In a concerted effort to move healthcare payments to a system of "quality over quantity," CMS finalized policies that greatly expanded packaging for outpatient providers in the 2015 OPPS final rule (www.gpo.gov/fdsys/pkg/FR-2014-11-10/pdf/2014-26146.pdf). It also introduced complexity adjustments with comprehensive ambulatory payment classifications (C-APCs).
CMS designates certain procedures as inpatient-only and identifies them using CPT codes. Hospitals normally only use CPT codes for outpatient coding, so this may be confusing for coders who use ICD-9-CM Volume 3 codes for inpatient procedures. Coders need to know which procedures are on the inpatient-only list to monitor compliance with this rule as they apply inpatient procedure codes.
Many hospitals and health systems include computer-assisted coding (CAC) systems as a strategic tool in their plan for ICD-10. CAC software is considered an antidote to the significant decrease in coder productivity anticipated with ICD-10.
Beginning January 1, 2015, physicians will no longer need to provide certification for an inpatient admission unless the admission is expected to last for at least 20 days or the case is an outlier.
Coding for sepsis requires a strong knowledge of ICD-9-CM coding guidelines, as well as complete and accurate documentation. That's not a surprise to any coding professional. They need those two elements to successfully code any medical record.
