Preliminary findings released by the Massachusetts Health Policy Commission (HPC) show that maximized coding may have increased statewide commercial spending for inpatient services by nearly 11% between 2013 and 2018.
Q: We recently had a patient who was admitted with sepsis and the physician documented sepsis, a urinary tract infection (UTI) related to a chronic Foley catheter, and pneumonia. Can we report sepsis first instead of the complication code, or is the complication always first?
Findings from a retrospective study recently published in the Journal of Cardiac Failure show that pulmonary hypertension is frequently identified but rarely coded in electronic health records.
Q: Would it be appropriate to query the provider for clarification if documentation for an orbital fracture doesn’t specify the location of the fracture and whether it is open or closed?
Oceanside Medical Group, a clinic providing mental health services in Santa Monica, California, is disputing an Office of Inspector General (OIG) report that estimated the group received $2.6 million in overpayments for psychotherapy services by failing to comply with Medicare billing and documentation requirements.
The American Medical Association recently released the 2020 CPT code set, adding 248 new codes including many for online E/M services and drug-delivery device implantations, set to go into effect January 1.
Q: How should we handle canceled inpatient-only procedures? Are these are still coded to the full intended procedure under OPPS and modified with a -73 or -74 modifier? Most of these cases result in changed orders to outpatient due to the patient being discharged the same day. Can the original inpatient order be used?
