Resource ICD-10 Monitor Articles

Great article on Acute Pulmonary Insufficiency following Surgery and educating providers on linking respiratory failure to an alternate medical condition.

Acute Pulmonary Insufficiency following Surgery​

Acute Pulmonary Insufficiency following Surgery – MedLearn Publishing

It’s not a valvular problem, but a definitional one. I recently received an email from a clinical documentation integrity (CDI) friend from my previous life as a physician advisor, asking my opinion on acute pulmonary insufficiency. She pointed out that the Association of Clinical Documentation...

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[Lori]

Reducing the Risk of Copy and Paste​

Material a provider has not read nor vetted for accuracy should not be C&P.
A great source to reduce the risk is the toolkit for the safe use of C&P.
Their definition of copy and paste:
“data that is volitionally obtained and used elsewhere without having to retype any of the information.”
When information from a previous encounter or another individual’s record is brought into a record, decisions can be made on faulty information which can result in errors that can affect patient outcomes.

How to Reduce the Risk of Copy and Paste – MedLearn Publishing

Providers should never C&P material they have not read nor vetted for accuracy.

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https://www.ecri.org/Resources/HIT/CP_Toolkit/Toolkit_CopyPaste_final.pdf

 

[Lori]

A problem list reminds the provider of what the patient has.

Many providers don’t understand or care about the history of coding designation.

Might it make sense to a provider to leave a code in place if they feel it will give them information?

Coders are permitted to update problem lists but not on their initiative, and the documentation must support the revision.

Whose responsibility is it to keep the problem list accurate?

Red More Here:

A Provider’s Take on Why the Problem List is a Problem – MedLearn Publishing

Unfortunately, the problem list is organized the way it is. -Medlearn Media NPOS Non-patient outcome spending

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[Lori]

More Diagnosis codes, are you prepared?

Three diagnosis codes were effective for discharges and visits.

The final list is expected to be published in mid-June.

Chapter	Letters	Mnemonics	# Of New Codes
1	A-B	Advancing Bugs	2
2	C-D49	Cancer/Death	0
3	D50 – D89	Dracula	20
4	E	Endocrine	11
5	F	Freud	83
6	G	“Gittery”	14
7	H – H59	Hyphema	0
8	H60 – H95	Hearing	0
9	I	Infarction	43
10	J	Just Gasping	1
11	K	Knot in Stomach	1
12	L	Lipoma	0
13	M	Musculoskeletal	35
14	N	Nocturia	139
15	O	Obstetrics	175
16	P	Perinatal	10
17	Q	Quirky	16
18	R	Relative Symptoms	0
19	S-T	Simply Traumatic	101
20	V, W, X, Y	Vehicles, Woops, eXposure, whY	477
21	Z	Zero Problems	48
22	U	Unusual	0

Get Prepared for More Diagnosis Codes – MedLearn Publishing

The tentative list includes 1,176 new diagnosis codes. -Medlearn Media NPOS Non-patient outcome spending

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[Lori]

Are your Behavioral Health screenings compliant?

Screening and assessment codes are selected based on the provider types performing them, time, or modality.

1. physicians (MD/DO)
2. non-physician practitioners (NPP):
   • Clinical psychologists (CP), clinical social workers (CSW), clinical nurse specialists (CNS), nurse practitioners (NP), physician assistants (PA), certified nurse-midwife (CNM), and independently practicing psychologists (IPP).
3. ancillary staff:
   • Technicians, medical assistants, and nurses

Payer guidance varies from payer to payer, especially reporting depression screenings.

Screening, Testing is used to evaluate the existence or absence of a mental health disorder when the possibility of one has been proven by screening or the presence of a comorbid illness. Test administration needs “medical necessity” for billing purposes, which must be supported by an ICD-10-CM code.

Medicare refers to specific Healthcare Common Procedure Coding System (HCPCS) code G0444 for Medicare patients who are undergoing a depression screening without symptoms (i.e., as a preventative treatment)

Behavioral Health: To Screen or not To Screen?

How to stay compliant in behavioral health screenings. Behavioral health screenings aim to detect mental health symptoms in many seemingly healthy people.

