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• Questions surround when time starts for proposed inpatient presumption

  The proposed CMS presumption for inpatient admission includes an interesting nuance that could spell the end of dedicated observation units. According to CMS, the starting point for counting utilization days “would be when the beneficiary is moved from any outpatient area to a bed in the hospital in which the additional hospital services will be provided.”

• Q/A: Should we use modifier -Q0 to override edits for ICDs?

  Q: We are hitting an edit for claims containing the codes for placement of implantable cardioverter-defibrillator (ICD) and Bi-V ICD systems. The edit states we must report certain diagnoses; otherwise, we need a modifier Q0 (investigational clinical service provided in a clinical research study that is in an approved clinical research study). These patients are not always part of a clinical study, so I don’t think the Q0 modifier is appropriate. Many of these patients have failed conservative measures and have cardiomyopathy and congestive heart failure. Can we bypass the edit and submit these claims anyway?

• Tip: Review codes that are now packaged

  As part of the April update to the I/OCE, CMS changed the status of the following codes from E (not paid under OPPS) to N (items and services packaged into APC rates.

• Membership update: Coding Clinic recap offers ICD-10 insight

  AHA Coding Clinic for ICD-9-CM released its second round of ICD-10 coding guidance in its First Quarter 2013 issue. HCPro CDI Education Director Cheryl Ericson, MS, RN, CCDS, CDIP, says the guidance contains information regarding diagnosis clarification, but also instances in which a CDI specialist may be called upon to clarify a procedure. Other than debridement of pressure ulcers, procedures rarely need to be clarified in ICD-9, but this paradigm may be changing under ICD-10.

  Visit the Featured Article on the ACDIS home page for a recap of the issue with an eye toward what it means for CDI specialists.

• News: CMS hears industry concerns related to EHR implementation during listening session

  CMS got an earful during a listening session regarding electronic health records (EHRs) held Friday, May 3. The session focused on systems and billing, and featured feedback from AHIMA, the American Hospital Association (AHA), the American Medical Association (AMA), among others.

• Solidify processes to avoid HAC penalties

  Hospital-acquired conditions (HACs) remain in the spotlight in the 2014 IPPS proposed rule even though CMS did not add any new conditions to the HAC list. Under the Affordable Care Act, CMS is required to penalize hospitals that are in the lowest-performing 25% for eight HACs. Beginning in 2015, those facilities would receive only 99% of what they would otherwise be paid under IPPS.

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