- Q&A: Does CMS' ICD-10 guidance apply to medical necessity?
Q: CMS released guidance this summer about not auditing or counting errors for the specificity of an ICD-10-CM code. CMS is not going to count the code as an error as long as the first three digits are correct. Does this apply to medical necessity diagnoses and edits?
- Q&A: Can we use DRG averages to comply with 2-midnight standards?
A lot of people still have questions about the 2-midnight rule and may wonder if their chosen practices comply with the regulation.
- Q&A: Rejections for compounded drug combinations
Q: We have been receiving rejections on claims including a line item for a compounded drug. We have applied modifier –JF (compounded drug) appropriately and the HCPCS code and units are correct. We can’t figure out what has been happening.
- Study: Putting focus on post-acute appointments can reduce readmissions
The American College of Cardiology’s “See You in 7,” can help to reduce heart-related readmissions, according to a study published in the September 1 issue of JACC: Heart Failure.
- Q&A: How do we report antibiotic injections during cataract surgery?
Q: Our ophthalmologists have begun using injections of antibiotics during cataract surgery rather than the pre-operative eye drops they have used in the past. We always reported the eye drops as a supply based on Medicare guidance.However, there is a lot more involved in the injection procedures, so we have been reporting them separately with the cataract procedure, as it is not “routine” on all of our cataract procedures—at least not yet. One of our auditors believes this is not a best practice. Is there documentation that supports either method?
- Avoiding instances of missed care
In today’s busy hospitals, sometimes necessary jobs go undone. Whether it’s a patient leaving the hospital without needed education about diabetes management or a patient getting pressure ulcers because he or she was not turned often enough, missed care can present a big problem.