Tuesday, December 15, 2015

Quick ICD-10 update from: ICD10Monitor & Optum 360 Eight areas of focus

If you don’t read anything else this holiday season, read this. Documentation improvement is at the heart of any successful ICD-10 coding program, and in this article I will highlight eight key areas of focus about ICD-10 and clinical documentation improvement (CDI).

1) Coding guidelines. While the majority of guidelines are unchanged in ICD-10, one in particular stands out: “a symptom(s) followed by contrasting/comparative diagnosis guideline has been deleted effective Oct. 1, 2014.”

The Centers for Medicare & Medicaid Services (CMS) does not want us reporting symptomology when the patient has a more definitive diagnosis. To be fair, Coding Clinic as well as the guidelines have been instructing us NOT to use symptoms when we had more definitive diagnoses for years; however, the overall guidelines still had this outdated rule up until the ICD-10 guidelines were published. It’s nice to see CMS finally eliminating this inconsistency. No longer does a patient who has “syncope due to either bradycardia or diabetic hypoglycemia” get reported with a principal diagnosis of “syncope.”

2) Coding Clinic. As we move farther and farther into ICD-10, Coding Clinic will become more and more important as a tool to stay on top of the state of ICD-10 coding. Here are some of the lessons learned from recent editions that you need to know now:
  • Diabetes and osteomyelitis are no longer an assumed relationship.
  • SIRS due to an infection (example: “SIRS due to pneumonia”) is NOT sufficient documentation for sepsis.
  • Acute cor pulmonale cannot be coded in the absence of an acute pulmonary embolism, only chronic cor pulmonale can be.
  • The Glascow coma scale CAN be captured from the EMT documentation as well as “other nonphysician documentation.”
  • Acute and sub-acute hepatic failure (Code K72.00) should be coded to add severity to patients with acute non-viral hepatitis.
  • According to CMS, it is entirely appropriate to report metabolic encephalopathy (Code G94.14) in a patient who is suffering from hypoglycemic induced confusion as a result of diabetic hypoglycemia.
  • Right sided weakness is coded right sided hemiparesis (Code I69.351) when a patient has unilateral weakness as a long term sequela of a stroke.

3) CMS add-on payments associated with new technology: A total of seven approved new technology add-on payments are at play for the coming fiscal year:
  • CardioMEMS Heart Failure Monitoring System, ICD-10 PCS Code 02HQ30Z,   Payment: $8,875. 
  • MitraClip System for cardiac valvular repair, ICD-10 PCS Code 02UG3JZ. Payment: $15,000
  • .
  • Lutonix drug-coated balloon for PTA and PTCA, 36 Codes in total, many of which were added
  • last-minute. How last-minute? They were released by CMS on Oct. 1. Payment: $1,035.72.
  • Argus II Retinal Prosthesis System, ICD-10 PCS Code 08H005Z and 08H105Z. Payment: $72,028.75.
  • Blincyto medication for ALL, ICD-10 PCS Code XW03351 and XW04351. Payment: $27,017.80.
  • Neuropace RNS System Neurostimulator for Epilepsy, ICD-10 PCS Codes 0NH00NZ and 00H00MZ. Payment: $18,474.
  • Kcentra Coumadin Reversal Medication, ICD-10 PCS Code 30283B1. Payment $1,587.50. 

4) What’s gone?
  • Accelerated /malignant hypertension
  • Hepatic encephalopathy
  • Diabetes uncontrolled has been replaced by diabetes, currently hyperglycemic or hypoglycemic. 
  • DRGs 237 and 238: major cardiac procedures with/without an MCC 

5) What’s changed?
  • PVD has switched from defaulting to a venous code to an arterial code.
  • SVT has gone from being an unspecified cardiac dysrhythmia to actually capturing the correct diagnosis (also now a CC).
  • A repeat MI has changed from eight weeks to 28 days and may provide an MCC as a secondary diagnosis as long as the principal isn’t also a cardiac diagnosis.
  • Multiple significant trauma only requires two rib fractures instead of three.
  • Anemia with cancer now codes to a principal diagnosis of cancer. 
  • Ventilation hours is now broken up into 3 codes: < 24 hours, 24-96 hours and > 96 hours.