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[Lori]

What is a symptomatic UTI? One where at least one of these signs/symptoms are present:

• Fever (>38.0C)
• Suprapubic tenderness (with no other cause)
• Urinary urgency (cannot be with a catheter is in place)
• Urinary frequency (cannot be with a catheter is in place)
• Dysuria (cannot be with a catheter is in place)

Urine culture has no more than two species of organisms identified, at least one of which is a bacterium of >105 CFU/ml.

Don’t get "CAUT" Without Knowing the Ins and Outs

The fifth most common type of health-associated infections is urinary tract infection. What seems to present itself as an easily identified query

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[Lori]

CMS published the ICD-10-PCS codes and guidelines for the 2023 fiscal year on May 26, 2022.
These inpatient procedure codes and guidelines will become effective Oct. 1, 2022.
Added to guidelines B3.19 (Detachment procedures of the extremities) and revised B4.1c (Procedure on Tubular Body Parts) and B6.1a (General Coding of Device).

CMS Releases 331 New PCS ICD-10 Codes

New codes and guidelines become effective Oct. 1, 2023. The Centers for Medicare & Medicaid Services (CMS) published the ICD-10-PCS codes and

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[Lori]

There are two vaccines being used against monkeypox

JYNNEOS vaccine & ACAM2000.

JYNNEOS -this is a live, nonreplicating vaccine which means that it is only effective as long as the viral units are alive since they can’t propagate. A second dose is indicated at four weeks, but at the moment, the CDC and WHO are trying to sort out who should receive doses, how big the doses should be, and how they should be administered. If a patient has been exposed, they can receive post-exposure prophylaxis if they present expeditiously. The other vaccine, ACAM2000 has more side effects and contraindications than JYNNEOS.

WHO (World Health Organization) just reclassified the previously named variants of monkeypox, Clade I (clade means descendants of a common ancestor, i.e., a variant) and Clade II, to eliminate stigmatizing the locale of where the illness was discovered. They are looking for a new name to replace “monkeypox,” too.

Monkeypox: The Latest Endemic

Quarantine is not recommended, but isolation is. Monkeypox is endemic in parts of Africa. In May 2022, an outbreak started and is now spreading

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[Lori]

Swing beds: A practical solution for rural hospitals

Rural hospitals with fewer than 100 beds, including critical access hospitals (CAH), with a Medicare agreement allowing them to use their beds for acute or skilled services.

Certain things sometimes aren’t done in a nursing home setting, either because it’s a high-cost item or involves processes done in such small numbers that the staff may not have the needed proficiency

The Medicare Carriers Manual states that “if the inpatient care is being billed by the hospital as inpatient hospital care, the hospital care codes apply. If the inpatient care is being billed by the hospital as nursing facility care, then the nursing facility codes apply.” Therefore, to code services to swing-bed patients correctly, you need to know how the hospital is billing for its care. When the hospital is billing the patient’s care as inpatient hospital care, you should submit initial hospital care codes (99221–99223) for admission to the swing bed, subsequent hospital care codes (99231–99233) for subsequent daily visits, and 99238 or 99239 for discharge. Alternatively, when the hospital is billing the patient’s care as nursing facility care, you should submit the subsequent nursing facility care codes (99311–99313) for daily visits, 99303 for admission from outside the hospital, and the appropriate nursing facility discharge code (99315 or 99316) for discharge to home. When a patient is discharged as an inpatient and admitted to swing-bed status for nursing facility care, submit a hospital discharge day code (99238 or 99239) for the discharge and a nursing facility admission code (e.g., 99303) for the admission. The critical-access status of your hospital should not make a difference in these coding scenarios, but it will impact the hospital’s reimbursement for its services.

Swing Beds Don’t Mean a Thing – Except Here

Swing beds are a practical solution for rural hospitals with fewer than 100 beds. By John Zelem, MD, FACS Unless you have been exposed to daily life at

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[Lori]

2023 E/M Code changes for Home and Residence Services.

“Home” may be defined as a private residence, temporary lodging, or short-term accommodation.

