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Issue 12, December 1, 2010 - VIEW THE FULL ISSUE

• Let the OIG Work Plan inspire your auditing,  compliance program

  Each year, the Office of Inspector General (OIG) Work Plan includes a host of inpatient-related...

• Take time to understand acute kidney injury versus acute renal failure

  Use these four tips when asking for clarification It’s the classic case of being “lost...

• Consider a concurrent coding program to improve  documentation, reduce DNFB

  Although most inpatient coders cringe at the mention of their hospital’s...

• ICD-9 vs. ICD-10: Know the facts

  Coders won’t officially begin reporting ICD-10 codes until October 1, 2013. However, between...

• BCCS advisors share coding insights

  As 2010 comes to an end, Briefings on Coding  Compliance Strategies would like to extend a...

• Know clinical implications of blood cell count variances

  A proliferation of new codes describes variances in blood cell counts, but what are the clinical...

Issue 11, November 1, 2010 - VIEW THE FULL ISSUE

• Medical necessity audits: Involve coders in your RAC defense strategy

  Hospitals have waited with bated breath for RAC medical necessity audits to begin. Now that the...

• Three-day payment window: Know these frequently asked questions

  Confusion about the three-day payment window has only grown since new guidance took effect June 25...

• Ensure documentation supports the codes you assign

  Coders are under a lot of pressure to accurately assign diagnosis codes and DRGs, capture all...

Issue 10, October 1, 2010 - VIEW THE FULL ISSUE

• New and revised ICD-9-CM codes require clinical specificity

  There is a plethora of new ICD-9-CM codes that take effect October 1, and coders had better be...

• Identify high-risk vulnerabilities to prepare for RACs

  Identify high-risk vulnerabilities to prepare for RACs Taking the time to understand lessons...

• Encoders: Crutch or tool?

  Like most coders facing stringent productivity standards nationwide, those working at the William...

• Five tips to ensure HAC, POA, and never event compliance

    The POA indicator, hospital-acquired conditions (HAC), and never events have been around...

• Don your clinical hat to distinguish between open, endoscopic, and bypass procedures

  Various medical specialties have undergone considerable practice modifications over the past few...

Issue 9, September 1, 2010 - VIEW THE FULL ISSUE

• CMS releases FY 2011 IPPS final rule

  The FY 2011 IPPS final rule released July 30 includes the usual suspects—POA...

• Three-day payment window continues to puzzle providers

  CMS discussed changes to the three-day payment window and fielded several related questions during...

• Providers still waiting for three-day payment rule clarification

  During the last few Open Door Forum calls, providers have lamented the operational challenges of...

• Case studies: Assigning the principal diagnosis

  The following four case studies test your knowledge of correct principal diagnosis (PDX...

• Don’t bypass coding rules to get more money

  Last month I discussed the importance of queries related to sepsis versus UTI due to an indwelling...

Issue 8, August 1, 2010 - VIEW THE FULL ISSUE

• Measure the effectiveness of your CDI program

    You’ve started a clinical documentation improvement (CDI) program and collected data...

• Don’t fall into these avoidable V code traps

  V codes play an important role in painting an accurate picture of an admission and facilitating...

• Review of neoplasm coding guidelines good strategy when preparing for RAC audits

  It shouldn’t come as a surprise that HealthDataInsights—the RAC for Region D—is...

• Don’t bypass coding rules for more money

  We all know that coders are under pressure to capture all relevant conditions (including CCs and...

Issue 7, July 1, 2010 - VIEW THE FULL ISSUE

• Should coders wait for the discharge summary before coding?

  There are many reasons why a coder could delay sending a claim, but should a missing discharge...

• Prepare for RAC audits by taking a closer look at mechanical ventilation

  Inpatient admissions requiring mechanical ventilation tend to be high-dollar cases, which is...

• ICD-9 code expansion on institutional claims may enhance data quality

  Coders and quality managers who lament that CMS processes a total of only nine diagnosis and five...

• CMS addresses three-day rule, proposed IPPS provisions

  CMS discussed several inpatient topics during its May 27 Hospital Open Door Forum (ODF), which...

• Don’t let bad coding advice lead you astray

  What should coders do when advice is misguided?

Issue 6, June 1, 2010 - VIEW THE FULL ISSUE

• FY 2011 IPPS proposed rule spurs discussions about regulatory hot topics

  The fiscal year (FY) 2011 IPPS proposed rule released April 19 addresses several highly debated...

• FY 2011 IPPS proposed rule, three-day payment window are topics as 500 listeners join April call

  CMS discussed several inpatient-related topics during its April 21 Hospital Open Door Forum (ODF...

