HCPro.com: Briefings on Coding Compliance Strategies

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January 2008 (Volume 11, Issue 1)	view entire issue

OIG Work Plan steps up focus on quality
Although the scope of work outlined in the Office of Inspector General (OIG) Work Plan for 2008 may not be as dramatic as it has been in past years, the OIG has intensified its focus on Medicare payments for transfers and other quality-of-care concerns. Keeping in line with the expansion of the recovery audit contractor (RAC) program, the OIG Work Plan also maintains a strong focus on DRGs. And although the Work Plan tends to inspire providers to conduct annual audits, organizations should actually conduct audits on a more frequent basis, experts say.

CMS discusses H&Ps, packaging during most recent ODF
CMS hosted a Hospital Open Door Forum (ODF) call on November 8, 2007, during which it discussed several inpatient and outpatient changes. Below is a summary of selected topics. CMS clarified that providers must document history and physicals (H&P) no more than 30 days before or 24 hours after admission or registration for surgery that requires anesthesia.

Recovery audit contractor update: Review Statement of Work, start preparations now to maintain compliance
Although the recovery audit contractor (RAC) demonstration program is slated to end in March, that doesn't mean the program is going away for good. In fact, the opposite is true. Despite recent efforts made by representatives Lois Capps (D-CA) and Devin Nunes (R-CA) to slow the nationwide RAC implementation and enact a one-year moratorium on the program, the Tax Relief and Health Care Act of 2006 (Section 302) instructs CMS to expand the program and use RACs to identify Medicare underpayments and overpayments across the country by 2010.

Physician queries: Ask the right questions to improve coding accuracy, obtain detailed documentation
The physician query process allows coders to clarify documentation for accurate code assignment. To generate a query, coders must ask physicians to explain inconsistent or vague documentation regarding a patient's diagnosis or treatment. However, clinician clarification is a delicate matter, and coders should seek it only when absolutely necessary. To keep the lines of communication smooth and tension-free, it's important to approach queries with tact and to be thoughtful so as not to lead the physician toward a certain diagnosis.

Heart failure, ejection fractions, hypertensive emergency, and more are topics for discussion at one hospital
For this month's column, we've asked one of our client hospitals to provide us with some topics that they'd like us to clarify. The following is a summary of our discussions with that hospital. Causes of heart failure Our client hospital wanted to know whether mitral valve insufficiency and aortic valve stenosis (code 396.2) are always the cause of heart failure. Category 396, Diseases of mitral and aortic valves, has an "includes note" that states "involvement of both mitral and aortic valves, whether specified as rheumatic or not."

Coding Q&A
Susan Von Kirchoff, MEd, RHIA, CCS, CCS-P, of BKD LLP in Little Rock, AK, answered the previous question.

Other recently-published articles from Briefings on Coding Compliance Strategies:

New guidance may create additional query opportunities

MS-DRGs on OIG radar: Ensure compliant coding

CMS discusses RAC expansion, ICD-10, and never events

CMS issues updated payment rates and wage indexes for FY 2009: Know how to apply the new data files

Go back to the source when coding secondary diabetes

Work with physicians to obtain clear-cut documentation for pressure ulcers

Get a bloody good understanding of GI hemorrhage

Clear up morphology and neoplasm code confusion

Brush up on the 2009 ICD-9-CM carcinoid codes

Examine postoperative condition coding

One-day stays

Look forward to improved complications data

Guidelines explain new codes for pressure ulcer staging, VAP

Avoid the trap of probable diagnoses

Get to know MIPPA’s hospital-related provisions

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