E&M category Domiciliary, Rest Home (alternatively, Boarding Home), or Custodial Care Services and the E&M category Domiciliary, Rest Home (alternatively, Assisted Living Facility), or Home Care Plan Oversight Services are deleted for 2023. The parenthetical notes direct the provider or coder to report these services elsewhere:

Also used to report services when the residence is in an assisted living facility, a group home that is not licensed as an intermediate care facility for individuals with intellectual disabilities, a custodial care facility, or a residential substance abuse treatment facility.

• For the E&M category Domiciliary, Rest Home (Boarding Home), or Custodial Care Services, in 2023, these services should be reported using the home or resident services E&M codes for New or Established Patients.
• For the E&M category Domiciliary, Rest Home (Assisted Living Facility), or Home Care Plan Oversight Services, in 2023, these services should be reported using the care management services codes or principal care management codes.

Parenthetical notes also state that travel time should not be counted towards total time when time is used for selecting the level of service.

Home Services are divided into two subcategories – New Patient and Established Patient – with the subcategories currently divided into four or five levels of service. For 2023, the category title is revised to Home or Residence Services and the New Patient subcategory levels of service will have four levels of services, with E&M code 99344 deleted (for 2023, both categories will have four levels of service).

When a Home is Not a Home

There are some key 2023 CPT® Evaluation and Management (E&M) Code changes for Home and Residence Services. EDITOR’S NOTE: The American Medical

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[Lori]

Centers for Medicare & Medicaid Services (CMS) released the related advance-notice final rule in April, and it includes major changes to the HCC reimbursement methodology that go into effect in 2024.
They have reclassified the HCC categories according to the clinical concepts in the ICD-10 codes.
Coders now need to crosswalk the old HCC categories to the new ones because of this reordering of the HCC category numbers.
The removal of the HCC designation for over 2,200 diagnoses the V28 HCC methodology changes.
The need to incorporate the SDoH codes into the reimbursement model has been suggested.

Read more here:

New Changes from CMS for HCCs Reimbursement – MedLearn Publishing

Hierarchical Condition Categories (HCCs) and value-based care have been a major focus for healthcare organizations during recent years. As many of you may know, the Centers for Medicare & Medicaid Services (CMS) released the related advance-notice final rule in April, and it includes major...

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[Lori]

Read and understand the clinical information in the chart.
What diagnoses and procedures were documented?
Then consider the implications.

Does conflicting information impact the MS-DRG or APR-DRG assignment?
Does missing information impact the code assignment?
Would additional information provide a more specific code?

How Critical Thinking Skills Help Avoid Denials – MedLearn Publishing

Denials have been on my mind for the last few weeks – specifically, how do we prevent them?

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[Lori]

Lab Testing Documentation Changes Coming

CMS announced on July 10 that retroactive changes will be made to the NCCI PTP edits between Column One codes 80305, 80306, and 80307 for presumptive test(s), and Column Two codes G0480-G04083 and G0659 for definitive test(s), to allow the use of an appropriate NCCI modifier.

For now, laboratories must append a suitable modifier if billing for both presumptive and definitive drug of abuse analysis on a single date of service.

CMS supplies the following instruction: “if laboratories bill the MACs for these tests together on or after July 1, 2023, and believe that an NCCI modifier is appropriate, the lab should include the applicable modifier on the claim. The MACs will adjust those claims with dates of service between July 1, 2023, and Oct. 1, 2023, to allow payment when an NCCI modifier was used. Alternatively, a laboratory may also choose to use the MAC appeals process if it does not wish to wait for the automatic adjustment to occur, or it can wait to submit its claims until CMS implements the change.”

Changes Coming for Documentation of Lab Testing – MedLearn Publishing

If your laboratory performs toxicology procedures to test for drugs of abuse, you have most likely become aware of the new Procedure-to-Procedure (PTP) edits effective July 1. The third-quarter National Correct Coding Initiative (NCCI) table updates were posted to the Centers for Medicare &...

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[Lori]

Auditing coding.

In coding situations where there may be some “grey area ” is to revisit the documentation to see what is truly supported and then follow the hierarchy of “coding rules.”

• First, the Coding Conventions
• Second, the Coding Guidelines
• Third, the Coding Clinic.

