Dig deeply into documentation whenever you assign the POA indicator
HIM-HIPAA Insider, March 8, 2011
Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!
You’re coding a record, and the documentation of a patient’s stage III pressure ulcer isn’t clear enough for you to determine whether the ulcer is POA. More importantly, what do you do?
Unfortunately, some coders simply default to POA indicator “N” instead of querying the physician, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, an independent HIM consultant in Madison, WI. However, the goal should be reducing the number of “Ns”—not accepting them as fact, Krauss says.
“Every case that’s not POA should be reviewed by a physician,” he says. “You may be sending a wrong signal to Medicare, and the immediate effect is that you’re forgoing reimbursement to which you may be entitled.”
Note: To read more, view the February issue of Briefings on Coding Compliance Strategies.
Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!
Related Products
-
The HIM Director's Handbook, Second Ed.
This second edition is an updated version of the earlier best seller and details everything you need to know to direct your...
-
ICD-10 Trainer
ICD-10 Trainer provides the latest news and updates related to ICD-10 regulations, and tips from HCPro experts and faculty...
-
Coding and You
Coding and You is written specifically to help non-coders; medical assistants, lab technicians, compliance professionals...
-
Coding and Physician Language
This unique handbook by coding expert Gloryanne Bryant, RHIA, CCS, CCDS, addresses the 32 most confusing conditions for...
-
Documentation Strategies to Support Severity of Illness
Written by well-known physician educator Robert S. Gold, MD, this handbook covers 32 of the most troubling conditions in...
Most Popular
- Articles
-
- Note from Hugh
- Note from the instructor: CMS clarifies payment amount to be applied to payment caps and manual review thresholds for outpatient therapy services provided by critical access hosptials
- Steps to comply with HIPAA 2.0: Revise your policies and procedures
- Recent Recovery Auditor activity
- The week in Medicare updates
- Steps to comply with HIPAA 2.0: Revise your policies and procedures
- Citing HIPAA, CVS to end prescription reminders via mail
- ACDIS/AHIMA brief provides guidance on query best practices
- Change your EMR to prepare for ICD-10
- 2014 Hospice Proposed Rule Released
- E-mailed
-
- Note from the instructor: CMS clarifies payment amount to be applied to payment caps and manual review thresholds for outpatient therapy services provided by critical access hosptials
- Q&A: Focused professional practice evaluation (FPPE)
- Change your EMR to prepare for ICD-10
- 2014 Hospice Proposed Rule Released
- Solidify processes to avoid HAC penalties
- Steps to comply with HIPAA 2.0: Revise your policies and procedures
- Citing HIPAA, CVS to end prescription reminders via mail
- 2014 IPPS Proposed Rule: CMS focuses on quality measures, inpatient status
- HCA initiative boosts flu shots among hospital workers
- Managing the precertification process
- Searched