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Briefings on Coding Compliance Strategies

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Submitting improper Medicare documentaion can lead to denial of fees, payback, fines, and increased diligence from payers. Let BOCCS help you avoid fraud and stay in compliance.

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April 2006 (Volume 9, Issue 4)	view entire issue

Ensure proper coding of these four thorny inpatient procedures
Editor's note: This is the second of a two-part series. Last month's story examined coding problems associated with biventricular defibrillators, carotid endarterectomy revisions, and Gliadel Wafers insertion. This month, we look at coding troubles with drug-eluting stent implantation, hip/knee revisions, percutaneous endoscopic gastrojejunostomies (PEJ), and the use of tissue plasminogen activator (tPA). Drug-eluting stent implantation, hip/knee revisions, PEJs, and use of tPA are among the most difficult and commonly missed inpatient procedures that HIM staff must code, experts say.

Comply with physician supervision requirements for diagnostic testing
Hospitals and nonhospital settings, such as independent diagnostic testing facilities (IDTF), have different physician-supervision requirements for diagnostic radiology tests. But the lines are blurred when a hospital also has free-standing clinics. And for many providers, the official rules and regulations are hard to find. Stacie Buck, RHIA, LHRM, vice president of Southeast Radiology Management in Stuart, FL, Duane Abbey, PhD., CFP, president of Abbey & Abbey Consultants, Inc., in Ames, IA, and Stacy Gregory, RCC, CPC, of Gregory Medical Consulting Services in Tacoma, WA, provide the following guidelines for the different settings and best practices for compliance.

Tackle physician documentation with education, review
One facility uses HIM professionals to drive improvement Documentation improvement programs offer your organization a chance to receive fewer denials and improve its case mix index. However, it's easy to become bogged down in the specifics of establishing a program. For example, determining whether HIM professionals or clinical staff should be on the documentation im-provement team, specifying how the process should work, and obtaining the necessary physician and administration buy-in are thorny issues. One hospital answered these questions with a solution that has been a resounding success.

Turn to AHA/CMS for answers to tough coding questions
New partnership to provide HCPCS help for hospitals If you have an outpatient coding question, the newly formed American Hospital Association (AHA) clearinghouse wants to help. The AHA and CMS announced on January 6 that in an attempt to improve billing and data quality, they would jointly establish a resource to handle HCPCS-related questions. The clearinghouse, which also re-ceives advice from the American Health Information Management Association, provides HCPCS-coding education to hospitals, policy makers, and the public, says Nelly Leon-Chisen, RHIA, director of coding and classification for the AHA in Chicago.

Lobby the experts to help make a difference
Experience can change your perspective. Some-times you gain new insights and additional knowledge that can change the way you approach your profession. Unfortunately, sometimes the "gurus," or policy-makers, don't learn the same insights, and sometimes they don't change their approach, leaving you to perpetuate inconsistent concepts. Sometimes even the gurus recognize the errors of their ways and make corrections. For example, the cooperating parties for ICD-9-CM issued new definitions for chronic kidney disease (CKD) codes in October 2005 and changed the 403.x0 series to hypertensive kidney disease without kidney disease. It took the vigilant eyes of a few to point out the inconsistency of these definitions and begin the process to correct them-and it worked.

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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