The code-over-code approach uses the reviewer’s codes as the denominator and the coder’s correct codes as the numerator. There are times when the coder’s correct codes may be 0 and, of course, that will lead to a 0 percent accuracy rating.

Another approach that’s easier to use and requires less counting is the case-over-case approach that is often used to determine if the correct DRG or APC was attained.

Case-over-case is also known as the financial accuracy rate when it is used to reflect DRG or APC accuracy. But, we all know you can get the right DRG but not use the most specific code. So, the DRG is right, but the code is wrong.

Bottomline, use code-over-code for coding accuracy and use case-over-case for financial accuracy. If you use case-over-case for coding accuracy, it’s harsh, and doesn’t give the coders credit for their correct codes.

Intrigued by Coding Accuracy? Here Are Some Approaches for Measuring – MedLearn Publishing

We use the code-over-code approach recommended by the American Health Information Management Association (AHIMA) publication Benchmarking to Improve Coding Accuracy and Productivity published in 2009. The code-over-code approach uses the reviewer’s codes as the denominator and the coder’s...

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[Lori]

What is non-complaince in medical coding?

Non-compliance in healthcare typically means a patient who intentionally refuses to take prescribed medication or does not follow treatment recommendations.

Non-compliance was once a more popular term used in the medical community to remove perceived risk from the provider, however, recent research has created a different picture.

According to research from Sous, W., Frank, K., Cronkright, P. et al. (2022), the term ‘non-compliant’ has been shown to compromise care, particularly for marginalized communities. Ethically, this term has failed to demonstrate a provider’s respect for patient autonomy and has created a reverse effect of the ‘do no harm’ mantra.

Read more here:

Why it’s Time to Retire the Term Non-compliant – MedLearn Publishing

Non-compliance in healthcare typically means a patient who intentionally refuses to take prescribed medication or does not follow treatment recommendations. This term is often used in medical documentation as physicians and/or care team professionals categorizing patients in the ‘not doing what...

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[Lori]

The Hospital Inpatient Prospective Payment System (IPPS) Final Rule for the 2024 fiscal year (FY) takes effect on Oct. 1, 2023, it will usher in a number of important updates and changes to reimbursement factors and programs.

Changes include the creation of 15 new Medicare Severity Diagnosis Related Groups (MS-DRGs) and the deletion of 16 existing ones, as well as updates to the complications and comorbidities (CCs) and major complications and comorbidities (MCCs) lists.

Some changes to the code edits and the inclusion of new ICD-10 codes, as well as the New Technology Add-on Payment (NTAP) program.

Also included are adjustments related to the social determinants of health (SDoH).

Read more here:

Get Ready for IPPS 2024 Coding Impacts – MedLearn Publishing

When the Hospital Inpatient Prospective Payment System (IPPS) Final Rule for the 2024 fiscal year (FY) takes effect on Oct. 1, 2023, it will usher in a number of important updates and changes to reimbursement factors and programs, such as the Hospital Value-Based Purchasing (VBP) Program...

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[Lori]

The 2024 Inpatient Prospective Payment System (IPPS) Final Rule was issued in early August.

Can this be Fixed?

Procedures Unrelated to Principal Diagnosis Grouping Logic in the 2024 IPPS Final Rule that resulted from a combination code located in an MDC that doesn’t correspond to the part of the combination triggering the procedure.

There were many other changes in the 2024 IPPS Final Rule.

FY 2024 IPPS Final Rule Home Page | CMS

This is the home page for the FY 2024 Hospital Inpatient PPS final rule. The list below centralizes any IPPS file(s) related to the final rule. The list contains the final rule (display version or published Federal Register version) and a subsequent published correction notice (if applicable)...

www.cms.gov

Fixing Procedures Unrelated to Principal Diagnosis Grouping Logic in the 2024 IPPS Final Rule – MedLearn Publishing

The 2024 Inpatient Prospective Payment System (IPPS) Final Rule was issued in early August. It is a dense document, in excess of 2,000 pages, and its creators inform us what comments came in on the proposed rule, with their specific responses. I am not sure it is crucial to post every comment...

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