Conducting pre-billing audits can be challenging, but when done correctly, it can save organizations from spending time recoding and rebilling claims that payers deny. These audits can be conducted on the front end, in both inpatient and outpatient settings, once records have been coded.
Do your coders ever feel as if they work more hours than most coders? Or perhaps they think their compensation is lower than other coders across the country? Have you ever wondered how your coders compare to the average coder?
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.
The ICD-10 delay forced many healthcare organizations to rethink their ICD-10 staffing and implementation plans. Baptist Health System in Birmingham, Alabama, devised a plan to prepare for the one-year delay of ICD-10 by revising its budget and relying on new graduates to fill coder positions.
Coding and documentation should tell a patient's complete story. With the greater specificity in ICD-10, organizations should be better able to capture these stories, and the respiratory codes, listed in Chapter 10: Diseases of the Respiratory System (J00?J99), are no exception.
More than ever before, HIM is being recognized as an enterprise profession important to ambulatory, acute, and postacute settings. A good example of the transformation is HIM's involvement in CMS' risk adjustment and Hierarchical Condition Category coding system.
There has been a fair amount of coverage on the documentation requirements needed to assign ICD-10-CM diagnosis codes. While changes in documentation requirements for pregnancy, coma, diabetes, fractures, and pressure ulcers are frequently cited, less information is available regarding the documentation requirements for procedures.