6) What’s new?
  • Persistent Afib (CC)
  • Chronic pulmonary insufficiency following surgery (MCC)
  • Sundowning as well as delirium superimposed on a chronic dementia, which is a CC (FO5 acute infective psychosis)
  • In rare circumstances, a principal diagnosis can qualify as an MCC. Examples include traumatic cerebral edema, saddle pulmonary embolism with acute cor pulmonale, CMV pancreatitis, and candial sepsis.
  • We also have codes that qualify as a CC when listed as the principal diagnosis: diverticulosis with perforation and abscess, CMV hepatitis, and hydronephrosis with ureteral stricture.
  • Non-pressure ulcers of the thigh, calf, ankle, heel, midfoot, and lower leg may provide a CC opportunity when the wound character is described in the record (breakdown of skin, fat layer exposed, necrosis of muscle, necrosis of bone, etc.).  
  • DRGs 268 and 269: aortic and heart assist procedures except pulsation balloon with/without an MCC as well as DRGs 273 and 274: percutaneous intracardiac procedures (with and without an MCC) have been added.

7) Combo codes.
  • A COPD patient receiving antibiotics may not have pneumonia, but the combination code for COPD with acute lower respiratory tract infection is a CC. 
  • CAD with angina is now a combination code, which may include a CC component.
  • Combo codes specifying a CVA as well as the specific site of the cerebral lesion are a part of ICD-10.
  • Combo codes for an MI that reflects the site of the occlusion in an ST elevated MI. 

8) ICD-10 procedures that cause inappropriate DRG shifts (CDI has no ability to impact):
Example 1
  • ICD-9: Alcoholic cirrhosis of the liver with bleeding esophageal varices and endoscopic excision/destruction of lesion/tissue of esophagus: DRG 432: Cirrhosis & Alcoholic Hepatitis With MCC
  • ICD-10: Alcoholic cirrhosis of liver and secondary esophageal varices with bleeding and an occlusion of esophageal vein with extra-luminal device, percutaneous endoscopic approach: DRG 981 Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC. 

Example 2
  • ICD-9: Morbid obesity with laparoscopic gastric banding: DRG 619 to 621 OR Procedures for Obesity
  • ICD-10: Morbid obesity with alveolar hypoventilation and restriction of stomach with extra-luminal device, percutaneous endoscopic approach: DRG 989.  Non Extensive OR Procedure Unrelated to Principal diagnosis.

There are certainly a number of bullet points in this summation that could merit their own write-up, and several of the broad sections listed above could easily be turned into hour-long educational presentations. 2016 will be a critical year for CDI specialists to pay very close attention to Coding Clinic as well as quirks in how the documentation gets translated into DRGs and ICD-10 codes. As we move forward into the coming year, the types of queries necessary to produce quality data collection will continue to evolve.
More than any year in recent memory, both CDS and coders will need to approach each new day as an educational opportunity. If there are any CDI or coding directors out there who had been looking for an excuse to institute mandatory regular coding or CDS meetings, you now have it, especially when the quarterly coding clinics are issued.
About the Author
Allen Frady is a senior consultant for Optum360. His experience includes areas in management, implementation, education and clinical practice.  With 20 years in healthcare, he provides clients assistance in the areas of documentation, program implementation and compliance.  His background includes critical care nursing, coding, auditing, utilization review, and documentation improvement.
Contact the Author
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Friday, July 31, 2015

Next up on my "Webinar Circuit" ICD-10pcs Training for Ultrasound...

AudioEducator and myself are happy to extend to you a $20.00 discount on the session..  This makes is only $177.00 for the training (what a DEAL!!!)  when you can have the entire group listen in for the same price and get the discount.  Use Promo Code  "Webb20" at checkout!  I hope to "hear you are there" ...  :)  Use the link below...  and I've included a pic of the flyer...


Get $20 Off On Registering NOW!
(Use Codé "Webb20" at Checkóut )

Speaker: Lori-Lynne A. Webb
Live Webinar
 Wednesday, August 19, 2015
Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Length: 60 minutes
Get Hands-on Coding and Documentation Strategies to Put In Place in Preparation for ICD-10 PCS
With the complete revamp of procedural coding in ICD-10 PCS, good clinical documentation helps to “tell the story”. ICD-10 PCS will provide a more complete clinical picture of patient care, reduce risk, and/or manage risk, in addition to providing a more complete picture of their medical/clinical rècords (HIPAA), and the entire coding/billing processes for reimbursement from 3rd pàrty payers and ìnsurance companies. Hence, becoming proficient in coding ICD-10 PCS is a priority, as the conversion deadline is fast approaching.