• Don’t let improper discharge disposition codes fly under the radar at your facility

  You may think the discharge disposition codes you  assign are correct, but discharge plans...

• Understand causes of anemia in cancer patients before reporting 285.22

  Name as many reasons why a cancer patient may develop anemia as you can. Is anemia in neoplastic...

Issue 5, May 1, 2010 - VIEW THE FULL ISSUE

• Use PEPPER to improve coding compliance

  Aside from being a catchy acronym, PEPPER (Program for Evaluating Payment Patterns Electronic...

• Ask the correct questions to ensure compliance when reporting cirrhosis and alcoholic hepatitis with an MCC

  MS-DRG 432 (cirrhosis and alcoholic hepatitis with MCC) is one of many MS-DRGs slated for RAC...

• Understand nuances of reporting inpatient-only procedures

  Inpatient-only procedures are published in the annual outpatient prospective payment system (OPPS...

• Establish a robust coding auditing program

  Many reasons justify establishing an internal auditing program. An organization may have a...

• Revised code definitions, physician education can help differentiate between bacteremia, septicemia coding

  Several decades ago, coders assigned 038.x to denote bacteremia as well as septicemia. Back then...

Issue 4, April 1, 2010 - VIEW THE FULL ISSUE

• Know the coder’s role in accurate portrayal of readmission data

  The statistic is striking. Nearly 18% of admissions result in readmissions within 30 days of...

• Five tips for coding postoperative or post-traumatic infections with operating room procedures

  RACs already are validating countless MS-DRGs in hospitals nationwide, and the number of eligible...

• CMS fields questions related to three-day payment rule

    CMS discussed several inpatient-related topics during its March 4 Hospital Open Door Forum...

• Exercise caution with septicemia codes

  The signs and symptoms of septicemia, bacteremia, viremia, and fungemia (i.e., shaking, chills...

• Coding conundrums: Let’s clear the air about complications and septicemia

  I’d like to take this opportunity to clarify a few concepts that I think continue to confuse...

Issue 3, March 1, 2010 - VIEW THE FULL ISSUE

• Audit present-on-admission indicators to ensure compliance, data accuracy

  Was it present on admission (POA) or did it develop during the patient's stay?

• Seven tips to keep your coding compliance program fresh

  Just because your coding compliance program is in place doesn't mean it's doing its job...

• Understanding circulatory system anatomy will help you prepare for coming conversion to ICD-10-CM/PCS

  Dust off a medical terminology book and start reviewing anatomy and physiology. This may be the...

• Audit wound debridement MS-DRGs before your RAC does

  Coders don't need a RAC audit to tell them that reporting inpatient wound care is particularly...

• CMS addresses three-day payment rule, condition code 44, observation, ABNs, and other inpatient topics

  CMS discussed several inpatient-related topics during its January 14 Hospital Open Door Forum...

• Clinically Speaking: Don’t rely solely on an encoder

  Despite the evolution of codes for chronic and acute heart and renal disease over the past 20...

Issue 2, February 1, 2010 - VIEW THE FULL ISSUE

• Brush up on sequencing as RAC complex reviews get under way

  As RACs begin to roll out complex reviews and request medical record documentation, compliant...

• Think twice before assigning codes for surgical complications

  CDI programs can greatly enhance documentation, but what happens when a hospital's risk-adjusted...

• California-based IRFs reflect on their experiences during RAC demonstration project to prepare for future audits

  Two California facilities continue to draw on their experience during the RAC demonstration...

• Get to the heart of the causes of cardiomyopathy

  Cardiomyopathy is typically a long-lasting disease (-pathy) of the heart (cardio-) muscle (-myo...

Issue 1, January 1, 2010 - VIEW THE FULL ISSUE

• Know when to report uncertain diagnoses

  Coders may often wish they could read physicians’ minds when clinical documentation is...

• CMS Open Door Forum update: CMS fields observation, value-based purchasing questions

  Inpatient-related topics such as observation, inpatient admission, new quality measures, and...

• Understand Medicare appeals process to ensure RAC success

  Recovery Audit Contractors (RACs) are here to stay forever ... or at least until they reduce the...

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

  Documentation and coding audits help identify a coding compliance program’s strengths and...

• Know your top 10 MS-DRGs

  What are your top 10 MS-DRGs according to volume (i.e., number of discharges)?

• Briefings on Coding Compliance Strategies 2009 index

  Coding and billing 2010 IPPS final rule: CMS delays documentation and coding adjustment, reduces...