In the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status
Community Hospital in Munster, Indiana, is disputing an Office of Inspector General (OIG) report that found DRG assignment errors and incorrect inpatient rehabilitation facility (IRF) claims, resulting in an projected $22,051,602 in overpayments.
CMS released Transmittal 4246 on February 22, revising language in Chapter 13 of the Medicare Claims Processing Manual regarding the billing of E/M codes on the same date of service as superficial radiation treatment delivery.
In 2018, most organizations held the line on coder productivity, according to the results of sister publication HIM Briefings’ 2018 coding productivity survey.
A retrospective study recently published in Pediatrics found that a statewide administrative database containing billing and coding information for newborn discharges accurately captured risk factors and outcomes for perinatal patients. This suggests that administrative databases may be effectively used to analyze performance metrics and accelerate data quality improvement efforts locally.
Pay close attention to new CPT documentation and coding guidance for reporting radiological imaging. For example, a new paragraph titled “Imaging Guidance” in both the surgery and medicine guidelines advises that even when imaging guidance or supervision are included in a surgical procedure code, you must still follow the radiology documentation requirements in the CPT manual.
An inpatient study recently published in the Journal of the Academy of Nutrition and Dietetics demonstrates the importance of accurate ICD-10-CM reporting for malnutrition to ensure accurate Medicare severity diagnosis-related group (MS-DRG) assignment and the establishment of appropriate comparison benchmarks such as expected geometric mean length of stay (GMLOS).