Join expert speaker Lori-Lynne A. Webb, in this 60-minute webinar to help you and your facility provide clear cut and accurate coding to substantiate  medical necessity and “proof” when claims are submitted to 3rd pàrty carriers (ìnsurance companies) for reimbursement.

This webinar will provide in depth clinical documentation strategies for facilities and Hospital based ultrasound techs and coders to put in place in preparation for the conversion to ICD-10 PCS. The concept behind this is to prepare staff and coders regarding the changes in ICD-10 PCS from ICD-9 Volume 3.

Lori-Lynne will also cover strategies to help providers document more clearly and concisely for the needs of ICD-10 PCS. The rationale behind this educatìon is to help the providers themselves be better prepared to document clearly, so their coders/billers/managers can more easily and successfully choose the correct ICD-10 PCS code and make the transition to ICD-10 PCS more seamless.

This is the nuts & bolts of what is encompassed within a patient vìsit to the facility for OB ultrasound and Gyn and Pelvic ultrasound. The vìsit can be long or short, but the documentation must “tell the story” of why the patient is seeking care, what is being evaluated, why it was evaluated, and the plan of care moving forward.
 Read more
Areas covered in the session:
·  Documenting clearly the “why” and in-depth detail of that care so that providers who view the rècord can understand what was done and why
·  Discussion on the providers’ documentation “proof” and “medical necessity” needed to bill 3rd pàrty payer’s for the patients’ vìsit with you
·  Correct usage of the ICD-10 PCS tables to “tell the story” of the ultrasound procedure and how it cross codes back to ICD-9 volume 3
·  AIUM documentation protocol guidelines for ICD-10 PCS
·  Good clinical documentation strategies for use in preparation for the ICD10 PCS changeover onOctober 1, 2015.
·  And more
Call us at 1-866-458-2965 and mention SOCAHC01
Get answers to your questions in a Q&A segment after the session
Speaker Bio:
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA approved ICD-10-CM/PCS traìner is an independent coding, compliance, and auditing specialist. She has 20+ years of multi-specialty coding experience and teaches coding, compliance, auditing and billing skills for clinical and clerical staff, utilizing AMA and AHIMA curriculum. She specializes in Women’s OB/GYN services, Maternal Fetal Ultrasound Services, Urology and General Surgical procedures, to include physicìan based and hospital based services. Read More

Friday, July 10, 2015

07 10 2015 - Job Openings in Boise, Idaho

Hi all,
PMI of Boise, Idaho   has two open positions: 1) Coder and 2) Administrative Assistant:

Certified Professional Coder
 Certified Coding Position in Boise, Idaho.  Remote positions considered.  Seeking experienced coder for professional physician services.  Demonstrated expertise in surgical and interventional radiology desired. Full time positions with flexible working hours.  Specialty coding certification and ICD-10 certification strongly preferred. Benefit package.
 Applicants can submit a cover letter and resume by fax to ATTN:  Coding Manager 208-472-8172 or e-mail resume@pmiboise.com

Administrative Assistant
Opportunity for experienced administrative assistant in fast paced, large medical billing company.  Medical billing experience preferred.  Coding experience very desirable.  Job requires various support functions for coding department.  Normal business hours.  Benefit package.
Send resume to resume@pmiboise.com

Good Luck!!! 

