With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
The 2017 ICD-10-CM updates included a significant number of additions to digestive system diagnoses, especially codes for pancreatitis and intestinal infections. These codes are largely focused in the lower gastrointestinal (GI) tract, and a review of the anatomy of this body system could help improve accurate documentation interpretation and code selection.
Probably the most onerous duty physicians have is the preparation of the inpatient discharge summary, especially after a long or complicated hospital stay.
Pneumonia discharges impact hospital payments under the Hospital Value-Based Purchasing Program as well as the Hospital Readmissions Reduction Program. The selection of a principal diagnosis, secondary diagnosis, present on admission (POA) status, and discharge status on each claim determines whether a pneumonia discharge will be included in the measure.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the Office of Inspector General or Recovery Auditor.
One area of CPT coding that saw big changes for 2017 is for dialysis circuit coding. The existing codes have all been deleted, and new codes have been created (36901-36909) for reporting these procedures.
Even though we are set to inaugurate a new president of the United States who vowed to abolish Obamacare, I believe that Donald J. Trump will not touch provisions that address perceived cost inefficiency or quality within our healthcare system. In fact, if you’ve read CMS’ game plan for transforming healthcare published in JAMA in 2014, note that many of these provisions began with George W. Bush and have been embraced by the AMA with the implementation of MACRA.
The implementation of ICD-10 in 2015 was considered an industrywide success. Coders were trained, HIM departments were prepared, and outsourced coding companies expanded their roles. As we enter the second year of ICD-10, what should HIM directors expect from their coding teams and outsourced vendor partnerships?
Each year, CMS reviews procedures on the inpatient-only list, which consists of services typically provided on inpatients and not payable under the OPPS, to consider whether they are being performed safely and consistently in outpatient departments.
