COPD and Pneumonia: Code First or Code Also?

One subject brought up several weeks ago on an edition of Talk Ten Tuesdays was the sequencing of J44.0, chronic obstructive pulmonary disease (COPD), with acute lower respiratory infection and pneumonia. Guest Stacey Elliot referred to the Coding Clinic from the third quarter of 2016, which says: “based on the instructional note, the COPD must […]

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Key ICD-10 Changes That Impact Pathology/Lab Coding in 2017

Have you updated your reporting of malignant carcinoid tumors, viral hepatitis, GIST or ovarian cyst coding? You haven’t had to deal with annual ICD-10-CM updates until Oct. 1, 2016. Now that the changes are effective, ensure your lab is on top of the latest changes. Take a look at how the first annual update in […]

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What Should Hospital Administrators Concentrate More On?

Hospital administrators have to juggle between various tasks like managing finances, projects and the usual daily hospital operations. To top it all, the priorities are constantly changing from one department to another. Consequently, it is very important to know which task takes precedence over the others. Here are a few points that can help you […]

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Remote CDI: A Remote Possibility?

During a recent edition of Talk Ten Tuesdays, Dr. Erica Remer responded to a listener’s question about clinical documentation integrity specialist (CDIS) working remotely. Here is Dr. Remer’s response. As I tell residents, historically, charting and chart review was done on the floor, because that’s where the chart was. Clinical documentation integrity specialists (CDISs) and […]

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C&M Update: Enhancements to ICD-10 Continue

The ICD-10-CM/PCS Coordination and Maintenance (C&M) Committee met this past week, and there were lots of proposed enhancements to the code set presented and discussed. According to the Oxford dictionary, “enhancement” means an increase or improvement in quality, value, or extent. This definition truly describes the efforts of the C&M Committee and those who participate […]

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ICD-10 Codes Aren’t Oppressive After All

Alexander Miller, M.D., a dermatologist in Yorba Linda, Calif., has a simple message for colleagues grappling with the new ICD-10 codes: Don’t panic! “It’s just a matter of restructuring one’s thinking,” Dr. Miller tells Dermatology Times. “It was no problem for us to handle these codes,” he says, even in his office that continues to […]

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Contact with Nonvenomous Frog, Subsequent Encounter

EDITOR’S NOTE: This article focuses on physician engagement and ICD-10 education. However, the term “physician” includes everyone licensed and credentialed to record a patient diagnosis, such as wound care and other clinical staff. St. Joseph’s Healthcare System (SJHS)in Paterson and Wayne, N.J. is truly an ICD-10 success story. Under a new administration and clinical documentation […]

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Modifier 50 Is the Backbone to Your Bilateral Spinal Surgery Reimbursement

Ask your carriers how they want these surgeries reported to avoid reduced reimbursement. Spine surgeons who perform bilateral surgeries such as lumbar laminotomies (63030) should append modifier 50 (Bilateral procedure) to the procedure code and double their charges rather than report multiple units. Coders who follow this rule will be well prepared to report complex […]

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The Opioid Payment Crisis

Addiction services may be a societal necessity – especially as the Central Massachusetts opioid crisis proves particularly fatal – but it is a business, and in this area of medicine, the playing field is not necessarily equal for patients or providers. This reality has shaped how addiction treatment companies have responded to the pent-up demand […]

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How to Take Advantage of New Coding Opportunities in 2017

A new year means new codes and new revenue opportunities for medical practices—but also new challenges to ensure the codes are used correctly. Below is a brief summary of new current procedural terminology (CPT) codes, modifiers and place of service codes that went into effect January 1, 2017. Add-on prolonged E/M services You’ll find a […]

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Risk Adjustment: Excitement and Anxiety

The excitement and anxiety about risk adjustment in the healthcare industry is growing on a daily basis, and we are hearing tremendous hopes to learn and gain new expertise about the shift from fee-for-service (or volume-based) to fee-for-value (or value-based) reimbursement. Everyone in today’s healthcare organizations is feeling an increased urgency to equip themselves with […]

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Importance of DRG Reconciliation in the CDI and Coding Processes

The Centers for Medicare & Medicaid Services (CMS) performs diagnosis-related group (DRG) validation to ensure that reported diagnostic, procedural, and discharge status information matches both the attending’s description and the information contained within the beneficiary’s health record. CMS auditors are instructed to validate the principal diagnosis, secondary diagnoses, and procedures affecting or potentially affecting the […]

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MIPS Reporting: MACRA Final Rule Lists Available Quality Measures for MIPS reporting

MIPS Eligible Clinicians can opt to report as individuals or as a group. A group is defined by the Tax Identification Number (TIN). If you choose this option, the group will be assessed as a group practice across all four MIPS performance categories. Eligible clinicians can take their reporting scores with them if they should […]

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Reimbursement, Billing in Radiology: Updates and Issues

Radiology, as a business, has become increasingly complex as regulatory demands grow and revenues, both on the hospital and physician side decrease. Doing more with less has become a common theme and both the commoditization of billing as well as the implementation of ICD-10 codes have played an important role over the past year, according […]

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The Evolution of the International Classification of Disease

The International Classification of Disease is perhaps one of the most important diagnostics documents in the medical world. It categorizes diseases and medical incidents that can be encountered, and the document reflects a broader context in which it is created. The ICD aids with health policy decision making and can with a process of finding […]

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Coding for Clarity: Echocardiography Gains Two New CPT Add-On Codes

New technologies need new codes CPT codes describe medical, surgical and diagnostic services and procedures. These codes communicate uniform information about medical services and procedures to healthcare providers, payers, administrators and accrediting bodies. They are also vital as financial and analytical tools. New codes are necessary when novel technologies enter clinical practice, as was the […]

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