Sunday, June 28, 2015

Master coding for heatstroke and related diagnoses in ICD-9-CM and ICD-10-CM

I originally wrote this back in 2014, but still relevant, due to the heat-wave that has been on the rise here in Idaho....  Please be safe my friends, and enjoy!  :) 


Master coding for heatstroke and related diagnoses in ICD-9-CM and ICD-10-CM

By Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP,
AHIMA approved ICD-10cm/pcs training. 
Summer and hot weather bring a variety of sun and heat-related illnesses to the forefront of a quick-care or urgent care practice. Coders will need to discern the differences between the signs and symptoms of heat stroke, sunstroke, and other heat-related illnesses in order to choose the correct code in both ICD-9-CM and ICD-10-CM.
The following ICD-9-CM codes, located in category 992, are used to report heat- and light-related signs and symptoms:
•        992.0, heat stroke and sunstroke
•        992.1, heat syncope
•        992.2, heat cramps
•        992.3, heat exhaustion, anhydrotic
•        992.4, heat exhaustion due to salt depletion
•        992.5, heat exhaustion, unspecified
•        992.6, heat fatigue, transient
•        992.7, heat edema
•        992.8, other specified heat effects
•        992.9, unspecified effects of heat and light
These ICD-9-CM codes are separated into a specifically denoted code set for the effects of heat and light in Chapter 17 (Injury and Poisoning), rather than grouped into Chapter 16 (Symptoms, Signs, and Ill-Defined Conditions).
In ICD-10-CM, comparable codes are located in Chapter 19 (Injury, Poisoning, and Certain Other Consequences of External Causes) under category T67 (Effects of heat and light). The ICD-10-CM codes include:
•        T67.0-, heatstroke and sunstroke
•        T67.1-, heat syncope
•        T67.2-, heat cramp
•        T67.3-, heat exhaustion, anhydrotic
•        T67.4-, heat exhaustion due to salt depletion
•        T67.5-, heat exhaustion, unspecified
•        T67.6-, heat fatigue, transient
•        T67.7-, heat edema
•        T67.8-, other effects of heat and light
•        T67.9-, effect of heat and light, unspecified
These codes require a seventh character to note the encounter type, using one of the following options:
•        A, initial encounter
•        D, subsequent encounter
•        S, sequela
Coders will need to use two X placeholders in order to complete the code. For example, to report an initial encounter for heat edema in ICD-10-CM, use code T67.7XXA.
The current ICD-9-CM and ICD-10-CM draft codes for these diagnoses are nearly identical in the information they report, even though the codes look very different.
Heatstroke and sunstroke
A patient suffers heatstroke when the body's temperature rises too high as a result of excessive heat exposure. In essence, the body loses its ability to cool itself and overheats. Heatstroke can have a quick onset in severe conditions and situations, especially with extreme physical exertion or exercise. Heatstroke can happen rather quickly, especially if the person becomes dehydrated.
Heatstroke is classified into two separate categories:
•        Classic heatstroke: This can occur during a heat wave or very hot weather. Babies, seniors, and patients with chronic health concerns and diagnoses are more susceptible to classic heatstroke than the rest of the population because their ability to thermoregulate is already decreased. 
•        Exertional heatstroke: This can occur as a result of physical exertion, such as strenuous and/or sustained exercise in a hot environment (indoors or outdoors). Exercise or exertional heatstroke can affect any age group, but tends to affect more physically active people and children, teens, and young adults more than sedentary or older individuals. This is a very common risk, especially for athletes, firefighters, and military personnel that are subject to varied circumstances. Interestingly, patients who have had a heatstroke previously are considered at high risk for recurrence, as the body’s thermoregulation system has already been compromised by the drastic effects of a heatstroke.
The signs and symptoms of a heatstroke can occur individually or as a combination. According to the National Health Service (UK) the following symptoms are some, but not all, of the most commonly identified symptoms seen in heatstroke cases:
•        Profuse sweating that abruptly stops
•        Accelerated or weak heartbeat
•        Hyperventilation with rapid breathing and/or shallow panting
•        Muscle cramps
•        Skin that is hot, dry, and/or red
•        Nausea and/or vomiting
•        Sudden headache
•        Mental confusion, irrational behavior
•        Reduced and/or loss of muscle coordination
•        Dizziness, vertigo, lightheadedness, syncope
•        Seizure
•        Loss of consciousness
•        High core body temperature, typically 102°F or higher
Prolonged sun exposure in high temperatures and high humidity, as well as extremely hot or dry weather conditions, can contribute to the risk of a heatstroke. Rapid dehydration and the body’s sweat response make heatstroke a very real possibility.
The weather heat index give us an idea of how the high levels of heat/humidity/dryness affect the body:
•        80°F-90°F, fatigue possible after physical activity or sun exposure
•        90°F-105°F, heat exhaustion, heat cramps, and sunstroke possible after prolonged physical activity or sun exposure
•        105°F-130°F, heat exhaustion, heat cramps, and sunstroke likely after prolonged physical activity or sun exposure
•        130°F and higher, sunstroke likely with sustained exposure to the sun
The media has played an important role in bring heat-related illness/heatstroke to the forefront, especially for young children, the elderly, and animals. Just a few degree increase in temperature can quickly bring on symptoms of a heatstroke.
Coding considerations
When coding for actual heatstroke cases, coders need to carefully review the provider documentation. We can only code what we know. If the provider does not specifically diagnose the patient with heatstroke, but only documents the compilation of symptoms, then we should only code those symptoms. We cannot jump to the “association” of the patient's symptoms to the definitive diagnosis of “heatstroke.”
In ICD-9-CM the guidelines also tell us to “use additional codes” to identify any other associated complications, such as:
•        Alterations of consciousness (780.01-780.09)
•        Systemic inflammatory response syndrome (995.93-995.94)
Coders should also be aware of the Excludes notes:
•        Burns (940.0-949.5)
•        Diseases of sweat glands due to heat (705.0-705.9)
•        Malignant hyperpyrexia following anesthesia (995.86)
•        Sunburn (629.71, 692.76-692.77)
For example, sunburn is reported with its own diagnosis codes and would need to be coded separately in addition to heatstroke.
The ICD-10-CM codes in category T67 have both Excludes1 and Excludes2 notes. The Excludes1 codes are:
•        Erythema (dermatitis) ab igne (L59.0)
•        Malignant hyperpyrexia due to anesthesia (T88.3)
•        Radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
These conditions should never be reported with the codes for heatstroke.
The Excludes2 notes are:
•        Burns (T20-T31)
•        Sunburn (L55.-)
•        Sweat disorder due to heat (L74-L75)
The Excludes2 conditions may occur at the same time as codes from category T67 and can be reported separately.
ICD-10-CM also contains similar instructions to ICD-9-CM for using additional codes to identify associated complications when reporting heatstroke and sunstroke (T67.0-):
•        Coma and stupor (R40.-)
•        Systemic inflammatory response syndrome (R65.1-)
Physicians will need to explicitly state “heatstroke” as a definitive diagnosis, and not just denote these signs and symptoms presented by the patient in their documentation.
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, and ICD-10-CM/PCS trainer is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist, with more than 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding. She can be reached via e-mail at webbservices.lori@gmail.com or you can also find current coding information on her blog: http://lori-lynnescodingcoachblog.blogspot.com/.

