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Learning ICD-10: Documenting Type 2 Myocardial Infarction

I am in the middle of a heads-down project, but I popped my head up long enough to read the new ICD-10-CM guidelines for 2018 (thanks for the notification, Gloryanne Bryant!). I had to take a moment to comment on the Type 2 myocardial infarction (MI) guidelines. The reasons we should be documenting and coding […]

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Final Fiscal Year 2018 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities

Overview On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2018 final policies are summarized below. Updates to […]

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Does a CDI Program Improve Physician Engagement?

Last month, the American Health Information Management Association (AHIMA) released a practice brief titled “Impact of Physician Engagement on Clinical Documentation Improvement Programs.” The brief contains some extremely valid and interesting points. Genuine, consistent physician engagement is essential for any clinical documentation improvement program meant to achieve scale and long-term sustainability. The practice brief starts […]

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Moving Your Practice Past Industry Benchmarks

I often get the question, “What should my monthly numbers be?” My first response is, taking into account collections among other things affecting their practice, “What are your minimum requirements, annual goals, and what amount of time and energy are you willing to put in, in order to reach those results?” This is not the […]

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Release of New Codes Coming Down to Wire

Why is it important to take these new code changes seriously? It is extremely important to for coders, but we have to think of opportunities for documentation improvement and physician documentation. For simplicity, we want to minimize errors and maximize output. For many of this year’s code changes, we already see the documentation in record, […]

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Doctors Would Report Opioid Diagnosis Codes Under Deal

Ohio doctors would report the specific diagnosis of every patient who receives a prescription painkiller under a tentative agreement reached Friday with the Kasich administration. The 11th-hour compromise between the Republican governor’s office, the state Medical Board and associations representing doctors and hospitals followed months of wrangling over new opioid prescribing rules proposed in April […]

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Why We Need To Stop Calling Physicians “Providers”

It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry […]

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New EHR Alert Increases HCV Screening Among Baby Boomers

Implementation of an electronic health record-based prompt significantly increased hepatitis C screening rates among baby boomers in primary care. According to the researchers, HCV screening among adults born between 1945 and 1965 increased fivefold during a 1-year period following implementation of the Best Practice Advisory (BPA) EHR alert. “Although there has been dramatic advances in […]

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Some New Myocardial Infarction Codes Challenge Interpretation

The addendum for new codes coming out was recently released with many notable additions and deletions. The next several articles in this series will address some of these conditions in order to help us get ready for the October 1 implementation date. One of the things I love most about getting the codes well before […]

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DOJ Charges Hundreds With Opioid-Related Fraud

The U.S. Department of Justice (DOJ) arrested 412 individuals, including 115 licensed medical professionals, across the country for alleged involvement in health care fraud schemes totaling around $1.3 billion in false billing and “unlawful” distribution of opioids and other narcotics, according to a statement. It is the largest health care fraud enforcement action ever taken […]

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Final ICD-10-CM Codes for 2018 Contain a Few Surprises

The final codes include 322 more changes than what was proposed by CMS in April’s hospital IPPS rule. Starting Oct. 1, it will be possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis and nicotine. Those nine new […]

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How to Avoid TCM Coding Denials

• CPT code 99495 (TCM with moderate medical decision complexity and a face-to-face visit within 14 days of discharge) • CPT code 99496 (TCM with high medical decision complexity and a face-to-face visit within 7 days of discharge) Payment information: CMS began paying for TCM in 2013, and many commercial payers began doing so shortly […]

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Clinical Documentation Integrity: Where Business Acumen Governs High Performance

Clinical documentation integrity (CDI) as a profession is quite similar in nature to running a business. Successful businesses exhibit certain operational qualities and traits that serve to ensure continued growth and prosperity, and their leaders possess a long-term vision and ability to consistently meet, exceed, and solidly predict current and future needs of their customers. […]

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ICD-10: Abide By These Rules When Coding Foreign Bodies

Know when to apply these secondary codes. Foreign bodies (FBs) entering through one of the three ENT-specific pathways is a relatively common occurrence. While these situations are found primarily with children presenting for service, FBs of the ear, nose, and throat don’t necessarily discriminate when it comes to age. However, when it comes to coding, […]

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Price Gouging in the ER: Patients Often Overcharged

Emergency departments across the United States charge adult patients 340% more than what Medicare pays for services, but minorities and the uninsured receive the biggest bills, according to new research from the Johns Hopkins University School of Medicine. The study, published in JAMA Internal Medicine, found that on average emergency departments charge anywhere from 1.0-12.6 […]

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Optimizing the Monitoring of ICD-10 Coding Productivity

With the help of hindsight and data, we can now more accurately predict coding productivity and staffing needs. The run-up to ICD-10 had most of us very concerned, expecting to experience a decline in productivity of as much as 40 percent or more. Early productivity reports, based on perceptions and/or small sample sizes, confirmed that […]

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