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Briefings on Coding Compliance Strategies

Issue 12, December 1, 2008 - VIEW THE FULL ISSUE

• New guidance may create additional query opportunities

  Coders and CDI specialists now have concrete guidance regarding when, how, and to whom they should...

• MS-DRGs on OIG radar: Ensure compliant coding

  Since October 1, 2007, providers have been adapting to a revised hospital inpatient reimbursement...

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

  CMS discusses RAC expansion, ICD-10, and never events CMS hosted a Hospital & Hospital Quality...

• CMS offers RAC details despite temporary program halt

  Officials answer questions during special ODF By now, one point remains clear: CMS has halted the...

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

  Hospitals have been waiting for finalized wage indexes and standardized payment rates since CMS...

• Go back to the source when coding secondary diabetes

  As of October 1, coders began reporting new codes for secondary diabetes. To maintain coding...

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

  by Robert S. Gold, MD Applying the present-on-admission (POA) indicator to pressure ulcers is no...

Issue 11, November 1, 2008 - VIEW THE FULL ISSUE

• One-day stays

  Forty percent of Medicare admission denials relate to improper one-day stays. If this statistic...

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

  Most surgeons find carcinoid tumors incidentally, either during the postmortem exam when a patient...

• Examine postoperative condition coding

  Just because a physician documents a condition during the postoperative period doesn’t mean...

• Clear up morphology and neoplasm code confusion

  The ICD-9-CM Manual provides many helpful tools you can use to your advantage. For example, despite...

• Get a bloody good understanding of GI hemorrhage

  Gastrointestinal (GI) bleed and its manifestations can be confusing without some insight into...

Issue 10, October 1, 2008 - VIEW THE FULL ISSUE

• Prepare for the arrival of the new ICD-9-CM codes

  Now that fall is here, coders need to be ready to use the new and revised ICD-9-CM codes. The...

• Get to know MIPPA’s hospital-related provisions

  On July 15, Congress enacted the Medicare Improvements for Patients and Providers Act of 2008...

• Avoid the trap of probable diagnoses

  Most inpatient coders are accustomed to seeing “probable,” “suspected,”...

• Guidelines explain new codes for pressure ulcer staging, VAP

  One of the more challenging series of new ICD-9-CM codes assists in fully describing pressure...

• Look forward to improved complications data

  In the beginning, there was raw data: one hospital’s death rate compared to another...

Issue 9, September 1, 2008 - VIEW THE FULL ISSUE

• Avoid inappropriate physician queries

  Since the implementation of Medicare Severity DRGs in October 2007, the volume of physician queries...

• Create a successful CDI educational session

  A successful clinical documentation improvement (CDI) program includes three essential elements...

• CMS discusses the RAC evaluation report, therapy cap extensions, MIPPA, and more

  CMS hosted a hospital Open Door Forum (ODF) call July 17, during which representatives discussed...

• Learn about the preadmission services window policy

  Editor's note: The following article is adapted from the June 18 National Government Services...

• Q&A: Principal diagnoses and acute MIs

  Editor's note: Dr. Gold founded DCBA, Inc., a consulting firm in Atlanta that provides...

Issue 8, August 1, 2008 - VIEW THE FULL ISSUE

• Get acquainted with chronic conditions

  How do you define chronic? Many medical dictionaries and Web sites describe chronic diseases as...

• Focus on documentation for new ICD-9 codes

  Education among coders and physicians will help prevent a flood of physician queries that might...

• Don't 'grab and run' with diagnoses

  If they don't perform a thorough record review, clinical documentation improvement (CDI...

• It's a balancing act: Maintaining acid-base balance

  Complex processes go on inside the body in order to maintain homeostasis, or the status of being...

Issue 7, July 1, 2008 - VIEW THE FULL ISSUE

• AHIMA's draft query practice brief leaves many questions unanswered

  Editor's note: The following article went to press prior to AHIMA's publication of its final...

• CMS proposes payment for diagnoses reported with POA indicator U under certain circumstances

  Editor's note: The following article went to press before CMS released its 2009 IPPS final...