Sunday, June 21, 2015

Physician Query Process: Part 5: Format of a Physician Query, Developing the Statement at Issue, and the Importance of Hospital Policies and Procedures Related to the Physician Query Process

This is part 5 of the 11 part series from Barry Libman, Inc.    I've reposted here, GREAT INFO

by Christopher G. Richards, RHIA, CCS, Senior Associate, Barry Libman, Inc.

How to format your query
All physician queries should be structured in a consistent manner. At a minimum, include:

  • Patient name
  • Admission and/or discharge date/date of service
  • Medical record number/Account number
  • Date of the query
  • Name/contact information of coder or person raising the issue/concern.

You then formulate and state the issue you need documented.

How to develop the statement of the issue at the heart of the query:
presented as a question

  • Must include factual clinical indicators from the chart and must ask the physician to make a clinical interpretation of those facts
  • The query format should not sounAll physician queries should contain elements of the following:
  • Must be d presumptive, directing, prodding, probing or as though the clinician is being led to a diagnosis
  • AND – must instruct the physician where to document the clarification resulting from the query.

The importance of an organization’s physician query policy and procedures

The hospital needs to have good policies and procedures that it can follow when it comes to the use of physician queries. Organizational policy and procedures should address:

  • Consistency of the query format
  • Frequency and appropriateness (query fatigue)
  • Templates
  • Insuring compliance and addressing non-compliance
  • Policy maintenance
  • More important than anything else – the policy must address whether the physical query form becomes a permanent part of the medical record or whether the physicians are required to clarify the query answer in a progress note or somewhere as an addendum.

