CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it comes to putting those rules into practice, things can get even more difficult.
As patient advocates, case managers often need to question physician decisions that do not follow evidence-based criteria or that go against patient wishes.
Observation services are a specific set of services provided to a patient while the physician decides whether to admit or discharge the patient. That means if a patient undergoes a procedure that requires “active monitoring,” he or she is not receiving observation services during the procedure.
It will take time for coders to become comfortable translating terminology used in physician documentation to root operation terminology used in ICD-10-PCS, according to Lolita M. Jones, RHIA, CCS, independent consultant in Fort Washington, MD, who spoke during HCPro’s November 18, 2010, audio conference, “ICD-10-PCS Surgery Coding: Understand and Apply Five Medical Surgical Root Operations.” But Jones thinks coders will get there eventually.
In 2010, HCPro’s Revenue Cycle Institute conducted its second annual in-depth study on RAC preparedness among healthcare providers. The results are now in: RAC audits have picked up, but preparation and education are still under way for many, and HIM plays an important role.