• CMS launches demonstration project to bundle payment for physician and hospital services

  Those in the HIM world know that hospital and physician incentives have never been completely...

• The IPPS PC Pricer: Make the most of this helpful software

  Do you work in the finance department or business office at your facility? Are you part of a...

• ACS is only ACS when it's caused by a change in the coronaries

  When I have written about acute coronary syndrome (ACS) in the past, I have referred to an article...

Issue 6, June 1, 2008 - VIEW THE FULL ISSUE

• Prepare to be dazzled by the more than 300 proposed ICD-9 code changes

  Coders may face the largest number of code changes in more than a decade if CMS finalizes the...

• OIG questions short-stay outlier trends for LTCHs

  According to a report the Office of Inspector General (OIG) issued in late March, short-stay...

• CMS discusses FY 2009 IPPS, IRF-PPS proposed rules, clarifies patient status errors, and more

  CMS hosted a hospital Open Door Forum (ODF) call April 24, in which representatives discussed...

• Is asking for clarification 'leading'?

  In 2000, CMS released a note that forbade individuals from asking physicians questions and...

Issue 5, May 1, 2008 - VIEW THE FULL ISSUE

• CMS releases 2009 IPPS proposed rule

  CMS released its IPPS proposed rule for fiscal year (FY) 2009 April 14, and although hospitals will...

• Don't take RAC medical necessity denials lying down

  By now, almost everyone knows the results of the threestate recovery audit contractor (RAC...

• CMS discusses Hospital Compare Web site, observation, quality reviews, and more during recent call

  CMS hosted a hospital Open Door Forum (ODF) call March 13, in which various representatives...

• A snapshot of the effect of MS-DRGs on cardiac coding

  Medicare predicted that after Medicare Severity DRGs (MS-DRG) were implemented, facilities would...

• The newest on PEGJ: Understand what a percutaneous endoscopic gastrojejunostomy is, and what it isn't

  We learn something new every day. For the past several years, I've been complaining about advice in...

Issue 4, April 1, 2008 - VIEW THE FULL ISSUE

• Alleviate discharge disposition confusion to ensure compliance

  Discharge dispositions-two-digit codes that indicate a beneficiary's status when he or she...

• Break the encoder addiction to ensure compliance

  Although coders may have been able to rely on coding software and encoders under the original DRG...

• Improve documentation and coding now, before recovery audit contractors go national in 2010

  Recovery audit contractors (RAC) have identified certain target DRGs and compliance areas as part...

• Solicit detailed documentation to improve your hospital's profile for stroke patients

  It has been quite a while since I've written about stroke documentation. Since my last column on...

Issue 3, March 1, 2008 - VIEW THE FULL ISSUE

• Reduce unnecessary one-day lengths of stay

  As the Office of Inspector General (OIG) continues to crack down on medically unnecessary one-day...

• OIG stresses quality, medical necessity in most recent semiannual report

  A recent semiannual report issued by the Office of Inspector General (OIG) reminds providers that...

• CMS discusses proposed 2009 LTAC hospital changes, POA indicator during recent Open Door Forum call

  CMS hosted its most recent hospital Open Door Forum (ODF) call January 31 in which a number of CMS...

• Maintain compliance when coding from the medical record

  You might think that everything between the first and last page of a medical record is fair game...

• Understand coding, core measures for heart disease

  I have always stressed the importance of proper documentation regarding heart failure and acute...

Issue 2, February 1, 2008 - VIEW THE FULL ISSUE

• Medicare improper payment level at an all-time low

  As part of its goal to reduce improper payments for services provided to Medicare beneficiaries...

• Hospitals experience POA snags due to systems problems, insufficient documentation

  Although present-on-admission (POA) indicator assignment is going smoothly for most hospitals, a...

• Report hospital quality measures to ensure an accurate public profile and full reimbursement

  For the past several years, hospitals nationwide have been becoming familiar with inpatient quality...

• To code or not to code: That is the question

  ICD-9-CM diagnostic and procedural code assignment usually follows certain patterns. But despite...

Issue 1, January 1, 2008 - VIEW THE FULL 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...

• 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...

• 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...

• 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...

• 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...

• Coding Q&A

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