- See more at: http://www.libmaneducation.com/physician-query-process-part-5-format-of-a-physician-query-developing-the-statement-at-issue-and-the-importance-of-hospital-policies-and-procedures-related-to-the-physician-query-process/?utm_source=LE+Physician+Query+Blog+Series+Eblast+Part+5&utm_campaign=LE+Physician+Query+Blog+Series+Eblast+Part+5&utm_medium=email#sthash.DnAn0Gj6.dpuf

Tuesday, June 2, 2015

Job opportunity in Wyoming...

I got this in my e-mail this morning, and am passing along...  Not too often this type of opportunity presents itself... If interested give Krissy a call! 

Hello.  I am working with a small hospital in sought after, breathtaking Wyoming seeking a Physician/Outpatient Coder.  Physician coding n a physician clinic or hospital is required.  

CPC or CCA certification along with AHIMA or AAPC is preferred.  Also prefers someone with work experience as a coder or strong training background in coding and reimbursement.  (This position is based in Wyoming, it is not a remote job.)

Competitive salary and benefits package.  No State Tax!
If this is something you would like additional information on, please forward me over your updated resume and let me know the best time to get a hold of you to give you the additional details.  We also give referral bonuses!
Thanks and I look forward to hearing back from you.
Krissy Quinlan
Senior Healthcare Consultant
Management and Executive Search
Contingency/Retained/Interim Placement
Permanent Placement Division

Tuesday, May 26, 2015

Free ICD-10 Training in the Boise Area!!! June 23 & 24th

This is another opportunity to take advantage of FREE ICD-10 education.  This came in my e-mail today, and I wanted to get out to all of you as soon as possible.  Classes are in Boise Idaho.

Optum would like to invite you to a coding class focused on chronic condition coding for the Medicare population. Each course provides pertinent coding information and possible hands-on practice, time permitting. Some of our classes are approved by the American Academy of Professional Coders (AAPC) and offer Continuing Education Units (CEUs). Each attendee will receive a certificate upon completion.  Check the flyers below to see what is included with each session, as they cover different aspects of ICD-10cm.

Dates for these classes are June 23 and June 24th, 2015 and are free -  However you do have to register.   The June 23rd class is from 12:30 - 2:30 p.m. and held at the Boise Public Library and is covering Risk Adjustment

The June 24th Class is from 6:30 to 7:30 at the Library at Cole & Ustick, Boise. and is covering Perpheral Vascular diseases.

If you need the actual PDF form, please contact me, and I can forward to you via e-mail.

Friday, May 22, 2015

Physician Query Process: Part 4: Dealing With Legibility Issues And Challenging Handwriting?

**This is part 4 of an 11 part series from Libman Education.  This is good information.  More Information on the query process can be found at AHIMA.org

Physician Query Process: Part 4: Dealing With Legibility Issues And Challenging Handwriting?

by Christopher G. Richards, RHIA, CCS, Senior Associate, Barry Libman, Inc.
As part of a continuing series of discussions relevant to the coding community, Libman Education presents this 11-part series on the importance of a well implemented physician query process. 

We’ve all seen this:

Handwritten and illegible entries in the patient health record are an important consideration in the query process. It is important to decide when bad handwriting rises to the level of a physician query.
In general, if your inability to read certain documentation is clearly going to impact your ability to assign an accurate code, then you need to consider a query.

From a quality of care and risk management perspective, illegible entries can:
  • Cause miscommunication among clinicians about the patient’s condition
  • Result in improper care and cause serious patient injury
  • Raise questions of legal viability
  • Easily lead to poor data quality and incorrect reimbursement
  • Cause data collection, billing and reporting errors
- See more at: http://www.libmaneducation.com/physician-query-process-part-4-dealing-with-legibility-issues-and-challenging-handwriting/#sthash.uUK5SUi1.dpuf 

Physician Query Process: Part 3: Appropriate Use Of Yes/No Physician Queries

**This is part 3 of an 11 part series from Libman Education.  This is good information.  More Information on the query process can be found at AHIMA.org

Physician Query Process: Part 3: Appropriate Use Of Yes/No Physician Queries

Christopher G. Richards, RHIA, CCS, Senior Associate, Barry Libman, Inc.

As part of a continuing series of discussions relevant to the coding community, Libman Education presents this 11-part series on the importance of a well implemented physician query process.

