, from a few hours to monthly training and monitoring of new coding staff. We utilize a Learning Management System (LMS) to house coding education sessions. Individual participants are provided a username/password to access the LMS from a designated website.
Education Counts
Our 70-years of combined teaching experience has taught us that academic instruction fused with practical application creates a comprehensive learning experience that benefits our team and yours.
Pat Maccariella-Hafey
Executive Director of Education
Beth Martilik
Assistant Director of Education
Kim Carrier
Director of Coding Quality Assurance
Coding Tip: Acute Renal/Kidney Failure/Injury vs Dehydration as a Principal Diagnosis
Patients being admitted for acute renal failure due to dehydration have been happening for many, many years now. Typically what happens is a patient gets dehydrated for one reason or another. Once dehydration sets in, it can quickly start to affect many body organs. This can lead to acute renal/kidney failure/injury.
Coding Tip: Unspecified Condition Codes and Combination Codes
One area that coders struggle with is when to report a separate condition code when an already assigned combination code includes the condition. For example, if an obstetric patient is admitted and delivers, and the physician documents “obstetric patient delivered with anemia,” should both code O99.02 Anemia complicating childbirth and D64.9, Anemia, unspecified be coded or should only O99.02 be assigned?
Part 5 – New 2019 CPT Codes: Category III, Evaluation and Management, etc.
This is Part 5 of a five part series on the new 2019 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
Query Tip: Be Consistent with Query Format
All queries require at least two elements – clinical indicators and a query question. Coders can also include multiple choice options for response or leave the query open-ended for a free text response. The order in which these elements are listed in a query is open to coder or facility preference.
Query Tip: Choosing Reasonable Options for Response
The key to choosing reasonable options for a query response is to remember that the query must stand alone. Any clinical indicators supporting the options must be included in the query itself. In this week’s Query Tip, we provide examples of two queries in which the options for response are not reasonable based on clinical indicators used by coder.
Coding Tip: Obstetric Tidbits for PCS
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Coding Tip: Pregnancy, Childbirth, and the Puerperium Tidbits
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
Most Common DRG’s with Recommendations 2018: Part 5
In part 5 of our series, we look at DRG 64—Intracranial hemorrhage or cerebral infarction with MCC. For this DRG recommendation the majority (almost all) were recommended to DRG 65 (Intracranial hemorrhage or cerebral infarction with CC) with deletion of the reported MCC.
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Popular Posts
IPPS Proposed Rule: CC/MCC Designation Changes
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
It Only Takes One Code
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
How to Reduce Claims Denials
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
$30M Settlement for Medicare Advantage Upcoding
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
HIAlearn – Coding Staff Development & Training
Unmatched industry expertise
Ensuring the educational development of your coding staff is of utmost importance. Whether you need additional focused education based on review findings or the tools to foster ongoing coder development, HIA has you covered with the latest coding updates and regulatory changes. Much of our material is approved by AHIMA and/or AAPC for CEUs. View our extensive HIAlearn library here.
HIAlearn Offerings
Education may take many avenues, including on-site visits, audio recordings and online education modules. Training can consist of one-on-one, group sessions or self-paced. Programs can be tailored to fit any time frame, from a few hours to monthly training and monitoring of new coding staff. We utilize a Learning Management System (LMS) to house coding education sessions. Individual participants are provided a username/password to access the LMS from a designated website.
Education Counts
Our 92-years of combined teaching experience has taught us that academic instruction fused with practical application creates a comprehensive learning experience that benefits our team and yours.
Pat Maccariella-Hafey
Executive Director of Education
Coding Tip: Acute Renal/Kidney Failure/Injury vs Dehydration as a Principal Diagnosis
Patients being admitted for acute renal failure due to dehydration have been happening for many, many years now. Typically what happens is a patient gets dehydrated for one reason or another. Once dehydration sets in, it can quickly start to affect many body organs. This can lead to acute renal/kidney failure/injury.
Coding Tip: Unspecified Condition Codes and Combination Codes
One area that coders struggle with is when to report a separate condition code when an already assigned combination code includes the condition. For example, if an obstetric patient is admitted and delivers, and the physician documents “obstetric patient delivered with anemia,” should both code O99.02 Anemia complicating childbirth and D64.9, Anemia, unspecified be coded or should only O99.02 be assigned?
Part 5 – New 2019 CPT Codes: Category III, Evaluation and Management, etc.
This is Part 5 of a five part series on the new 2019 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
Beth Martilik
Assistant Director of Education
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
Query Tip: Be Consistent with Query Format
All queries require at least two elements – clinical indicators and a query question. Coders can also include multiple choice options for response or leave the query open-ended for a free text response. The order in which these elements are listed in a query is open to coder or facility preference.
Query Tip: Choosing Reasonable Options for Response
The key to choosing reasonable options for a query response is to remember that the query must stand alone. Any clinical indicators supporting the options must be included in the query itself. In this week’s Query Tip, we provide examples of two queries in which the options for response are not reasonable based on clinical indicators used by coder.
Kim Carrier
Director of Coding Quality Assurance
Coding Tip: Obstetric Tidbits for PCS
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Coding Tip: Pregnancy, Childbirth, and the Puerperium Tidbits
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
Most Common DRG’s with Recommendations 2018: Part 5
In part 5 of our series, we look at DRG 64—Intracranial hemorrhage or cerebral infarction with MCC. For this DRG recommendation the majority (almost all) were recommended to DRG 65 (Intracranial hemorrhage or cerebral infarction with CC) with deletion of the reported MCC.
Get Started
Subscribe to our weekly newsletter
Popular Posts
IPPS Proposed Rule: CC/MCC Designation Changes
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
It Only Takes One Code
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
How to Reduce Claims Denials
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
$30M Settlement for Medicare Advantage Upcoding
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
See how HIAlearn
will benefit you
Overcome common coding challenges identified during audits and coding staff performance reviews with HIAlearn Action Plans.
See how HIAlearn
will benefit you
Overcome common coding challenges identified during audits and coding staff performance reviews with HIAlearn Action Plans.
