CMS issued the fiscal year (FY) 2017 IPPS proposed rule Monday with updates to several MS-DRG classifications and relative weights. The amount of proposed MS-DRG changes, said Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts, was expected due to the transition to IDC-10.
There are new enforcement editing requirements regarding the coverage and billing of Partial Hospitalization Program services, likely due to significant problems with these claims and coding highlighted in the 2016 proposed and final OPPS rules.
The new modifier -PO (services, procedures, and/or surgeries furnished at off-campus provider-based outpatient departments [PBD]) and the alternative payment provisions under the Bipartisan Budget Act Section 603 are both related to off-campus PBDs but define "off-campus PBD" slightly differently.
In February 2016, just four months after ICD-10 go-live, sister publication HIM Briefings (formerly Medical Records Briefing) asked a range of healthcare professionals to weigh in on their productivity in ICD-9 versus ICD-10.
Last year, as ICD-10 implementation approached, organizations throughout the U.S. reported varying levels of comfort with regard to readiness and understanding of the impact of ICD-10 on physician workflow. For some, it was business as usual. For other physicians, ICD-10 became one more check box on the list of reasons to leave practice.
In February 2016, just four months after ICD-10 go-live, HIM Briefings asked a range of healthcare professionals to weigh in on their productivity in ICD-9 versus ICD-10.
In general, the time spent coding records has increased since ICD-10 implementation for most record types. In fact, one respondent said his or her facility noticed a 40%?50% decline in productivity. However, another respondent noted that coder productivity often varies based on the physician who documented in the record, as some physicians are more in tune with the language of ICD-10 than others. One-third (33%) of respondents were coders, whereas 21% identified as coding directors, managers, or supervisors. Approximately 16% identified as HIM directors, managers, or assistant directors or managers, while 12% of respondents were clinical documentation improvement (CDI) specialists. A small percentage of quality/performance improvement directors, vendors, consultants, IT directors/managers, billers, and auditors weighed in as well. More than half (53%) of respondents work in acute care hospitals.
One respondent said that his or her facility expects the same productivity in ICD-10 as it had in ICD-9, a nearly impossible feat in some cases. "The productivity requirements have not changed from ICD-9 to ICD-10. The current requirement for our facility is 18 charts per day (minimum 14). Very challenging and almost unobtainable."
The HCPro survey questions asked for the average minutes to code a record type. Some respondents wrote in the daily number of records coded, while others indicated the number of records averaged per hour.
The April Integrated Outpatient Code Editor had a large volume of clarifications and changes to correct issues with processing claims related to new policies adopted in January. This article will explain when organizations can reprocess claims that were negatively affect by the edits.
Q: I have a question regarding which place of service (POS) code I should use for an orthopedic doctor who did a consultation on a patient that came through the ED. The patient has a spiral fracture of the humerus. The electronic record documents that the patient was admitted to the medical unit on January 31 but was a “boarder” in the ED until February 2, waiting on a room to be available. The orthopedic doctor saw the patient on February 1. The patient did finally receive a room assignment on February 2. In this scenario would I use POS 22 (outpatient hospital) or 23 (ED)? This patient has Medicare.
This week’s updates include implementation of the award for Jurisdiction A DME MAC workload; April 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.1; and more!