Specific instances where Yes/No queries are acceptable, but in general, queries should not be designed to ask questions that result in a Yes/No response.  Like everything in life, there are exceptions.

1. Exception: POA queries when a diagnosis has already been documented.
Was the pressure ulcer POA?  Yes/No

2. Substantiating or further specifying “a diagnosis that is already present in the record”
Is this patient’s diabetes insulin dependent?  Yes/No

3. Establishing a cause-and-effect relationship between documented conditions such as manifestation/etiology, complications and conditions/diagnostic findings
Is there a cause and effect relationship between the patient hypertension and their heart failure?  Yes/No

4. To resolve conflicting practitioner documentation
A consultant states the patient’s BMI is 30 but the dietician states it is 41.7.
Is the dietician’s calculation correct?  Yes/No

Anytime you are presenting a physician with a Yes/No type query, always offer an “other” option for uncertain/unclear and to create a space for the physician to leave a comment.

Next: Dealing With Legibility Issues And Challenging Handwriting?

For more information contact:
Christopher G. Richards, RHIA, CCS
Senior Associate, Barry Libman, Inc.

Physician Query Process: Part 2: Describe General Aspects Of A Compliant Physician Query –

**This is part 2 of an 11 part series from Libman Education.  This is good information.  More Information on the query process can be found at AHIMA.org
Physician Query Process: Part 2:  Describe General Aspects Of A Compliant Physician Query – 

by Christopher G. Richards, RHIA, CCS, Senior Associate, Barry Libman, Inc.

As part of a continuing series of discussions relevant to the coding community, Libman Education presents this 11-part series on the importance of a well implemented physician query process.

Here are some basic query guidelines:  Just like on Jeopardy, a query must BE IN THE FORM OF A QUESTION!

Physician queries should focus on conditions or diagnoses already established in the medical record. A query should not introduce NEW information or information from another admission. Your focus is on accurately coding the current admission.

Queries apply to ALL payer types regardless of the impact on reimbursement. The focus must be on the data quality with respect to accurate code assignment. Queries are NOT just for DRG assignment.
A compliant query should seek clarifications based on a statement of the facts found in the record that you as the coder turn into a question for the physician to answer. A compliant query asks the physician to clarify existing documentation/facts present in the record.

A compliant query should not and must not be “leading” in nature.
What do we mean when we talk about avoiding “leading queries?”

“A query is never intended to lead the provider to one desired outcome. The query must provide reasonable, clinically supported options, include clinical indicators, and must not result in a yes/no*. They must include the option that no additional documentation or clarification can be provided.”

*There are a couple exceptions (as always) to the yes/no rule, discussed later in part 3
Example of a Leading Query
Dear Dr. Jones,
Based on your documentation, this patient has anemia and was transfused 2 units of blood. Also, there was a 10 point drop in hematocrit following surgery.  Please document “acute blood loss anemia,” as this patient clearly meets the clinical criteria for this diagnosis.

This is non compliant and will lead to trouble. The query intent is NEVER to tell the physician to document something.

For more information contact:
Christopher G. Richards, RHIA, CCS
Senior Associate, Barry Libman, Inc.
- See more at: http://www.libmaneducation.com/physician-query-process-part-2-describe-general-aspects-of-a-compliant-physician-query/#sthash.BuUKEJoc.dpuf

Friday, May 8, 2015

Five more facts about ICD-10 Facts from CMS

Five More Facts about ICD-10

1.  If you cannot submit ICD-10 claims electronically, Medicare offers several options
CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But, if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:
  • Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
  • In about half of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
  • Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.
2.  Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015
Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
3.  Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes
Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
4.  Costs could be substantially lower than projected earlier.
Recent studies by 3M and the Professional Association of Health Care Office Management have found many Electronic Health Record (EHR) vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
5.  It’s time to transition to ICD-10
ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:
  • Improve coordination of a patient’s care across providers over time
  • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
  • Support innovative payment models that drive quality of care
  • Enhance fraud detection efforts
Keep Up to Date on ICD-10: Visit the ICD-10 website for the latest news and resources to help you prepare.

Physician Query Process: Physician Query Basics And When To Query

Hi again... this is a copy of a blog post from Libman Inc.  You can find the entire 11 part series at Libman Education...  Good Stuff!

by Christopher G. Richards, RHIA, CCS, Senior Associate, Barry Libman, Inc.
As part of a continuing series of discussions relevant to the coding community, Libman Education presents this 11-part series on the importance of a well implemented physician query process. 

What is a physician query?
Simply put, a physician query is a written communication tool that will allow coders to improve the accuracy of coding by actively involving the physician in the documentation clarification process. Full and complete documentation is the essential key to accurate coding. A physician query should present specific facts derived from the medical record and convey clearly to the physician why additional clinical clarification is needed.

Does a physician query have an exact definition?
A physician query is defined as a written question to a physician to obtain additional, clarifying documentation to improve the specificity and completeness of the data used to assign diagnosis and procedure codes in the patient’s health record.

Why do you query a physician?
As stated, you would query a physician to ensure complete and accurate health record documentation. Querying a physician is a vital part of that documentation process.

When do you query a physician?
This is important to ensure an appropriate query and also to avoid unnecessary queries. If coding a record is difficult, ask yourself if the patient’s health record has any:
  • Conflicting information
  • Ambiguous information
  • Incomplete information
  • Clinically relevant information not addressed
  • Significant reportable condition or procedure
If you answered “yes” to any of the above you should consider a physician query.
But – know when NOT to queryDo not query
  • to question a provider’s clinical judgment
    e.g. chest x-ray is negative but the provider documents clinical pneumonia
  • when the benefit is strictly for reimbursement
  • when there is clinically insignificant findings or irrelevant information
  • when the improvement to data quality is negligible
Value the physician’s time! Know when to NOT initiate a formal query.

Describe General Aspects Of A Compliant Physician Query

For more information contact:
Christopher G. Richards, RHIA, CCS
Senior Associate, Barry Libman, Inc.
Pamela Haney, MS, RHIA, CCS, CIC, COC
Director of Education and Training, Libman Education
  • AHIMA Practice Brief: Managing an Effective Query Process, 2008
  • AHIMA Practice Brief: Ensuring Legibility of Patient Records, 2003
  • AHIMA Practice Brief: Guidance for Clinical Documentation Improvement Programs, 2010
- See more at: http://www.libmaneducation.com/physician-query-process-part-1-physician-query-basics-and-when-to-query/?utm_source=LE+Physician+Query+Blog+Series+Eblast+Part+1&utm_campaign=LE+Physician+Query+Blog+Series+Eblast+Part+1&utm_medium=email#sthash.XXxRHkQO.dpuf

Thursday, May 7, 2015

CMS: Five Facts about ICD-10 -

Five Facts about ICD-10

To help dispel some of the myths surrounding ICD-10, CMS recently talked with providers to identify common misperceptions about the transition to ICD-10. These five facts address some of the common questions and concerns CMS has heard about ICD-10:
  1. The ICD-10 transition date is October 1, 2015. The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.
  2. You don’t have to use 68,000 codes. Your practice does not use all 13,000 diagnosis codes available in ICD-9, nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.
  3. You will use a similar process to look up ICD-10 codes that you use with ICD-9. Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.
  4. Outpatient and office procedure codes aren’t changing. The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of Current Procedural
    Terminology (CPT) for outpatient and office coding. Your practice will continue to use CPT.
  5. All Medicare Fee-For-Service providers have the opportunity to conduct testing with CMS before the ICD-10 transition. Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure that you can submit claims with ICD-10 codes. During a special acknowledgement testing week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.
Keep Up to Date on ICD-10: Visit the ICD-10 website for the latest news and resources to help you prepare.

CMS offers Free ICD-10 training in Idaho in May11, 13, 15, 2015

CMS is offering three free ICD-10 training sessions in Idaho, designed for physicians and practice managers.
The dates, times, and locations are listed below.  Registration required (link is within the training brochure below).
May 11, 2015
5:00 p.m. – 7:00 p.m.
Coeur d’Alene
Kootenai Health
2003 Kootenai Health Way
May 13, 2015
9:00 a.m. – 11:00 a.m.

Idaho Division of Medicaid
3232 W. Elder Street
May 13, 2015
5:00 p.m. – 7:00 p.m.
ISU Student Union Building (Snake River Room)
981 S. 8th Avenue
Click here to see the training brochure for complete details.